So What's Really Going to Happen to the Group Market

[Crabcake Johnny]

Who's gonna bite when an agent tries to churn? "Ok...why should I leave the Aetna tin foil plan and go with the Blue Cross tin foil plan? Same benefits and same rate. But thanks for the call."

Now, you might call to bump them to the pewter or aluminum plan.

 

[ABC]

if your state does not establish and state based exchange then the federal exchange comes in.
The federal Gov. have given no information on the status of their exchange. We are 2 years out.

In Indiana it is estimated the cost of running a state based exchange is anywhere from $66-$88 Million. The consultants and the DOI have no clue where that money is going to come from.
Thus I think the state could opt out and allow the federal gov take on the cost.

Any exchange that is developed is the biggest IT solution in history because you are going to have to integrate Medicaid, Social Security, Department of Justice, IRS, Medicare and who know who else. Then when you apply online it will automatically
decided if you qualify for the different programs. I just don't see think integration happening on the state level.

So if the Fed exchange comes in those plans are not eligible for subsidies. That is the debate right now as the way the law was written. They wrote the law this way because the fed gov. does not want to take on the cost. If you look at the PCIP plan they will be out of money soon.

The fact the federal gov punted the essential benefit issue just shows you how much this administration is over their head. This was one of the biggest issues of the law.

 

[Crabcake Johnny]

ABC....yet again, please cite a reference. You're getting misinformation.

States can either administer their own exchange or have the gov. administer it. Regardless, everyone who qualifies will receive the subsidy.

I don't know where you're getting your information - but stop going there:-)

 

[Ann H]

if your state does not establish and state based exchange then the federal exchange comes in... So if the Fed exchange comes in those plans are not eligible for subsidies. That is the debate right now as the way the law was written. They wrote the law this way because the fed gov. does not want to take on the cost...

________________________________________________

ABC....yet again, please cite a reference. You're getting misinformation.

States can either administer their own exchange or have the gov. administer it. Regardless, everyone who qualifies will receive the subsidy.

I don't know where you're getting your information - but stop going there:-)

________________________________________________

Actually, ABC is correct, and this has been an issue in the news lately. The Wall Street Journal said it well in the following paragraphs located at the following link:

The law encourages states to create health-insurance exchanges, but it permits Washington to create them if states decline. So far, only 17 states have passed legislation to create an exchange.

This is where the glitch comes in: ObamaCare authorizes premium assistance in state-run exchanges (Section 1311) but not federal ones (Section 1321). In other words, states that refuse to create an exchange can block much of ObamaCare's spending and practically force Congress to reopen the law for revisions.
​

Adler and Cannon: Another ObamaCare Glitch - WSJ.com

 

[Yagents]

ABC is right. There is a battle going on with the way the law was written. It states only state exchanges get subsidies. It's a written flaw that repubs are using to dismantle this thing. Now, some dept must determine what the intent of the law was, and interpret the legislation to allow subsidies in both exchanges. I tried to find the thread where this was brought up before, but no success.

But I did find the thread on clawbacks Exchange Subsidy "Clawback"

500% FPL and unlimited clawback is allowed. Otherwise max of $3500

 

[Crabcake Johnny]

I went through the PPACA (there are a zillion drafts) and cannot find that clause the WSJ referred to.

Let's break it down like this - just as an example:

Alabama residents get the subsidy
Arizona residents don't

But under the law, everyone must have coverage or pay a fine. So how do you tell AZ residents that, for example, earn 200% FLP that they, by law, have to pay $1,400 per month?

If it is indeed some kind of loophole, it'll be closed. It's a non-starter.

Also, in reading the WSJ article, it's simply a matter of how it's interperated. Basically, the actual law states the subsidies will be issued through the state exchanges. It simply never actually spelled out "how" people will receive those subsidies if a state defers to the government.

Does anyone here really think this law will take full effect with half the country unable to receive subsidies? Common.

Even after reading the WSJ article, ABC's assertion is incorrect. There is nothing in the PPACA that bars/blocks people from receiving a subsidy if a state defers to the government for exchange administration. It's only about "how" they receive the subsidy.

 

[HealthGuy]

Seriously, interpriting this law is worse than the law itself.

 

[Crabcake Johnny]

The real fun begins states set their rules for carriers and their exchanges. Some will have OEP, others may not. Some will allow agent commissions, others may not. MD introduced a bill last year that would bar any agent from earning a commission in the exchange.

Then the federally administered exchanges with have their own set of rules. Good times a' coming.

 

[ABC]

Latest ObamaCare Glitch Enables States to Block New Entitlement Spending | Cato @ Liberty

Here is an article of the debate on the federal exchange subsidies.

If the law stays on the books this is a debate that will get national attention.

 

[Crabcake Johnny]

Listen, any batshit crazy author can write an article. Nothing in the law blocks people from receiving a subsidy if they choose a federally administered exchange. It's only about how they receive the subsidy.

Same with the WSJ article. When asked, the government said "we don't see it being an issue." Well, the author thought it was still an issue. Fine, that's his right. There won't be an issue regarding this come implementation in 2014. But anyone can chose to wear the tin foil hat if they want to.