The Current State Of ObamaCare - ACA

[Tkruger]

Errors made by marketplaces or plans

I wonder if this would cover carriers who report Dr.'s as in network when they are not.

We had about a dozen of these this past enrollment.

 

[Yagents]

Feds are now checking MEC status by calling employers to verify eligibility of APTC to employees. I'm gonna bet at least 10% of those getting tax credits now, should not be receiving them due to having "access" to MEC through an employer group plan.

PPACA coverage cops are calling your group clients | LifeHealthPro

 

[RayNY]

Feds are now checking MEC status by calling employers to verify eligibility of APTC to employees. I'm gonna bet at least 10% of those getting tax credits now, should not be receiving them due to having "access" to MEC through an employer group plan.

PPACA coverage cops are calling your group clients | LifeHealthPro

Who is checking the employers to see if they are accurate?

"Hi Mr. Employer, this is the Feds. You may face a $2000-$3000 per employee penalty if you don't offer compliant health coverage to all full time employees. Do you offer compliant coverage?"

"Yes, of course I do!"

"Oh, great. In that case, we'll just add thousands of dollars of tax liability to your employees for lying about their coverage and obtaining coverage on the exchange. Have a great day!"

 

[Tkruger]

Who is checking the employers to see if they are accurate?

"Hi Mr. Employer, this is the Feds. You may face a $2000-$3000 per employee penalty if you don't offer compliant health coverage to all full time employees. Do you offer compliant coverage?"

"Yes, of course I do!"

"Oh, great. In that case, we'll just add thousands of dollars of tax liability to your employees for lying about their coverage and obtaining coverage on the exchange. Have a great day!"

Remember 50 Full time equivalent...and affordable coverage.

 

[Yagents]

Comedy hour webcast of HHS / carrier rah rah meeting.

https://www.regtap.info/reg_librarye.php?i=1561

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Hillary ideas:

1. Let people over 50 buy into medicare.

2. Phase out subsidies for those above 400% FPL cliff.

Clinton calls for health care public option, Medicare buy-in | LifeHealthPro

 

[Yagents]

As consumers continue to have complex questions about the process of signing up for a health plan through Affordable Care Act marketplaces, the assisters who answer these questions play a vital role in ensuring enrollment success, according to a new report from the Robert Wood Foundation.

http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2016/rwjf429067

Report: ACA marketplace assisters still play vital role - FierceHealthPayer

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AND AETNA IS STAYING IN, and expanding:

The 15 states where it currently participates are Arizona, Delaware, Florida, Georgia, Illinois, Iowa, Kentucky, Missouri, Nebraska, North Carolina, Ohio, Pennsylvania, South Carolina, Texas and Virginia.

Aetna plans to remain in Obamacare markets, may expand | Reuters

Aetna Not Withdrawing From Any Health-Law Insurance-Exchange States - WSJ

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Fixing O'care was on the agenda:

Committee hearing video:
https://energycommerce.house.gov/he...increasing-patient-choice-and-plan-innovation

ACA 'Tweaks' Suggested at House Hearing | Medpage Today

Avik Roy, a senior fellow at the Manhattan Institute for Policy Research, a right-leaning think tank in New York City, told the House Energy & Commerce Health Subcommittee that in order to apply for a subsidy on an ACA health insurance exchange, consumers must first estimate how much income they are going to make in the following year -- something that can be very difficult for part-time or contract employees to do.

"If they have to estimate their income for the next month and they happen to estimate inaccurately, the Treasury Department by law is supposed to go after them; that's an incredibly burdensome system," he said. "This is a serious problem, and the best way to deal with it is through a statutory change that would use the previous year's taxable income as basis for whatever assistance you provide in the following year."

 

[Yagents]

Major carrier in AZ stated they are looking at 128% MLR.
Asked my rep: "Why not raise prices to breakeven level?"
Answer: "We can't raise them high enough"

They are referencing the quote below, where at a certain higher premium level, only the high utilizers will buy coverage, and it becomes even more of high risk pool.

Health Insurance Exchange Consumers Satisfied with Health Plans

"Insurers incurred large losses in 2014 despite receiving $6.72 billion in net reinsurance payments for their individual market QHPs [Qualified Health Plans]. The average loss ratio (medical claims paid divided by premium income) for the 289 QHPs equaled 1.110 when weighting QHPs by claims. This loss ratio suggests that premiums for individual market QHPs will have to rise significantly when the reinsurance program ends. Assuming that insurers generally need at least 15 percent of premiums to cover administrative expenses, premiums in 2014 were roughly 26 percent too low, on average, to cover insurers' full costs of offering individual market QHPs," the report stated.

"If average premiums had been 26 percent higher, however, that would have lowered total enrollment and increased selection effects. Relatively healthy people and higher income enrollees, who qualify for little or no subsidies that make the insurance more attractive, would have been deterred to a greater degree than people who expected to use more healthcare services. As a result of this dynamic effect, the average premium increase would likely have needed to be substantially greater than 26 percent for insurers to break even on their QHPs in 2014."

 

[somarco]

at a certain higher premium level, only the high utilizers will buy coverage

This is the way it has always been, even before Ocare. Takes a balance of low enough premium to write a certain volume.

Rates too low and you lose your butt.

Rates too high and you lose your butt.

 

[sman]

This is the way it has always been, even before Ocare. Takes a balance of low enough premium to write a certain volume. Rates too low and you lose your butt. Rates too high and you lose your butt.

The Goldilocks plan will work. Can't believe nobody has figured that out yet.

 

[Yagents]

The system is broken. I'm now on board with the 64% of Americans:

When Gallup asked those who favor keeping the Affordable Care Act or replacing it with a federally-funded system to choose one of them, they chose the federally-funded option by a 2-to-1 — 64 percent to 32 percent.

Breaking News at Newsmax.com Gallup Poll: Americans Favor Federally-Funded Healthcare

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Hear this before?

Sorry, We Don't
Take Obamacare

http://www.nytimes.com/2016/05/15/sunday-review/sorry-we-dont-take-obamacare.html?_r=0