The Dismantling of ObamaCare - Ongoing Updates.

[Yagents]

So is it just the CSR's or the advanced premium tax credits? Seems to be a difference in this article and what I saw on the news this morning.

Trump to end key ACA subsidies, a move that will threaten the law’s marketplaces

Whichever it is, seems to be a done deal.

I'm not a fan of Trump nor was I of Obama, but regardless of what he means all the appointments set for next month may be for nothing. I've always got Medicare.

Just the illegal CSR's. APTC is codified in law.
The state of FL required carriers to REJECT CSR's anyway next year, that's why the silver rates went up 40+ % to account for CSR loss, and is also why they mandated FB to offer off exchange silver plans, which won't have the CSR and rate increase baked into the premium.

What's behind the 45% hike in unsubsidized Obamacare premiums? A Florida directive to insurers.
The 44.7 percent average premium increases for unsubsidized Affordable Care Act health policies announced last month has been blamed on uncertainty surrounding the law and funding mechanisms for it.
But more directly, that hike was driven by a Florida Office of Insurance Regulation directive this summer that required insurers to reject a key federal subsidy, which the Trump administration has repeatedly threatened to cancel.
At issue are what are known as cost-sharing reduction payments, or CSRs, which are government payments to insurers to help reduce deductibles, co-pays and co-insurance rates for lower-income beneficiaries.
Florida Blue, the state’s largest health insurer and the only one offering Obamacare plans in all 67 counties, had announced earlier this year that forgoing CSRs would force it to raise prices by at least an additional 20 percent.
The state made the requirement anyway, citing the need to ensure market stability.
“It was not possible to submit rates to account for both the inclusion and elimination of CSRs,” the state insurance office explained in a written statement to The USA Today Network in Florida. “Thus, to maintain a stable and competitive health insurance market for consumers statewide, insurers submitted an amended rate filing accounting for the elimination of these payments.”

Roughly 90 percent of Florida beneficiaries receive separate subsidies to reduce premiums that the Trump administration can't arbitrarily remove, so most policyholders won't feel the full brunt of the increases.
And most of next year's increase only applies to mid-level Silver plans on the exchange.
Still, Florida Blue estimates that about 66,000 of its 1 million individual-market customers will see “significantly higher” premiums in 2018. About 6,000 of them live in Southwest Florida.
Nine Florida insurers will offer plans on the government’s exchange at healthcare.gov. Rate increases range from 26.5 percent for Florida Health Care Plan Inc. to 71.2 percent for Molina Healthcare of Florida Inc.

Florida Blue is raising rates an average 38 percent next year. That is about 23 percentage points higher than the average rate the company would have offered with the CSRs still in place, said Florida Blue spokeswoman Christie Hyde DeNave.
Congress is now debating the fate of CSRs. Emerging proposals would guarantee the payments for at least one or two more years.
Florida Blue, the only insurer to offer Affordable Care Act plans in each of the state’s 67 counties, will raise rates an average 38 percent next year.
That is about 23 percentage points higher than the average rate the company would have offered with the CSRs still in place, said Florida Blue spokeswoman Christie Hyde DeNave.
Unlike the better-known subsidies that lower overall premiums for the vast majority of Obamacare beneficiaries, CSRs can be withdrawn without an act of Congress.
The Trump administration has repeatedly threatened to do so in the past – at one point saying they would be reviewed month-to-month – but has not announced plans to do so next year.
That has left insurers throughout the country in a bind: Should they assume the subsidies won’t be there and hike prices, or should they set prices lower and just hope the CSRs will remain in place?
“I think it’s a reaction to an administration, to a political situation that’s not looking to stabilize the market,” said Gary Claxton, an expert on health care markets for the non-partisan Kaiser Family Foundation. “So they’re dealing with the uncertainties in ways that are keeping the insurers in the marketplace.”
It is unclear how many states have taken this approach with CSRs, because not all rates have been made public. But a number of insurers have already concluded that the Trump administration is likely to strip away the subsidies.
In Georgia, for instance, rates will go up an average 56.7 percent, far higher than the rates insurers initially considered. Reports out of Virginia show that rates will increase as much as 81 percent.
Insurers in Florida, which leads the nation in Obamacare signups, received more than $1.3 billion in CSR payments in 2016, according to the most recent data on such payments.
“They could lose a lot of money,” Claxton said.
Open enrollment for 2018 coverage under the health law starts Nov. 1 and runs through Dec. 15.

 

[TampaHound]

Trump may have also signed his own proverbial death warrant with this. Support for the ACA has never been higher and the people that are most likely to suffer are his base. Two: The mid-terms are coming and most Republicans don't want to face an angry mob. Three: Supposedly, 1/6 of the economy is related to health care. If the economy starts to go south, people will blame Trump and the Republicans (putting more pressure on moderates to oppose the President). Four: Bannon is a loose cannon, and although he can influence the midterms to some extent, the establishment Republicans are to well entrenched to be budged much. Again if things go south expect Bannon to no longer be much of a player.

 

[Ann H]

Most likely this is President Trump's oft-used negotiation technique. It's like, "The Republicans couldn't do it. I went to the Democrats and they won't work with me on it. So, I bombed it. Do you want to work with me now?"

It also serves to say, "I promised to repeal it, and gut it at the Agency levels too. I did what I said I would do."

Honestly, out of the 4 points of the Executive Order, only one of them is powerful. The Association idea is lifeless. "Across state lines" means nothing. Removing CSR direct reimbursements makes no difference when the carriers spike CSR Silver premiums and the government pays most of that premium anyway. It's the STM rule that has the most power. However, most people (including the media) don't understand that, and in the eyes of the public (and probably most congressmen), this was a major earthquake under Obamacare. It really wasn't. State DOIs have been preparing for this by saying carriers could file 2 sets of rates -- one with CSR payments and one without. As posted above, Florida prepared harder. They knew this had a 99% likelihood of coming. Other than the STM rule, it's really just smoke and mirrors.

 

[Ann H]

This serves to bring me back to a point I was making months to years ago. The law really has 3 big loopholes - group self-funded plans, Christian sharing ministries, and HIPAA-excepted plans such as short-term and indemnity.

Historically, those have been horrible (except the group self-funded plans). But they don't have to be horrible. If a carrier will take an STM and upgrade it to get rid of those weird exclusions, they can sell something that is more similar to major medical of pre-ACA. Same thing with indemnity if HHS will release the restriction that Obama placed on them outside of the ACA law.

This actually gives carriers a chance to reinvent the market. They could use the hype over "across state lines" and "association health plans" to get the market interested at looking at alternatives. And if they would give agents a viable, credible insurance plan to sell (not the currently super-limited STM), then it's game. Pre-ACA, the STM was a bad choice because it was "temporary". Today, almost every plan is temporary, and gets cancelled Dec. 31st of every year. It's really possible, and let's see if carriers seize the moment. Unfortunately, in a lot of cases like this, it's the shady seamy players who seize the moment first, and the reputable ones come later.

 

[bluediamond]

Just the illegal CSR's. APTC is codified in law.
The state of FL required carriers to REJECT CSR's anyway next year, that's why the silver rates went up 40+ % to account for CSR loss, and is also why they mandated FB to offer off exchange silver plans, which won't have the CSR and rate increase baked into the premium.

What's behind the 45% hike in unsubsidized Obamacare premiums? A Florida directive to insurers.
The 44.7 percent average premium increases for unsubsidized Affordable Care Act health policies announced last month has been blamed on uncertainty surrounding the law and funding mechanisms for it.
But more directly, that hike was driven by a Florida Office of Insurance Regulation directive this summer that required insurers to reject a key federal subsidy, which the Trump administration has repeatedly threatened to cancel.
At issue are what are known as cost-sharing reduction payments, or CSRs, which are government payments to insurers to help reduce deductibles, co-pays and co-insurance rates for lower-income beneficiaries.
Florida Blue, the state’s largest health insurer and the only one offering Obamacare plans in all 67 counties, had announced earlier this year that forgoing CSRs would force it to raise prices by at least an additional 20 percent.
The state made the requirement anyway, citing the need to ensure market stability.
“It was not possible to submit rates to account for both the inclusion and elimination of CSRs,” the state insurance office explained in a written statement to The USA Today Network in Florida. “Thus, to maintain a stable and competitive health insurance market for consumers statewide, insurers submitted an amended rate filing accounting for the elimination of these payments.”

Roughly 90 percent of Florida beneficiaries receive separate subsidies to reduce premiums that the Trump administration can't arbitrarily remove, so most policyholders won't feel the full brunt of the increases.
And most of next year's increase only applies to mid-level Silver plans on the exchange.
Still, Florida Blue estimates that about 66,000 of its 1 million individual-market customers will see “significantly higher” premiums in 2018. About 6,000 of them live in Southwest Florida.
Nine Florida insurers will offer plans on the government’s exchange at healthcare.gov. Rate increases range from 26.5 percent for Florida Health Care Plan Inc. to 71.2 percent for Molina Healthcare of Florida Inc.

Florida Blue is raising rates an average 38 percent next year. That is about 23 percentage points higher than the average rate the company would have offered with the CSRs still in place, said Florida Blue spokeswoman Christie Hyde DeNave.
Congress is now debating the fate of CSRs. Emerging proposals would guarantee the payments for at least one or two more years.
Florida Blue, the only insurer to offer Affordable Care Act plans in each of the state’s 67 counties, will raise rates an average 38 percent next year.
That is about 23 percentage points higher than the average rate the company would have offered with the CSRs still in place, said Florida Blue spokeswoman Christie Hyde DeNave.
Unlike the better-known subsidies that lower overall premiums for the vast majority of Obamacare beneficiaries, CSRs can be withdrawn without an act of Congress.
The Trump administration has repeatedly threatened to do so in the past – at one point saying they would be reviewed month-to-month – but has not announced plans to do so next year.
That has left insurers throughout the country in a bind: Should they assume the subsidies won’t be there and hike prices, or should they set prices lower and just hope the CSRs will remain in place?
“I think it’s a reaction to an administration, to a political situation that’s not looking to stabilize the market,” said Gary Claxton, an expert on health care markets for the non-partisan Kaiser Family Foundation. “So they’re dealing with the uncertainties in ways that are keeping the insurers in the marketplace.”
It is unclear how many states have taken this approach with CSRs, because not all rates have been made public. But a number of insurers have already concluded that the Trump administration is likely to strip away the subsidies.
In Georgia, for instance, rates will go up an average 56.7 percent, far higher than the rates insurers initially considered. Reports out of Virginia show that rates will increase as much as 81 percent.
Insurers in Florida, which leads the nation in Obamacare signups, received more than $1.3 billion in CSR payments in 2016, according to the most recent data on such payments.
“They could lose a lot of money,” Claxton said.
Open enrollment for 2018 coverage under the health law starts Nov. 1 and runs through Dec. 15.

It was early and the first thing I saw when opening my computer. It also didn't help trump and the press are just saying subsidies. I knew we'd still have silver plans on exchange and FB will still have a b and c and that the rates were adjusted just in case this happened. Man, I have to get awake before I post anything. But it woke me up pretty fast.

 

[Chazm]

WgTs

Most likely this is President Trump's oft-used negotiation technique. It's like, "The Republicans couldn't do it. I went to the Democrats and they won't work with me on it. So, I bombed it. Do you want to work with me now?"

It also serves to say, "I promised to repeal it, and gut it at the Agency levels too. I did what I said I would do."

Honestly, out of the 4 points of the Executive Order, only one of them is powerful. The Association idea is lifeless. "Across state lines" means nothing. Removing CSR direct reimbursements makes no difference when the carriers spike CSR Silver premiums and the government pays most of that premium anyway. It's the STM rule that has the most power. However, most people (including the media) don't understand that, and in the eyes of the public (and probably most congressmen), this was a major earthquake under Obamacare. It really wasn't. State DOIs have been preparing for this by saying carriers could file 2 sets of rates -- one with CSR payments and one without. As posted above, Florida prepared harder. They knew this had a 99% likelihood of coming. Other than the STM rule, it's really just smoke and mirrors.

What’s the STM rule?

 

[Yagents]

Short-term medical back to 12 months

 

[junkman]

Short-term medical back to 12 months

Is that a done deal? Now we have to revisit who has the STM that has the fewest procedure limitations for those who can pass underwriting.UHC limits their RX to $3,000.

 

[Ann H]

Is that a done deal? Now we have to revisit who has the STM that has the fewest procedure limitations for those who can pass underwriting.UHC limits their RX to $3,000.

It is not a done deal. The Executive Order tells the departments of HHS, Labor & Treasury to work on it. Technically, to change a Rule & Reg, the departments must issue a proposed rule, allow 60 days for comments, issue a new proposed or final rule with their decision on those comments, and then state a date on which the new rule will be effective. So, it won't be in time for this year's OEP clients. Yes, I think they plan to push it through quickly, and this particular change in a rule/reg is not complicated. However, the Rules & Regs take some time to be changed.

STM carriers are anxious for this. So, it might be possible that you issue your 3 month STM, and then when the new rule is effective, the STM carrier offers to extend the expiration date another 9 months. Already some carriers are offering four back-to-back STMs of 3 month terms each. So, it wouldn't be hard to do.

 

[Helpico_Insure]

It is not a done deal. The Executive Order tells the departments of HHS, Labor & Treasury to work on it. Technically, to change a Rule & Reg, the departments must issue a proposed rule, allow 60 days for comments, issue a new proposed or final rule with their decision on those comments, and then state a date on which the new rule will be effective. So, it won't be in time for this year's OEP clients. Yes, I think they plan to push it through quickly, and this particular change in a rule/reg is not complicated. However, the Rules & Regs take some time to be changed.

STM carriers are anxious for this. So, it might be possible that you issue your 3 month STM, and then when the new rule is effective, the STM carrier offers to extend the expiration date another 9 months. Already some carriers are offering four back-to-back STMs of 3 month terms each. So, it wouldn't be hard to do.