Wednesday, February 26, 2014

Why Most Small-Business Owners Will See Premiums Rise Under A.C.A.

New York Times
A new report from the federal government that says more small employers will see premiums increase than fall under the Affordable Care Act appears to have put the Obama administration on the defensive once again. But the report is remarkable as much for what it reveals about the current state of the small-group market as for how it might look under Obamacare, as the law is commonly known.
The report was produced by the Centers for Medicare and Medicaid Services at the request of Congress, and it is largely an exercise in the theoretical. The Affordable Care Act outlaws premium discrimination based on a company’s industry, the size of its group, or the health status and gender of its employees. The law also limits premium variation based on age, and the study assumes that when all these rules eventually take effect, all small companies and their workers will pay essentially the same rates.
Meanwhile, the agency estimates that today, under the current rules, two-thirds of small employers pay premiums that are below the average rate and one-third pay above-average premiums. Therefore, under an Affordable Care Act that is fully in place, two-thirds will see their premiums rise, and one-third will see premiums fall.
Of course, we have long known that some people would pay more for health insurance under Obamacare and some people would pay less. What is interesting is the skew: Why is it that two-thirds of employers, and employees, according to the study, have paid below-average premiums? Why isn’t it closer to 50/50? The answer, according to the study, is that under the old system, companies that paid lower premiums because their employees posed smaller health risks were more likely to offer health insurance in the first place.
But according to Jonathan Gruber, a health economist at M.I.T. whose work was cited in the C.M.S. report, those companies’ premiums were not as far below the average as the premiums of those businesses that insured older, less healthy employees were above the average. “The most expensive firms are very expensive, while the cheaper ones aren’t that much cheaper,” Mr. Gruber said. “So what that means is that while the cheaper firms will lose, they will lose by less than the most expensive firms gain. The 65/35 is still consistent with the overall roughly net zero result that the Congressional Budget Office, myself, and others have estimated.”
It is also possible that companies that have not provided health insurance because it was too expensive may now be offered rates lower than what they were quoted in the past. The report estimates 18 million people get insurance through the small-group market, though not all will be affected by the new premium rules one way or the other. But according to the most recent figures from the Census Bureau, about 31 million people work for businesses with fewer than 50 employees. That means the current market leaves about 42 percent of small-business employees uninsured, and some of those would most likely find small-group insurance more affordable under the new rules.
The report did not quantify how much premiums would rise or fall. And it acknowledged that Congress asked the agency to study only three of the law’s provisions and that other aspects of the law could affect how premiums change. “The impact could vary significantly depending on the mix of firms that decide to offer health insurance coverage,” the study said. “In reality, the employers’ decisions to offer coverage will be based on far more factors than the three that are focused on in this report.”
Republicans in Congress took the opportunity presented by the report to attack the law. Representative Sam Graves, the Republican from Missouri who heads the House Small Business Committee, called it “one more in a long line of broken promises from President Obama and Washington Democrats.”
Curiously, the Obama administration seemed restrained in its response, choosing not to address the new study directly. When asked for a comment, a spokeswoman for the Department of Health and Human Services, Joanne Peters, said only, “Since the Affordable Care Act became law, health care costs have been growing at the slowest rates on record and premiums are growing at less than one-half the pace seen a decade ago. The law is making it easier for businesses to offer coverage, just like it did in Massachusetts when employer coverage increased after reform passed.”
Tom Daschle, the former Democratic majority leader in the Senate and President Obama’s first nominee to lead the Department of Health and Human Services, bemoaned what he said was an increasingly one-sided debate. “There are so many ways to look at this,” said Mr. Daschle, who is now a senior policy adviser to the law firm DLA Piper, of the C.M.S. report. For one thing, he said, the tax credits available to very small businesses that offer insurance will “change tremendously the way premiums are paid.”
He went on to question why the administration had not responded more forcefully. “I think it’s been a big mistake that we’re not pushing back as hard as we can,” he said. “There’s an old saying attributed to Winston Churchill: a rumor gets halfway around the world before the truth gets its shoes on. That has happened over and over again with the Affordable Care Act.”
-------Seems time will tell.  However costs for small group plans that were non-grandfathered migrating from the small group market to ACA plans have seen significant increases in older family coverage plans but decreases to younger insureds. BBS 
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Tuesday, February 25, 2014

Maryland Ends Contract with health exchange provider

WASHINGTON — Maryland officials voted to end their contract with their health exchange provider and replace it with the company that fixed the federal health exchange.
"This transition will support the exchange's goal of enrolling as many Marylanders as possible in quality, affordable health coverage by the close of open enrollment on March 31," reads a statement from the board of the Maryland Health Exchange, which met Sunday night. "The exchange is preserving all rights to seek damages against Noridian and its subcontractors for problems with the IT system."
Noridian will be replaced by Optum/QSSI, the same company the federal government brought in to fix after its bug-filled rollout Oct. 1.
Open enrollment ends March 31, leaving the state little time, especially if the site is so problematic that it needs to be rebuilt from scratch. The site crashed on its opening day and has faced problems ever since, including frozen pages and lost applications. According to an enrollment report released this month, 33,000 people have enrolled in private health plans. The enrollment goal is 70,000.
Isabel FitzGerald, secretary of the Department of Information Technology, recommended the change of providers.
Some of the state health exchanges, such as California's and Kentucky's, have done well. California has already met its enrollment goals for the year.
Others, such as in Oregon and Hawaii, have had to turn to paper enrollment processes because their websites have been so problematic. Both states' exchange directors resigned in December. Hawaii's site opened two weeks later than planned and had only 257 people enrolled in the first month. Oregon's enrollments had to be processed by hand. Oregon launched a beta site this month that allows navigators to enroll people through a computer system. This month, Hawaii ranked last in the nation for enrollments.
--------Since the eschanges are a mess and you are trying to find a medical plan and having issues please try this link to Carefirst Individual Medical Plans ------BBS

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Tuesday, February 11, 2014

Md. officials explore options for health insurance exchange

By Published: February 10 (The Washington Post)

The Maryland health insurance exchange has so many structural defects that a key member of Gov. Martin O’Malley’s Cabinet said Monday that officials are “actively investigating alternative options” for the next enrollment period, which begins Nov. 15.That would mean walking away from all or part of a system that has cost tens of millions of dollars to build.

The system has “serious IT defects” that have made it difficult for Marylanders to enroll in health insurance as part of President Obama’s Affordable Care Act and for the state to properly process applications, said Joshua M. Sharfstein, Maryland’s secretary of health and mental hygiene, at a Monday afternoon meeting of a newly formed oversight committee. That has resulted in “substantial manual work,” he said, and heavy reliance on call centers with more than 400 employees.

Maryland officials were some of the earliest and most enthusiastic supporters of health-care reform, and O’Malley’s administration had bragged that its health-insurance marketplace would be one of the best in the country. Maryland is one of 14 states that launched their own exchanges instead of relying on the federal one, and its experience has been one of the worst.
State officials had estimated that 150,000 to 180,000 Marylanders would sign up for private health plans during the first enrollment period, which started Oct. 1 and will end March 31. As of Friday, the tally was at 29,059.

The struggling health exchange has become a focal point in the state gubernatorial race. Maryland Lt. Gov. Anthony G. Brown (D), who is running for governor, was tasked with implementing the Affordable Care Act in Maryland. Brown has said that it was his job to set up a legislative framework for the exchange, and that he entrusted the creation of the system to the exchange’s governing board, staff and contractors.

The exchange is expected to cost more than $260 million over four fiscal years, according to documents given to lawmakers Monday. That estimated total includes not only the cost of building the system, but also the salaries of exchange administrators and employees, the call centers and other operational costs. Much of this funding came from the federal government, but Maryland is expected to pick up $47 million of the total estimated cost.

Maryland hired Noridian Healthcare Solutions, based in North Dakota, to build the system and signed a contract worth more than $193 million over five years. So far Noridian has billed the state for nearly $78 million, and Maryland has paid the company nearly $65 million.
Noridian took off-the-shelf health-care software sold by IBM and hired a technology company, EngagePoint, to stitch it together into one system. Some of the most serious problems with the system are caused by defects in core software, said Isabel FitzGerald, Maryland’s secretary of information technology. Those problems have caused applications to lose chunks of data or become lost in the system, she said. The system also doesn’t provide real-time status updates for applications, so some people are left wondering whether they are actually enrolled.
Clint Roswell, a spokesman for IBM, said in a statement on Monday that the company continues to work with Noridian, subcontractors and exchange officials to “enhance the performance of the state’s health insurance marketplace.” He noted that Noridian “is responsible for the overall implementation,” and that the latest statistics show that more than 95 percent of consumers now entering the site are having a “positive experience.”
Sharfstein said these software problems are a “significant reason” for the bungled launch of the state exchange on Oct. 1 and the ongoing problems it faces. But he also placed blame on Noridian.

“The contractors have not delivered what they said they would deliver,” Sharfstein said. “There’s no question about that.”  Sharfstein said it would not be beneficial to the state to drop Noridian before the first enrollment period ends. He would not say if the state plans to take legal action to recover money from the companies involved with the building of the exchange, but said that “all options against any and all vendors remain on the table.”  A spokeswoman for Noridian did not return a request for comment.  Noridian and EngagePoint are suing each other in a fight over money and employees. In court papers filed Friday, EngagePoint alleged that Noridian “concealed its lack of relevant expertise” when it bid on the contract. Noridian’s president and chief executive, Tom McGraw, responded by saying in a statement that the accusations are “false, unsupportable and will be contradicted by evidence that we present in court and arbitration.”

Maryland will continue to use the system for the remainder of the current enrollment period, which ends March 31. Switching systems now would only cause more turmoil, state officials have said. After that, the state will have just seven months to either overhaul its system — which, officials say would require rebuilding substantial segments — or partnering with the federal government’s marketplace, swapping out parts for superior technology from other state systems or joining a state consortium.

“This will be a critical decision and requires due diligence and fair consideration of all the options,” FitzGerald said. “At the same time, we recognize the earlier that we can make that decision, the more time we will have to prepare for next fall’s open enrollment.”
Sharfstein and FitzGerald did say that hundreds of fixes have been made to the exchange, and they will continue to work to improve it.

Although some users, especially those who are tech-savvy and have simple applications, are able to sign up for health insurance relatively quickly, FitzGerald said that there are “significant” problems that will continue to remain once enrollment ends March 31.

----Unfortunately, the people who are getting hurt in this case are those who are trying to abide by the rules under the ACA.  With Governor O'Malley now offering the "Bridge Plan" to fill the gap.  This plan allows those people who weren't able to get coverage on the exchange revert back to the MHIP (Maryland Heath Insurance Plan) as a stop-gap until they are able to finally be processed through the Maryland Health Exchange.  (Brooks Benefit Services)

Monday, February 10, 2014


On the heels of the Obama Administration delaying the Employer Mandate until 2015, today Treasury officials said that the Obama Administration is now delaying the Employer Mandate until 2016.  What this means is that employers with between 50 and 99 Full-Time Employees and/or Full-Time Equivalent employees won't be subject to fines/penalties associated with not offering affordable, minimal essential coverage for at least another year.

Tuesday, February 4, 2014


Maryland Health Insurance Plan Bridge Program

On January 30, 2014 Governor Martin O’Malley signed Senate Bill 134 - Maryland Health Insurance Plan – Access for Bridge Eligible Individuals. The bill allows “Bridge Eligible Individuals” as defined in § 31-101 of the Maryland Insurance Article to obtain temporary health insurance through the Maryland Health Insurance Plan (MHIP) with retroactive coverage.

MHIP Bridge Program Policies and Procedures
  • Individuals eligible for health insurance through Medicaid, Medicare or an employer sponsored plan are not eligible for the MHIP Bridge Program.
  • Applications must be submitted by March 31, 2014 (a postal date mark constitutes the submission date).
  • MHIP Bridge coverage will be terminated on the effective date of a Bridge Eligible Individual’s enrollment in a qualified health plan (member must provide notice in writing to CareFirst for voluntary termination to occur).
  • A MHIP member whose coverage was terminated December 31, 2013 or thereafter and are eligible for the Bridge Program will be reinstated in their last MHIP plan option with no deductible reset.
  • Bridge Program applicants must submit the following documents for enrollment consideration:
  1. Proof of Maryland residency
  2. MHIP Standard enrollment application form
  3. Tax return document and/or other proof of income if applying for enrollment in one of the MHIP+ plan options
  4. MHIP Bridge Program Application Addendum (Addendum must contain applicant’s signature, a written description of when and how the applicant attempted to enroll through the Maryland Health Connection (MHC) and coverage effective date choice to be considered complete)
Enrollment Coverage Choice Will Be as Follows:

Date Application Received       Effective Date of Coverage Options
Jan. 1 – Feb. 15, 2014                  January 1, 2014 or February 1, 2014
Feb. 16 – Mar. 15, 2014               February 1, 2014 or March 1, 2014
Mar. 16 – Mar. 31, 2014               March 1, 2014

  • All MHIP Bridge Program enrollees’ coverage will be terminated on March 31, 2014, unless that date is extended by the MHIP Board of Directors.
  • Bridge Program application forms can be downloaded from
  • A paper copy will be mailed to the individual upon request by calling 1-888-444-9016.
  • Enrollment applications must be mailed to CareFirst at Maryland Health Insurance Plan, Enrollment and Billing, 10455 Mill Run Circle, RR-380, Owings Mills, MD 21117-9685.
  • CareFirst will process applications within 3 business days of receipt of a complete application.
  • If the application is incomplete, CareFirst will notify MHIP staff daily and MHIP staff will reach out to the applicant to obtain the missing information in a timely fashion to facilitate a prompt enrollment.
  • CareFirst will mail an approval letter and a payment slip to the individual.
  • Upon receipt of payment from the individual, CareFirst will effectuate coverage and mail an ID card. Coverage is not effective until full payment is received.
  • Members and providers can confirm coverage with CareFirst prior to an ID card being received by calling 1-888-444-9016.
  • Certificates of Coverage will be mailed to new enrollees with terms of plan and coverage dates.
  • MHIP and the Maryland Health Benefit Exchange (MHBE) will work together to assist Bridge Program enrollees in getting coverage through the MHC. An existing MOU and data sharing agreement between MHIP and MHBE will facilitate this process. Bridge Program eligible individuals will be placed on a priority list and given assistance with transitioning, as soon as possible, into a qualified health plan through MHC. MHBE will manage the priority list.
  • MHBE will use social media, direct contact and other communication outlets to inform individuals of the MHIP Bridge Program as an option of choice should other options not be available for the individual.
*From MHE-2/2014