White House Says ACA Enrollment Has Hit Their Revised Lower Goal of Six Million

White House Says Health Care Rolls Top Goal: 6 Million

By DAVID S. JOACHIM MARCH 27, 2014

WASHINGTON — The White House said on Thursday that more than six

million people had signed up for medical insurance plans under President

Obama’s health care law, exceeding the administration’s revised goal for

enrollment by the Monday deadline.

Demand for new policies has surged in recent days as the open

enrollment period draws to a close, the White House said, with 1.5 million

visits to HealthCare.gov and 430,000 calls to the program’s call centers on

Wednesday alone. The enrollment figure is up from five million a week

ago.

Mr. Obama, who was traveling in Italy, held a conference call to thank

volunteers who are helping to enroll uninsured Americans, officials said.

“The president encouraged the navigators and volunteers to redouble

their efforts over the next four days and leave no stone unturned in trying

to bring affordable health coverage to as many Americans as possible,”

White House officials said in describing the call.

Enrollment began in October. The administration recently scaled back

its original estimate of signing up seven million people.

Republican lawmakers have played down the enrollment numbers and

continued to press for an overhaul or a repeal of the law. Even some

Democratic senators in competitive re-election races have prescribed changes to the law.

Some conservative commentators took to Twitter on Thursday to ask

how many of the six million enrollees had paid their insurance premiums.

The White House has not been willing to say.

© 2014 The New York Times Company

CAREFIRST DECIDES HOW TO HANDLE THE PRESIDENTS CHANGE OF HEART

As we all know the President is now allowing the states to decide whether they let individuals keep their plans if they want. (Even if they aren't grandfathered)  It appears that this would only be a one year reprieve in any regard.  It also passes the buck to the States.  There was also a question if small employer groups would be allowed to remain with their current plans without having to be forced into reform coverage.  According to Carefirst, Individuals who have received termination notices will be given the opportunity to remain on their current plans if they renew them by mid-December.  In reference to the small group employers (those under 50 full-time employees)  there will be no change from current procedure.  In other words, non-grandfathered small group plans will need to move to reform plans at their renewal in 2014.  

NEVERMIND, YOU CAN KEEP YOUR PLAN.....ATLEAST FOR INDIVIDUALS

Today in a statement from the President, individual policyholders will now be allowed to maintain their current health plan if they so choose.  This was on the heels of tremendous pressure put on the President because of statements made by him....."if you like your health plan, you can keep your health plan, period".  As we all know this turned out to be untrue.  What seems to be overlooked are all of the individuals and families in employer based coverage being forced into reform plans. (Employer Group Under 50 Employees)  If employer based plans are not "Grandfathered" same as individual market, they would lose their current plan and be forced into a plan that now conforms to the Affordable Care Act (health reform).  The individual market is being addressed, the small group employer market is being overlooked.  

SMALL GROUP HEALTH PLANS COSTS THROUGH THE EXCHANGE

One of the largest medical insurance carriers in Maryland has announced that costs for Small Group Health Plans through the Exchange will cost 10% to 20% more due to mandated Essential Health Benefits  taxes, fees and assessments imposed on carriers.  Here is a partial break-down of those additional mandates/costs:

Transitional Reinsurance Program: $5.25 Per Member Per Month
Health Insurer Fee: Estimated at 2-3% of Premium
QHP Certification Fees-Not yet determned from Federal Government
Non-Grandfathered Groups-Pediatric Dental and Vision Being Added to Small Group Plans

This comes on the heels of information from President Obama's budget sent to Congress on April 11th, 2013 stating that costs for the Network of Health Insurance Exchanges for only half of the states will cost more than doulble the intial estimate.  Even though the intial costs projections were for the set-up of all states Exchanges.  Go figure, this is going to cost a heck of a lot more than we first were told by the President and the Federal Government.

PPACA-W-2 REPORTING-IRS GUIDANCE CHART

Below please see additional guidance from the IRS regarding reporting value of employee benefits on form W-2.  If you have a hard time reading please go directly to the IRS site here

HAGGLING OVER HEALTHCARE-A SUPREME DECISION

Is making individuals pay for health insurance or pay a penalty constitutional?  That, over three days last week, was being argued in front of the US Supreme Court.  At this point it's any body's guess, however, a decision will be reached sometime in June. 

In additional to the individual mandate, what else will need to be taken out of the Health Reform Law in order to protect it from abuse?  At the very least, guaranteed issue coverage would need to be taken off the table.  And possibly open enrollment periods added in.  Without this there would be no way to protect from people jumping on and off plan when they needed care......which would be catastrophic. 

During the several days of testimony the more liberal Justices seemed to drive questions that would uphold the law while the conservative Justices were not as sure about congress' power regarding making people purchase health coverage.  The Justices include 5 Republicans and 4 Democrats. 

This is a very big deal to the Obama Administration.  He has even issued a "Challenge" to the Supreme Court to uphold the law.  If this law fails or at least a major portion (Individual Mandate), it could have devastating impacts on his re-election effort.

CLASS ACT ON LIFE SUPPORT

You remember the CLASS Act (Community Living Services and Supports Program), it's the part of the Health Reform law that created a long-term care program for everyone.  It also had the brakes put on it by the Obama Administration.  The reason for this is that it is an actuary time-bomb.  It would build up reserves over 5 years (during this time nobody can use it) and then, because it has no pre-existing condition limitations, would go quickly into a death-spiral from all the sick people making claims.  As part Health Reform, the CLASS Act also needed to be self-sustaining. 

Interestingly, the CLASS Act is on the books as reducing the federal deficit.  The administration is using premiums that haven't been paid for a program that hasn't been established count as reducing the deficit. 

Anyway, unless they can make this program self-sustaining, it doesn't seem that it's going to be implemented.  At least not anytime in the near future.

McKinsey Report: Act II

ACT II

This whole McKinsey report thing has been a mess, and a lot of publicity for McKinsey.  The McKinsey Report was a survey of more than 1,000 employer groups and found that approximately 30% would "definitely" or "probably stop offering employer sponsored health coverage to their employees because it could be less costly to send the employees to the exchange and pay a penalty, if any.  

The White House is still pushing McKinsey to release more information on the findings since the outcome of the McKinsey Report was so different from that of the Congressional Budget Office, RAND or Urban Institutes findings. 

McKinsey commissioned IPSOS, the third largest market and research firm in the world to conduct the survey.  The survey was comprised using employer groups ranging from less that 20 employees to more than 10,000 and from a pool of hundreds of thousands of people in IPSOS databases. 

There are many surveys and some will have countering views.  However, if I am an employer and paying $10,000 a year for my employees health care and they can go to an exchange and get it cheaper while I pay a $2000 penalty, I may just do that.  And so may many other employers.  However, many won't because they may believe that keeping their coverage intact, keeps them more competitive. 

I guess time will tell and we will see what happens in 2014.  Cause if you can't keep the plan you have, as the President promised, it may be big pill to swallow for many people. 

Boring But Important-States Can Opt-Out of Health Care Plan (Mandates) 3 Years Earlier

"If your state can create a plan that covers as many people as affordably and comprehensively as the Affordable Care Act (PPACA) does, without increasing the deficit, you can implement that plan, and we'll work with you to do it."  This is was President Obama said while speaking at the National Governors Association 2011 Meeting in Washington, D.C.  on February 28th.  What this means is that states would be able to withdraw from some of the law's regulatory mandates in 2014 instead of 2017 through a "state innovation waiver".

In bipartisan support of "Empowering States to Innovate Act" it allows states to establish independent insurance regulatory models instead of Health Exchanges.  In addition it also allows those states to have no individual mandate and no penalties for those companies with more than 50 employees that do not meet PPACA requirements.  This could be of great interest to those states who filed a lawsuit against the PPACA's individual mandate, in Florida.

Even though there would be more flexibility for the states, they still would be required to offer policies that are as comprehensive and affordable as those offered through the exchange, cover as many residents as would have through PPACA and not increase the deficit.  In addition, certain mandates would need to stay, including: No lifetime limits, Dependents can stay on parents plan until age 26, Patients can choose any network physician and Carriers must spend at least 80% on Health Care and no more that 20% on administrative costs.

The questions I have would be how would the fed be able to police these plans?  In other words how would they ever be able to prove how many residents would have been covered under PPACA versus the states own version?  Also, states will have the opportunity to do more.  In other words they could go the other way and set-up a government run single-payer plan. 

Florida Stopping Implementation of PPACA (Health Reform)

This is a follow-up to the previous post, District Court Judge Roger Vinson Just Said No, Too!  As a result of the recent federal court ruling, by U.S District Judge Roger Vinson, which declared PPACA or at least the Individual Mandate to be unconstitutional, Florida has stopped the implementation of the law.  Florida Governor Rick Scott said, "We're not going to spend a lot of time and money with regard to trying to get ready to implement that until we know exactly what is going to happen and I hope and believe that either it will be declared unconstitutional or it will be repealed.  Florida Insurance Commissioner Kevin McCarty stated, "PPACA, a major component of the federal Affordable Care Act package, is not now in effect in Florida."  In addition McCarty said that he told the director of HHS (Health and Human Services) Office of the Consumer Information and Oversight, that Florida would not be spending any of the funds it had been allocated to implement the insurance exchange program. 

Since there were 25 other states that also were part of the lawsuit, I wonder how many of them will make decisions, at the state level, to stop implementation until a final determination has been made?  Final determinations could take as long as two years. 

District Court Judge Roger Vinson Just Said No, Too!

On January 31, 2011 District Court Judge Roger Vinson declared the "Individual Mandate" of the PPACA (Health Reform) unconstitutional.  Vinson stated, "because the individual mandate is unconstitutional and not severable, the entire act must be void."  So the count is 2-2.  Judges in Michigan and Virginia, both democrat appointees, have ruled the Health Reform constitutional and Judges in Virginia and now Florida, both republican appointees,  have ruled, at least the individual mandate, as unconstitutional.  The Department of Justice is going to appeal the decision which was filed in March of 2010 by Florida but then 25 other states joined the suit.  The case will ultimately be heard in the Supreme Court which could take up to two years. 

As it stands now, in 2014, if someone doesn't purchase health insurance they will pay a fine of $95 per year or 1% of income whichever is greater and by 2017 amount goes to $695 or 2.5% of income to a maximum of 3X the individual penalty.  In addition, if you earn up to $14,000 you get coverage for free, up to $44,000 and it's subsidized.  Big freaking deal!  Since it's guaranteed issue, I'll take my chances and get coverage when I'm sick. 

Non-payers will receive a notice from the IRS.  If they don’t pay, the IRS will take it from their tax refund in the future.  If they continue to not pay the fine, they will not be subject to any criminal prosecution or penalties.  The secretary cannot file a notice of lien or file a levy on any property.  As stated in a previous post, this penalty has no teeth! 

So my question is what do the democrats do if the individual mandate is ultimately and finally deemed to be unconstitutional?  Do they allow each state to individually allow the reform?  If so, I'm thinking every sick person and their mother will flock to that state for guaranteed issue health care coverage with crushing claims that will make the coverage unaffordable for everyone else.  Or do they come back with a plan that doesn't create a penalty for not having coverage, but just increase taxes and give it to everyone?

Interestingly, some republicans and democrats are trying to come up with ideas that wouldn't require people to carry coverage but would encourage.  For example, people would be given a deadline to enroll and if that deadline is missed, they would have to satisfy long waiting periods.  Or people who apply late and are eligible for tax credits could be penalized by reducing their subsidies.  (sounds like a penalty to me)

Wouldn't it be great if healthy people paid less for coverage, sick people paid a bit more and for those who are truly unable to afford it, given help?  Instead of throwing all this money at bigger government to wrangle this thing, use it to help those who need it the most. 

"Read My Lips, I'm Rolling Back Bush-Era Tax Credits".......Well, Perhaps Not.

In an address to the to the American people this evening, December 6, 2010, the President indicated that compromises needed to be made.   It seemed that he was talking more to democrats, almost trying to convince them that his decisions/compromises were necessary.  In his address, he slated several items which he was going to take back to the democratic caucus:

1. Temporary 2% Reduction in Payroll Taxes
2. 2 Year Extension of Bush-Era Tax Credits-At first, the President was trying to get the extension for the middle class only and remove it for Americans earning more than $250K per year. 
3. 13 Month Extension on Unemployment Benefits
4. Estate Tax Compromise-2 Years at 35% with a 5 Million Exemption
5. 1 Year Reduction in Social Security Taxes-This was a late add-on. 

So why is this important to Health Reform (PPACA)?  It is important to health reform because these taxes could potentially have been a huge funding source for the reforms.  Just the elimination of the Bush-Era Tax credits alone could cost the Federal Government more that one trillion dollars.  This, in-turn, could hamper the amount the Federal Government would be able to push to the States in order to set-up the State-Run Health Reform Programs.  For more information on the funding of health reform,  please go to: "Guess Who Gets to Pay for Health Reform?" (PPACA)