Largest U.S. Co-Op Health Plan To Fold, Fourth To Close This Year
Health Republic Insurance of New York, the largest cooperative health plan in the U.S., has been ordered to shut down as it nears insolvency, affecting hundreds of thousands of enrollees' coverage, the Washington Post reports. ...
Co-ops were created under the Affordable Care Act to offer lower prices and compete with large insurers (Goldstein, Washington Post, 9/25).
An HHS Office of the Inspector General audit released earlier this year found co-op plans were facing financial difficulties and experiencing low enrollment.
According to the audit, 22 of 23 co-ops operated at a loss in 2014. The report found 13 of 23 co-ops fell short of enrollment goals (HHS OIG audit, July 2015). ...
In a unanimous vote, the House passed legislation today that would rescind the Affordable Care Act’s expanded definition of a small employer. The bipartisan bill has had strong support from employers and benefit industry insiders who feared the expansion could lead to premium increases and jeopardize the ability for small and mid-sized businesses to compete in today’s market.
The benefit industry applauded the bill’s passage.
“The Big ‘I’ is pleased to see this legislation pass the House of Representatives with such strong bi-partisan backing,” says Robert Rusbuldt, Big “I’” president & CEO. “One analysis from the actuarial firm Oliver Wyman estimated that the effect of expanding the definition of the small employer would result in nearly two-thirds of workers in small to mid-size firms receiving premium increases in 2016. H.R. 1624 would protect small to mid-sized employers and employees at those firms from seeing significant premium increases that are anticipated due to the Affordable Care Act.”
The ACA proposes that effective Jan. 1, 2016, the definition of a small group employer increases from 1-50 employees to 1-100 employees. The Protecting Affordable Coverage for Employees Act (PACE) would maintain the current definition of a small group market as 1-50 employees and give states the flexibility to expand the group size if they feel the market conditions in their state necessitate the change....Emphasis added.
Health insurance premiums for the program that covers federal employees and retirees will increase an average of 6.4% next year, the U.S. Office of Personnel Management disclosed Tuesday.
That 6.4% increase for the Federal Employees Health Benefits Program — the nation's largest group plan with 8.2 million enrollees —ends a four-year run in which the average annual premium increase was under 4%. Premiums increased an average of 3.2% in 2015, 3.7% in 2014, 3.4% in 2013 and 3.8% in 2012. ...
Nearly half a million ObamaCare enrollees were able to claim more than $235 million in excess subsidies that they will never have to pay back, a recent IRS audit showed, thanks to a quirk in the law that leaves the program vulnerable to potentially billions in excess subsidy payments.
Because ObamaCare subsidies are based on income, enrollees have to guess about their income for the next year when they sign up, which the exchanges use to calculate the tax credits. Enrollees can then opt to take these credits in advance, in which case they're sent directly to insurers, who subtract them from the enrollees' monthly bills. That's called the "advanced payment tax credit" or APTC.
If an enrollee guesses wrong, they'll either get additional subsidy money when they file their taxes, or they'll have to pay some or all of their excess subsidy money back. But the law caps how much of the excess subsidy money must be returned for those making less than 400% of poverty. (Families at 400% or above are ineligible for any subsidies.) The caps range from $300 to $2,500, depending on income and filing status.
To illustrate how the caps work, consider a family of four that enrolled in ObamaCare and guessed their income would be $40,000. That family would receive a subsidy of $7,980 for the year, according to a Kaiser Family Foundation subsidy calculator....
If it turns out that the family actually made $95,000, their subsidy should have been just $828, and they'd technically owe the difference — $7,152 — back to the government.
But because their actual income was less than 400% of poverty, the most they'll have to pay back is $2,500.
In other words, by underestimating their income, this family was able to leverage $4,645 in excess ObamaCare subsidies....
Medi-Cal provides free health care to low-income people, including families, seniors, people with disabilities and children in foster care. Nearly a third of the state — 12.5 million people — are enrolled in Medi-Cal, which saw a dramatic increase under the Affordable Care Act.
But the state stands to lose $1 billion in federal funding after the Obama administration warned California that its tax system — currently California only taxes the plans that accept Medi-Cal patients — doesn’t comply with federal law. The federal government provides matching funds to California for Medi-Cal.
To prevent the $1 billion loss of matching federal funds, California must tax all health plans — not just those that accept Medi-Cal enrollees. Insurers that don’t participate in Medi-Cal are fighting the broader tax.
If all health care plans are forced to pay a new tax, it is likely the costs will be passed down to customers.
Lawmakers are weighing whether to tax all health plans at the same flat rate. ...