ACA premiums to rise 25 percent in biggest jump yet

Zachary Tracer clarifies on ACA premiums rising yet again.

Originally posted on

Posted October 25, 2016



Premiums for mid-level Obamacare health plans sold on the federal exchanges will see their biggest jump yet next year, another speed bump in the administration’s push for enrollment in the final months of the U.S. president’s term.

Monthly premiums for benchmark silver-level plans are going up by an average of 25 percent in the 38 states using the federal website, the U.S. Department of Health and Human Services said in a report today. Last year, premiums for the second-lowest-cost silver plans went up by 7.5 percent on average across 37 states.

Individuals signing up for plans this year are facing not only rising premiums, but also fewer options to choose from after several big insurers pulled out from some of the markets created under the Affordable Care Act, known as Obamacare. While the ACA has brought uninsured numbers to record lows in the U.S., millions remain uninsured. To attract more people, the government has emphasized that subsidies are available for many people to help cushion the premium increases.

Protecting consumers

About 77 percent of current enrollees would still be able to find ACA plans for less than $100 a month, once subsidies are taken into account, according to the report. Subsidies are calculated based on the cost of the second-lowest-premium silver plan in a given area. Silver plans typically cover about 70 percent of an individual’s medical expenses, though additional subsidies can help make the coverage more generous for lower-income individuals.

“Even in places of high rate increases this year, consumers will be protected,” Kathryn Martin, assistant secretary for planning and evaluation at the health department, said on a conference call with reporters. Her message to consumers is to check if they are entitled to subsidies and shop for options: “The odds are good you’ll find plans more affordable than what the public debate about the ACA might lead you to expect.”

Changes in the cost of the benchmark silver plans varied widely among regions, and the median benchmark premium increase was 16 percent. Premiums actually declined about 3 percent in Indiana, to $229 a month. In Arizona, on the other hand, the benchmark premium more than doubled, from $196 a month to $422, the report shows.

The data released Monday confirm reports based on state regulatory filings that have been accumulating for months, showing much higher premiums for 2017., which tracks the health law, had also estimated a 25 percent rise in premiums on average, weighted by membership.

Silver plans are mid-level on Obamacare’s marketplaces, with other plans including bronze, gold and platinum.

The government data show that some people may be able to find lower-cost plans by switching from their current coverage. The U.S. said that if all people who currently have ACA plans switched into the cheapest option of the same “metal” level, they could cut their premiums by 20 percent. Some people will have to switch because their plan will no longer be offered.

See the original article Here.


Tracer, Z. (2016 October 25). ACA Premiums to rise 25 percent in biggest jump yet. [Web blog post]. Retrieved from address


Number Of Uninsured Falls Again In 2015

Interesting article from Kaiser Health News about decreasing uninsured rates by Julie Rovner

The federal health overhaul may still be experiencing implementation problems. But new federal data show it is achieving its main goal — to increase the number of Americans with health insurance coverage.

According to the annual report on health insurance coverage from the Census Bureau, the uninsured rate dropped to 9.1 percent, down from 10.4 percent in 2014. The number of Americans without insurance also dropped, to 29 million from 33 million the year before.

The Census numbers are considered the gold standard for tracking who has insurance and who does not, because its survey samples are so large. It does change methodology from time to time, however (most recently in 2013), so years-long comparisons are not necessarily accurate.

Still, between 2013 and 2015, the first two full years the health law was in effect, the uninsured rate dropped by more than 4 percentage points. The total number of uninsured fell by 12.8 million. Meanwhile, the percentage of Americans with insurance for at least some part of the year climbed to 90.9 percent, by far the highest in recent memory.

“I don’t remember it ever being in the 90s before,” said Paul Fronstin of the Employee Benefit Research Institute, who has been tracking insurance statistics since the early 1990s.

The Obama administration was quick to take credit for the insurance improvements. “The cumulative coverage gains since 2013 have put the uninsured rate at its lowest level ever,” said members of the White House Council of Economic Advisers in a statement.

The 2015 report shows insurance gains across all income levels, ages and types of employment, although some groups did better than others. Young adults — specifically 26-year-olds — remain the most likely to lack coverage. Although the Affordable Care Act guaranteed that young adults could stay on their parents’ plans longer than in the past, that protection ends when they turn 26.

Among states, those that took the health law’s option to expand the Medicaid program for the poor saw greater gains in coverage than those that did not. “The overall decrease in the uninsured rate of 2.4 percentage points in expansion states, compared with 2.1 percentage points in no-expansion states,” said the report. The state with the highest percentage of uninsured residents remained Texas at 17.1 percent; the state with the fewest uninsured remained Massachusetts with an uninsurance rate of 2.8 percent.

The single largest source of health insurance remains plans provided by employers. An estimated 177.5 million Americans had employment-based coverage in 2015, which was up more than 3 million from 2013.

See the original article Here.


Rovner, J. (2016 September 13). Number of uninsured falls again in 2015. [Web blog post]. Retrieved from address

10 states with the highest uninsured rates post-ACA

Originally posted on

While the uninsured rate has dropped to a record low of 13.4% nationwide, according to Gallup figures, rates differ dramatically across states. Here are the 10 states with the highest uninsured rates in the aftermath of health care reform implementation, according to WalletHub.

A decreasing rate of uninsured Americans shows the Affordable Care Act has impacted the number of individuals with health care coverage, but that impact varies widely by state. We’ve already highlighted the 10 states with the lowest uninsured rates post-ACA. Here are the 10 states with the highest uninsured rates, according to WalletHub, which analyzed data from the Kaiser Family Foundation, the Centers for Medicare and Medicaid Services, the Department of Health and Human Services, and the U.S. Census Bureau. Seven states were excluded from analysis because of data limitations.

10. Georgia

Pre-ACA uninsured rate: 21.66%

Post-ACA projected uninsured rate: 18.16%

Difference before and after: -3.50%

9. Wyoming

Pre-ACA uninsured rate: 18.92%

Post-ACA projected uninsured rate: 18.29%

Difference before and after: -0.63%

8. Oklahoma

Pre-ACA uninsured rate: 19.76%%

Post-ACA projected uninsured rate: 18.33%

Difference before and after: -1.43%

7. Alaska

Pre-ACA uninsured rate: 20.48%

Post-ACA projected uninsured rate: 18.96%

Difference before and after: -1.52%

6. Nevada

Pre-ACA uninsured rate: 26.52%

Post-ACA projected uninsured rate: 19.58%

Difference before and after: -6.94%

5. New Mexico

Pre-ACA uninsured rate: 24.29%

Post-ACA projected uninsured rate: 19.59%

Difference before and after: -4.69%

4. Florida

Pre-ACA uninsured rate: 24.73%

Post-ACA projected uninsured rate: 19.61%

Difference before and after: -5.12%

3. Louisiana

Pre-ACA uninsured rate: 22.41%

Post-ACA projected uninsured rate: 20.91%

Difference before and after: -1.50%

2. Mississippi

Pre-ACA uninsured rate: 18.11%

Post-ACA projected uninsured rate: 21.46%

Difference before and after: 3.34%

1. Texas

Pre-ACA uninsured rate: 26.8%

Post-ACA projected uninsured rate: 24.81%

Difference before and after: -1.99%

Play or Pay in 2015 — so many requirements, so little time

Originally posted August 6, 2014 by Dorothy Summers on

2015 is getting close and the Employer Shared Responsibility Mandate (“Play or Pay”) under the Affordable Care Act (ACA) is almost here. So what does this mean for your organization? Play or Pay requires certain employers to offer affordable and adequate health insurance to full-time employees and their dependents, or they may be liable for a penalty for any month coverage is not offered.

Play or Pay goes into effect in the calendar year of 2015 for large employers only. However, mid-size employers aren’t entirely off the hook. They’ll have to report on insurance coverage even though they won’t be liable for penalties in 2015. By January 1, 2015, businesses with 100 or more full-time or full-time-equivalent employees must ensure they are offering health benefits to all of those working an average of 30 hours per week, or 130 hours per month. If an employer has a non-calendar year plan and can meet certain transitional rules, they can delay offering employee health benefits until the start date of their non-calendar year plan in 2015. Mid-sized employers will have to comply beginning in 2016.

Here are important questions that employers need to answer today:

  1. Do you know which category your business fits into?
  2. How do you classify who is a full-time employee?
  3. What do you need to do to comply with Play or Pay requirements?

Let’s take an in-depth look at each of these questions.

Which category do you fit into?

Whether you are a small, mid-sized, or large employer is determined by the number of full-time and full-time equivalent employees (FTEs). It sounds simple on the surface:

  • Small employers have 1-49 full-time or FTE employees
  • Mid-sized employers have 50-99 full-time or FTE employees
  • Large employers have 100+ full-time or FTE employees

However, it’s important to remember that these numbers can be affected by several factors, including whether the employer is a part of a control group, seasonal employees and variable-hour employees. That brings us to our next question:

Who is a full-time employee?

The law defines a “full-time employee” for penalty purposes as an employee who, for any month, works an average of at least 30 hours per week, or 130 hours. This includes any of the following paid hours: vacation, holiday, sick time, paid layoff, jury duty, military duty and paid leave of absence under the Family and Medical Leave Act.

Employees who aren’t considered full-time include non W-2 leased workers, sole proprietors, partners in partnerships, real estate agents, and direct sellers.

Variable-hour employees—those who don’t work a set amount of hours each week—fall into a gray area. That is, they don’t need to be counted as full-time employees until and unless it becomes an established practice for them to work more than 30 hours per week.

To assist employers in determining whether variable hour workers will meet the definition of full-time employees (and therefore need to be offered health insurance), employers may use various “look back” and “look forward” periods. Here is a summary of terms used for measuring variable-hour employees:

  • Measurement Period: A period from three to 12 months in which the employer would track hours to determine whether the employee worked an average of more than 30 hours per week.
  • Stability Period: A period from six to 12 consecutive months in which the employer must provide health insurance coverage to employees who worked more than 30 hours per week in the Measurement Period. Note: must be at least six months and cannot be shorter than the Measurement Period.
  • Administrative Period: A period not to exceed 90 days, which falls between the Measurement Period and Stability Period, and/or a short period after a new employee’s date of hire. Using this waiting period allows employers to analyze eligibility of full-time employees and provide enrollment information to enroll them in a plan before penalties could be assessed.

Does your plan meet the Play or Pay requirements?

To avoid penalties, you’ll need to make sure your plan meets certain requirements. First, coverage must be offered to full-time employees and their dependents. Under the ACA, dependents are defined as children under age 26. Spouses are not considered dependents.

Obamacare Challengers Eye Supreme Court Date

Source: - Originally posted by Kimberly Atkins of the Boston Herald.

Aug. 03--The legal battle over Obamacare federal subsidies could land before the nation's top court as soon as next year after challengers asked the U.S. Supreme Court to take up the case.

If the high court grants the request and ultimately rules that the Obama administration lacked authority under the law to authorize subsidies for individuals who purchase health care through the federal exchange rather than state-created exchanges, it would gut a crucial source of funding for the law and severely threaten its viability.

The Supreme Court petition, filed late Thursday, comes just more than a week after federal appellate courts in Virginia and Washington, D.C., issued conflicting opinions as to whether the text of the law, which allows individuals to qualify for subsidies if they purchase insurance on exchanges "established by the state," applies to those in the 36 states that either refused to set up an exchange or for some other reason require residents to go to the federal exchange to enroll.

The Virginia plaintiffs, who claim that they would have qualified for the unaffordability exemption from the law requiring them to purchase health care but for the existence of the federal exchange subsidy, went directly to the Supreme Court instead of asking a full panel of the Virginia federal appellate court to rehear that case "because it's important to get a resolution as soon as possible," said Sam Kazman, general counsel at the Washington-based Competitive Enterprise Institute, which coordinated and funded the challenges to the federal subsidy.

Kazman said the case, one of several legal challenges to various provisions of the law that was largely upheld by the U.S. Supreme Court in 2012, was legal and not political.

"Once you get agencies going beyond the implementation of the law to actually rewriting it, one, it spells trouble and two, it's unconstitutional," Kazman said.

The Justice Department declined Friday to seek immediate Supreme Court review of the D.C. federal court that struck down the administration's interpretation of the law the same day the Virginia court upheld it. Instead, it asked a full panel of the D.C. Circuit to review the three-judge ruling.