The Employer Mandate: Essential or Dispensable?
Have you wondered how the passing of the AHCA will impact employers? Check out this article by David Blumenthal, M.D and David Squires from Commonwealth Fund and see how employers will affect by the passing of the most recent healthcare legislation.
The Commonwealth Fund’s Sara Collins has blogged that, “Employers are at the heart of the U.S. health insurance system and their ongoing commitment to it will be critical to its success and viability over time.” The point is undeniable. More than 150 million Americans under the age of 65 get their coverage through the workplace, and employer-sponsored insurance remains critical to the success of the Affordable Care Act’s (ACA) coverage plans.
Some may therefore be surprised by the growing talk of repealing the ACA’s requirement that employers cover their employees. To unpack this issue, let’s take a look at the ACA provision itself, why it was enacted, and the potential upside and downside of repeal.
The Employer Mandate
The ACA section under discussion is often called an employer mandate, but that’s an oversimplification. The law says that employers with 50 or more employees have a choice. They can offer health insurance that meets minimum standards for affordability and coverage to employees working 30 or more hours a week. Or they can pay the federal government a penalty if at least one of their employees receives a federal subsidy for a private insurance plan sold through one of the new ACA insurance marketplaces.
You can call this a mandate. Or you can call it a requirement that businesses share responsibility for the costs of covering all Americans, either by helping to buy insurance directly for their own employees, or helping the federal government do so.
The language here matters. The concept of shared responsibility reflects a political calculation and a statement of values. It asserts that for the ACA to be fair and politically viable, all Americans have to do their part. All U.S. citizens are required to have health insurance, and many will have to pay a penalty if they go without it (the individual mandate). Employers must cover workers or help the government financially to do so. Taxpayers have to support the expansion in Medicaid eligibility and marketplace subsidies. Hospitals have to take cuts in Medicare payments, medical device makers need to accept additional taxes, and so on. The most successful American social programs—such as Social Security and Medicare—rely on this concept of shared responsibility.
The Rationale
Whatever you label it, the employer coverage requirement has several rationales beyond the concept of shared sacrifice. Policymakers want to deter employers who now provide coverage to their employees from dumping workers into the marketplaces, either by dropping coverage completely or limiting benefits to the point where workers will chose to buy insurance elsewhere. The requirement also attempts to nudge employers who don’t cover employees into offering health insurance. And on the assumption that some businesses will chose to pay rather than offer coverage, the employer provision provides an important source of revenue to cover the ACA’s expenses: an estimated $139 billion over 10 years.
The Rationale for Repeal
Several arguments are fueling the repeal push. First, implementation will be administratively complex and burdensome. For example, employers will have to report many new details about their workers, including what coverage they have been offered and whether they have received coverage elsewhere.
Second, some economists are concerned that the employer requirements will distort hiring decisions, leading companies to bring on fewer low-income employees who might be eligible for subsidized coverage in the marketplaces. Firms with payrolls near 50 workers might hire fewer workers altogether. Economists also believe that if employers incur penalties for not offering coverage, workers might contribute to the costs of insurance through reduced wages. Other economists, however, believe these effects will be modest.
Third, modeling from RAND and the Urban Institute suggests that when fully implemented in 2016, the employer provisions will increase the number of insured Americans by only a few hundred thousand. The overwhelming proportion of U.S. employers already provides insurance to their employees, and would continue to do so without the penalties in the ACA, the analysts contend.
Concerns About Repeal
Supporters of the employer requirement posit that projections that employers would stay in the health insurance business without the ACA requirements are just that—projections. Balanced against employers’ past record of providing coverage is an increasing tendency for businesses to reduce the generosity of coverage. In fact, the law’s requirements that workplace coverage be affordable and meaningful may be as important as the requirement that employers offer coverage at all.
Eliminating the employer provisions would also leave a big hole in funding for the ACA. The likelihood that supporters and opponents could reach agreement on how to raise the missing cash seems low, especially given the recent history of the congressional effort to replace the Medicare physician payment formula known as the SGR. This year, a bipartisan consensus on policy crashed and burned when Republicans and Democrats could not agree on new sources of revenue to pay for the legislation.
Finally, and perhaps most importantly, repealing the employer mandate would undermine the concept of shared responsibility and potentially add momentum—which could grow in a new Congress or under a new president—to the idea of eliminating the individual mandate as well. After all, why should individuals have to buy insurance when businesses don’t? Virtually all disinterested analysts agree that the individual mandate is critical to the stability of the new insurance marketplaces created under the ACA, and to reducing the number of uninsured Americans.
Proceed with Caution
The full effects of repealing the employer provisions of the ACA remain speculative. A repeal seems unlikely in the short term, in part, because a repeal effort would open the floodgates to partisan warfare over undoing the ACA in its entirety, or to changing other elements of the law that could have more far-ranging consequences.
However, if serious bipartisan discussion of ACA improvement becomes possible, expect to see a repeal of employer coverage provisions front and center on the legislative agenda. Under these circumstances, lawmakers should still proceed with caution. It may be wise to experiment with implementing the employer provisions and to reassess their comparative benefits and costs at a later date. The philosophy of shared responsibility is foundational to the law’s political viability, and should not be discarded without compelling evidence that the employer requirements are not essential to the ACA’s success.
See the original article Here.
Source:
Blumenthal D., Squires D. (2017 June 4). The employer mandate: essential or dispensable [Web blog post]. Retrieved from address https://www.commonwealthfund.org/publications/blog/2014/jun/the-employer-mandate
Insurer Participation on ACA Marketplaces, 2014-2017
Have you wondered how the health insurance marketplace has fared since the passing of the ACA. Here is a really good article by Ashley Semanskee and Cynthia Cox highlighting the impact the ACA has had on insurance marketplaces across the country.
Since the Affordable Care Act health insurance marketplaces opened in 2014, there have been a number of changes in insurance participation as companies entered and exited states and also changed their footprint within states. Our earlier analyses of insurer participation and some notable company exits can be found here.
In 2014, there were an average of 5.0 insurers participating in each state’s ACA marketplace, ranging from 1 company in New Hampshire and West Virginia to 16 companies in New York. 2015 saw a net increase in insurer participation, with an average of 6.0 insurers per state, ranging from 1 in West Virginia to 16 in New York. In 2016, insurer participation changed in a number of states due to a combination of some new entrants and the failure of a number of CO-OP plans. In 2016, the average number of companies per state was 5.6, ranging from 1 in Wyoming to 16 in Texas and Wisconsin.
In 2017, insurance company losses led to a number of high profile exits from the market. The average number of companies per state in 2017 was 4.3, ranging from 1 company in Alabama, Alaska, Oklahoma, South Carolina and Wyoming to 15 companies in Wisconsin. In 2017, 58% of enrollees (living in about 30% of counties) had a choice of three or more insurers, compared to 85% of enrollees (living in about 63% of counties) in 2016.
Insurer participation varies greatly within states, and rural areas tend to have fewer insurers. On average, metro-area counties have 2.5 insurers participating in 2017, compared to 2.0 insurers in non-metro counties. In 2017, 87% of enrollees lived in metro counties.
There are a number of areas in the country with just one exchange insurer. In 2017, about 21% of enrollees (living in 33% of counties) have access to just one insurer on the marketplace (up from 2% of enrollees living in 7% of counties in 2016). Often, when there is only one insurer participating on the exchange, that company is a Blue Cross Blue Shield or Anthem plan. Before the ACA, many state individual markets were often dominated by Blue Cross Blue Shield plans.
See the original article Here.
Source:
Semanskee A., Cox C. (2017 June 1). Insurer participation on ACA marketplaces, 2014-2017 [Web blog post]. Retrieved from address https://www.kff.org/health-reform/issue-brief/insurer-participation-on-aca-marketplaces-2014-2017/
Why and How to Avoid High-Risk Pools for Americans with Preexisting Conditions
With the passing of the AHCA many people with preexisting conditions can now be put into a high-risk pool by insurers. Here is a great article by Jean P. Hall from Common Wealth Fund on how Americans with preexisting conditions can avoid being put into a high-risk pool.
The American Health Care Act (AHCA)—the U.S. House of Representatives’ bill to repeal and replace the Affordable Care Act (ACA)—would allow states to apply for waivers to reduce existing consumer protections and provide funding for states to set up high-risk pools or other mechanisms for people with preexisting conditions who have lapses in their coverage. In previous posts, I have talked about the high costs and meager coverage associated with high-risk pools that operated before the ACA and the fact that their use did not significantly reduce costs for other people who buy their own health plans in the individual market. Moreover, the Congressional Budget Office analysis of the AHCA finds that the funding it makes available to states for the high-risk pools is inadequate.
In a recent commentary for Annals of Internal Medicine on high-risk pools, I note that people with preexisting conditions constitute roughly 51 percent of Americans. Here, let’s explore who might end up in a high-risk pool, what their experiences might be, and policymakers’ alternative options for stabilizing the marketplaces.
The U.S. Department of Health and Human Services (HHS) estimated that 23 percent of Americans with preexisting conditions had a period of uninsurance in 2014, often because of job changes or periods of financial instability. Young people reaching age 26 who transition off their parents’ coverage also sometimes experienced gaps in coverage—and some of them have preexisting conditions. Should the AHCA become law, individuals with preexisting conditions and lapses in coverage who live in states that obtain waivers to allow insurers to charge people based on their health would likely end up in high-risk pools.
Research has shown that the greater out-of-pocket costs and limited coverage associated with high-risk pools led to enrollees forgoing needed care and experiencing worse outcomes. In fact, before the ACA, high-risk pool enrollees in Kansas were eight times more likely to transition to federal disability programs than members of the general population with these conditions.
Current Medicaid beneficiaries also would be affected. The Congressional Budget Office analysis of the AHCA estimated that 14 million fewer people would have Medicaid coverage as a result of the federal funding cuts. Many of them would be forced to look to the individual insurance market to gain coverage, yet half of these former Medicaid beneficiaries would have serious preexisting conditions. Given the historically very high costs for consumers associated with high-risk pools, the majority of these individuals would likely go uninsured instead. Many would end up using the emergency room to access care once their needs become urgent, and their uncompensated health care costs would be borne by others with insurance. Some would likely suffer serious health consequences, even preventable deaths.
Supporters of the AHCA suggest that the legislation gives states more options to design coverage for their citizens, thereby better meeting their needs. Section 1332 of the ACA, however, already gives states a great deal of flexibility in designing their marketplaces while still providing comprehensive and affordable coverage. Indeed, both Alaska and Minnesota are pursuing 1332 waiver programs to specifically address concerns about high-risk individuals by implementing reinsurance programs, rather than segregating people with preexisting conditions into high-risk pools. These programs would maintain the overall larger pool of insured people in the state while protecting insurers against catastrophic costs. Reinsurance programs, such as the one temporarily instituted under the ACA for its first three years, have historically been proven to bring down premium costs for everyone. Given that reinsurance programs are a more effective and evidence-based mechanism for stabilizing the individual insurance market, state policymakers should strongly consider pursuing these programs under the existing ACA rules instead of establishing high-risk pools. And, federal policymakers should acknowledge and support this mechanism to strengthen the marketplace, bring down costs, and encourage participation by insurers.
See the original article Here.
Source:
Hall J. (2017 June 5). Why and how to avoid high-risk pools for americans with pre-existing conditions [Web blog post]. Retrieved from address https://www.commonwealthfund.org/publications/blog/2017/jun/how-and-why-to-avoid-high-risk-pools
Gaps in Coverage Among People With Pre-Existing Conditions
The passing of the American Care Act (ACA) in 2010 brought many changes to the healthcare marketplace. One of the most important changes that this legislation brought was coverage for people with pre-existing conditions. This legislation allowed people with pre-existing conditions to gain access to health care without facing higher premiums. But with the passing of the AHCA the market for pre-existing conditions is on the verge of changing. Check out this great article from Kaiser Family Foundation on how the AHCA will effect people with pre-conditions.
The American Health Care Act (AHCA), which has passed the House of Representatives, contains a controversial provision that would allow states to waive community rating in the individual insurance market. In this brief we estimate the number of people with pre-existing conditions who might be affected by such a policy.
How the State Waiver Provision Works
Under the provision, insurers in states with community rating waivers could vary premiums by health status for enrollees who have had a gap in insurance of 63 or more consecutive days in the last year. The higher (or lower) premiums due to health status would apply for an entire plan year (or the remainder of the year in case of people signing up during a special enrollment period), at which point enrollees would be eligible for a community-rated premium unrelated to their health.
States waiving community rating would be required to set up a mechanism to subsidize the cost of high-risk enrollees, such as a high-risk pool, or participate in a reinsurance arrangement that makes payments directly to insurers. States are not required to set up an alternative source of coverage for people who face higher premiums based on their health.
The bill makes $100 billion available to all states for a variety of purposes, including high-risk pools, reinsurance programs, and cost-sharing subsidies. An additional $15 billion is made available for a federal invisible risk-sharing program, which would be similar to a reinsurance arrangement. Another $15 billion is earmarked for spending on maternal and newborn care, mental health, and substance abuse services for the year 2020. The AHCA also allocates $8 billion over five years to states that implement community rating waivers; these resources can be used to help reduce premiums or pay out-of-pocket medical expenses for people rated based on their health status.
Premiums varied significantly based on health status in the individual market before the Affordable Care Act (ACA) prohibited that practice beginning in 2014. Insurers in nearly all states were also permitted to decline coverage to people with pre-existing conditions seeking individual market insurance. We estimate that 27% of non-elderly adults have a condition that would have led to a decline in coverage in the pre-ACA market. While insurers would have to offer insurance to everyone under the AHCA, people with declinable pre-existing conditions would likely face very large premium surcharges under an AHCA waiver, since insurers were unwilling to cover them at any price before the ACA.
How Many People Might be Affected by Community Rating Waivers?
The effect of a community rating waiver would depend crucially on how many people with pre-existing conditions have gaps in insurance that would leave them vulnerable to higher premiums.
Using the most recent National Health Interview Survey (NHIS), we estimate that 27.4 million non-elderly adults nationally had a gap in coverage of at least several months in 2015. This includes 6.3 million people (or 23% of everyone with at least a several-month gap) who have a pre-existing condition that would have led to a denial of insurance in the pre-ACA individual market and would lead to a substantial premium surcharge under AHCA community rating waiver.1
Among the 21.1 million people who experienced a gap in coverage and did not have a declinable pre-existing condition, some also had pre-existing conditions (such as asthma, depression, or hypertension) that would not have resulted in an automatic denial by individual market health insurers pre-ACA but that nonetheless could also result in a premium surcharge.
In many cases, people uninsured for several months or more in a year have been without coverage for a long period of time. In other cases, people lose insurance and experience a gap as a result of loss of a job with health benefits or a decrease in income that makes coverage less affordable. Young people may have a gap in coverage as they turn 26 and are unable to stay on their parents’ insurance policies. Medicaid beneficiaries can also have a gap if their incomes rise and they are no longer eligible for the program.
Through expanded Medicaid eligibility and refundable tax credits that subsidized premium in insurance marketplaces, the ACA has substantially reduced coverage gaps. In 2013, before the major provisions of the ACA went into effect, 38.6 million people had a gap of several months, including 8.7 million with declinable pre-existing conditions.
Some people with a gap will ultimately regain coverage through an employer-based plan or Medicaid, and would not be subject to premium surcharges based on their health. However, anyone who has been uninsured for 63 days or more who tries to buy individual market insurance in a state with a community rating waiver would be subject to medical underwriting and potential premium surcharges based on their health.
Uncertainty Around the Estimate
There are a variety reasons why our estimates might understate or overstate number of people with pre-existing conditions who could be subject to premium surcharges under the AHCA.
People with health conditions would have a strong incentive under an AHCA waiver to maintain continuous coverage in order to avoid being charged premiums that could potentially price them out of the insurance market altogether. The question is how many would be able to do so, given the fact that the premium tax credits provided for in the AHCA would be 36% lower on average for marketplace enrollees than under the ACA and would grow more slowly over time. In 2013, before tax credits for individual insurance were available and the ACA’s Medicaid expansion took effect, the number of people with pre-existing conditions who experienced a gap in coverage was 41% higher. Among people with individual market insurance in 2015, we estimate that 3.8 million adults (representing 25% of all adult enrollees) had a pre-existing condition that would have led to a decline before the ACA. These individuals would not be subject to premium surcharges under AHCA community rating waivers, so long as they maintain continuous coverage. Because individual market subsidies would be significantly reduced under the AHCA, these individuals could face added challenges remaining continuously covered.
About 49% of people with pre-existing conditions who had a gap in coverage in 2015 had incomes at or below 138% of the poverty level, and some of them could be eligible for Medicaid (depending on whether their state has expanded eligibility under the ACA and what eligibility rules are in states that have not expanded). They would not face any coverage restrictions associated with their health status in Medicaid. However, under the AHCA enhanced federal funding for expanding Medicaid would be repealed, and federal matching funds would be capped. The Congressional Budget Office projects that 14 million fewer people would be enrolled in Medicaid by 2026. So, while some people we identify as having a coverage gap would be eligible for Medicaid under the AHCA, many more people currently enrolled in Medicaid would lose that coverage under the AHCA and be uninsured. They would be eligible for premium tax credits, but the AHCA’s subsidies do not scale by income so individual market insurance would likely be unaffordable for people who are poor, including those with pre-existing conditions.
There is also significant uncertainty surrounding how many states would seek to waive community rating under the AHCA. Some states might do so to roll back what they consider to be excessive regulation of the insurance market initiated by the ACA and preserved under the AHCA. Other states might come under pressure to implement waivers from insurers who believe the market would be unstable, given that the AHCA repeals the ACA’s individual mandate. What states decide to do may ultimately have the greatest effect on how many people with pre-existing conditions face potentially unaffordable insurance premiums.
See the original article Here.
Source:
Levitt L., Damico A., Claxton G., Cox C., Pollitz K. (2017 May 17). Gaps in coverage among people with pre-existing conditions [Web blog post]. Retrieved from address https://www.kff.org/health-reform/issue-brief/gaps-in-coverage-among-people-with-pre-existing-conditions/?utm_campaign=KFF-2017-May-Pre-Ex-AHCA-Coverage-Gap&utm_medium=email&_hsenc=p2ANqtz-927vhm-poW6B4a5Qht6venQyS6-j9mRL1ecYqhgHd3bWp8UT-yBNineOJVRUwxXkUvJ3TalIEo_JBE9QE5o-n_pzrwyA&_hsmi=52007627&utm_content=52007627&utm_source=hs_email&hsCtaTracking=148c8fd6-8ba2-4f02-a508-45b17365a226|3ae33023-7ef1-44a9-a84c-b2a8d055e6bd
Preexisting Conditions And Continuous Coverage: Key Elements Of GOP Bill
Do you suffer from a preexisting condition? Take a look at this article by Michelle Andrews from Kaiser Health News and find out how the passing of the AHCA will impact your health care.
Before he was diagnosed with head and neck cancer in 2015, Anthony Kinsey often went without health insurance. He is a contract lawyer working for staffing agencies on short-term projects in the Washington, D.C., area, and sometimes the 90-day waiting period for coverage through a staffing agency proved longer than the duration of his project, if coverage was offered at all.
When Kinsey, now 57, learned he had cancer, he was able to sign up for a plan with a $629 monthly premium because the agency he was working for offered group coverage that became effective almost immediately. The plan covered the $62,000 surgery to cut out the diseased bone and tissue on the left side of his face, as well as chemotherapy and radiation. His share of the treatment cost was $1,800.
If the American Health Care Act, which the House recently passed, becomes law, people like Kinsey who have health problems might not fare so well trying to buy insurance after a lapse.
The Republican bill would still require insurers to offer coverage to everyone, including people who have preexisting medical conditions, such as diabetes, asthma or even cancer. But it would allow states to opt out of the federal health law’s prohibition against charging sick people more than healthy ones. In those states, if people have a break in coverage of more than 63 days, insurers could charge them any price for coverage for approximately a year, effectively putting coverage out of reach for many sick people, analysts say. After a year, they would be charged a regular rate again.
Coming up with a figure for how many people have preexisting conditions that could put them at risk for facing unaffordable health insurance premiums has been the subject of debate, with estimates ranging from 133 million on the high end to 2 million on the low end.
What we know is that before the Affordable Care Act, known as Obamacare, insurers in the individual market frequently charged people more if they were sick. According to a 2009 survey of individual market insurers by America’s Health Insurance Plans, a trade group, 34 percent of coverage was offered at higher-than-standard rates, while 6 percent of those offers included waivers that excluded coverage for specific conditions.
But some health policy analysts suggest that it’s not only people who have a gap in coverage who could be affected if a state seeks the health law waiver. There could be consequences for anyone with a preexisting condition, even those who have maintained continuous insurance coverage. That’s because the bill opens the door for insurers to set rates for people based on their health. For example, those without a health condition could be offered discounted premiums.
“If you have a preexisting condition, you’re going to be put into the block of business with the sicker risk pool,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms.
Requiring people to maintain continuous coverage is the Republicans’ preferred alternative to Obamacare’s individual mandate that requires people to have insurance or pay a fine. But there are many reasons people may have a gap in coverage, especially if they’re sick, say consumer advocates.
“If they’re diagnosed with cancer and going through a grueling treatment, they might move closer to their caregiver or the cancer center,” said Kirsten Sloan, vice president for policy at the American Cancer Society Cancer Action Network. “They may quit their job for that reason, or they may lose their job.”
Once people have a gap in coverage they may really be in a bind if the available coverage is unaffordable. To address this, the Republican bill requires states to set up a high-risk pool or reinsurance program or participate in a federal risk-sharing program.
State high-risk pools, which were available in 35 states before the ACA passed, have been widely criticized, however, as inadequate for people with expensive health care needs. Premiums were often extremely high, and there were frequently lifetime or annual limits on coverage. Some plans excluded coverage for as long as a year for the very conditions people needed insurance.
Still, Thomas Miller, a resident fellow at the American Enterprise Institute, says high-risk pools offer a reasonable solution for the 2 million to 4 million people in the individual market he estimates have preexisting conditions but would otherwise be medically uninsurable or offered such high-cost coverage that they couldn’t afford it. The $130 billion over nine years that the bill sets aside to use for high-risk pools or other individual market activities, along with an additional $8 billion over five years for states that get waivers from ACA community-rating requirements, “could be adequate” to meet the need, he said.
Besides, he argued, the higher rates would last for only a year.
“Once you’ve paid up, you graduate back to the regular market,” Miller said. “It’s not like being sentenced to the Gulag.”
Kinsey said he plans to keep his coverage up to date from now on, but he doesn’t think it’s fair to charge sick people higher rates even if they have a break in coverage.
“It would be problematic,” he said. “I’m not in favor of that.”
See the original article Here.
Source:
Andrews M. (2017 May 16). Preexisting conditions and continuous coverage: key elements of GOP bill [Web blog post]. Retrieved from address https://khn.org/news/preexisting-conditions-and-continuous-coverage-key-elements-of-gop-bill/?utm_campaign=KFF-2016-The-Latest&utm_source=hs_email&utm_medium=email&utm_content=52062246&_hsenc=p2ANqtz-90h4NOm7X9KLzIv7cYUNaGbi_qAFjmLW8NHmH89fiCT1u4SVQ8G95MFvTb3ljYlm3XiY20qWwsBfqH8PKOCwaULkf-ug&_hsmi=52062246
Poll: Majority Sees GOP Health Bill as Step Backward
Have you wondered how other Americans feel about the repealing of the ACA? Check out in this great article by Jonathan Easley from The Hill about a poll taken from Harvard detailing how people across the country really feel about the passing of the AHCA.
A majority of voters see the GOP healthcare bill as a step backward and want to see the Senate make significant changes to it.
According to data from the latest Harvard-Harris Poll survey, provided exclusively to The Hill, 55 percent view the House-passed bill as a step backward, compared to 45 percent who described it as a step forward.
Seventy-seven percent of Republicans view the bill as a step forward, while 77 percent of Democrats and 61 percent of independents view it as a step back.
Fifty-seven percent of voters said they want to see the Senate make significant changes to the bill if it is to be passed into law, including 64 percent of Republicans and 66 percent of independents.
Sixty percent of voters want the Senate bill to ensure people with preexisting conditions can get affordable healthcare.
An amendment to the House bill offers state waivers that would allow carriers to charge people more based on their health.
“The voters want to neither go back to ObamaCare nor to the House bill,” said Harvard-Harris co-director Mark Penn.
“The Senate is going to have to thread the needle here and craft a new compromise. The voters are mostly concerned with pre-existing conditions and are against any penalty for not having insurance. Solve the preconditions dilemma and they might have something that could get public support.”
The Harvard-Harris online survey of 2,006 registered voters was conducted May 17–20. The partisan breakdown is 36 percent Democrat, 32 percent Republican, 29 percent independent and 3 percent other. The poll uses a methodology that doesn't produce a traditional margin of error.
The Harvard–Harris Poll is a collaboration of the Harvard Center for American Political Studies and The Harris Poll. The Hill will be working with Harvard-Harris throughout 2017. Full poll results will be posted online later this week.
Satisfaction with the bill cut sharply along partisan lines.
See the original article Here.
Source:
Easley J. (2017 May 24). Poll: majority sees GOP health bill as step backward[Web blog post]. Retrieved from address https://thehill.com/policy/healthcare/335003-poll-majority-sees-gop-health-bill-as-step-backward
Planned Parenthood Funding Could Thwart GOP Efforts On Health Bill
With the many changes coming to healthcare thanks to the passing of the American Health Care Act (AHCA) in Congress. See how funding for planned parenthood could become a problem for the AHCA trying to pass in the Senate in this great article by Julie Rovner at Kaiser Health News.
If there’s anything congressional Republicans want to do more than “repeal and replace” the Affordable Care Act it’s defund Planned Parenthood, which provides health care to women around the country. But Senate rules could prevent lawmakers from accomplishing both of those goals in the same bill, as they intend to do.
The American Health Care Act, passed by the House earlier this month to overhaul the federal health law, would bar funding under the Medicaid program for one year to any “prohibited entity” that “is primarily engaged in family planning services, reproductive health, and related medical care; and … provides for abortions” other than those for rape, incest or to protect the life of the woman.
Although Planned Parenthood is not mentioned, it is clearly the target of the provision. On the other hand, the Senate parliamentarian could rule that the language does not qualify to be included in this specific bill.
The provision has mostly flown under the radar in recent debates about the bill. But defunding Planned Parenthood is a top priority for powerful anti-abortion groups counting on its inclusion as a condition to support the bill. It would pose enormous political problems for the measure if it does not pass the Senate.
“Congress has the votes to get it done. There are no excuses for inaction,” warned Marjorie Dannenfelser, president of the Susan B. Anthony List, in a statement aimed at lawmakers in March.
Whether Congress truly has enough votes to pass the bill is unclear. Congress is using the “budget reconciliation” process for its health law overhaul because reconciliation bills cannot be filibustered in the Senate and require only a simple majority vote — rather than the typical 60 — to pass. Republicans control only 52 seats in the Senate.
Under Senate rules for reconciliation, any provision in the measure must primarily be aimed at affecting the federal budget, either adding to or subtracting from federal spending. Items for which spending is “merely incidental” to a broader purpose can be ordered dropped from the bill by the parliamentarian under the “Byrd Rule,” named for its author, Sen. Robert Byrd (D-W.Va.), a longtime Senate leader who died in 2010.
In the past, policies related to abortion have been singled out as violating that rule. For example, Robert Dove, who served as parliamentarian twice under Republican control of the Senate, said in a 2010 interview that he ruled an abortion ban out of order in a 1995 reconciliation bill because “it was my view that the provision was not there in order to save money. It was there to implement social policy.”
Republicans have defended the inclusion of the Planned Parenthood provision in the reconciliation bill. House Speaker Paul Ryan (R-Wis.), when defending the lack of anti-Planned Parenthood language in the spending bill that passed last week to keep the government running, said the measure “needs to be in the reconciliation bill — as it is — because that’s how you get it into law.”
Planned Parenthood gets an estimated 75 percent of its government support from the Medicaid program, mostly for birth control, sexually transmitted disease screening and treatment, and well-woman care. The language, if it becomes law, would have a major effect on the organization and its affiliates. The federal “Hyde Amendment” has for 40 years barred the use of federal funds for most abortions, but the fact that many Planned Parenthood affiliates offer separately funded abortion services has made the organization a longtime target of abortion opponents.
Defenders of the provision point out it is identical to language included in a 2015 budget bill that was vetoed by President Barack Obama.
“That same language already has a track record of success, passing Congress in 2015,” also under the Senate’s reconciliation rules, wrote Tony Perkins, president of the anti-abortion Family Research Council, in a blog post for supporters.
But passing parliamentary muster once “does not guarantee” the same language will be approved again, said Richard Kogan, a budget process expert at the Center on Budget and Policy Priorities, a Washington-based think tank. “A true precedent exists only when a point of order has been raised and the chair has made a ruling,” he said.
And while the language has not changed, circumstances around it have. For one thing, since 2015 the Congressional Budget Office has interpreted the language less broadly than it is written. “CBO expects that, according to those criteria, only Planned Parenthood Federation of America and its affiliates and clinics would be affected,” CBO said in its official estimate of the original House bill.
That would not, on its face, rule the language impermissible as part of the reconciliation bill. But supporters of Planned Parenthood said if lawmakers thought there was no potential problem, they would have simply named the organization in the bill, as in separate legislation introduced this year.
The CBO also lowered its estimate of how much the provision would save — from $235 million for a one-year defunding in 2015 to $156 million in 2017. The bill includes only a one-year ban on funding because CBO has estimated a permanent funding ban would actually cost money — as women who don’t get birth control get pregnant, have babies and possibly end up qualifying for Medicaid.
In the end it will be up to Senate parliamentarian Elizabeth MacDonough to make the call. Typically, the parliamentarian hears both sides argue their case before making a decision on whether a provision is allowable or not.
Even if MacDonough approves the provision, however, it is still not smooth sailing in the Senate. At least three GOP senators — Susan Collins of Maine, Lisa Murkowski of Alaska and Dean Heller of Nevada — have said they are uncomfortable with defunding Planned Parenthood.
“That is an important issue to me, because I don’t think that low-income women should be denied their choice of health care providers for family planning, cancer screenings, for well-woman care,” Collins said Sunday on ABC.
Those three votes would, if the senators followed through, be enough to force the provision out in the Senate.
And if the bill went back to the House with no Planned Parenthood defunding, “it would be problematic, I believe, based on my conversations with my colleagues,” said Rep. Mark Meadows, (R-N.C.), a leader of the House Freedom Caucus who helped negotiate the final language in the House bill.
Anti-abortion groups like Susan B. Anthony List are counting on the language staying in. “We urge the Senate to keep these non-negotiable provisions and quickly advance this bill to the President’s desk,” said a statement from Dannenfelser, the group’s president.
See the original article Here.
Source:
Rovner J. (2017 May 12). Planned parenthood funding could thwart GOP efforts on health bill [Web blog post]. Retrieved from address https://khn.org/news/planned-parenthood-funding-could-thwart-gop-efforts-on-health-bill/
HR Pros Were Relieved When Obamacare Replacement Bill Got Pulled
Find out how HR professionals really felt about the fall of the AHCA in this great article from HR Morning by Tim Gould.
Everybody knows that the GOP’s attempt to repeal and replace Obamacare came to a rather ignominious end. But how did the HR community feel about that outcome?
HR powerhouse Mercer addressed that question in a recent webcast, and the results were eye-opening.
Here are some stats from the webcast, which asked a couple key questions of 509 benefits pros.
On how they felt about the American Health Care Act being pulled:
- Very relieved it didn’t pass — 24%
- Relieved it didn’t pass — 32%
- Very disappointed it didn’t pass — 5%
- Disappointed it didn’t pass — 16%, and
- No opinion — 23%.
So (utilizing our super-sharp math skills here) considerably more than half of the participants were not in favor of the AHCA, while just slightly more than one in five were disappointed it was shot down. Looks like Obamacare isn’t as deeply disliked as we’ve been led to believe — at least with benefits pros.
Mercer also asked participants to rate priorities for improving current healthcare law — using 5 as the top rating and 1 as the lowest. Those results:
- Reduce pharmacy costs — 4.4
- Improve price transparency for medical services/devices — 4.1
- Stabilize individual market — 4.0
- Maintain Medicaid funding — 4.0, and
- Invest more in population health and health education — 3.7.
Perspective? As Beth Umland wrote on the Mercer blog, “Policymakers should view this health reform ‘reboot’ as an opportunity to partner with American businesses to drive higher quality, lower costs, and better outcomes for all Americans.”
A glance back
In case you’ve been hiding in a cave somewhere for the past several months, here’s a quick recap of the fate of the American Health Care Act.
Why did the AHCA fail, despite Republicans controlling the House, Senate and White House?
The answer starts with the fact that the GOP didn’t have the 60 seats in the Senate to avoid a filibuster by the Democrats. In other words, despite being the majority party, it didn’t have enough votes to pass a broad ACA repeal bill outright.
As a result, Senate Republicans had to use a process known as reconciliation to attempt to reshape the ACA. Reconciliation is a process that allows for the passage of budget bills with 51 votes instead of 60. So the GOP could vote on budgetary pieces of the health law, without giving the Democrats a chance to filibuster.
The problem for Republicans was reconciliation severely limited the extent to which they could reshape the law — and it’s a big reason the why American Health Care Act looked, at least to some, like “Obamacare Lite.”
Ultimately, what caused Trump and Ryan to decide to pull the bill before the House had a chance to vote on it was that so many House Republicans voiced displeasure with the bill and said they wouldn’t vote for it.
Specifically, here are some of what conservatives didn’t like about the American Health Care Act:
- it largely left a lot of the ACA’s “entitlements” intact — like government aid for purchasing insurance
- it didn’t do enough to curtail the ACA’s expansion of Medicaid
- too many of the ACA’s insurance coverage mandates would remain in place
- the Congressional Budget Office estimated that the bill would result in some 24 million Americans losing insurance within the next decade, and
- it didn’t do enough to drive down the cost of insurance coverage in general.
See the original article Here.
Source:
Gould T. (2017 April 14). Hr pros were relieved when obamacare replacement bill got pulled Ob[Web blog post]. Retrieved from address https://www.hrmorning.com/hr-pros-were-relieved-when-obamacare-replacement-bill-got-pulled-off-the-table/
Health Reform Expert: Here’s What HR Needs to Know About GOP Repeal Bill Passing
The House of Repersentives has just passed the American Health Care Act (AHCA), new legislation to begin the repeal process of the ACA. Check out this great article from HR Morning and take a look how this new legislation will affect HR by Jared Bilski.
Virtually every major news outlet is covering the passage of the American Health Care Act (AHCA) by the House. But amidst all the coverage, it’s tough to find an answer to a question that’s near and dear to HR: What does this GOP victory mean for employers?
The AHCA bill, which passed in the House with 217 votes, is extremely close to the original version of the legislation that was introduced in March but pulled just before a vote could take place due to lack of support.
While the so-called “repeal-and-replace” bill would kill many of the ACA’s taxes (except the Cadillac Tax), much of the popular health-related provisions of Obamacare would remain intact.
Pre-existing conditions, essential benefits
However, the new bill does allow states to waive certain key requirements under the ACA. One of the major amendments centers on pre-existing conditions.
Under the ACA, health plans can’t base premium rates on health status factors, or pre-existing conditions; premiums had to be based on coverage tier, community rating, age (as long as the rates don’t vary by more than 3 to 1) and tobacco use. In other words, plans can’t charge participants with pre-existing conditions more than “healthy” individuals are charged.
Under the AHCA, individual states can apply for waivers to be exempt from this ACA provision and base premiums on health status factors.
Bottom line: Under this version of the AHCA, insurers would still be required to cover individuals with pre-existing conditions — but they’d be allowed to charge astronomical amounts for coverage.
To compensate for the individuals with prior health conditions who may not be able to afford insurance, applying states would have to establish high-risk pools that are federally funded. Critics argue these pools won’t be able to offer nearly as much coverage for individuals as the ACA did.
Under the AHCA, states could also apply for a waiver to receive an exemption — dubbed the “MacArthur amendment” — to ACA requirement on essential health benefits and create their own definition of these benefits.
Implications for HR
So what does all this mean for HR pros? HR Morning spoke to healthcare reform implementation and employee benefits attorney Garrett Fenton of Miller & Chevalier and asked him what’s next for the AHCA as well as what employers should do in response. Here’s a sampling of the Q&A:
HR Morning: What’s next for the AHCA?
Garrett Fenton: The Senate, which largely has stayed out of the ACA repeal and replacement process until now, will begin its process to develop, amend, and ultimately vote on a bill … many Republican Senators have publicly voiced concerns, and even opposition, to the version of the AHCA that passed the House.
One major bone of contention – even within the GOP – was that the House passed the bill without waiting for a forthcoming updated report from the Congressional Budget Office. That report will take into account the latest amendments to the AHCA, and provide estimates of the legislation’s cost to the federal government and impact on the number of uninsured individuals …
… assuming the Senate does not simply rubber stamp the House bill, but rather passes its own ACA repeal and replacement legislation, either the Senate’s bill will need to go back to the House for another vote, or the House and Senate will “conference,” reconcile the differences between their respective bills, and produce a compromise piece of legislation that both chambers will then vote on.
Ultimately the same bill will need to pass both the House and Senate before going to the President for his signature. In light of the House’s struggles to advance the AHCA, and the razor-thin margin by which it ultimately passed, it appears that we’re still in for a long road ahead.
HR Morning: What should employers be doing now?
Garrett Fenton: At this point, employers would be well-advised to stay the course on ACA compliance. The House’s passage of the AHCA is merely the first step in the legislative process, with the bill likely to undergo significant changes and an uncertain future in the Senate. The last few months have taught us nothing if not the impossibility of predicting precisely how and when the Republicans’ ACA repeal and replacement effort ultimately will unfold. To be sure, the AHCA would have a potentially significant impact on employer-sponsored coverage.
However, any employer efforts to implement large-scale changes in reliance on the AHCA certainly would be premature at this stage. The ACA remains the law of the land for the time being, and there’s still a long way to go toward even a partial repeal and replacement. Employers certainly should stay on top of the legislative developments, and in the meantime, be on the lookout for possible changes to the current guidance at the regulatory level.
HR Morning: Specifically, how should employers proceed with their ACA compliance obligations in light of the House passage of the AHCA?Garrett Fenton: Again, employers should stay the course for the time being, and not assume that the AHCA’s provisions impacting employer-sponsored plans ultimately will be enacted. The ACA remains the law of the land for now. However, a number of ACA-related changes are likely to be made at the regulatory and “sub-regulatory” level – regardless of the legislative repeal and replacement efforts – thereby underscoring the importance of staying on top of the ever-changing guidance and landscape under the Trump administration.
Fenton also touched on how the “MacArthur amendment” and the direct impact it could have on employers by stating it:
“… could impact large group and self-funded employer plans, which separately are prohibited from imposing annual and lifetime dollar limits on those same essential health benefits. So in theory, for example, a large group or self-funded employer plan might be able to use a “waiver” state’s definition of essential health benefits – which could be significantly more limited than the current federal definition, and exclude items like maternity, mental health, or substance abuse coverage – for purposes of the annual and lifetime limit rules. Employers thus effectively could be permitted to begin imposing dollar caps on certain benefits that currently would be prohibited under the ACA.”
See the original article Here.
Source:
Bilski J. (2017 May 5). Health reform expert: here's what HR needs to know about GOP repeal bill passing [Web blog post]. Retrieved from address https://www.hrmorning.com/health-reform-expert-heres-what-hr-needs-to-know-about-gop-repeal-bill-passing/
An Employer’s Guide to Navigating the ACA’s Strong Headwinds
Check out this great article from United Benefit Advisors (UBA) by Michael Weiskirch on how employers should continue to monitor the healthcare debate between the ACA and the AHCA.
One might describe the series of events leading to the death of the American Health Care Act (Congress’s bill to repeal and replace the Affordable Care Act) as something like a ballistic missile exploding at launch. The Patient Protection and Affordable Care Act (ACA) repeal debate began nearly a decade ago with former President Barack Obama’s first day in office and reemerged as a serious topic during the 2016 presidential election. Even following the retraction of the House bill, repeal of the ACA remains a possibility as the politicians consider alternatives to the recent bill. The possibility of pending legislation has caused some clients to question the need to complete their obligation for ACA reporting on a timely basis this year. The legislative process has produced a great deal of uncertainty which is one thing employers do not like, especially during the busy year end.
While the “repeal and replace” activity is continuing, it is imperative that employers and their brokers put their noses to the grindstone to fulfill all required reporting requirements. To accomplish this, employers will need brokers that can effectively guide them through this tumultuous season. We recommend that employers ask their brokers about their strategies for
- Implementing the employer shared responsibility reporting
- Sending all necessary forms to the employer’s employees
- Submitting the employer’s reporting to the IRS
- Closing out the employer’s 2016 filing season
Employers should also inquire about any additional support that the broker provides. They should provide many of the services that we at Health Cost Manager provide to our clients: They should apprise their clients of the latest legislative updates through regular email communication and informational webinars. Brokers should also bring in experts in the field that have interacted with key stakeholders in Washington. And most important, they should remain available during this uncertain period to answer any questions or concerns from clients.
We know employers would prefer not to have to comply with these reporting obligations – many have directly told us so. We understand this requires additional work on their part to gather information for the reporting and increased compliance responsibility. Knowing how stressful the reporting season can be for employers, brokers should go out of their way to help their clients feel confident that they can steer through the reporting process smoothly. The broker’s role should be to take as much of the burden off the employer’s shoulders as possible to enable them to reach compliance in the most expedient manner possible. Sometimes this involves stepping in to solve data or other technical issues, or answering a compliance-related question that helps the client make important decisions. It’s all part of helping employers navigate through the ACA’s strong headwinds during these uncertain times.
Audit-proof your company with UBA’s latest white paper: Don’t Roll the Dice on Department of Labor Audits. This free resource offers valuable information about how to prepare for an audit, the best way to acclimate staff to the audit process, and the most important elements of complying with requests.
See the original article Here.
Source:
Weiskirch M. (2017 April 13). An employer's guide to navigating the ACA's strong headwinds [Web blog post]. Retrieved from address https://blog.ubabenefits.com/an-employers-guide-to-navigating-the-acas-strong-headwinds