Affordable Care Act
The Obama administration will tighten the rules for people who enroll in insurance through HealthCare.gov outside of official enrollment periods. Many insurers blame extensions and late sign-ups for the high costs. On Monday, a top federal health official said that the administration will remove some criteria for late sign-ups and make other criteria language clearer.
Insurers say that the rules are so broad that people can wait until they get ill to buy insurance. Unfortunately, that raises health-care spending and overall premiums because people who are sicker generally cost more to insure.
Mr. Slavitt, the acting Medicare administrator, called out the “bad actors” that are taking advantage of the existing rules and that enforcing more rules outside the open enrollment would ensure that the special enrollment period served its original purpose.
“It’s critical to enforce the integrity of the open enrollment period,” he said.
He also said the agency has created an enforcement task force to ensure that people are being honest, and said the task force has terminated coverage for some consumers who didn’t have legitimate reasons for enrolling outside the deadline.
Federal officials said in August, nearly 950,000 new consumers selected a plan through the federal exchange, HealthCare.gov, outside the open enrollment period between Feb. 23 and June 30, 2015.
About half of those consumers obtained coverage after the enrollment deadline because they lost their health insurance and others were given through April to sign up if they said they had learned about the penalty for going uninsured only when they filed their taxes.
Read more: (The Wall Street Journal)
California is becoming a battleground state in the fight over health insurance mega-mergers.
Consumer advocates are putting pressure on regulators in California and a dozen other key states to scrutinize the deals amid concerns that consumers will be left with fewer choices and higher costs.
There’s a lot at stake for families and employers if the deals go through and leave three health insurers in control of nearly half of the U.S. commercial insurance market.
Anthem Inc. is trying to buy Cigna Corp. for $54.2 billion, and Aetna Inc. wants to take over rival Humana for $37 billion. Anthem and Aetna would join UnitedHealth Group Inc. atop the industry. Another deal, Centene’s $6.8-billion acquisition of Woodland Hills insurer Health Net Inc., will also affect Californians.
California’s two insurance regulators have begun holding public hearings to examine these mergers and more hearings are expected in the coming weeks, particularly on Anthem, which sells Blue Cross policies in California and other states. If the Cigna deal goes through, Anthem will become California’s largest health insurer, topping HMO giant Kaiser Permanente.
The other acquisitions will enable Aetna and Health Net to become bigger players in the state, behind Kaiser and Blue Shield of California.
Much of the debate centers on whether insurers should be required to limit rate increases for a time, expand their provider networks and make other pledges to improve patient care in order to win regulatory approval at the state level.
Read more: (Los Angeles Times)
A new survey from payroll services ADP (Automatic Data Processing Inc. ) reveals that about 40 percent of mid-sized and large companies that are offering health coverage to workers aren’t familiar with two new Obamacare-related forms that must be filed with the Internal Revenue Service starting this tax season.
“That’s a bit concerning,” said Vic Saliterman, ADP senior vice president and general manager for health-care reform.
Both the 1094-C and the 1095-C forms are designed to track compliance with the Obamacare rule that mid- to large-sized employers offer affordable health insurance to workers or face a fine.
The 1094-C forms will be used by companies to indicate to the IRS where they’ve complied with that rule, and 1095-C forms will indicate whether a worker and his dependents have received job-based health coverage.
ADP, which provides outsourced payroll and human resources management services, found that even when companies knew about the forms, not all of them have been compiling the often-complicated data to complete them.
Twenty-one percent of firms with between 50 and 999 employees told ADP that they either haven’t assembled the data yet, or weren’t sure if they had. And 13 percent of firms with 1,000 or more workers said they had not started to put together that data, or weren’t sure if it was being done.
Companies can be fined $260 per worker, with a maximum penalty of $6 million if a company is found to have blatantly disregarded rules requiring the new forms, Saliterman said.
Read more: (CNBC)