Affordable Care Act

Obamacare Health Industry News Recap: 8/17-8/21: What we learned this week

Published on August 21, 2015



  • A Change To Out-Of-Pocket Health Insurance Limits Irks Employers

In a rule published in February, the administration said that starting next year individuals must not be held financially responsible for more than the individual annual maximum spending limit, regardless of the type of plan they’re in.
Now some employers say the administration is unfairly changing the rules that determine how those limits are applied and that the changes will be costly.
According to the provision for next year, even if a family plan has a $13,700 maximum out-of-pocket limit, no one in the family can be on the hook for more than $6,850 before the employer or insurer starts covering that person’s medical bills at 100 percent.
As an example, consider the situation where a mother, father and child will be covered by a family plan with a $13,700 out-of-pocket spending limit. If the mother gets sick and has $10,000 in out-of-pocket spending, the health plan would have to start covering her care after she spent $6,850, even if the total family medical spending hadn’t yet hit the plan’s $13,700 out-of-pocket maximum.
While some are very supportive of the new provision, like JoAnn Volk, senior research fellow at Georgetown University’s Center on Health Insurance Reforms, many are not.
According to a letter sent to the administration in June by the ERISA Industry Committee, a group representing large employers who want to withdraw the ruling wrote, “The new cost-sharing limit shifts medical costs to employers for individuals who have not reached, and might never reach, the umbrella limit.”
Read more: (NPR)

  • Poll: Americans Favor Government Action On Drug Prices

According to a new survey, most Americans value the prescription products the drug industry produces, but they sure don’t like the prices and want the federal government to take action.
Results showed just over half of Americans or 54 percent are currently taking a prescription drug. While most say their drugs are easy to afford, consumers in general (72 percent) believe drug costs are unreasonable, according to the poll by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent part of the foundation.)
Prescription prices have come under scrutiny as even some people with insurance struggle with the costs, particularly for some drugs for cancer and other hard to treat illnesses.
Consumers also struggle with accessing information on prescription drug benefits.
Read more:  (Kaiser Health News, California Healthcare Foundation )

  • Study: 2 Million Exchange Enrollees Miss Out On Cost-Sharing Assistance

According to a new analysis by Avalere Health, more than 2 million people with coverage on the health insurance exchanges may be missing out on subsidies that could lower their deductibles, copayments and maximum out-of-pocket spending limits.
The findings by Avalere Health raise concerns that a number of those lower-income people could get stuck with health bills that they could have avoided if only they had selected a plan that might have had higher monthly premiums—but which gave them access to the federal subsidies.
Avalere found that 8.1 million individuals with this coverage had income levels that should have qualified them for cost-sharing reductions. But only 5.9 million received the reductions, which are automatically applied if people enroll in silver-level plans.
Some of those who were eligible probably bought cheaper bronze-level plans, says Elizabeth Carpenter, a vice president at Avalere.
“Consumers are picking plans on [Obamacare] exchanges based on premiums, rather than out-of-pocket costs,” said Avalere CEO Dan Mendelson. “As a result, some patients may be paying more than they need for care.”
Read more: (Kaiser Health News, CNBC)

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