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White House: More ACA Changes

The Trump administration has announced new Affordable Care Act (ACA) rules for individuals and employers for this fall open enrollment and for the health insurance plans next year.

1.  As of now, the ACA open enrollment period will start on November 1st and end on December 15th.  This is substantially shorter than the most recent open enrollment period.  The intention seems to be to provide a standard 12- month policy period for everyone, and shore up complexities in processing insurance plans that could have a  1/1,  2/1,  or a 3/1 effective date.

2.  Anyone who signs up for health insurance outside of the open enrollment period, will have to provide specific and verifiable proof of eligibility to enroll based on a qualifying life event.  In the years before the ACA this was always the case, and is a reasonable requirement.  The intention to return to this protocol is to eliminate the opportunity to “game the system”  and for people to obtain coverage when they were not actually eligible to do so.  In many cases, over the years, expensive medical procedures and treatments were covered for some of these people, but then they stopped paying premiums and cancelled their plans as soon as the coverage was not needed for those procedures and treatments.  This ultimately affects everybody’s premiums.

3.  The administration’s new ACA rule allows insurers to refuse to cover a person who hasn’t paid their premiums.  The insurance companies will have to apply this to all employers or individuals.  Supposedly some state laws will have to change regarding this rule.   Also, this rule will apparently not be applied to employer plans sold on the federal small business SHOP marketplace due to “operational constraints,” according to the information available.

Regardless, Evansville Insurance Center deems this to be creating an uneven playing field.  The problems with SHOP enforcement of this rule should be resolved before it is a rule levied on all other insurance plans.

4.  Health plans will also get more flexibility in creating products to sell in their market- and not be restricted to the bronze, silver, gold, and platinum Qualified Health Plan benefit designs that were required by ACA rules.   This is the great news!  Insurance companies should now be able to design health insurance plans that are more suited to the particular people they are intended to cover.  Hopefully this new rule will be the mark that we are on the way to good changes.

Source:  Virgil Dickson, Modern Healthcare.

Judge Decides No Merger

The Anthem and Cigna merger is not allowed, according to a federal judge deciding the merger case because of a complaint filed by the Obama DOJ.  Anthem’s response is below:

“Anthem is significantly disappointed by the decision as combining Anthem and Cigna would positively impact the health and well-being of millions of Americans – saving them more than $2 billion in medical costs annually,” said Joseph R. Swedish, Chairman, President and Chief Executive Officer, Anthem. “Anthem has been a leader in providing individuals with access to high quality, affordable healthcare. Our decision to acquire Cigna is grounded in our commitment to this goal and to leading our industry during this period of dynamic change. If not overturned, the consequences of the decision are far-reaching and will hurt American consumers by limiting their access to high quality affordable care, slowing the industry’s shift to value based care and improved outcomes for patients, and restricting innovation which is critical to meeting the evolving needs of healthcare consumers. Moving forward, Anthem will continue to work aggressively to complete the transaction while remaining focused on serving as America’s valued health partner, delivering superior health care services to our approximately 40 million members with greater value at less cost.”

Source: Anthem Investor Relations as reported by BusinessWire.

Georgia is Making a Move

Go Georgia!!

“State Rep. Brad Raffensperger has introduced a resolution that would urge Republican Gov. Nathan Deal to submit a request for a 1115 waiver to transition the state’s Medicaid program into a per-capita capped system…Under that model, the CMS would distribute a limit of federal dollars per person in the state. Spending would grow as the number of enrollees did, and the state could set eligibility, benefits and delivery system approaches however it chooses.

“Raffensperger said that change could expand Medicaid to people living below the poverty line, which would reduce uncompensated care costs for hospitals. The Georgia Hospital Association’s most recently estimated that its members faced $1.02 billion in uncompensated care costs for indigent Georgia citizens in 2014. That same year, 66% of rural hospitals had negative margins. In all, 41% of Georgia’s hospitals ended 2014 with negative margins, according to the Georgia Hospital Association. Currently, there are about 565,000 uninsured low-income Georgians below the poverty line in a recent Deloitte study.

“‘Working together for both the nation’s and Georgia’s best interest, I believe [(Governor) Deal and (HHS nominee) TomPrice] can craft the block grant funding solution that reflects the desire of Congress, President Trump and our conservative, fiscally responsible values,’ Raffensperger said.”  Source: Modern Healthcare.

Indiana Gets A Head Start on Changes

Good news for Indiana residents! The Governor Holcomb and his administration has taken steps in hope of avoiding any loss of federal Medicaid expansion dollars necessary to continue HIP coverage till 2021, regardless of efforts to repeal or changes to come to the Affordable Care Act!. So thankful for a state government that watches the road ahead! May other states find Indiana’s leadership in healthcare helpful in their own solutions!

“State officials refused to say whether the expansion would continue if Congress repealed Obamacare and eliminated funds for Medicaid expansions. If that happened, it’s unlikely states would have the money to make up for the lost federal aid.

“Indiana’s effort to continue its Medicaid expansion demonstrates how states that expanded Medicaid under the Affordable Care Act — even Republican-controlled ones — are counting on additional federal dollars to pay for those expansions. It also reflects deadline pressure: They can’t wait for Congress to finish its debate over the future of the health law because they need to set budgets and programs now for next year.

“According to Indiana’s request, continuing the Medicaid expansion will cost Indiana $1.5 billion but bring $8.6 billion in federal funding from 2018 to 2020.

“‘Indiana has built a program that is delivering real results in a responsible, efficient, and effective way,’ Gov. Eric Holcomb, a Republican, said in a statement. ‘I look forward to maintaining the flexibility to grow this remarkably successful tool and to preserve our ability to respond to the unique needs of Hoosiers.’

“Several other states including Kentucky and Ohio are considering adopting features of Indiana’s Medicaid plan.”  Source: Kaiser Health News.  To read more Click Here.