Updated August 17, 2017
White House Says That It Will Make the CSR Payments Due for August
The White House announced on Wednesday that the federal government will pay insurance carriers the CSR payments (Cost-Sharing Reduction payments), in August, despite the President threatening to withhold that money, which he labeled a “bailout” to insurance carries.
The Obamacare law promised insurance carriers that the federal government would reimburse them for the amount of discounts that insured Americans received in the form of tax credits if they enrolled in a silver plan and earned between 100% and 250% of the federal poverty level. This money has been withheld for a while now and insurance carriers and the Congressional Budget Office warned that premium prices will go up across the board if this money isn’t received as promised. In total, about $7 billion is owed to insurance carriers to cover these discounts given to Americans.
The Congressional Budget Office (CBO) issued a report on August 15th saying that if the federal government refused to pay out the CSR payments to insurance carriers for the rest of the year that a number of carriers would leave the market, which would result in approximately 5% of Americans having no options for health insurance in 2018. CBO also estimates that premium prices would go up 20% in 2018 across the board because insurance carriers would be required under the law to give these discounts to Americans who buy the silver plan and earn a certain amount of money, but they would not be getting that money back from the government.
Not funding the CSR payments will also have a negative affect on the federal budget because premium costs will rise, which will in turn increase the subsidy amounts people are eligible for and that the government will have to pay.
A number of members of Congress have openly commented that they need to do something soon to ensure that the CSR payments are made to insurance carriers so that the market does not become more unstable in the coming months.
Updated August 14th, 2017
Carriers Given Extension to Submit Insurance Plan Details and Rates
As a way to possible signal to Americans and the healthcare industry that the Trump administration is still hopeful that this year’s open enrollment period can be salvaged, the President and HHS told insurance carriers that they have until September 5th to submit their insurance plan and rate proposals. The original deadline was August 16th. They also have until September 27 to say either way whether they will offer plans on the marketplace this year. Americans can start shopping and enroll on November 1st.
Congress and the President are on vacation and neither the House nor the Senate meet for a session until September 5th, but difference members of Congress have reported that there are people actively working on legislation that will strengthen the insurance market and prompt carriers to offer plans this season, despite the President’s warning that he would rather let Obamacare implode.
One issue that Congress needs to address is whether the administration will pay the cost sharing reduction payments promised in the Obamacare law to carriers to cover the subsidies granted to many families. There is a hefty bill due to carriers for the past couple of years for these subsidy amounts and if they aren’t paid, the cost of premiums this year and in future years will go up significantly, which will make insurance unaffordable for most.
The federal court system is already litigating and ruling for insurance carriers who have brought lawsuits against the government for failing to provide them certain funding promised in the law, and it’s almost certain that many more lawsuits will be filed by carriers if the administration refuses to pay the cost sharing payments.
Updated July 31st, 2017
Consumer Searches for “What Is Obamacare” Are Up 1,400% In The Last Month
In what can only be described as a sort of depressing statistic, HealthNetwork, the parent company of this website, has recently released data that indicates that monthly searches for “What Is Obamacare” are up more than 1,400%.
Not only are searches for this term up dramatically, but the Spanish language searches for the same phrase have also increased as well.
Why should you believe us regarding this data? Well, the main reason to do so would be the reach that HealthNetwork as a company has had with Americans seeking out health insurance options for the last four years. In 2016 HealthNetwork reached more than 18 million American households seeking help with their health insurance options. Only Healthcare.gov reached more health insurance shoppers in 2016.
Another source for consumer search and behavioral trend data, is Google Trends. Below is a screen shot from their tool showing the increase in “What Is Obamacare” searches. Source: Trends.Google.com
So Why Does That Matter?
It’s unfortunately one indicator that the previous administration didn’t do as effective of a job as they needed to in creating real awareness with all consumers in the United States. It also is not a ringing endorsement for Healthcare.gov, either. When consumers seeking out information on Obamacare are doing so for the first time, they don’t start off by searching for “what is Obamacare” , typically. No, they typically just start off by searching for “Obamacare” or “Obama Care”.
Searches for “what is Obamacare” are up because it’s in the news cycle every day. The scary part of this, is that it indicates that there’s a significant amount of Americans, millions, who have yet to do any kind of research on Obamacare.
Creating awareness with consumers, operating in a manner in which you’re embracing outside players in healthcare to help make government subsidized health insurance approachable, and not so government like, this will help resolve this problem.
As much as we admire what President Obama was trying to accomplish, many of the individuals who ended up getting involved in the process, on a legislative and operational level, focused too much attention on the politics of Obamacare and what it could mean for Democrats and the future of the party.
Obamacare was designed in such a way as to not only be an access and delivery mechanism for “healthcare”, but also as an advertisement for the Democratic party. A number of individuals within CMS, HHS and the team that is and or was responsible for Healthcare.gov, made their focus less about reaching the end goal of enrolling as many Americans as possible in a healthcare plan, and much more about the Affordable Care Act and how it would help swing more voters to the Democrats.
That clearly didn’t work out, as the last two elections are a very clear indication that if you focus on party and not people, it results in too much attention being paid to areas where it isn’t needed. That is precisely when things begin to spiral out of control, and leads to a political backlash from Americans who feel like they’ve been cheated out of something they desperately need.
Just Focus On Fixing Healthcare, Not The Politics, That’s What People Want
If you focus too much on any secondary goal, instead of doing whatever it takes to make healthcare reform work, or put more bluntly, “leveraging political opportunity”, people sense it, and it upsets them, and then they just tune you out until there’s someone they are politically aligned with who is doing the talking. That’s precisely who is searching for “What Is Obamacare” right now, the individuals who tuned out the previous administration. HealthNetwork’s data is also showing more of these type of “what is obamacare” searches in “Red States” than “Blue States”.
Without a true bi-partisan effort being made on Trumpcare, Republicans are destined to repeat the same history of the Democrats. Then we’ll be writing about this same thing in three years, only next time it will be “What Is Trumpcare” that everyone is searching for.
Another Warning For Politicians – Consumers Are Getting More Informed And They’re Asking The Right Questions
Oh, and one other data point regarding consumer search, another term that is relatively new and seeing massive search volume, and should be a concern for anyone in this next mid-term election, searches for “Does Congress have Obamacare” are now one of the 5 most searched terms regarding Obamacare or healthcare reform.
Updated July 28th, 2017
Skinny Repeal of Obamacare Fails – Obamacare Remains In Place For Now
After a stunning blow to Republican-led healthcare reform efforts, the Affordable Care Act remains the law of the land, at least for now. Early morning on Friday, July 28, the Senate voted narrowly against a “skinny repeal” bill that would have eliminated Obamacare’s individual and employer mandates as well as its tax on medical devices. The vote was 51-49 against, with three Republican lawmakers adamantly refusing to support the GOP measure. Sens. John McCain of Arizona, Lisa Murkowski of Alaska and Susan Collins of Maine voted with Democrats to destroy the bill.
The vote came as a surprise to Republican Majority Leader Mitch McConnell, who has spent the last several weeks negotiating and attempting to wheedle support from his colleagues in Congress. As the vote failed last night, McConnell seemed genuinely shocked that his conference couldn’t agree on the measure.
The so-called skinny repeal bill could have spelled disaster for the private insurance market in the short and long term, causing premiums to jump an additional 20 percent next year while reducing the number of the nation’s insured by 15 million people according to the Congressional Budget Office. Those were hard pills for lawmakers to swallow, but no one expected the skinny bill to pass muster. Instead, it was seen as a Trojan Horse tactic to push the legislative process to the next stage.
McCain was outspokenly against this tactic, one that he didn’t trust. Personal meetings and conversations with House Speaker Paul Ryan, Vice President Mike Pence – not to mention a phone call from President Trump himself – would not sway the Arizona senator from standing his ground on the issue of partisan lawmaking. The senator had warned earlier this week that his Congressional colleagues needed to come together on the legislative process.
A long-time opponent of Obamacare, McCain believes that his conservative peers need to take a lesson from history and avoid passing a partisan reform bill. Instead, they need to work with Democrats and pass a healthcare bill that seeks real reform.
For now, the Republican effort at unseating the Affordable Care Act has been thwarted, and there are no current plans to revive the effort in the immediate future. Congress will shift its focus to defense legislation and the nomination for a new FBI director. Obamacare remains the law of the land, which means every American must have ACA-compliant health insurance for the year. The next enrollment period will start on Nov. 1 and end Dec. 15 for the 2018 plan year.
Updated July 26th, 2017 @ 10:15 a.m.
Senate Already Fails to Get Votes to Pass GOP Sponsored Obamacare Replacement Plan
Yesterday afternoon the Senate voted narrowly to begin discussions on healthcare reform and how to repeal and replace Obamacare. The final vote came down to a 50/50 tie, with Vice President Pence casting the tie-breaking “Yea” vote.
Debate and discussion on what the effects of an Obamacare repeal-only plan and the replacement bills from the House and Senate would do to the country took place almost immediate and were expected and did go into the night.
Late yesterday evening, the Senate took up a vote on the BCRA with a few additional amendments, one that would allow insurance carriers to sell plans that didn’t comply with Obamacare (didn’t cover pre-existing conditions) so long as they also sold at least one plan on the marketplace that did cover pre-existing conditions. This amendment was proposed a couple of weeks ago by Senator Ted Cruz. The second amendment added to the BCRA added an additional $100 million in funding to the budget for states to provide relief to people who would lose Medicaid under the roll back provisions of the BCRA. The third set of amendments was proposed by Senate Majority Leader, Mitch McConnell and would remove the individual and employer mandates.
The vote resulted in a 57 “Nay’s” , including 7 from Republicans. The bill needed 60 “Yea’s” to pass.
The Senate will start debate and discussions on the Obamacare repeal-only proposal today, Wednesday July 26th, and a vote on this option is slated for later in the afternoon.
Updated July 25th, 2017 @ 3:04 p.m.
Plan to Discuss Obamacare Repeal Gets Majority Vote
It’s official, Republicans got their 50 votes plus Vice President Mike Pence’s tie-breaking vote, which allowed them to reach the 51 votes required in order to move forward with discussion and debate on how to undo Obamacare and how to replace it – either with Senate’s version of healthcare reform, which was called the BCRA, or the House’s version of Trumpcare, the AHCA, or something in between – the “Skinny Repeal Bill” – which would repeal certain aspects of Obamacare and allow for improvements of other parts.
Debates start this evening.
It remains to be seen if this is the point at which Democrats and Republicans can begin the process to actually work with one another in order to draft legislation that improves on Obamacare, not dismantles it leaving millions without health coverage.
Just today, a video of former House Speaker John Boehner was leaked from a private event in which he says that it is impossible for Republicans to completely remove Obamacare. According to the former speaker, now that Americans truly understand what it is the Affordable Care Act (Obamacare) does, and how it has some significant consumer protections, it is politically impossible to take that away from millions of Americans.
Even more interesting, is that he directly addresses the issues with the more extreme members of the Republican party, by referring to the Freedom Caucus, as the “knucklehead caucus”. According to Former Speaker Boehner, “Now, these are the guys in the Republican party who are – you can call them right of the right. They’re anarchists, they’re for nothing.”
We’d say that accurate description is quite perfect for the Freedom Caucus. Hopefully this vote starts the wheels in motion that will allow Republicans and Democrats to start behaving like adults, and start thinking about people, not “party” first. Healthcare reform that will last, and actually improve lives, will 100% require bi-partisian effort.
Updated July 25th, 2017 @ 2:50 p.m.
Obamacare Repeal-Only Vote Update
No Democrats have voted yet and Senators McCain and Johnson have not voted yet. More updates coming within minutes….
Updated July 25th, 2017 @ 2:40 p.m.
Obamacare Repeal-Only Vote Count Update
48 “Yes” votes and 2 “No” votes.
Susan Collins of Maine and Lisa Murkowski of Alaska are the only “No” votes so far.
Votes are still being whipped so Republicans could still achieve a majority.
Stay tuned for more updates….
Updated July 25th, 2017 2:10 p.m.
Senate to Vote on Obamacare Repeal Today
After President Trump requested that the Senate delay their August break until a vote on healthcare reform happened, Senate Majority Leader, Mitch McConnell announced that he would hold a vote on an Obamacare repeal and roll back on a multi-year timeline would happen today.
For those of you reading this and many other headlines in the news today and wondering whether a vote to repeal Obamacare today means that Obamacare is immediately gone, rest assured that this vote is only to determine whether enough Senators actually want to start discussions and debates on the subject. This is essentially the step that the GOP has been trying to get to regarding the last two attempts at the BCRA too – the “do most of us agree to discuss this issue” step.
No one knows just how the vote will go today. There have been comments made by various Senators (Republican Senators) over the past week or so that they’d be surprised to even get to 50 “yes” votes on the issue of repealing Obamacare without a replacement, and there are some that think that more Republicans will vote “yes” than they are leading on to.
Either way, it’s clear what Senate Majority Leader, Mitch McConnell and President Trump think about the issue – they think that its their duty to constituents to repeal Obamacare and fulfill the promise that the party has made for the last seven years. In fact, President Trump has already sent out several tweets about the issue in the past 24 hours and McConnell published and referenced a statement on his official website.
Congress convenes on the floor at noon and the vote is scheduled to happen a few hours after they convene.
Updated July 21st, 2017
CBO Says Second Try at BCRA is Still Bad – Leaves 22 Million More Uninsured
The Senate published more amendments to their Better Care Reconciliation Act yesterday, July 20th, which included: changes to the age-ratio premium calculation, the benchmark plan percentage to determine tax credits, repealed several taxes imposed by Obamacare including the individual and employer mandates and the small business tax credit, and made changes to Medicaid and HSA’s.
Most interestingly, this amendment removed the Cruz Amendment from the last version, which allowed carriers to offer plans on the marketplace that did not cover pre-existing conditions so long as they offered at least one plan that did.
Other than stripping Ted Cruz of his signature addition, there didn’t seem to be too much else in this version of the BCRA that wasn’t already included in the original version in some form, which may be why the CBO thought that it would do just as poorly at keeping people insured.
One piece that did seem to be more prevalent in this amendment to the BCRA that wasn’t sung as loudly before, was just how much they wanted the states to take responsibility for the insured rates and affordability of insurance for their residents. There were a number of places where the bill stated that it would fund grants to the states to create programs to help stabilize the market and make premiums and out-of-pocket expenses more manageable for residents. They also gave the states a little more leeway on Medicaid eligibility requirements and the age-ratio premium calculations.
Considering the CBO’s score and considering that there’s nothing revolutionary in this amendment that separates it from the first draft, which couldn’t get the votes to move on the first time around, it’s probably pretty safe to say that we’ll see something else from the Senate pretty soon.
To be continued….
Updated July 19, 2017
Obamacare Repeal Now and Replace Later Scored the Worst Plan Yet by CBO
After the amended version of the BCRA failed to get enough votes to proceed forward in the Senate for a second time, the new plan of action was to simply repeal Obamacare now (however the actual effective date of the repeal would be later on) and deal with a replacement plan in the coming months. This plan was called the Obamacare Repeal Reconciliation Act of 2017 and if it has a name, it will be scored by the CBO.
If you recall, the CBO said that the House’s version of healthcare reform – the AHCA – would leave 23 million more Americans uninsured than if Obamacare remained in place. The BCRA, the Senate’s attempt at healthcare reform, faired slightly better and would only leave 22 million more Americans uninsured than if Obamacare remained in place. The CBO announced on July 19th that if we just repealed Obamacare and essentially went back in time to 2009, before the law was passed, 32 million more people would be uninsured by 2026 than if Obamacare remained in place.
The CBO also estimated that by next year, 17 million more people would be uninsured if Obamacare was gone than if it remained in place and that the average premium price would increase by 25 percent by next year as well. By 2020, premiums would be 50% more and by 2026 premium prices would be double what they would be if Obamacare remained in place.
To make matters worse, the CBO believes that carriers would flee from the market by 2020 due to the skyrocketing premiums, which would leave nearly half of the population living in an area with no carrier options.
A number of Senators have gone on the record in the last day or two saying that simply repealing Obamacare now with the hopes and promises that they’ll figure out and pass something better in the future is not the way to go.
It’s pretty safe to say that the Obamacare Repeal Reconciliation Act is more than dead on arrival.
Updated July 18th, 2017
Trumpcare Is Dead For Now – Will President Trump Work With Democrats To Revive It?
It’s un-officially official, Trumpcare is dead in the water for the time being. Or we should say that the BCRA and the AHCA, are dead in the water. Trumpcare might not be dead at all, we simply might be headed for that impossible moment that was so humorously described in Ghostbusters, where cats and dogs are living together, and or Republicans and Democrats agree on something. In all fairness, in Ghostbusters they were describing “the end times” which is not exactly the same thing, but nevertheless we try to inject humor into this otherwise dry subject matter whenever possible.
Democrats And Republicans Have To Work Together In Order To Survive And Fight Other Battles
By that we mean that Republicans and Democrats are actually going to have to work together in order to pass healthcare reform that can actually get passed, and survive. It could also be true politically as well. If millions of Americans lose their healthcare, or if premiums continue to go up, there will be consequences for both sides of the isle. While Republicans haven’t extended any invitations to Democrats to join in the process of drafting realistic legislation to repeal and replace Obamacare, Democrats have not been exactly behaving like adults either. Remember when Chuck Schumer took time out from everyone’s busy lives to do a prop joke in front of the press on Capitol Hill?
Nothing motivates President Trump to work with Democrats more than by trying to humiliate him at every opportunity. Oh apparently there’s bonus points if you can do it using his own words, at a juvenile snickering press conference.
We can appreciate that people are frustrated, but we can’t help but point out the obvious that at some point, politicians should reflect for a moment and ask if something like the example above benefits the American people, or is it just wasteful and selfish political theatre.
Until now Republicans have been trying to go it alone, without the help of Democrats. This of course contradicts the campaigning that President Trump did as the ultimate deal maker. According to President Trump, he would be able to quickly get Democrats and Republicans in a room to hash out their differences and bring a bi-partisian bill forward to fully Repeal and Replace Obamacare.
During his campaign, repeal and replace was the only option he was willing to accept. Now having gone through the wringer and taken hits from both sides of the isle, he’s changed his tune a bit. That said, based on some of his most recent tweets, we think it is possible he might be ready to start working with Democrats.
Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!
— Donald J. Trump (@realDonaldTrump) July 18, 2017
Freedom Caucus Plays Spoiler In House Bill
President Trump very well have actually wanted to include Democrats from the outset, but behind the scenes it became very clear very quickly, that doing so would not go over well with the Freedom Caucus and their billionaire backers. So the House version of Trumpcare, the AHCA, went through various revisions, including last minute tweaks made by a threatening Freedom Caucus.
They made demands that are politically impossible, and that became very clear when the BCRA, which was much more “generous” than the AHCA, was scored by the CBO, and subsequently the American people. Trumpcare and its various versions, be it the AHCA, BCRA, Ted Cruz’s thing, or Rand Paul’s non-starter idea that require HSA’s and every American to be earning $100,000 a year in order to scale, are wildly unpopular with Americans.
Despite Fears Of Political Backlash From Freedom Caucus – Some Republicans Are Against The BCRA
So now we end up where we are at today. An announcement that regardless of whether or not John Mccain becomes available for a vote or not, there will be no vote because many other Republican Senators are opposed to it.
President Trump sent out a flurry of tweets, one of which seemed to indicate that he might help Obamacare accelerate its pathway to complete implosion. That’s more likely a bluff, only because doing so would most likely doom his future re-election prospects, and seriously place the mid-term elections in 2018 at risk. Democrats will seize on the opportunity to remind every voter that it was more important for Republicans to allow Obamacare to fail, and take millions of Americans health insurance with it, than to just do what politicians used to do years ago, find a way to compromise and agree on a middle ground with one another.
President Trump is a populist, he wants people to be happy with him, he’s got no reason to be fearful of the Freedom Caucus or its backers. They’ve been trying to sabotage him since the election, why would this be any different?
This very well could be the turning point at which President Trump has the same moment of realization as the fictional Mayor of New York in Ghostbusters.
Our guess is that in time, President Trump and Republicans will come to the realization, that it is far more important to save the lives of millions of registered voters.
Updated July 13th, 2017
BCRA Amendments released – but will it bring in more Republican votes?
The Senate released its amendments to the Better Care Reconciliation Act (BCRA) today, July 13th. The proposed revisions are as follows:
- The Cruz-Lee Amendment: Insurance carriers can offer plans on the marketplace that do not comply with Obamacare, meaning they don’t cover the ten essential health benefits or pre-existing conditions and don’t regulate out-of-pocket costs, so long as they also offer a plan on the marketplace that does comply with Obamacare. The government would provide funds to insurance carriers to offset the costs associated with the Obamacare-compliant plans, which would more-than-likely be purchased by a sicker pool of people who need more coverage.
- Medicaid Rollback: There are no substantial changes to Medicaid in the amendment. Medicaid funding would be rolled back starting in 2021 and would be restored to pre-Obamacare era funding and participation by 2024. States could choose whether they receiving funding from the government for Medicaid based on a block-grant or per-capita calculation and could also impose a rule that anyone receiving Medicaid assistance must be employed unless they are pregnant, elderly or disabled.
- Obamacare Taxes: The Obamacare taxes on the country’s wealthiest executives and people will remain in place, which will help the federal deficit.
- Cost-Sharing Reduction Payments: The government will continue to pay insurers the cost-sharing reduction payments through 2020.
- Continuous Coverage Requirement: The amendment gets rid of the individual and employer mandates under Obamacare and imposes a continuous coverage requirement. Under the continuous coverage requirement, if a person goes without health coverage for more than 63 consecutive days, they will be charged an additional 30% a month on their health insurance premiums by the insurance carrier for an entire calendar year. Additionally, the person would be prohibited from getting health insurance coverage for a full six months after reaching the 63-day limit, which would prevent people from only getting coverage because they became sick.
- Out-of-Pocket Costs Assistance: The amount contributed by the government to help offset the out-of-pocket costs of people is increased by $70 billion to $182 billion. This money goes to the states to implement reform efforts, including HSA.
- HSA Reform: Health Savings Accounts (HSA), which is pre-tax money, can be used to pay your health insurance premiums, which was previously prohibited by the rules.
- Opioid Crisis: An additional $45 billion is given to the states to fight the opioid crisis in America.
- Catastrophic Plans: People who enroll in a catastrophic plan can get tax credits to help offset the premium costs. This was previously prohibited by Obamacare.
- Lower Premium Health Insurance Plans: People can enroll in lower-premium health plans that have high deductibles but allow for three visits to your primary care physician a year and limit how much you have to spend a year out-of-pocket and they can get tax credits for those types of plans to make them even more affordable.
Updated July 12th, 2017
CMS Allows the State of Alaska to Create Their Own Insurance Plan
Going into the 2018 open enrollment period, the people of the State of Alaska are faced with the reality that they only have one carrier option in the state – Premera Blue Cross. Alaskans have also suffered from sky rocketing premiums, year-over-year, which has made coverage very unaffordable. In total, Alaska has seen a 203 percent increase in their premium costs since Obamacare went into affect in 2010. On July 11th, the Centers for Medicare & Medicaid Services (CMS) announced that it has approved the State of Alaska’s request to take steps to bring more coverage options that are affordable by essentially creating a state-run and funded insurance carrier.
The State of Alaska submitted a request for what is called a 1332 State Innovation Waiver, which is a provision under Obamacare that allowed states to basically create an insurance plan to offer their residents that is designed to bring more choice and stability to the market. CMS says in their announcement that they hope more states file applications for a 1332 State Innovation Waiver to help bring stability to the market. Under Obamacare, states had to wait until after January 1, 2017 to request these waivers, so this year was the first year that states had the option to take this action.
Under this 1332 State Innovation Waiver, Alaska will be allowed to create a state-operated insurance carrier that will offer plans for the next five plan years (starting on January 1, 2018) and these plans are designed to cover claims of people who have costly pre-existing conditions. The State of Alaska has identified 33 specific high cost conditions that it will cover under this new plan, meaning that anyone with one of these 33 specific medical conditions will get state-run insurance coverage now.
This high-risk pool plan will allow insurance carriers the opportunity to offer coverage to people who are healthier without fear of getting a sicker population, which will now be covered by the state’s plan. Knowing that you can market and insure a healthier group of Alaskans should compel carriers to come back into the marketplace in the state. The State of Alaska also predicts that by offering this state-operated plan to sicker Alaskans, the overall premiums for the state will come down by 20 percent in 2018.
The 33 medical conditions that will be covered are:
- HIV and AIDS
- Sepsis shock
- Metastatic cancer
- Lung, brain, pediatric acute lymphoid, leukemia and other severe cancers
- Non-Hodgkin’s lymphomas and other cancers and tumors
- Mucopolysaccharidosis (a metabolic disorder)
- Lipidoses and glycogenosis
- Amyloidosis, porphyria and other metabolic disorders
- End-stage liver disease
- Chronic hepatits
- Acute liver failure or disease and neonatal hepatitis
- Intestinal obstruction
- Chronic pancreatitis
- Inflammatory bowel disease
- Rheumatoid arthritis and other autoimmune disorders
- Hemolytic anemia including in newborns
- Sickle cell anemia
- Thalassemia major
- Coagulation defects and other hematological disorders
- Anorexia and bulimia nervosa
- Amyotrophic lateral sclerosis and other anterior horn cell diseases
- Quadriplegic cerebral palsy
- Cerebral palsy (not quadriplegic palsy)
- Myasthenia gravis/ myoneural disorders including Guillain-Barre syndrome and inflammatory and topic neuropathy
- Multiple sclerosis
- Parkinson’s disease, Huntington’s disease, sponocerebellar disease and other neurodegenerative disorders
- Cystic fibrosis
- End stage renal disease
- Premature newborns
- Stem cell and bone marrow transplants including complications from the procedures
- Amputation of limb including complications from the surgery
Updated July 3rd, 2017
Senate Version Of Trumpcare (BCRA) Just As Unpopular As House Version (AHCA)
It’s been a month since we last updated our visitors on what has become the rollercoaster of healthcare reform in America. After the House voted to pass the AHCA on May 4th, which punted the responsibility to the Senate, and the CBO released its score the plan – which was not as good as if Obamacare remained in place – the Senate decided to start from scratch and released their version of Trumpcare, which they named Better Care Reconciliation Act (BCRA), on June 22nd.
Unfortunately for the group of Republican Senators who slaved away drafting the BCRA behind closed doors, the CBO scored this plan almost as poorly as it did the House version. Subsequently the BCRA quickly became just as unpopular with Americans as the House version of Trumpcare, the AHCA, according to polls.
Senate Majority Leader, Mitch McConnell, intended to take the Senate version of healthcare reform to the floor for a vote before the July 4th vacation. Although the Republicans have a majority in the Senate, there’s no wiggle room for “No” votes from their side, so after realizing that he had at least four definite “No’s” from Ted Cruz, Rand Paul, Ben Sasse and Mike Lee (there was actually speculation of it being more like 10 “No” votes from Republicans), McConnell announced that he would delay the vote until after the holiday so that he could work on improving the bill.
While on the July 4th hiatus, the latest hype about healthcare is the sentiment that maybe Congress should shift strategies and worry about repealing Obamacare first and replacing it later. Ben Sasse and Rand Paul, who were both pretty firm “No’s” on the BCRA, are now firmly in the “repeal now, replace later” camp, along with a number of other GOP Senators. President Trump even went so far as to promote the idea, or threat, depending on whom you ask, on Twitter.
If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!
— Donald J. Trump (@realDonaldTrump) June 30, 2017
Americans may be surprised that the President is going along with this new suggestion considering the fact that he campaigned on a simultaneous repeal and replace plan of action. This was also his plan leading up to his inauguration, which he conveyed at his first news conference since the summer before on January 12th.
REPEAL AND REPLACE OBAMACARE!
— Donald J. Trump (@realDonaldTrump) October 26, 2016
Considering that it turns out that healthcare reform is actually incredibly complicated, and it is actually hard to draft healthcare legislation that will make the people happy, and that their representatives in Congress can vote for with a straight face, a “repeal now, replace later” course of action may be the only way to go in many GOP Senator’s minds.
The problem with “repealing now and replacing later” is that even if the repeal portion contains a long timeline, meaning that it will not take affect for several months or even a year, which gives Congress more time to get something else passed, the feeling among Americans will be that there is no healthcare law of the land and that they are simply not protected. This could be a disaster with respect to the upcoming 2018 midterm elections, that is of course if you’re trying to maintain your Republican seat. This is also bad for the healthcare industry that has been pleading with both sides of the political isle for some help in creating some stability in the health insurance marketplace.
Finally, this goes from bad to worse for Americans who will technically still have the opportunity to get insured and get subsidies during the 2018 Open Enrollment Period, but may fail to do so because the only headline running across their mind is that Obamacare was repealed and there was no replacement plan. Consumer confusion about the status of healthcare reform is very easy to generate and virtually impossible to subside. It’s also very detrimental because people who should get health insurance coverage and really need it, won’t get it because they are confused about whether it’s even available in the first place.
That’s the outlook for anyone who doesn’t even pay the least bit of attention to the politics, and or listen to their respective camps. Sprinkling in any level of political bias, or “focusing on party lines” behavior, that only complicates matters further for consumers.
We’ll have to wait and see what happens in the next week or so with constant dramatic saga that is, “healthcare reform” in 2017. Mitch McConnell eluded to there being a revised BCRA after he’s done watching the fireworks on the 4th . President Trump has even dropped some hints that a “great surprise” is coming with respect to the repeal and replacement of Obamacare.
In relatively short order we should know if McConnell has found a way to get more “Yes” votes from either side of the aisle, or whether he’s going to throw in the towel and and place his bet that a majority of Senators will vote “Yes” to repealing Obamacare first.
We advise you that you sign up for updates from us to ensure that you are up to date with all of the latest on Trumpcare. Or if you would like a link to another resource for information about healthcare reform under Trumpcare, visit Trumpcare.com.
Updated May 25, 2017
The CBO released their score of Trumpcare 2.0 and the news is just as expected
The Congressional Budget Office (CBO) announced their score for this version of the American Health Care Act and the news is good and bad. Here are the highlights:
- 14 million more people would be uninsured under Trumpcare than if Obamacare would remain in place in 2018.
- 51 million people would be uninsured under Trumpcare in 2026 versus 23 million under Obamacare.
- Anyone who used their tax credits, which are offered starting in 2020 under Trumpcare, to buy a non-major medical plan is part of the uninsured count because their coverage would not cover regular medical claims.
- Trumpcare would stabilize the market because insurers would be able to offer different kinds of plans and the subsidies offered until 2020 and the tax credits offered after that would attract healthy people; however people living in states that took the waivers to not cover the essential health benefits and to allow carriers to charge more for pre-existing conditions would be unstable under Trumpcare because coverage could be unaffordable even with additional financial help from the government.
- To this same point, the CBO believes that Trumpcare would not bring costs down for people who live in states that took those waivers, but that it would generally bring down premium costs after 2020. Before 2020, premium costs would rise.
- Finally, Trumpcare would save the country money and would bring down the deficit by $119 billion, but this amount is actually less than the first iteration of Trumpcare written. While rolling back Medicaid and subsidies would save money, the elimination of the individual mandate, the employer mandate and some Obamacare taxes that were designed to put money back into the program would be gone under Trumpcare.
The Senate was waiting for the CBO score to help weigh the pros and cons of the House’s version of the AHCA. The Senate promised that their revisions and redrafting of the bill would take some time and it remains to be seen whether the CBO score persuades them to keep or change different aspects of the law.
Updated May 17, 2017
CMS Announces Rule Change to Online Enrollment Process
If you were one of the millions of people who enrolled in a plan last Open Enrollment Period, you probably felt more frustrated than previous years in part because of the fact that the enrollment process was slow and confusing. Consumers or agents working on behalf of consumers on the phone were able to shop and start the application process in one place, but were required to go to Healthcare.gov to complete the identity and income verification piece of the process, before going back to the original website to finish up the application.
This handoff to Healthcare.gov may not seem like a big deal, but it was if the consumer was trying to navigate this process on their own and didn’t understand why they ended up on a governmental website and it was definitely a big deal if an agent or consumer was trying to do this on a day when Healthcare.gov was having technical issues or experiencing high volume.
Thankfully for consumers and the industry, these problems should be gone during all future open enrollment periods with this new rule from CMS. Going forward, online broker websites and software being used by agents to complete enrollment will send the identity and income verification information to Healthcare.gov, on behalf of the consumer, behind the scenes and without any Healthcare.gov interaction.
This new enrollment process will not be available to consumers trying to enroll outside of the open enrollment period or who have a complicated situation with their income or identity that would require additional documentation proof.
CMS also stated in their published rule that this new, streamlined process was only a temporary fix and that they have plans for a more developed and integrated enrollment process with online brokers that will make things even easier in future open enrollments.
Updated May 4, 2017 at 9:05 p.m. EST
Republican Senators are Ready to Rewrite the AHCA
If House Republicans were hopeful that the Senate would be happy with and vote on their version of the AHCA, they are sorely mistaken according to the number of Republican Senators who have spoken out today following the passing of the American Health Care Act.
The Senate patiently awaited a healthcare reform bill from the House, but after seeing a version passed by such a narrow margin and less than 24-hours after the last piece was added, which increased the high risk pool funds used to provide financial assistance to people who are charged more for their coverage due to their pre-existing conditions, and before the CBO could analyze and provide a score, they made it clear that they would be handling this issue and responsibility differently.
They also plan to take their time. Several Senators commented today that they will only bring a bill to a vote once they know they have the 51 votes needed to pass it and they don’t care how long that may take.
Updated May 4, 2017 at 2:20 p.m. EST
AHCA Vote Finally Happened
And…. it passed. Republicans needed 216 “Yea’s” to pass the ACHA and they won it with a final vote of 217 – 213. Not a single Democrat voted for the ACHA.
On to the Senate.
Updated May 4, 2017
Today is the day – again – when Republicans in the House will try to pass an Obamacare replacement plan. The first version, the American Health Care Act (AHCA or Trumpcare), was pulled from the floor on March 24th. Since then, Paul Ryan and other Republicans have worked on amendments to the bill that would or could get passed. Keep in mind, even if it passes the House, it still has to go to the Senate where they can propose amendments and make changes.
The version of AHCA that the House will vote on today looks a little different than what was originally proposed. Initially, the AHCA cut out any requirement that insurance carriers had to offer coverage that included the ten essential health benefits. This exclusion angered constituents around the country, who spoke up to their Representative and who, in turn, announced that they would vote “No” on the AHCA.
In response to this issue, Republican Tom MacArthur from New Jersey proposed what is now known as the MacArthur Amendment. The MacArthur Amendment makes the following changes:
- States can apply for a waiver to change the age ratio for premium costs. Under Obamacare, the age ratio was capped at 3:1. Under the MacArthur Amendment of the AHCA, the age ratio could be as high as 5:1, meaning that people of a certain age demographic could pay 5x more than another demographic if your state decided to allow it.
- Regarding the ten essential health benefits, the MacArthur Amendment would allow states to seek a waiver from requiring insurance carriers to cover it in their health plans. This would bring costs down for premiums.
- Finally, regarding the pre-existing conditions, the MacArthur Amendment would allow states to seek a waiver that would permit insurance carriers to charge people with pre-existing conditions more for their health insurance than someone without one.
The big take-away from the MacArthur Amendment is that it gives a lot more power to the states to make decisions on what insurance carriers operating in their state can or cannot do.
The last piece of the MacArthur Amendment on pre-existing conditions still caused a lot of issues for moderate Republicans and their constituents after it was proposed. In response, Rep. Fred Upton from Michigan and Rep. Billy Long from Missouri met with President Trump to discuss how they could better protect people who do have pre-existing conditions and who may be charged higher premiums for their health insurance. The result of that meeting was another amendment that added money to the pool of money already created by the MacArthur Amendment. The new agreement added another $8 billion, which comes out to a total of $138B for a five year period, to the fund designed to provide financial relief to people who have to pay more for their health insurance due to their pre-existing conditions.
After it was announced that the President agreed to this term, more Republicans shifted their vote and it was determined that the GOP may have the votes to pass the AHCA.
The vote is scheduled for March 4th. We’ll see what happens.
Updated April 25, 2017
Healthcare reform is still a big news item. Almost daily, the media is discussing what and how to replace Obamacare. The AHCA failed a few weeks ago and Americans are patiently awaiting the next plan, which the GOP promises they are working on currently. There’s another group patiently (or impatiently) riding out this healthcare reform wave too – health insurance carriers. For years, carriers have requested changes to Obamacare that would bring more young and healthy people to the pool of insured people, would stabilize the market and would bring down their costs, which would in turn bring down costs for the insured. CMS issued a final rule on Obamacare on August 13th that made changes designed to do all of those things.
Here’s a quick summary of those changes, which address 4 main categories: enrollment periods, giving carriers flexibility to create new types of plans, saving carriers money and saving Healthcare.gov money. The last three categories are designed to bring down the costs of health insurance and save Americans money.
Changes to the enrollment periods
Open Enrollment Period
Open enrollment will be shorted to last just forty-five days, from November 1st to December 15th each year. This means you have less time to window shop.
Special Enrollment Period
Enrolling outside of the open enrollment period will be more difficult under this rule. Previously, you would experience a qualified life event, enroll in a new plan and then you would have to provide proof of your life event, if that documentation was even requested at all. This method permitted a lot of people to enroll only when they really needed coverage because they were sick. This is an issue that carriers wanted CMS to fix. Under this rule, the new pre-enrollment verification process requires you to prove your life event to Healthcare.gov through documentation before the carrier has to issue you coverage.
If you get married or give birth, foster or adopt a child and need additional coverage for that person, you will only be allowed to add that person to your existing plan. This qualified life event does not permit you to change your carrier or change your plan entirely.
If you lose coverage because you did not pay your premium bill, you may not enroll in a new plan during the Special Enrollment Period. Losing coverage due to non-payment of a premium is not a qualified life event.
Changes that will give carriers more flexibility
Previously, carriers were required to offer a tiered level of plans that covered, on average, a set percentage of the costs. Carriers were unable to offer many different types of plans because they weren’t able to deviate very much from the percentage of costs they had to cover. Under this new final rule though, the average percentage is adjusted for each tier, which gives carriers the flexibility to create different types of plans that will work for different people.
Changes that will save carriers money, which will bring down the cost of health insurance
One big issue with the creation of Obamacare is that it created a lot more administrative work for carriers. Each new regulation and requirement created more paperwork and more work. This new final rule made changes to the requirements regarding the number of essential community providers (medical providers that service low-income and medically underserved communities) that carriers must contract with in each service area, which is ultimately designed to save carriers administrative dollars.
Another change implemented in this final rule is that carriers may withhold future health coverage of a person who still owes them money from a plan issued in the past. One big gripe by carriers is that people are keeping health insurance for as long as they need it and then they are dropping coverage. Carriers are required to continue to offer coverage during a grace period, even if they are not receiving premium payments. To resolve this issue, the rule now permits a carrier to deny coverage until the person pays them back the money they owed them for missed premiums.
Similarly, this rule allows carriers to apply the binder payment, the payment required for any new or renewed plan to take effect, to an outstanding payment due to that carrier by that insured. This is just another way for the carrier to make up some of the money that is owed to it and it should deter people from missing payments.
Changes that will save Healthcare.gov money, which will put more money back into the pool
There is a specific pool of money or budget set aside to implement all aspects of Obamacare. The more money that is spent on administrative and management functions, the less money that is available for subsidies, cost savings tax credits, Medicaid funding, and other programs that will ultimately improve the health of our nation and bring down the costs of healthcare. This rule changed the requirements placed on Healthcare.gov to validate the network of health plans, which will save taxpayer dollars. Under this new final rule, Healthcare.gov is permitted to defer to the State’s review and approval of a health plan’s network as being adequate and compliant with the law. There is no need any longer for Healthcare.gov to complete its own audit of the plan network.
Another interesting thing to note from this final rule is that CMS is exploring additional ways to get people to keep their insurance year-round. This concept of “continuous coverage” was a replacement for the individual mandate in the GOP’s Obamacare replacement plan – the AHCA. One example that CMS outlined in the final rule was making enrollment during the Special Enrollment Period contingent on the consumer proving that they had insurance coverage for the previous 6 or 12 months.
Updated March 25, 2017
“Obamacare is the Law of the Land”
After one stalled vote in the House, Speaker Paul Ryan informed President Trump shortly before the rescheduled vote on Friday, March 24th that he didn’t have the votes to repeal and replace Obamacare with the American Health Care Act (AHCA). Minutes before the vote was set to start at 4:00 p.m. EST, it was announced that the President advised Speaker Ryan to take the bill off of the floor and cancel the vote.
In a statement made in front of the press a short time later, Speaker Ryan admitted that he was disappointed that they couldn’t get a consensus amongst his party and that it was time to move on from healthcare. He also stated, very clearly, that Obamacare was the law of the land for the foreseeable future.
At an appearance in the oval office, in front of reporters, President Trump eluded to the fact that the AHCA would have been passed if it hadn’t had been for concessions made to the Freedom Caucus the day before, which were to remove the ten essential benefits. They were also pushing to get rid of the pre-existing condition mandate as well.
So here is the present state of healthcare in case you are feeling just as confused as ever:
There will be an open enrollment period on November 1st, which is when you can shop for health insurance again. You are still required by law to be insured or else you will be penalized when you file your federal taxes.
If you didn’t get insurance in 2016 because you thought that Obamacare would be repealed, there’s a good chance you’ll be penalized. Luckily the tax penalty is prorated by the number of months in a year that you’re uninsured so if you have a qualifying life event and can get insurance soon, your penalty will be less than it would be if you waited until next year.
Your plan will cover you even if you have preexisting conditions and will provide you the ten essential health benefits. It will also cover your kids until age 26 and will not cut you off if you reach some annual or lifetime payout amount.
Medicaid expansion is also still in place so all of those millions of Americans who were going to lose their coverage under the AHCA will still be insured.
You can still get subsidies to help you pay your health insurance premiums.
As a number of Congresspeople stated today in various interviews with the press, now is the time for Republicans and Democrats to work together on improving what we have because everyone will admit that it needs to be fixed.
Take some time to write your representative and ask them to work on your behalf and not their party’s behalf to bring down premiums, to compel carriers to reenter the market and to offer better plans.
Updated March 23th, 2017
Republicans Delay Trumpcare Vote Until Friday, March 24th, 2017
President Trump’s first legislative test is looking even more precarious as Republicans delayed a crucial House vote scheduled for Thursday, March 23, a date that should sound familiar to millions of Americans by now. This time seven years ago, former President Obama signed his signature healthcare reform bill into law.
Now, on the anniversary of that date, Republicans had been attempting to destroy the legislation that made up the Affordable Care Act by replacing it with a perplexing mix of bad proposals that few in Congress – Democrats or Republicans – support.
The American Health Care Act (AHCA), nicknamed Trumpcare, has been nothing short of bewildering since its introduction by GOP lawmakers on March 6th, 2017. Late Thursday afternoon, Republicans announced that they would be delaying the House vote because they lacked sufficient support to push their bill through the lower chamber. Ironically, opposition is coming in from all sides, most vocally from the House Freedom Caucus, an ultra-rightwing group determined to destroy every scrap of the ACA that they can, including popular provisions that some conservatives actually support, like the pre-existing conditions clause that is supported by upwards of 80% of Americans.
The Freedom Caucus has been unabashed in its opposition to Trumpcare, even more so than congressional Democrats, who object to the bill on ideological grounds. On the other side of the spectrum, Freedom Caucus members claim the Trumpcare doesn’t go far enough in eradicating the ACA. In a truly puzzling move, Republican lawmakers on Thursday conceded to caucus demands by offering to nix the essential health benefits provision of Obamacare. Unfortunately for Speaker of the House Paul Ryan, the bill’s chief cheerleader, even this concession wasn’t enough to sway caucus votes in the right direction.
Under Obamacare, insurers must cover 10 essential health benefits in major medical plans in order for them to be considered ACA-compliant. These benefits include basics like wellness checkups and emergency room visits, but they also cover less obvious medical services, such as laboratory testing, rehabilitation and mental health care. Republicans have argued for years that these essential benefits are costly and unnecessary. The average single man, for instance, would have no need for maternity care, nor would a woman past her childbearing years require contraceptive services. We do however have a massive opiod problem here within the United States, and stripping out care for addiction coverage is only going to make that national crisis much worse. Ironically, President Trump wants to build a wall on the Mexican border to keep heroin and narcotics out, but the individuals within the country with dependency issues on them, they’re looking at not having any sort of health coverage to address getting off of these substances if the Freedom Caucus has anything to say about it.
But the essential benefits provision, aside from making health insurance more expensive, also protects people who do need these services. Without a provision requiring insurers to cover basic benefits, plans could be tailored to specific needs – at a much higher cost for the people who would use them. Including essential benefits in all major medical plans ensures that the costs get distributed throughout the entire risk pool, not just among people who need more care.
What is one of the most heartbreaking scenarios, and again truly puzzling as to whom the Freedom Caucus is trying to serve, are pregnant women. Prenatal care and care after child birth are currently one of the ten essential benefits. How on earth is any politician going to be able to explain why removing these protections and essential benefits that provide care for mothers and children, including children still being carried to term, is a good thing for Americans?
Adding to the hullaballoo is a recent report from the Congressional Budget Office (CBO), which is predicting an even worse outcome from Trumpcare than originally projected. Republicans in Congress attempted to gain support for the bill by introducing a number of changes on Monday, March 20, to meager success. After crunching the numbers with these amendments included, the CBO is now predicting that Trumpcare will only reduce the federal deficit by about $151 billion between 2017 and 2026 – a difference of about $200 billion over its initial estimate.
Breaking news from Washington, D.C. says that President Trump is insisting on a House vote for Friday despite the fact that there are not enough Republican votes to pass the AHCA in its current form. It remains to be seen whether Ryan and other GOP lawmakers can convince fellow party members to back the bill. Analysts argue that even if Trumpcare somehow succeeds in the House, it will certainly hit a brick wall in the Senate.
Updated March 22nd, 2017
Freedom Caucus Sells Out To Koch Brothers Demands – Forces Trump To Most Likely Remove Essential Benefits From AHCA
Just when we thought things couldn’t get much more absurd than they already are, the Freedom Caucus, which was already riding high from their public opposition to President Trump’s healthcare reform, throws us another curveball. This pitch, is of course, being called by the co-managing team of Koch enterprises founders, Charles and David Koch.
In the latest twist, it seems that the Freedom Caucus has felt a sudden sense of empowerment to actually demand that President Trump remove from the AHCA, the ten essential benefits that health insurance carriers are obligated to provide.
Now first let’s just get something out of the way, some elements of the Affordable Care Act, or Obamacare, are a little overkill. Some parts of the essential benefits are simply not applicable to everyone. So there are valid complaints when it comes to the Affordable Care Act. That said, people, countrymen, legislators, human beings with a soul, let’s not throw the baby out with the bathwater.
While it doesn’t make sense to provide women over 55 with contraceptives to prevent pregnancy, despite some instances where pregnancy does naturally occur even at that later stage in life, most women aren’t going to use birth control when they’re past a certain age. There are elements of the ACA when taken literally, and put into place by health plans, seem like overkill. We totally get it and agree. No one is arguing that there is massive room for improvement, but there is zero chance that any member of the Freedom Caucus would want to have to rely on the stripped down version of health insurance coverage that they are pushing for. There’s even word coming forward that Freedom Caucus members are saying that they want the protections that don’t allow insurance carriers to exclude for pre-existing conditions stripped out.
That said, the Freedom Caucus is making it sound as if health insurance premiums are going to plummet if the ten essential benefits are repealed. First of all, that’s not how the health insurance industry works, and it simply isn’t true. Don’t take our word for it, these healthcare experts are all in agreement on the matter and don’t think it will make any real significant impact.
Changes that impact pricing on on monthly premiums won’t take effect for a very long time. Even if it did, we’re not entirely sure that Americans would even want the coverage that they could sign up for. If what’s being rumored actually passes the house and ends up being voted on the senate floor as is, well then the Koch brothers have effectively used their limitless pit of money to screw over the American people.
How did they do this? By having their political organizations announce last minute, that any republican member who opposes the AHCA in a house vote, will have their organizations financial backing and support come election day. It’s amusing, brazen and just another reminder of how the “little people” just have zero chance against billionaires who can “Rent A Rep” at their leisure, especially those in the Freedom Caucus.
We’re not going to get into all the details of the core of the ten essential health benefits, but here’s one of the major ones that almost everyone should be able to appreciate. Under the AHCA, or Trumpcare, maternity care is considered an essential health benefit. This means providing adequate coverage for women who need medical care before and after a pregnancy. That’s a benefit that is viewed as a reasonable requirement by all Americans. Allowing “kids” to stay on their parents plan until they are 26 is considered universally popular with a large majority of voters. Does the GOP really think that discriminating against pregnant women is really going to fly with voters? Of course not, but the Freedom Caucus is threatening to derail the entire legislative process if they don’t.
Who doesn’t love a pregnant woman? Apparently the Koch’s, because they’re forcing the administration to remove basic coverage from the AHCA that would ensure that women who are pregnant, or post pregnancy, don’t pay 70% higher costs (or more) for health coverage.
We really don’t know what to say at this point. It’s clear that the Koch’s are setting a trap for Trump and Paul Ryan to fall into, and they’re either falling for it, or they’re preparing for a battle in the senate once the bill passes the house.
There’s zero chance that President Trump actually allows this “stripped for parts” healthcare bill to move forward beyond the house. He’s rightly too concerned with following through with his campaign promises to actually allow this to happen. This wouldn’t just leave people out in the streets to die, it would literally move things so far back, that the days when insurance carriers could simply reject people for pre-existing conditions would be a whimsical memory of better times with respect to healthcare in the United States of America.
If you would like to express your frustration to the thoughtful and dedicated representatives of the “Freedom Caucus”, here’s a link where you can find out exactly how to get in touch with them.
Updated March 21st, 2017
Conservative House Republicans Threaten To Derail The Trumpcare Train Despite Last Minute Changes To The Bill To Appease Them
With two days to go before the House votes on the American Health Care Act (AHCA), the latest effort by rightwing politicians to repeal and replace Obamacare, GOP lawmakers have made a few changes to the bill to sweeten the pot for unsupportive conservatives. The AHCA was released two weeks ago to lackluster support among Republicans and outright hostility from Democrats. Plenty of controversial provisions exist in the bill, but it was the Congressional Budget Office’s shocking estimate that created an uproar.
According to the CBO, 24 million more people would be uninsured by 2026 under Trumpcare than they would under Obamacare. Their estimate is based on voluntary canceling absent an individual mandate as well as limitations being imposed on Medicaid.
On March 20, Republican lawmakers announced key changes to the bill, no doubt an attempt to sway on-the-fence conservatives to vote for its passage. Initial objections to the AHCA came from all sides, but the most vigorous objectors were members of the House Freedom Caucus, an ultra-conservative group that sympathizes with the Tea Party movement. They believe that Trumpcare doesn’t go far enough in fulfilling the promise to upend the Affordable Care Act.
By contrast, some Republican lawmakers object to the bill on grounds that it strips too many people of access to health insurance, particularly those from states where conservative governors chose to expand Medicaid coverage. Congressional Democrats agree. Under Trumpcare, significant changes to Medicaid would impact funding and consumer access to coverage. The latest set of amendments to the proposed bill includes:
- Repealing Obamacare taxes earlier than scheduled: Under the ACA, certain taxes, including taxes on medical devices, have been levied to help fund the law’s income-based tax credits. The Republican plan seeks to eliminate those in 2018, but one of the changes issued Monday changes that date to 2017 in an effort to appeal to hard-right conservatives.
- Shifting Medicaid to a block-grant funded system: Medicaid is funded in an open-ended match system right now, meaning that for every dollar a state spends on Medicaid, the federal government matches it on a dollar-per-dollar basis. Instead, Republicans wanted to introduce a per-capita cap, which would cap federal assistance based on enrollment. Now, GOP lawmakers are proposing shifting the system to a block-grant system instead. Under block grants, states would be given a set amount of funding per year regardless of enrollment.
- Allowing states to impose work requirements for Medicaid: An additional change to the Medicaid proposals introduced on Monday is the provision to allow states the option to institute work requirements for able-bodied enrollees. Under the ACA, 31 states and the District of Columbia expanded their Medicaid programs to include able-bodied adults without children as long as they met the expanded income requirements (138 percent of the federal poverty line). Trumpcare would allow states to require those people to work in order to qualify for Medicaid, and there’s an added incentive for choosing this option. States would be given an extra 5 percent funding if they enforced work requirements for Medicaid recipients.
- Expanding tax credits for older Americans: While not officially among the amendments introduced to Congress this week, a Republican press release indicates that tax credits will be expanded for people aged 50 to 64. As it’s written, the AHCA changes Obamacare tax credits from income-based to age-based, with older people getting higher subsidies. But critics have pointed out that older people need costlier care, and age-based credits aren’t enough to bring down costs. In response, the GOP is offering additional sums to older Americans, which they’re hoping will appease advocate groups like AARP.
The AHCA goes to the House Rules Committee on March 22 and is expected to reach the House by March 23, which is the 7-year anniversary of the day that former President Obama signed his signature healthcare bill into law. Despite amendments introduced by Republicans this week, analysts aren’t sure that the changes will be enough to sway opposing conservatives, and they certainly do nothing to assuage the fears of congressional Democrats. President Trump and the AHCA’s chief supporter, House Speaker Paul Ryan, have been lobbying for conservative votes over the last two weeks. The bill is expected to hit significant road blocks in the Senate, assuming it passes a House vote on Thursday.
This could prove to be very dangerous for those within the Freedom Caucus, the main Republican opponents of the AHCA, which is also known as “Trumpcare”. Apparently the CEO of ultra-conservative organization Heritage Action For America feels so confident that the House will not vote it forward that he felt he should tweet about it following a meeting in the house offices.
Barring additional changes, the AHCA keeps the architecture of ObamaCare (Title I regs) in place. Heritage Action will be keyvoting against.
— Michael Needham (@MikeNeedham) March 21, 2017
For those unfamiliar, Heritage Action has been involved with the fight to repeal the ACA for some time now. In fact, in August of 2010 the organization helped secure support from 170 other Republicans for a petition led by Rep. Steve King of Iowa. Yes, that Steve King of Iowa. For those unfamiliar, he recently let Americans know precisely how he feels about the contributions that immigrants make in the United States with tweets and follow up interviews that simply made matters worse. Most Republicans are quickly distancing themselves, along with most Iowans, from Steve King. His political future is certainly in question moving forward, at least in Iowa. Although according to reporting by USAToday, at least one person, David Duke of the KKK was supportive of King’s comments.
Not to take anything away from other conservative groups who feel that the current update to the AHCA doesn’t go far enough, the Koch Brothers backed Americans For Prosperity also tweeted that they plan to key vote against the bill.
Currently, we can’t support the GOP healthcare plan. Without major changes, we’ll key vote against it & stand with those that stand with us.
— AFP (@AFPhq) March 21, 2017
Just a quick reminder that the Koch brothers, who are owners of the second largest company in the United States, and have an approximate net worth of $ 50 Billion each, stand to save tens of millions, if not hundreds of millions in 2017 if the “Obamacare tax” imposed on the wealthy is repealed on a timeline that is more in line with “conservative” standings that support the free market.
We try to avoid the politics, we really do, but sometimes you just have to “call them like you see them”. Across the board, both conservative and liberal groups, including the nonpartisan CBO, have expressed great concern that many parts of the AHCA will hurt those already living in poverty, along with Americans working jobs that barely allow them to keep a roof over their head, harder than anyone else.
From our vantage point, seeing as we understand the mechanics of the health insurance industry, everything being focused on right now is purely about partisan politics and grandstanding.
If you would like to express your opinion with your local representative within the house, feel free to use the following link.
House Of Representatives List
Updated March 14th, 2017
CBO Analysis Predicts That 24 Million Americans Will Lose Coverage Under Trumpcare By 2026
The Congressional Budgetary Office (CBO) finally released their findings and rating of the new healthcare reform proposal being called Trumpcare. Critics are quick to note that the CBO, although bipartisan (neutral and not politically leaning), which is currently headed by a conservative, is not always accurate in their findings (they haven’t been accurate with every estimate made about Obamacare for instance), but many more are warning that the CBO’s report should be taken seriously.
Here is breakdown of their analysis and what they found:
24 million Americans will be uninsured under Trumpcare within the next decade. 14 Million will be uninsured by 2018 and this is mostly due to the fact that Trumpcare doesn’t include a mandate to get health insurance and it also rolls back Medicaid expansion, which currently accounts for roughly 28% of all insured people in the U.S. (more than 74 million Americans).
The federal deficit would be reduced by approximately 337 billion dollars over the next decade, which would be due to the savings from the Medicaid program expansion and the fact that there are no more subsidies given.
Premiums would increase until 2020 and would then decrease, which is what they also found with Obamacare. By 2026, the average monthly premium would be 10% less than it would be if Obamacare would stay in place.
The CBO estimates that the healthy pool of people who don’t have high medical expenditures, would be attracted to Trumpcare and its tax credits and would be enticed to enter the market.
Insurance for older Americans would be higher than it would be under Obamacare because Trumpcare allows insurance carriers to charge older Americans 5x more a month in premium costs. Obamacare currently caps the premium multiple for older Americans at 3x more per month.
Democrats are urging Republicans and President Trump to go back to the drawing board after hearing the CBO’s findings.
Updated March 7, 2017
On March 6, 2017, House Republicans finally revealed their healthcare reform bill, which had been under a literal lock and key from the media and most of Congress for over a week. This bill is just a proposal or starting point and the features it offers Americans and the requirements it removes from Obamacare may look very different in the final version after negotiations from both sides of the aisle take place.
Americans who are eager to know what their new healthcare options will be and what will be required of them under Trumpcare will need to have some patience. Although negotiations and discussions open up next week in Congress about the law, it may still be several weeks or months before anything is approved and ratified by a vote.
For those who are curious about what the first proposed draft looks like, here are some bullet points:
- Subsidies are replaced by premium tax credits. Starting in 2020, Americans will no longer be offered subsidies to discount the cost of their monthly premium, but will rather qualify for premium tax credits that will decrease the cost of insurance as a person gets older, which means that younger people will get less assistance despite their income level. For instance, a person aged 29 and younger will only receive $2,000 a year in tax credits, but a person aged 50-59 years old will receive $3,500 a year in tax credits, but no family can receive more than $14,000 a year in tax credits.
- Prohibition on coverage denial for pre-existing conditions and other discriminatory reasons. No insurance carrier can deny coverage or a claim for a pre-existing condition just as was in place in Obamacare. Also similar to Obamacare, carriers are not allowed to discriminate by imposing higher premium costs and dependents may stay on their parents’ plan until age 26.
- Eliminate the individual mandate but impose a surcharge on premiums if an individual gets insurance after a lapse in coverage. Trumpcare eliminates the legal requirement that all Americans have health insurance, but imposes a 30% rate hike on the monthly premium amount for any American who goes without coverage for more than 63 days in a calendar year. This means if you decide not get health insurance and you are uninsured for more than 63 days in a year and then the following open enrollment period you decide to get health insurance and your monthly health insurance premium is $500, you will actually be charged an additional $150, for a monthly total of $650 because you were uninsured for more than 63 days the year prior.
- Retroactively eliminate tax penalty for uninsured Americans for 2016 tax year. If you were uninsured in 2016 you will not be taxed on your 2016 federal income taxes as was required by Obamacare.
- Medicaid expansion is eliminated. Starting in 2020, there is no longer an option for states to offer Medicaid coverage to adults that make up to 133% of the federal poverty level. This is one of the more divisive points within the bill that is expected to cause friction between republicans, democrats and more extreme members of the GOP who would prefer that medicaid be eliminated entirely.
- Keep Special Enrollment Period. Similar to Obamacare, Americans will be allowed to change their health insurance plan during an annual open enrollment period. If an individual loses coverage or has a qualifying life event outside of the open enrollment period (OEP), they may enroll in a plan or change their coverage during a special enrollment period (SEP), but they must be able to demonstrate that they had continuous coverage before the qualified life event occurred. Unlike Obamacare, there will no longer be Open Enrollment Periods after the 2018 Open Enrollment Period, because the requirement to simply have continuous coverage will kick in. This means that if you want to change your health insurance plan for no reason at all, you’ll probably have to wait until your insurance policy’s renewal anniversary (a year after you first signed up), which is similar to how it used to be.
- Legal immigrants are eligible for coverage under Trumpcare and tax credits. Similar to Obamacare, this law applies to U.S. citizens and legal immigrants who are not incarcerated.
- The tax credits can be applied to any type of health plan. Under Obamacare, the subsidies were only available for plans purchased on the exchange and that met the standards of the law. Under Trumpcare, the tax credits can be used towards any type of health plan, including a short term health plan, or one purchased off the exchange.
- Plans must still cover the 10 essential health benefits required under Obamacare. All qualified health plans offered on the exchange must cover the 10 essential health benefits first required by Obamacare. Additionally, Trumpcare keeps the requirements imposed by Obamacare that prohibited any lifetime or annual payout limits and for plans to offer and cover preventative benefits at no cost, which includes contraception for women.
- Qualified health plans will not cover abortions. Trumpcare does prohibit any tax credits to be applied to a health insurance plan that covers abortions unless the situation is necessary in order to save the mother’s life or in the case of rape or incest.
- Health Savings Accounts (HSAs) are encouraged and improved. Trumpcare increases the annual tax-free contribution limit for HSAs to $6,550 per individual and $13,100 per family in 2017. Previously it was $3,350 per individual and $6,750 per family in 2016.
- Employer mandate tax is eliminated. Any large employer that does not offer health insurance to their employees is no longer taxed and the tax credits offered to small employers who offer health insurance to their employees is also eliminated.
- State exchanges may still exist. States are still allowed to set up and maintain state exchanges, just like they did under Obamacare.
If you called Healthcare.gov on January 31st and left your contact information on the voicemail system, you now have extra time to complete enrollment
President Trump Instructs Healthcare.gov to Stop Outreach to Americans About Obamacare Deadline
President Trump has instructed CMS and Healthcare.gov, the federal healthcare exchange to no longer market the open enrollment deadline or to encourage people to sign up for health insurance coverage. This has been described as “sabotage” by some news outlets as well as those within government who oppose his decision, including former employees of Healthcare.gov.
While we do not agree with nor understand his decision, we have to face facts and accept it. While nothing has been announced and our preference is to not speculate on upcoming events. That said, based on his actions yesterday, we feel that it is very safe to assume that there will NO EXTENSION for open-enrollment.
We can not be any more clear than we are right now. Do not wait to enroll in a plan. If you do not wish to use the government health exchange that is fine, you can still sign up for coverage through a reputable third party health insurance website. Below is a form that will allow you to get pricing information on plans that comply with the ACA and are available in your area.
Updated Updated 1/25/2017
20th Century Fox Launches Viral Marketing Campaign That Is Confusing People Trying To Sign Up For Obamacare
We received some emails from Americans who were either frustrated or confused by the website HealthcureGov.com, that they accidentally clicked on after searching for “Obamacare Enrollment” in Google. After replicating this same thing within Google, we can confirm that it seems that some marketing team involved with the promotion for the upcoming release of the movie A Cure For Wellness has clearly decided to take advantage of the hot button issue that is on the minds of tens of millions of Americans, “Obamacare”.
Running ads promoting a movie is one thing, but what you will find if you venture over to Healthcuregov.com which is obviously intentionally confusingly similar to Healthcare.gov, is a website that looks very similar to the government exchange. They’ve even gone so far as to create an almost 100% identical favicon.
This is really poor taste and it might not be exactly clear to 20th Century Fox marketing that this is not only going to upset a lot of people whose time they just wasted, but it could actually get them in a lot of trouble legally.
Registering the domain Healthcuregov.com is a violation of the cybersquatting law, which a single violation of can result in upwards of a $100,000 fine. You can also argue that the design of the site being so close to that of the actual government exchange, is violating copyright law and could not be considered “parody”.
Really the most troubling part of this for us, as advocates for Americans who are simply trying to get healthcare coverage, is that the website could actually lead to many people missing the enrollment deadline of January 31st.
Why is that? Because this website that is promoting a movie, a website that is clearly designed and using a domain name in order to trick people into thinking it is a government website about healthcare, is misleading people into thinking that the deadline to enroll is 23 days away. Why is that?
Well that’s because the release date for the movie A Cure For Wellness, comes out on February 17th, 2017.
This is incredibly irresponsible marketing on the part of 20th Century Fox and it is literally placing Americans lives in danger just to promote a movie. Domain registration records clearly indicate that 20th Century Fox registered the domain on January 18th of this year.
We’re reaching out to the company directly to ask them to take the reckless website down as well as their marketing campaign.
For the record, the deadline to enroll in a major medical health insurance plan under Obamacare is January 31st, 2017. If you need coverage you should enroll now.
Story Update – Since we wrote about this yesterday and subsequently began alerting others within the industry, apparently 20th Century Fox took notice and decided to kill off this terrible idea. The domain now redirects to the movies main website and is no longer confusing Americans about the enrollment deadline.
Second Story Update – As of 1/27/2017, 20th Century Fox has continued to market A Cure For Wellness in an even more aggressive manner. This is reckless and is literally putting peoples lives in jeopardy.
Major News Outlets Are Encouraging People To Sign Up For Health Insurance
In case it hasn’t become clear over the last week, but as things stand now, without question your ability to sign up for health insurance, could become quite challenged. President Trump signed an executive order that could potentially lead to the collapse of the current health insurance marketplace. I’m not referring to Healthcare.gov either. No, the underlying market supported by insurance carriers and their policy holders. This is why it is 100% critical that you do not delay, and find a way to enroll. You can use a trusted private marketplace like the one below. Or you could use the government exchange website mentioned above. Just get enrolled before it is too late.
Enroll Now – President Trump Has Signed An Executive Order For Obamacare
It Is Unclear How Much Longer You May Be Able to Get A Grandfathered Plan. Do Not Wait Any Longer To Get Coverage. Do Not Stop The Enrollment Process Until You Are Enrolled. This Is Urgent. Americans Must Take Action Immediately Or Face The Possibility Of Having Much Lower Quality Health Coverage Options.
2017 Obamacare Deadline & Important Enrollment Dates
1-31-2017 is the last day to sign up for private health insurance nationwide. If you qualify for Medicaid or CHIP you can sign up for coverage any time of the year. Coverage will start of Feb. 1 if you sign up and pay your premium by Jan. 15.After that, coverage starts on March 1.
If you live in one of the following areas, your deadline for open enrollment may change.
* Extension granted to all Minnesotans so long as they purchase insurance through state exchange
* Deadline extended to 6 p.m. on Friday for any Coloradoan who started the enrollment process on January 31st, but was unable to pick a plan and complete the application.
Special Enrollment Periods (SEP) are triggered by qualifying life events, like losing job-based coverage or having a baby, and typically last for 60 days after the event. Because of the potential repeal of Obamacare, you are better off to expect that there will not be any SEP following 1/31/2017.
Our advice is to enroll now because you have nothing to lose by doing so. If you are enrolled in an Obamacare plan by January 31st, you will be grandfathered into a plan at that point. You will not be able to lose coverage for all of 2017, but it is imperative that you enroll before the deadline. If you try to enroll on 1/31, which is always the busiest and most difficult day to enroll of the year, you may not be able to do so. That’s a risk that you really should not take if you need health insurance.
Obamacare Repeal Is Becoming More And More Likely
Senate Republicans aren’t listening to what the American people want, according to a recent poll by NPR and IPSOS. Just 14% of Americans polled want a repeal of Obamacare without a true replacement for it ready to go into effect at the same time. It’s easy to understand why. There’s millions of Americans who rely on prescriptions, like insulin for diabetics, including children with type 1 diabetes. These are essential benefits many now rely on in order to survive. If there is a true full repeal, and that repeal goes into effect immediately, it is unknown how long anyone with an existing plan will have coverage. This is entirely new territory for the health insurance industry within the United States. Health insurance executives are currently advising the government to not hastily enforce a repeal because it will most likely throw the entire healthcare system into total chaos, and the death spiral that’s been predicted could become a reality very quickly.
Apparently no one that has an R next to their name within the Senate, excluding uber contrarian and original thinker Rand Paul is willing to listen. He voted against the repeal yesterday, as the only Republican holdout.
Here’s our advice, enroll today, because you’ve got nothing to lose in doing so at this point. If you wait until the end of open-enrollment 1/31/2017 , you might not be able to get enrolled at all. On 1/30 and 1/31 it is going to be a chaotic scramble for millions and you are best to avoid that headache. We’re throwing our hands up in frustration because this rush to repeal and hopefully replace, it’s going to be a symbolic gesture on the part of the Republican Senate that literally serves to benefit no one. That is of course unless you’re a Republican Senator, because then you get to finally follow through on doing that thing you’ve claimed to have wanted to do for years, repeal Obamacare.
Obamacare’s Confusing Possible Repeal Is Causing Major Concern For Americans
We’re going to take a break from being completely neutral with our perspective on the current status of Obamacare, because right now there’s just too much at stake and no one within either political party is giving the American people answers.
Right now the senate is angling to find ways through the reconciliation process to repeal Obamacare, and what it intends to do with said repeal is currently up for debate. No one entirely knows at this point how a repeal would work, nor if it could actually be pulled off without taking coverage away from tens of millions of Americans. Even Republicans are in disagreement with one another on how long a repeal and replace plan would take to implement.
Our take on the matter is that the political infighting and grandstanding is going to continue without question beyond 1/20/2017 when Donald Trump is sworn into office, and certainly beyond the Obamacare Enrollment Deadline of 1/31/2017. Part of it simply has to do with elected officials trying give the perception that they’re trying to serve their political party, without regard to the collateral damage it may cause American families. Mostly though it is simply because that’s what politicians do in turbulent times, disagree with one another and ask for your support to help keep them in office in order to “fight on your behalf”.
We’re not entirely sure what is going to happen with respect to your healthcare options after 1/20/2017. That makes us nervous and that should make you even more nervous. It is entirely possible that health insurance carriers participating in the exchanges currently, announce a withdrawal from the marketplace within the next thirty days. While that won’t go into effect until 2018, here’s a scenario in which it could harm you if you do not have coverage by the deadline to enroll.
If insurance carriers announce a planned exit from the exchanges starting in 2018, it could make obtaining coverage after 1/31/2017 impossible if you want a major medical plan. Once the deadline for enrollment is up on 1/31/2017 you can only obtain coverage if you have a qualifying life event or for special circumstances. It is unlikely that if insurance carriers are exiting the exchanges, and if Obamacare is repealed, and or “repealed and delayed”, that they would be required to enroll consumers in a plan outside of open-enrollment. If you or a family member is planning on having a baby, currently pregnant and or if you have complicated medical issues, obtaining coverage that will actually cover those expenses could be impossible after 1/31/2017.
So What Does This Mean?
It means that this year it is even more important that you enroll for coverage well before the deadline. Not having coverage is a far more risky proposition simply because of the uncertainty surrounding Obamacare and or a repeal. Making matters worse, is that CMS is now requiring all enrollments to be handled in some part with the assistance of the government exchange. This is bringing the enrollment process which in previous years could be a speedy task to accomplish, to an absolute crawl on big enrollment days. On 12/15/2016, there were more than one million consumers waiting on hold to enroll because of issues with the government exchange. This is precisely why CMS extended the December 15th deadline for coverage starting on 1/1/2017, for five days. Major bottlenecks in how everything is processed this year, resulted in more than 1 million people not being able to enroll on 12/15/2016.
If you wait until 1/31 to enroll, you should anticipate waiting on hold for six hours or more, and or not being able to complete enrollment. This has happened in past years with high traffic enrollment days, and there is a very strong probability it will happen this year in particular. Additionally we should note that historically more people try to enroll on 1/31 and or the final day of enrollment, than on any other. There are millions of people who are “waiting to see what happens” and have delayed enrolling in a plan or renewing their current plan. We highly advise because of everything mentioned above, that you not take that risk.
With respect to risk vs reward, there’s no risk in signing up now. If there’s some magical replacement plan that materializes on 2/1/2017 that’s better than the plan you signed up for, then simply cancel the plan you purchased and go with that. That said, we can assure you that there will be no replacement plans for Obamacare, and or “Trumpcare” plans available for at least one year.
Please don’t procrastinate, don’t delay enrolling while the politics play out. Get coverage now and that way you have options for the future. Obtaining a full coverage major medical plan now, getting a grandfathered Obamacare plan now and then waiting to see what happens is a much less risky proposition.
CMS Seems Intent On Keeping Current Flawed System For Consumers To Enroll Online In 2017 and 2018
First we should absolutely note that the last two updates are getting a little into the weeds with respect to how everything works within the health insurance industry. You may or may not care too much about how exactly the “sausage gets made”. That said, we’re taking this opportunity to let you know, and the incoming administration, that if changes are not made that place the consumer experience first and foremost, any government based health insurance system is bound to fail. Specifically we’re referring to the dreaded “double-redirect” that occurs when a consumer goes from shopping for a health insurance plan on any other website than Healthcare.gov. Essentially if you want to enroll in a subsidized health insurance plan, the government requires that the individual be handed off to Healthcare.gov to complete part of the enrollment process. In past years, this was done behind the scenes and consumers didn’t have to try to make their way through the clunky experience that is Healthcare.gov. Now, not only do they have to be handed off to Healthcare.gov to verify data, they have to create a profile and then check their email for a link from Healthcare.gov.
It’s like shopping in a store, getting to check out, and then when you want to pay first you are asked to leave and go to the DMV and wait in line to prove who you are. Then once you do that, then you can then go back to the store and complete your purchase.
That is an oversimplification for sure, but it’s a fair description of government bureaucracy at work. Where things really fall apart because of this red tape, is when consumers have questions about a health plans specifics and there’s no one to turn to at Healthcare.gov that is a licensed agent. There is an important distinction between a call center rep answering calls in an outsourced call center, and a fully licensed health insurance agent with years of experience.
It is entirely understandable why the current team at CMS wants Healthcare.gov to be the focus, and enforce the double-redirect that drives down enrollments and makes enrolling so much more difficult than it needs to be. Because if Healthcare.gov isn’t the focus, and or required, then why were literally billions of tax payer dollars spent on getting all of this into place? If the free market can really handle creating the best consumer experience on its own, that makes keeping the current system in place all that much more difficult.
What oftentimes happens, and we believe is the case within CMS, is that while intentions are always good, the devil is in the details. In this case, the details are highly complicated health plans that are often being shopped by Americans for the very first time. Even before insurance carriers started leaving the exchanges, the abandonment rates of consumers leaving plans after a short period of time were exceptionally high. This is thought in large part to be from consumer dissatisfaction in plan selection, because there was not enough fundamental understanding on the consumers behalf in the first place.
Hopefully whatever changes are coming to the healthcare ecosystem, the primary focus is people, not politics or process, and certainly not justification of massive government contracts. Below is an excerpt from the just released guidance from CMS along with a link to the full PDF.
b. Enhanced direct enrollment pathways In the final 2018 Payment Notice63 and previous rules, CMS has begun to establish the regulatory framework to implement an enhanced direct enrollment process that would allow a consumer to apply for coverage on a non-FFM website without being redirected to HealthCare.gov. Under an enhanced direct enrollment process, the Marketplace would need to ensure an accurate eligibility determination and protect the privacy and security of all consumers that interacted with it via the direct enrollment partner. CMS will not implement this process until we can ensure technical readiness and sufficient oversight of the eligibility application processes. As such, we are maintaining the current “double redirect” direct enrollment approach for the 2018 plan year as we continue to explore program implementation details of an enhanced direct enrollment process. CMS must consider any additional risks an enhanced enrollment process may pose to consumer privacy and the security of the consumer data. We intend to conduct a privacy impact assessment as required by OMB Memorandum M-10-23. This will help to identify and assess any privacy and security risks presented by the enhanced direct enrollment pathway and will help identify necessary safeguards that need to be in place to protect the personal data that consumers would entrust to enhanced direct enrollment partners. These requirements would only apply upon implementation of any expansions made to the direct enrollment pathway.
Final 2018 Letter Regarding FFM
CMS Announces Obamacare Enrollment Deadline Extension Until 12/19/2016
Within the health insurance industry there are a lot of people who expected this. Reason being is that because of decisions made by CMS ahead of this open enrollment, the ability for brokers to efficiently enroll consumers online or over the phone has become incredibly more complicated than ever before. Average enrollment times for online or telephonic enrollment have increased by five times or more, particularly in peak times when a larger number of individuals are trying to get enrolled. CMS now (unnecessarily) requires consumers to be redirected to Healthcare.gov in order to complete an online enrollment with a web-based broker. This is almost the equivalent of asking someone trying to check out in a store, to leave the store and drive to verify their identity and payment information with their bank, and only then can they go back to the store to complete their purchase.
This has contributed to longer wait times for consumers over the phone who have questions about what plans are best for them, and subsequently made the process to connect with a licensed agent significantly more difficult. If CMS wants to reach their enrollment goals, and more importantly place priority on Americans, and not government red tape and politics, they should return to using the systems in place that worked in previous enrollment seasons. Consumers are the ones who are paying the price for the poorly timed decisions that CMS made ahead of this open-enrollment season. It is entirely possible that the decision to change course this year, was based on the strong assumption that Hillary Clinton would be elected as the next President of the United States, and there would not be a complete change over of management at CMS.
2017 Obamacare Enrollment Estimates Are In – Americans Are Enrolling – Just Not Quickly Enough
While the enrollment statistics below may give the Administration and the healthcare industry hope that consumers are in fact enrolling at a significant pace, what HealthNetwork is finding is that there are millions of consumers in the United States who are very confused about how the election of Donald J. Trump is going to impact their requirement to have health insurance this year and next. We have spoken with tens of thousands of American health insurance shoppers and more than 65% were incorrectly under the impression that they aren’t going to be required to have health insurance starting next year, which means that many people believe that they don’t really have to sign up for health insurance if they don’t want to.
But nothing could be further from the truth – that is unless you don’t want healthcare coverage and you don’t mind paying, minimally, a $695 tax penalty, per person. Unfortunately while there are hundreds, if not thousands, of reporters covering the politics that are being played out right now about how to repeal and replace Obamacare, no one seems to be ending the news report with the most important detail for Americans to know. That little detail is this – in no way is the election going to have an impact on anyone’s healthcare coverage requirements for all of 2017. Most likely there isn’t going to be a scalable national rollout of whatever “Trumpcare” ends up offering for at least two years.
Additionally what we are also finding from conversations with consumers is that there are some unethical insurance agents advising consumers to simply enroll in a short term health plan. Apparently some of which are disingenuously calling short term health plans “Trumpcare Plans”.
So let’s recap the facts, not the fiction or the spin, for the American people.
- You are still required to have health insurance for all of 2017.
- There are no such things as “Trumpcare Plans”. Short term health plans can be a good fit for some people, but not all, and they don’t exempt you from the tax penalty. Trump has nothing to do with them. “Trumpcare” is a slang term for whatever it is President-Elect Donald J. Trump’s healthcare reform policy ends up being.
- Health insurance plans will not decrease in price when President-Elect Trump is sworn into office on January 20th, 2017. Health insurance plan pricing is regulated and set and they will not change until the 2018 enrollment season.
- If you want health insurance coverage starting on January 1st, 2017, you have to enroll by December 15th, 2016.
- If you wait until the end of the open enrollment period to apply for a plan, particularly January 28th through January 31st, there is a very good possibility you may not be able to enroll. Or you should anticipate waiting on hold for at least a couple hours, possibly longer. Right now the federal data hub can have delays that backup enrollments for hours or even more than a day. On peak days the increased volume can bring the government exchange, as well as state exchanges to a crawl. We can not be more clear, this enrollment season will be much more challenging to enroll on the last few days.
If you would like a safe and secure way to determine what options are available to you, simply use the form below. You will not be harassed over the phone and HealthNetwork, a company which helps more than 17 million American households a year safely research their options, is not an insurance broker or a carrier.
Without Question The Election Has Impacted The Health Insurance Enrollment Season For This Year
Over 4 million people have signed up for health insurance since the 2017 open enrollment period started in November. The Centers for Medicare and Medicaid Services (CMS), which oversees the federal health care marketplace at HealthCare.gov, tracks enrollment numbers on a biweekly basis, calculated Sunday through Saturday of each week.
This year, open enrollment started on a Tuesday, which means two fewer days for reporting versus last year. Despite the deficit, more people have signed up for health insurance during this year’s enrollment period than at the same time in 2015. There have been 250,000 more signups during the first 40 days of this year’s enrollment period than last year’s.
Of the people who have signed up so far using the federal marketplace, 2.9 million are returning customers. The remaining 1.1 million enrollees are new to the marketplace this year. Enrollment has surged in the days leading up to the deadline to have coverage by January 1. Between Monday, December 12 and Tuesday, December 13, more than 700,000 people enrolled in a qualifying health care plan. Enrollment will continue through January 31, but December 15 marks the final day for people to sign up for a health insurance that starts on January 1.
This week’s snapshot includes enrollment tallies from designated market areas (DMAs) throughout the country. These DMAs represent local media markets and offer a better picture of enrollment nationwide. While some DMAs come from states that aren’t using the HealthCare.gov platform for enrollment, signup figures primarily are drawn from the federal marketplace and states that use it. The CMS will include enrollment numbers from state-based exchanges as the 2017 enrollment season progresses.
States with significant enrollment totals include Florida (over 878,670); Texas (449,094); North Carolina (238,414); Georgia (208,433); and Pennsylvania (190,719). Illinois, New Jersey, Tennessee, Michigan, Missouri, Wisconsin and Virginia have each had over 100,000 signups. In terms of DMAs, the Miami-Ft. Lauderdale market leads the pack with 343,473 signups. Atlanta, Dallas-Ft. Worth, Chicago, Orlando and Tampa also have high enrollment numbers.
CMS also tracks site usage in addition to enrollment figures. During weeks five and six, more than 6.5 million people visited HealthCare.gov while over 2.1 million people called in to the marketplace’s customer service center. It’s clear that people are looking for help when it comes to getting health insurance.
With the election of a new president for 2017, people have questions and concerns about the future of the American health care system. President-elect Trump and Republicans have promised to repeal Obamacare, but there’s been no consensus on a replacement plan to date. Uncertainty about getting covered for 2017 and beyond is no doubt driving enrollment numbers this year.
ACA-compliant plans cover pre-existing conditions, preventive care at no added cost and a host of other benefits. Most people on the marketplace – 85 percent according to the Department of Health and Human Services – also qualify for cost assistance, bringing average monthly premiums down to $75 a month or less. Consumers who need private health insurance have until January 31 to enroll in a qualifying health care plan on or off the marketplace.
Post Election Update Regarding Obamacare Enrollment In 2017
This is the only time of the year that you can change or enroll in a new health insurance plan. If you want or need new health insurance for January 1st, 2017, you MUST enroll in a new plan by December 15th, 2016. If you want or need health insurance at all in 2017, you MUST enroll during the Open Enrollment Period, which ends on January 31st, 2017.
The 2016 Presidential Election season has finally come to a close and the new President-Elect is Donald Trump. Whether or not he changes the law or intends to repeal Obamacare with an alternative does not change your requirements for this year.
As of 9:00AM Eastern Standard Time on November 9th, all health insurance exchanges and insurance carriers are experiencing record-setting traffic. Millions of Americans clearly still have concerns as to whether they will still being able to obtain health insurance post-election. Let us assure you that you can, in fact, still enroll in a health insurance plan. Nothing has changed with this 2017 open enrollment period and any changes that President Elect Trump may wish to make, will not go into effect until the first half of 2017.
We highly advise anyone who is seeking to obtain health insurance to sign up immediately because call volume and online enrollment traffic is already reaching record numbers. As we get closer to December 15th, it will only get more difficult and time-consuming to enroll in a plan.
If you want health insurance coverage for you or your family, you must get that coverage during the Open Enrollment Period. Otherwise you will be personally responsible to pay for your medical bills out-of-pocket.
If you are seeking information about President-lect Donald J. Trump’s upcoming healthcare reform plan, which has been coined “Trumpcare” by the press, you can find some information at the following link. Trumpcare
The 2017 Open Enrollment Period is finally here. If you are currently without insurance, need to shop around for a more affordable plan or one with better medical coverage, or your insurance carrier is leaving the market, which is effecting approximately 2.5 million Americans this year, now is the time to shop for a new Obamacare health insurance plan.
If You Want To Quickly Compare What Your Options Are For 2017 Rates, Please Use The Following Link.
2.5 Million Individuals Will Need To Find New Obamacare Plans
Open enrollment starts on November 1, 2016 and will end on January 31, 2017. If you find a plan that works for you by December 15th, the coverage can begin on the first day of the new year, January 1, 2017.
If you are already enrolled in an Obamacare healthcare plan and relying on auto-renewal this year – think again. You should still review your options this year for several different reasons:
Carriers exiting the exchange, the individual or family market, or the entire state
- New personal circumstances or events that impact your income
- Changes in reported income
- Pricing variations to the plan
- Base plan changes that effect your benefits and pricing
- Discontinuation of the plan
The first item on the list may be the most vital reason to manually review your coverage and re-enroll this year rather than accepting any changes made by automatic renewal. New developments in 2016 have created headlines about major insurance carriers pulling their plans from the Affordable Care Act exchanges for the 2017 enrollment, and yours may very likely be one of them.
It is predicted that enrollees will be affected by the withdrawal of major insurance carriers, Aetna, United Healthcare, Humana, and four government-run CO-OPs.
Many regional insurers also withdrew with a little less publicity. Among these local providers, many have a much smaller number of enrollees, but some cover thousands and they will have a substantial impact on their members.
Why are Insurance Companies Leaving the Obamacare Marketplace?
In 2013, health insurance companies were trying to estimate the financial influence of an untested risk pool in the new Affordable Care Act (ACA) marketplace. Without being able to discriminate based on health status, people who were less healthy and using more medical services were going to be covered and medical claims would dramatically increase. Insurers needed to accurately project the number of younger and healthier enrollees entering the market and use their premiums to offset the increased claims expenses. The projections fell short and premiums were set too low to create the necessary balance, and insurance companies began losing revenue.
As companies withdraw from the Obamacare market to recoup losses, the effect is reduced competition and mergers between companies that monopolize and limit coverage options in certain areas of the country. The ACA encourages marketplace transparency and competition, without it, premium rates will rise with the 2017 Open Enrollment. This problem should resolve itself when there are more accurate numbers collected over a few years of enrollment, premium, and claims history. The current consensus suggests this will happen by 2018.
Until then, consumers need to log into the marketplace and review their plan to see if they are one of the thousands in their state looking for a new company and an affordable plan. Qualifying for cost assistance can reduce the financial impact of premium increases, but you need to have plenty of time to review the medical needs for you and your family, as well as your household income, to know the actual premium cost for the plan you have chosen. Marketplace representatives are available online and by phone 24/7 to answer questions and explain your options at no cost. Health insurance agents are also able to assist you with enrollment.
Who is Most Affected By These Changes For Obamacare in 2017?
People living in the Pinal County area of Arizona currently have no carriers contracted to sell exchange plans and the residents of Alabama, Alaska, Oklahoma, and Wyoming, all have only one carrier in their exchanges in the upcoming year.
If you are insured by one of the major insurers, Aetna now only has plans available in Virginia, New York, and Nevada and backed out of previous ideas regarding expansion. United Healthcare exited 31 state exchanges and their coverage also only extends to those states. Humana left four more states including Alabama, Arizona, Colorado, and Utah.
Some companies are simultaneously exiting, partially withdrawing, and entering the market in different states. Cigna is leaving Georgia and Texas exchanges, but entering the North Carolina exchange in 2017. Blue Cross Blue Shield of Kansas is pulling out of the Kansas exchange while other BCBS entities continue with plans. Priority Health Insurance Company is pulling out of the exchange in Michigan while still offering HMO plans on the exchange through another carrier entity.
There is a detailed list of smaller regional carriersand entities that are also exiting the exchanges at the end of 2017, including ACA-created CO-OPs. They are impacting the residents of different states and areas or counties within them. Going to your marketplace will give you the details.
While the overall trend is towards a reduction in the number of carriers offering plans in the exchanges, there will be new carriers joining some exchanges in 2017.
What Should You Do Now?
You need to make sure you’re getting the best health insurance plan for your buck. Premium prices are increasing and although 85% of Americans qualified for an average subsidy savings of $290 per month, it’s important to make sure that you’re getting the best medical coverage for the cost for your family.
With nearly 2 million Americans forced to shop for health insurance in addition to the millions already uninsured, it’s important not to wait until the very end of open enrollment period or on big deadlines like December 15th to figure out your options.
If you’re ready to shop for health insurance plans in your region or speak to a licensed health insurance agent, let us help! Call our toll-free phone number or provide us some basic enrollment information and we’ll get you on your way!
Updated 9/19/2016 Many Americans have been reading the recent headlines regarding the number of insurance carriers who have or have threatened to exit the exchange. Many people have emailed in regarding receiving cancelation notices from a number of insurance carriers. Currently United Healthcare, Humana, AETNA and Oscar have announced a major withdrawal from the federal exchange in certain states. It is not yet entirely known how this will effect what coverage options are available starting on 11/1/2016 when open-enrollment begins. We will continue to update this website as more information becomes available. Right now it is still possible for both AETNA and Humana to continue to offer coverage in most of the states they are currently providing plans in. Recently the administration and HHS has been making some significant effort to help keep insurance carriers within the marketplace. The next thirty days will prove to be a critical time for the health insurance industry and for more than 15 million families who have coverage under Obamacare.
Updated 4/21/2016 We have been receiving a lot of email from individuals requesting more detailed information about short term health insurance. Short term health policies and their surge in popularity as an alternative option to on-exchange or “Obamacare” health insurance plans, has received extensive media coverage. Despite this increase in coverage from various news sources, consumers have still had a difficult time determining if short term health insurance is a viable option for them. More specifically, many people have requested that we provide some real life examples of what ones cost would be for a short term health plan, vs an Obamacare plan. So, we have now updated our site to include a detailed Obamacare VS Short Term Health Insurance analysis. Within that page is a link to an unbiased site where you can compare different short term plans.
Comparing Short Term Health Insurance And Obamacare
Updated 2/24/2016 If you missed the Obamacare, or health insurance, enrollment deadline on January 31, 2016, you may have to wait until the next open enrollment period to get an on exchange health insurance plan with subsidies to help you pay your monthly premium. However, if you experienced a “qualifying life event” (QLE) you may still be eligible to enroll in a plan for 60 days following the date that the QLE occurred. You should take note that CMS just announced new qualifying life event eligibility requirements that are being put in place to prohibit individuals from signing up for health insurance outside of the open enrollment period when they are not actually eligible. Detailed Information on the New CMS Eligibility Requirements for Enrolling in Health Insurance Outside of Open Enrollment.
Updated on 2/10/2016 We have received information detailing that there may be an extension for Obamacare plans through Healthcare.gov that runs until March 31, 2016. This extension pertains only to individuals who were unable to enroll because of taxation and tax return filing issue that may have prevented a consumer from completing enrollment. Please see the following link for more information. 2016 Obamacare Extension
If you have a Qualifying Life Event, you will still be able to enroll in health insurance through Obamacare.
We have had a large number of people email us asking for help regarding the new 1095 form requirements. There are three different forms that you have to be aware of. We have a very detailed article outline everything pertaining to the 1095-A, 1095-B and 1095-C forms. Information can be found at this link. 2015 1095 Forms
While a few state exchanges have extended their deadline by a couple days to allow those who started enrolling before midnight local time, to complete enrollment, for the vast majority of Americans, if you are uninsured on February 1st, you may face the tax penalty. The good news is that if you have a Qualifying Life Event at any point this year, you may still enroll in a health insurance plan and get subsidies to help you pay your monthly premium.
A few examples of Qualifying Life Events are:
- You got married or divorced
- You had or adopted a baby
- You lost your employer-sponsored health insurance
- You had a change in income that now allows you to get a subsidy or does not allow you to get a subsidy or you are no longer eligible for Medicaid or CHIP due to an income change
- You moved to a different location and your insurance is no longer available
- You left incarceration
- You became a legal resident or citizen of the United States
If you have one of these or another type of Qualified Life Event that allows you to enroll in health insurance outside of the regular, annual enrollment period, you will have sixty-days from the date of the event to shop and enroll in new insurance. If you do not enroll during those sixty-days, you may face the tax penalty for being uninsured.
If you find yourself without or between health insurance for only a short period of time and need to find coverage in case of an emergency, you can always look at a short term health insurance plan. Please be aware that if you have a pre-existing condition, carriers that offer short term health insurance plans may deny your coverage from the beginning or may deny to cover certain claims. Short term health insurance plans do not comply with the Affordable Care Act either and you may still face the tax penalty for being uninsured even though you have a short term health insurance plan.
Some people find short term health insurance plans valuable because having it is cheaper and safer that having no insurance at all while they are between major medical plans. You can shop and enroll in short term health insurance plans here as well.
The Federal Government has already announced that there will be no Open Enrollment Period deadline extension that will go through the tax season like last year and there’s no indication or guarantee that they will extend the deadline at all past the scheduled January 31st deadline, so do not delay enrolling in a new health insurance plan.
2016 Open Enrollment Period started on November 1, 2015 and ends on January 31, 2016. During this time, Americans are being encouraged to shop around for new rates and new health insurance plans. Even if you are happy with your health plan from last year, there may be a plan out there that is a better match for you or your family’s financial and medical needs. Updated rates are now online and available so you can quickly determine what the average 2016 Obamacare cost is right now.
Think you need a little extra help and guidance picking the right plan for your family? That is not a problem; it’s an opportunity to learn from a licensed health insurance professional. Simply call the phone number below and we’ll connect you with a knowledgeable and helpful health insurance agent that can provide you specialized advice, free of charge.
If you are seeking information about the federal poverty level for 2015, please use that link.
Prefer to shop and enroll online? Well, we’ve got you covered there too! Just fill out the enrollment form below and we’ll get you right on your way.
Update 12/15/2015: The Centers for Medicare & Medicaid announced on December 15th that any American who lives in a state that relies on the Federal Marketplace (FFM) will have until December 17th to enroll in a health insurance plan that will start on January 1st. Read more about the 2016 Obamacare Deadline
If you want health insurance coverage that begins on January 1st, make sure you enroll by December 15th, 2015; otherwise your plan will not begin until February 1st at the earliest. If you don’t enroll in a plan until the end of the 2016 Open Enrollment Period, your coverage will not begin until March 1st, 2016.
There’s no guarantee and we do not anticipate that there will be an extension for enrollment beyond January 31st, 2016 so don’t delay your enrollment. You can avoid long wait times by enrolling today.
Obamacare Deadline Information Updated
The 2015 open enrollment period finally closed on April 30th, after a brief extension was given to Americans who got their income taxes done and realized that they were assessed a penalty for being uninsured in 2014 and would certainly face the increased penalty in 2015. The Department of Health and Human Services revealed that nearly 12 million Americans enrolled in health insurance either through the Federal Marketplace or the state exchange during the enrollment period. This number exceeded the government’s projections by almost 3 million people.
If you recently lost your health coverage or are just wishing you could shop for a different plan, you either need to wait for the 2016 open enrollment period to begin November 1, 2015 or you need to wait until you experience an event that would be considered a Qualifying Life Event. Qualifying Life Events are described as circumstances that happen in people’s lives that would allow them to enroll in a new health insurance plan either on the Marketplace or through a carrier direct and to even get a subsidy if they were eligible, without having to wait for the next enrollment period. Some examples of these events are:
- You get married or divorced
- You have a child
- You lose your previous health coverage for some reason like your COBRA benefits end or you lose your employer-based health insurance
- You move to a different state or location and your previous plan is not offered in your new area
There are several other examples of Qualified Life Events that exist and whether or not you have experienced one of these events is tricky to understand. It is often best and easiest to discuss your life circumstances with a local health insurance agent as they are the best suited to listen to your situation and determine whether you meet the requirements of a Qualifying Life Event. Remember, if you do experience a Qualified Life Event, you have 60 days from the date of the event to enroll in a new health insurance plan. If you do not do it during that period of time, you may be penalized with a tax when you file your federal income taxes.
Another option for people currently without health insurance coverage is to take on a short-term health plan. Unfortunately, short-term health plans are not regulated the same way as regular, major medical plans under the Affordable Care Act and carriers that offer short-term plans can do things like consider whether you have a pre-existing condition, limit your annual payout for medical claims, and offer higher deductibles and coinsurance payments before the plan with kick in its part. The benefit of a short-term health plan is that you can have the peace-of-mind that you are covered in the event that something unexpected occurs. These types of plans also offer more flexibility in that you can sign up at any time of the year and can choose to keep the policy for as little as one month or for only six months.
The 2016 Open Enrollment Period will start on November 1, 2015. If you want your health insurance coverage to start by January 1, 2016, you must enroll by December 15, 2015. The last day to get insurance is January 31, 2016 unless the government or your individual state issues another extension.
The regular 2015 Open Enrollment Period closed out on February 15th and the results were staggering. More than 11 million Americans are able to call themselves insured individuals after enrolling in a health insurance policy on the state or federal marketplaces.
After the 2015 OEP closed out, many states and even the federal government extended deadlines to enroll because many individuals faced technical problems completing their application before the midnight deadline. The requirement for a person to enroll during this special extension in many, but not all circumstances (some states had exceptions to this rule), was that the individual must have started their application on the exchange’s website for with a representative at the federal or state exchange call center before the February 15th deadline passed.
Even though this extended enrollment period for the federal marketplace passed on February 22nd and many of the extended state exchange deadlines also passed at the end of February, but despite this, the government realized that there would be many people who would not realize that they really needed to enroll in health insurance until they got their 2014 taxes done and were told that they would face a tax penalty for being uninsured during the 2014 calendar year and would also face a penalty for not enrolling for 2015 either.
Due to this predicament, the government announced another special enrollment period, which is commonly being called the Tax Special Enrollment Period. This enrollment period started on March 15th and runs until April 30th and many of the state exchanged, the exception of only a few, have followed step and also created a Tax Special Enrollment Period for their residents.
Check out the list below to determine whether your state has a Tax Special Enrollment Period and the requirements to enroll in health insurance during this period of time.
Keep in mind that even if the Tax Special Enrollment Period, you may enroll in a new health plan if you experience a Qualifying Life Event. If you do experience one of the events below, you must enroll within sixty-days in order to avoid a tax penalty.
Examples of a Qualifying Life Event are: