Wednesday, July 23, 2014

ACA Split Court Decision/Subsidy Eligibility

[EasyDNNnewsToken:SMS_please_subscribe]On July 22, 2014, two separate U.S. appellate courts issued contrasting rulings pertaining to a key aspect of the Affordable Care Act (ACA). The issue at hand is language contained in the 2,700 page law addressing eligibility for subsidies (or tax credits) for those unable to afford the premiums for INDIVIDUAL health insurance. Specifically, the cases hinge of just four words – “…established by the state”, or in its entirety – “[ACA] subsidies shall be available to persons who purchase health insurance in an exchange established by the state”.

Since the overwhelming majority of states opted to defer to a federal or hybrid federal/state exchange (36) the language presented a significant problem. In effect, the language meant that only eligible individuals residing in one of the 14 states that opted to establish a state based exchange would be eligible for subsidies. The following graphic indicates (in white) those states that actually formed STATE based exchanges:

Wednesday, July 16, 2014

PCORI/CERF Requirement…Year 2

A little over a year ago, I posted a blog addressing the Affordable Care Act (ACA) – Patient Centered Outcomes Research Institute (PCORI) fee requirement, also referred to as the Comparative Effectiveness Research Fee (CERF).
Last year, affected plans were required to remit a fee equal to $1 per plan participant. This year, affected plans owe $2 per plan participant, based on their plan date. Since last years PCORI/CERF related post addressed the “who” and “what” of this particular ACA requirement; this post will address the “how”, as in how to calculate the average number of affected lives, and then calculate and remit the applicable fee.

Wednesday, July 9, 2014

ACA’s Future

Here are a few questions often posed pertaining to the Affordable Care Act (ACA):
“What does the future of health care/health insurance look like, once the ACA is fully implemented”?
“Will the ACA result in significantly fewer or more uninsured individuals”?
“After four years, what do we know about the affect of the ACA on premiums”?
This week's post offers my overall response, and associated concerns, related to these three, and perhaps other questions…
People who were previously denied health insurance coverage in the Individual health insurance market,

Wednesday, July 2, 2014

Supreme Court Ruling/Contraception Coverage

This week (June 30, 2014) the Supreme Court ruled in favor of plaintiffs – Hobby Lobby, Mardel, and Conestoga Wood Specialties – in their respective challenges to the Affordable Care Act;s (ACA) contraception mandate. The basis for their cases was simple in nature, but sweeping in scope, as there are over 90 similar cases currently pending in courts around the country. The court's decision was quickly followed by a tremendous amount of media coverage, some of which is patently false and misleading. Here's an overview of what we know at this point.
The Affordable Care Act (ACA) contains a provision requiring most employers to cover a range of contraception drugs and devices in their health plans, AT NO COST TO THEIR FEMALE EMPLOYEES.