Wednesday, August 13, 2014

ACA Employer Reporting…Continued

A previous post informed about an upcoming (voluntary in 2015; mandatory in 2016) Affordable Care Act (ACA) compliance requirement requiring employers (small and large) and health insurers to report on health insurance coverage offered to employees.
Recently the IRS released draft versions of various forms that employers will need to disclose detailed information to both their employees and the IRS. The purpose of the reporting is to assist the federal government in enforcing the ACAs individual mandate, employer mandate, and premium subsidy provisions.

Wednesday, August 6, 2014

ACA Changes, Repeals, Modifications, Clarifications…Thus Far

Readers and health care stakeholders may find it interesting (if not frustrating), that as of the date of this blog post (August 6, 2014) there have been a grand total of 42 changes* made to the Affordable Care Act (ACA) since its signing into law on March 23, 2010. Furthermore, the changes have not originated from a single source; nor have the changes been influenced/encouraged by a single political party. The fact is, of the 42 changes to date, 24 have been made unilaterally by the President; 16 resulting from acts of Congress; and perhaps the most notable – 2 – by the Supreme Court of the United States (SCOTUS). After taking last week off to enjoy a nice family vacation, I return this week to summarize these important changes.

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.

Thursday, June 19, 2014

ACA Transition Relief – Employer Mandate

In February of this year (2014), I provided an overview of the IRS' final regulations pertaining to the Affordable Care Act's (ACA) employer mandate. Since this is such a confusing provision of the ACA, to say nothing of the fact that there have been not one, but two separate delays of this provision, I decided to recap some of the more pertinent aspects of the final regulations and associated transitional relief.

Readers who are not completely familiar with the employer mandate (also referred to both as – “employer shared responsibility” and “pay or play provision”) can access an overview,

Wednesday, June 11, 2014

Prescription Drugs – Health Care’s Low Hanging Fruit

There is an often overused metaphor equating things easily obtained with “low hanging fruit”. And in the world of health care and consumer driven health care (CDH), there is perhaps NO lower hanging fruit to be had than prescription drugs. I would further submit that few if any other product category in our entire economy has the sheer number of FREE… DISCOUNTED… REDUCED… SAMPLE offers connected to it, by a variety of constituencies including – manufacturers, distributors, insurers and employers – than do prescription drugs. But do the very people these offers of “low hanging fruit” are directed toward understand the “what”, “why”, or even “where” associated with them?

Friday, June 6, 2014

Employers Reimbursing Employees for Individual Coverage

Recently, the IRS issued guidance which places harsh penalties on employers that deploy the strategy of “dumping” employees into the Individual health insurance marketplace. The guidance followed the White House's objection to the idea of allowing employers the ability to provide employees with a lump sum of money with which to buy individual insurance on the exchange/marketplace. This builds on guidance released last year from the Department of Labor (DOL) which was more broad in scope. A previous blog post addressed the DOL guidance, which effectively “killed” the ability to use tax preferred funds from HRAs and FSAs to fund Individual health insurance premiums, regardless of the source of such coverage.

Wednesday, May 28, 2014

COBRA, ACA, and Special Enrollment Rights

With the seemingly endless flow of guidance, updates, notices, and delays swirling about relative to the Affordable Care Act (ACA), a rather important piece of guidance may have been overlooked. Issued jointly by the Department of Labor (DOL) and Health and Human Services (HHS) earlier this month (May 2, 2014), this guidance provides an opportunity for individuals enrolled in COBRA coverage the option to dis-enroll in their COBRA coverage, and enroll in potentially lower cost individual health insurance coverage, FOR A LIMITED TIME.
This week's post addresses this guidance and provides additional information related to the transection of COBRA and the ACA.