Wednesday, February 25, 2015

King v. Burwell ~ Deciding the ACA’s Future

Next week (March 2, 2015), the Supreme Court of the United States (SCOTUS) will take up a very important case – King versus Burwell. All politics and rhetoric aside, this case has the potential to virtually upend the Affordable Care Act (ACA), and stakeholders should be informed as to its implications. At the core of the case is whether or not the federal government has the authority to issue subsidies (or tax credits) to otherwise eligible individuals that reside in a state that does not have a “state based health insurance exchange”

Wednesday, February 18, 2015

2015 ACA Compliance and Planning

As we approach the 5th anniversary of the signing of the Affordable Care Act (ACA) into law, compliance and planning have become more important than ever. Listed below are ACA provisions that have particular relevance this year, and deserve attention and planning… 1) The Individual Mandate went into effect in 2014, with a penalty of $95 or 1% of income (the greater of the two) for non-compliance. As citizens prepare/file their tax returns in early 2015, they will notice new questions relating to health…

Wednesday, November 5, 2014

The ACA and Newton’s 3rd Law of Motion

Sir Isaac Newton’s Third Law of Motion taught us that for every action, there is an equal and opposite reaction. As we near the end of the fourth full year of the [partial] roll out of The Affordable Care Act /Obamacare, it has become increasingly more challenging for people to differentiate action from the equal and opposite reaction. Put another way, some of the things we’re experiencing, required by the ACA, are directly attributable to the law itself (call these actions). And then there are things we’re seeing that are the result of the many requirements, mandates, fees/taxes, expansions associated with the ACA (call these equal and opposite reactions). This will all make more sense when you see the chart at the end of this article.

Friday, September 26, 2014

ACA’s Transitional Reinsurance Fee/Tax

Self funded health plans face a rapidly approaching compliance deadline of January 15, 2015 relative to the Affordable Care Acts so called “transitional reinsurance fee”. A previous post addressed the various reinsurance (or bailout) programs devised in the ACA (click –
These programs are sometimes referred to as the “Three R’s”, which are: Reinsurance Program; Risk Corridor; and Risk Adjustment.
The first of these reinsurance/bailout programs – the [temporary] reinsurance program…

Wednesday, September 10, 2014

ACA’s Health Plan Identifier Requirement

As the old saying goes, “the devil is in the details”, and the Affordable Care Act (ACA) has its fair share of DETAILS. Among the rapidly approaching compliance deadlines for many employers is requesting/obtaining a ten-digit Health Plan Identifier or HPID. While ALL employers offering health insurance plans must comply with this requirement, the due date for obtaining the ID, along with determining who is responsible for obtaining it varies based on a couple of factors. Here’s an overview of the whole HPID matter…

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,