Repealing employer mandate won’’t cripple Obamacare, study finds


The Washington Times by Tom Howell Jr. – May 11, 2014:Image

A new study says scrapping one of Obamacare’s most controversial aspects — the employer mandate — would not leave significantly more Americans without health insurance, despite the political fervor that surrounds any attempt to strip down the signature overhaul.

Researchers at the Urban Institute said keeping the provision, which requires companies of more than 50 employees to provide health coverage or pay fines, would only insure about 200,000 more people — a relatively small proportion of the roughly 250 million Americans who hold health insurance.

Congressional Republicans — and some Democrats — say the mandate is killing jobs in their home states and districts, as firms try to stay below the mandate’s 50-employee trigger by dropping workers or refusing to hire more.

They also want the law to define full-time work as 40 hours per week instead of 30. A number of stories have surfaced about part-timers who work between the two benchmarks being reduced to 29 hours or less so they are not counted toward the mandate.

“The requirement’s implications for coverage are small, and yet the negative labor market effects of keeping it in place could harm some low-wage workers,” Urban Institute researchers said in their report, which was released in partnership with the Robert Wood Johnson Foundation and spoke favorably of the health care law overall.

The study notes that Congress would have to find new revenue streams to make up for loss of penalties that, under the mandate, would kick in when at least one of the employer’s workers takes advantage of a government subsidy on the law’s health exchanges.

Repealing the mandate, which has been delayed twice, comes with political risk and reward for President Obama and his Democratic allies.

While it might alleviate some criticism from Republicans and the business community, changing any aspect of the law could look like a sign of retreat, especially after the administration beat back the GOP’s repeated efforts to dismantle the law.

“While the White House mocks Republican efforts to end this anti-job mandate — even threatening a veto of policies he developed — it’s clear that the consequences of Obamacare need to be stopped,” Senate Minority Leader Mitch McConnell, Kentucky Republican, said in response to the study. “It’s long past time for Washington Democrats to work with us to remedy the mess they created — and that means repealing this law and replacing it with real reforms that actually lower costs.”

For now, the mandate is a key part of the GOP’s anti-Obamacare arsenal. Whenever a restaurant or grocer cuts its workforce or raises prices, citing the mandate, ugly headlines are sure to follow.

Some large employers, including Target and Trader Joe’s, announced they would stop providing coverage to part-time workers, saying they might be better off in the health law’s exchanges.

The new study says these reports have taken a toll on the overall law’s popularity.

“Eliminating the employer responsibility requirements should substantially diminish employer opposition to the ACA,” the researchers wrote. “In fact, without that burden, employers may play more of a role promoting the expansion of coverage under the law.”

The mandate was supposed to take effect in 2014 alongside other major provisions of the health overhaul. But the Obama administration delayed the mandate to 2016 for companies with 50-99 workers and, starting in 2015, will phase it in for companies with more than 100.

Republicans have accused the White House of delaying the mandate to avoid blowback at the ballot box during November’s mid-term elections.

HHS offers another Obamacare extension to avoid ‘canceled’ health plans

ImageThe Obama administration will   allow some health plans that fall short of Obamacare coverage requirements to   continue past the November elections and through most of President Barack   Obama’s second term.

 The decision, announced   Wednesday by federal health officials, extends for two years an earlier   decision by the White House to let people keep their existing health plans   through 2014, even if those plans fell short of Affordable Care Act   requirements. Under the new policy, some people could renew plans in 2016,   meaning they’d be covered into 2017.

Without the change, Democrats   worried that another wave of canceled health policies would hit just weeks   before the November 2014 midterm elections, setting off more recriminations   over Obama’s earlier pledge that people can keep their plans if they like   them. 

The new policy could have a   limited practical impact. The extension is optional for both states and the   health plans themselves. To date, only about half the states have allowed the   older, often skimpier, plans to continue. And some insurers want to scrap   them to maximize enrollment in the new health insurance exchanges. And   officials predict more Americans will migrate to the new plans, particularly   if they qualify for subsidies.

One official said the number of   people in plans that have been extended is “falling quite rapidly.”

Republicans quickly lambasted   the move as blatant 2014 politics and another sign that the administration   just can’t get the law to work.

“The Obama   administration’s announcement today that it will continue to allow insurers   to sell health care plans that don’t meet Obamacare minimum coverage   requirements is not only another reminder of the president’s broken promise   that you can keep your plan if you like it but represents a desperate move to   protect vulnerable Democrats in national elections later this year,”   Senate Minority Leader Mitch McConnell said in a statement.

The Obama administration said   the move, revealed in a conference call with senior administration officials,   isn’t politics. “The goal is to implement the Affordable Care Act in a   common-sense way and to try to provide a smooth transition for consumers and   employers,” an official said on the call.

Documents accompanying the   announcement reveal that the changes were crafted “in close   consultation” with a large contingent of vulnerable Democrats, including   Sens. Mark Warner, Mary Landrieu, Jeanne Shaheen and Mark Udall as well as   Reps. Tim Bishop, Elizabeth Esty, Carol Shea-Porter, Gary Peters, Scott   Peters, Ann McLane Kuster, Kyrsten Sinema, Ann Kirkpatrick and Ron Barber.

The changes, part of new   regulations and guidance issued by the Department of Health and Human   Services, will give some consumers an extra two years to remain on health   plans that would otherwise be canceled for failing to meet Obamacare’s   minimum coverage requirements. Many of those plans had already been given a   one-year reprieve in November 2013, but now they could be sold through 2016.   It also extends the offer to people in small group health insurance plans,   where small businesses could also have faced plan cancellations in the coming   year.

The insurance industry has   worried that the move to “un-cancel” plans could make it harder for   the new markets to succeed, and some strong backers of the law also worry.   Sen. Tom Harkin (D-Iowa), for instance, said in an interview that he’d rather   see people in the newer policies with stronger coverage.

“We’ve been through this   before. They made that decision – fine,” Harkin said. “A lot of   people say they have policies that they don’t pay very much for but I put it   this way: they’re great policies as long as you don’t get sick.”

A new rule also requires that   an Obamacare program intended to protect insurers from unexpected costs is   fully funded by the insurance industry, rather than by taxpayers. Republicans   have said that taxpayers could be on the hook for an insurance industry   “bailout” through these provisions.

The rule also outlines the   administration’s plan to implement SHOP exchanges for small businesses. The   federal one had been delayed a year. The Treasury Department also said it was   streamlining some of the paperwork for employers. 

Source: Kyle Cheney, Politico   Pro

House panel OKs easing health reform law’s definition of full-time worker


A panel of the House of Representatives approved legislation Tuesday to ease the health care reform law’s definition of a full-time employee, shielding more employers from a stiff financial penalty imposed by the law.

Under the Patient Protection and Affordable Care Act, employers are required, effective in 2015, to offer qualified coverage to full-time employees – defined as those working an average of 30 hours per week – or be liable for an annual $2,000 penalty per employee.

The legislation, H.R. 2575, introduced by Rep. Todd Young, R-Ind., and approved by the Ways and Means Committee on a 23-14 vote, would change the definition of full-time employees to those working an average of 40 hours per week.

“This legislation restores a common understanding in America, spanning over half a century, of what constitutes full-time work. In other words, it restores a basic American value,” Rep. Dave Camp, R-Mich., the committee’s chairman, said in a statement prior to the panel vote.

In addition, even before the provision’s 2015 effective date, employers are cutting back employees’ hours below the 30-hour penalty trigger, Rep. Camp said.

But ranking member Rep. Sander Levin, D-Mich., said the bill would be a “tremendous step backwards for millions of hard-working Americans.”

The health care reform law’s “use of a 30-hour standard to define full-time was set to minimize gamesmanship and incentives that might tempt some employers to reduce hours in order to avoid their responsibility to offer affordable coverage,” Rep. Levin said in a statement.

The measure now goes to the full House. A similar bill, S. 1188, introduced last year in the Senate by Sen. Susan Collins, R-Maine, has been referred to but not acted on by the Finance Committee.

Source: Business Insurance Magazine, February 4, 2014

Why do I have to purchase Pediatric Dental if I don’t have kids or need it?

By Michelle AndrewsImage

OCT 25, 2013

Q. My husband is self-employed and currently has an individual plan. I recently received a letter that said that he must purchase pediatric dental insurance, and if he doesn’t provide proof that he has it they will automatically enroll him in a plan. We don’t have children, so why would we have to have pediatric dental insurance?

A. Under the health care law, starting in January new individual and small-group health plans must cover 10 so-called essential health benefits. The list of required benefits was developed following a process that solicited input from consumer groups and members of the public, employers, states, insurers, and medical and policy experts. The final list reflects a core package of benefits that it was determined everyone should have access to, even though most people may not use every single benefit. It includes hospitalization and prescription drugs, maternity and newborn care, mental health and substance abuse services, emergency care and doctor visits, as well as pediatric services, including vision and dental services for children.  

Pediatric dental coverage is sometimes offered as part of a regular health plan, but it’s also often sold on a standalone basis. So even though the health law requires that children in individual and small group plans have access to dental coverage, people are not required to buy separate pediatric dental coverage if they buy a plan on the state health insurance marketplaces, or exchanges, unless their state specifically requires it.

But people who buy plans outside the state marketplace may not have the same flexibility, says Colin Reusch, a senior policy analyst at the Children’s Dental Health Project.   

Outside the exchange, “There’s no exemption for that requirement to have pediatric dental coverage,” he says. “So if you’re buying insurance outside the exchange you may have to meet it.” 

It sounds as if your husband’s plan is a non-exchange plan. If that’s the case, he could shop for a plan on the exchange if he wants to avoid buying pediatric dental coverage.

What Did CBO Really Mean By 2 Million Jobs Lost?

This week, messaging was the name of the game. On Tuesday, the nonpartisan Congressional Budget Office (CBO) released an economic reportsaying that the healthcare law may cause Americans to work fewer hours — enough to be the equivalent of 2 million fewer jobs in 2017, which is nearly three times as high than what CBO has reported in the past. But the devil is always in the details. Yes, the report said that the equivalent of jobs lost would equal 2 million, but it also said it’s in large part about the number of hours people choose to work, not actual job loss. The report’s purpose is an analysis of the impact of PPACA on the supply of labor, or how many people chose to enter into the workforce. Basically, the CBO report was a report of incentives, whether or not PPACA increases or decreases incentives for Americans to work, and no one really knows how this will all play out over time.Image

As you can imagine, Republicans, once the report was released, went crazy with Facebook posts, tweets and public statements about how the president’s signature healthcare law is hurting the American workforce. As expected in response, the White House almost immediately published a blog post and began making their own public statements to put their spin on the report. Their basic argument is that PPACA will allow people who want to work less to do so because they will be able to get health insurance through the exchanges rather than through an employer. According to the White House, the law stops “job lock,” the phenomena where a person is afraid to quit a job and say start a small business because they will lose benefits. Conventional wisdom says the White House can spin all they want, though, and the 2 million number will still loom large over the 2014 election cycle.

The report also highlighted other important statistics that were overshadowed by the job loss numbers. CBO lowered the predicted exchange enrollment numbers from 7 million down to 6 million for this year. While it is a significant drop, we’re actually a little surprised it didn’t plunge a little further given how well the exchange websites have been working. Additionally, CBO reported that the risk corridors would save $8 billion in the long term. Why would it save so much money? Because the program is supposed to pay health insurers that have higher-than-expected costs, but the money flows both ways. So if insurers’ costs are lower than expected, the health plans are supposed to pay the government, resulting in cost-savings. CBO predicts that it will collect more from insurers than it actually gives to them in the first place.  Time will tell…

HHS Releases Updated Exchange Enrollment Numbers: Emerging Trends Continue to Raise Some Concerns

JANUARY 19, 2014 – 10:24 PMImage

On January 13, the U.S. Department of Health and Human Services (HHS) released updated enrollment figures for the Affordable Care Act’s (ACA) Exchanges during the first three months of operation. The report outlines the number of Americans who have accessed a state-based or federally facilitated Exchange as well as a demographic breakdown of new enrollees.   This blog highlights some of the key Exchange enrollment trends.

Federal Exchange Enrollment Tops State-Based Exchange Numbers

Federal Exchange enrollment outpaced state-based Exchange enrollment with 1.2 million of the 2,153,421 individuals selecting a federal Exchange policy, and 950,000 choosing a state-based option during the October 1 – December 28, 2013, open enrollment period. This is a significant difference from just a few weeks as the state-based exchanges had shown larger numbers most likely as a result of reporting timing.

One of the likely reasons the federal Exchange has enrolled more Americans is the demographic composition of where the Exchanges operate. There are currently 34 states, representing a majority of the country’s population, using the federally facilitated Exchange, while just 16 states (plus the District of Columbia) operate their own Exchange. Further there are generally larger numbers of uninsured Americans living in states using the federal system. Of the 17 states with the greatest proportion of uninsured people, 14 are using the federal Exchange. It follows that there would be larger enrollment in places where more people need insurance.

Young Adult Representation Lacks Luster

Enrollment demographics have received much attention since the consensus is that a large number of new enrollees must be younger, healthier Americans. This population tends to amass fewer claims, allowing their premiums to subsidize older consumers within a health plan. According to reports during the early phases of open enrollment, the government was hoping the younger population would represent at least 40% of the newly insured. The January 13 report points out that 24% of Exchange enrollees through December 28, 2013, were between the ages of 18 and 34. This is proportionate to the number of Americans in this age group (26%), but lower than the proportion of uninsured people in this demographic (about 38%).

The report also indicates young adults may be waiting longer than the rest of the population to enroll in coverage. “The general expectation is that people who are older and sicker are more likely to select coverage earlier in the initial enrollment period,” the report states, “while younger and healthier people will tend to wait until towards the end of the open enrollment period (which concludes March 31, 2014).” 
The growth in enrollment for young adults from October to December was larger than growth in other age groups, indicating that the overall share of young adults enrolling in plans is growing. Perhaps the initial technological difficulties caused some young consumers to disengage from the Exchange websites. Now that those glitches have largely been fixed, some may be giving the system a second chance.
While the main takeaway of the HHS report is the lower than expected young adult enrollment, there are other important facts to emerge from the first half of open enrollment.

Silver Plan Option Most Popular

In deciding what level of coverage to purchase, 60% of Americans have opted for “silver level” plans, meaning an average of 70% of health care expenses will be paid by the health plan. All other metal levels were significantly less popular: bronze (20%), gold (13%), platinum (7%), and catastrophic (1%).

Nearly 80% Receive Federal Subsidy

It’s also notable that 79% of consumers who have selected a health plan through an Exchange will receive a federal subsidy. Subsidies are available to those who do not qualify for Medicaid, but earn below 400% of the federal poverty line.
We will continue to keep you apprised of any updates to the enrollment figures and any additional information on demographic trends relevant to our clients. In the meantime, please visit www.BeWellInsurance/ to view past blogs and Legislative Alerts. Or you may for more blog posts, polls, surveys and numerous resources.

It’s important to note that the federal health care reform initiative discussed in this blog is referred to by several different acronyms including ACA, PPACA and ObamaCare. No matter what the term, Be Well Insurance Solutions will continue tracking and reporting on key health care reform trends that are impacting Brokers, payroll personnel and key stakeholders. 

[Author:  Michael Gomes, Executive Vice President, BenefitMall]


Producers vindicated as House slams navigators

After months of feeling ignored in favor of government-funded navigators, producers are finally enjoying their time in the spotlight. They’re also enjoying a bit of sweet vindication as a Republican-led House panel releases a report accusing navigators of committing significant errors and risking privacy.

Navigators, which were appointed in the Affordable Care Act rollout to help consumers enroll in health plans, have been giving enrollees bad information and haven’t done enough to protect privacy, the report said.

“Documents call into question the effectiveness of the Navigator program and the Obama administration’s ability to safeguard consumer information,” the House Oversight Committee concluded.  Click Here for full story:

As The Policy Cancellation and Extension Saga Turns

At the conclusion of last week’s episode in the real-life drama of individual and small-group health insurance policy cancellations, President Obama had gone on television and announced that if insurance commissioners and individual carriers wanted to, it was fine by him if they simply extended non-PPACA compliant plan coverage in effect as of October 1, 2013, for another 12 months. The National Association of Health Underwriter’s ( began keeping an up-to-date chart on the decisions states and carriers made on the matter and our friends at America’s Health Insurance Plans (AHIP) got tricky and made a color-coded map. Meanwhile, the House of Representatives passed a bill that would allow insurers to keep selling new non-compliant plans in 2014 and insurance company CEOs were seen entering and exiting the White House looking confused and unhappy. Image

This week, the show has been no less exciting. It started with weekend drama when the DC Insurance Commissioner, William White, was fired over a press statement that essentially said as a former actuary he would give the president’s plan all due consideration, but in general it didn’t sound like the greatest idea. Then the president and his surrogates announced that they didn’t intend to give insurers much regulatory relief in implementing the plan, particularly with regard to their request for reinsurance help if the extension policy does indeed result in market instability and adverse selection. Senator Marco Rubio (R-FL) took this a step further and proposed a bill to eliminate the law’s risk sharing mechanisms, which are consumer and insurer funded means of helping to shore up insurers that absorb more than their fair share of unhealthy consumers due to the law’s guarantee issue and community rating provisions.  

After that, more and more states insurance commissioners began announcing their decisions and quite a few said no thank you. Among the naysayers was the Covered California board, even though the state’s insurance commissioner had previously been positive. To try and smooth things over, President Obama invited some of the insurance commissioners over to the White House for a chat. Some of the commissioners went to the West Wing for what has been described as an awkward meeting, but six prominent commissioners wrote him a very polite letter saying thanks, but we think its in the best interest of our states if we stay home.

Thereafter, Families USA came out with a study claiming the whole problem was a bit overblown. Late yesterday afternoon, HHS released a letter templatefor insurers to use with consumers who may be able to stay in extended policies and then today they told the world that the last day people have to buy coverage in 2013 for a January 1 effective date is really December 23, not the previously reported December 15. Insurers quickly responded that changing dates again at the last minute is problematic for all, especially considering the wonky enrollment system and also reminded the world that coverage won’t actually be in force on January 1 if the insurer doesn’t have their premium money in hand by then.

We are hoping that our lawmakers will air a rerun next week, since both Congress and your Washington Update authoresses plan on leaving town to celebrate Thanksgiving. But regardless if new drama occurs or we just see more of the same, we’ll include another thrilling plot synopsis of the cancellation and renewal saga in our upcoming blog posts…