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Grants to Help with Consumer Protections

The Affordable Care Act created grant programs designed to help states oversee and enforce market reforms, and guarantee consumer protection for those using the new health care marketplace systems. To assist each state with its health insurance rate review processes, $250 million was made available to monitor insurance companies and prevent unjustified rate hikes beginning in 2014.

In 2015, the rate review led to roughly $1.5 billion in savings for consumers. The funds announced for 2017 are unused grant funding totaling $25.5 million from prior years. Each year, the unused portion of rate review grant funds remains available to plan and implement new insurance market reforms and consumer protections under Part A of Title XXVII of the Public Health Service Act (PHS). The first round of grants applied for are making their way to 22 states and the District of Columbia and you can see how each state plans to spend its grant money on the CMS website, which tracks these figures.

Approximately $21.6 million is being awarded to assist State Departments of Insurance in preparing and executing insurance market reforms and consumer protections. The remaining funds will be used toward other related expenses dealing with planning or implementing market reforms that extend across the health care industry for promotion, travel, equipment, supplies and indirect costs.

The Consumer Assistance Program Grants (CAP Grants) help to ensure that state laws, regulations, and procedures follow federal requirements as they evolve. The Obamacare marketplace is complex and continues to change as new phases begin and adjustments are made. Keeping up with providing new resources, education and accurate information to growing numbers of consumers requires many critical decisions for U.S. states and territories. Nearly $60 million will provide new programs for consumer assistance through direct support in answering health insurance questions. The funds go to state agencies and allow them to collaborate with non-profit organizations for additional support in helping consumers enroll, file complaints or appeals, obtain tax credits, understand their rights and actions, track problems and enforce regulations.

Each state needs funds to research, document, and analyze consumer questions and concerns relating to the required 10 minimum essential benefits that make up a qualifying health plan under the ACA. They also need to respond to these inquiries through additional manpower and facilities. The Department of Insurance is responsible for training staff to identify, assess and report issues regarding preventive services, equal benefits for mental health disorders and substance abuse, appeals processes, and the reduction in overall health insurance costs overall.

State Departments of Insurance are a critical component in making sure that health insurance providers are producing affordable plans that contain reasonable limits, and that costs that are justified. Companies must be proven financially stable so consumers stay protected. State regulations must also match new federal laws while addressing any discrepancies that appear.

Grants help each State Department of Insurance with incurred costs in promoting consumer education and awareness through industry professionals, associations and organizations; developing educational materials; updating their websites; presenting to stakeholders; participating in conferences; and purchasing advertising.

The grant award period runs from October 31, 2016, through October 30, 2018. Each grant will be treated as a project with a budget period of two years. Applicants each receive the baseline amount of $476,998 but are allowed to take less. Based on state population and the number of health insurance providers, a certain portion of funds is designated as “workload.” The remaining funds are earmarked for specified market reforms.

Consumer protection, quality service, and affordable products are the goals of the Affordable Care Act, and grants are built into the process. Individual states are integrating with the nationwide system and making the improvements necessary for consumers to understand the law, the system, insurance coverage options, and how to get the very best plans and service from their marketplaces. If your state spends its grant money wisely, then more tools will become available to simplify how you buy health insurance and how you receive information on upcoming changes.

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How Many People Would Lose Coverage if the ACA Gets Repealed?

The Affordable Care Act (ACA) has been integrated in stages for nearly seven years, with most of the policies in effect having been executed over the last three. Repealing and replacing it is a monumental task.

Republicans have already designed many alternatives in the last few years, but none of them made it past the Senate majority or President Obama. However, with the combination of a Republican Congress and President-elect Trump, the ACA’s days may be numbered.

Trump met with President Obama shortly after the election and made a statement regarding key provisions of the ACA that he now intends to keep. Preserving the policy that allows young adults to stay on a parent’s health insurance plan until age 26, and the ban on denying coverage to those with pre-existing conditions, means a full repeal has been set aside. But the Affordable Care Act will be completely transformed, and many people stand to lose their current health plans.

Total Uninsured

Prior Republican legislation indicates a two-year time frame to establish Trumpcare’s system of tax credits and health savings accounts (HSAs) for individuals, the modernization of Medicaid and the creation of a free-market enterprise for health insurance and pharmaceutical companies. These plans are designed to encourage competition and lower costs throughout the health care industry. Options for replacement should be offered by 2019.

In late 2015, the CBO estimated that about 22 million people would have lost health insurance after the end of 2017 if the GOP’s legislation HR 3762 had been enacted. These would have been people covered through Medicaid and the insurance marketplaces.

The Committee for a Responsible Federal Budget followed in 2016 with an estimate of almost 21 million people losing their insurance coverage. They believe Trump’s replacement plans would cover just 1 million of the 22 million individuals expected to sacrifice benefits under the ACA repeal.

The Rand Corporation shows that the combined effect of Trump’s proposals would leave 20.3 million uninsured. It’s clear that around 20 million people would lose their current health benefits under the law if the ACA gets repealed, and Trump does not appear to have an adequate explanation for how those affected would be covered under his version of national health care.

Medicaid Enrollees

Lower-income individuals would be more affected than others when the Medicaid expansion is repealed along with the ACA. It covers 15.7 million additional people with incomes below 138 percent of federal poverty level, a provision added in 2013. A Republican administration will focus on getting people off of Medicaid subsidies and into private plans with tax credits to help cover the premiums.

Trump wants to replace current funding for low-income individuals to each state using block grants or per-capita allotments to supplement their own programs. This transition will not likely happen until 2018 or 2019.

Marketplace Consumers

If the estimates overall are roughly 22 million, and 15.7 of them are subsidized by Medicaid, that leaves about 6.3 million marketplace enrollees without their current coverage once the exchanges get dismantled under Trumpcare. However, there are many unknown variables regarding the replacement plans and the success of tax cuts, credits and deductions applied to the purchase of health savings accounts. The details of changes to Medicare and Medicaid could have wide-ranging effects on estimates in either direction.

Avik Roy, president of the Foundation for Research on Equal Opportunity, along with several economists, came up with vastly different numbers based on three different but very specific proposals for repeal and replacement. The Patient CARE Act would only reduce coverage by 3 million people, A Better Way would reduce coverage by 2 million, and Roy’s own proposal claims to increase the number of insured by 9 million.

The particulars of Trumpcare can greatly change the outcome; we might end up somewhere in between. For the 20 million or more Americans who count on the ACA for coverage, their future depends on those particulars.

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Reaching Millennials for ACA Enrollment

As open enrollment for 2017 Obamacare coverage begins, the Centers for Medicare and Medicaid Services (CMS) is starting a new initiative to reach millennials who qualify for tax credits, but are not using them. The Affordable Care Act did a great deal to make health insurance available to everyone, especially for millennials. The rates for uninsured young adults have dropped considerably since 2010, but the CMS says that millions more millennials are still not taking advantage of the program.

The CMS estimates that around 90 percent of young adults with qualifying incomes would also qualify for tax incentives that would make health insurance more affordable. The problem is that most young adults have no idea they qualify for these incentives. As open enrollment starts, the CMS is working with the White House to spread the word and educate younger generations – specifically those aged 18 to 34 – on Obamacare.

Going Where Millennials Go

The CMS understands that millennials are not likely to get this new information from Healthcare.gov, so the government is going where millennials are known to go. Many popular social media platforms, such as gamer site Twitch.com, will start hosting ads from the CMS outlining the benefits of enrollment in various health care plans offered by the Affordable Care Act.

The CMS will also be touting its new mobile interface, which will make comparing plans during the enrollment process much easier this year. It’s estimated that 20 percent of all young adults access the internet exclusively through their smartphones. Previous limitations on the ACA mobile app explain why so many millennials did not bother to register. With the new and improved app, the CMS is confident that more millennials will be able to check out the available plans and enroll.

A Massive Effort to Encourage Millennial Response

The CMS and White House are not campaigning for millennial enrollment on their own. The list of associated organizations helping in this effort to reach young adults includes:

  • American Hospital Association
  • Autism Speaks
  • The Truth Initiative
  • Planned Parenthood Federation of America
  • United Methodist Church
  • American Medical Student Association
  • March of Dimes

Dozens of groups are getting involved, and they will all be reaching out to millennials on social media using the hashtag #HealthyAdulting. Since many of these organizations are popular with the young adult demographic, the CMS expects to be able to reach millions of millennials quickly.

Government Support

Government agencies, such as the Department of Defense, Medicaid and the Children’s Health Insurance Program (CHIP) will also be distributing helpful information to millennials while encouraging young enrollees to explore their health care options when signing up for various military programs. In addition, the IRS will be developing a list of millennials who could benefit from this information by pulling out the names of young adults who paid the federal tax penalty for not having health coverage.

The CMS is intent on getting as many millennials as possible to sign up for insurance and protect their health. With this combined initiative, the CMS anticipates that it can reach as many as 5 million young adults before the open enrollment period ends on January 31.

2017 Open Enrollment Deadlines

Millions of Americans Need to Plan to Shop for Health Insurance this Open Enrollment Period

Marketplace enrollees may discover that their health coverage for 2017 differs dramatically from their 2016 plans. An estimated 2 million people who enroll using state and federal health insurance exchange sites will be forced to choose new coverage for next year. This is due to several major and minor insurance providers dropping out of the exchanges. United Healthcare, Humana and Aetna — three major national insurers — have already announced that they will not be participating in many or all of the markets where they currently offer coverage. In some states, smaller issuers have also dropped out, citing financial loss as the primary motivator.

Under the Affordable Care Act, consumers have the option to let their health plans “auto renew,” which essentially means that a person’s health insurance coverage will simply renew each year unless changes are made. During open enrollment each year, enrollees can also make changes or sign up for a new health plan altogether. Unfortunately, many consumers allow their plans to renew automatically.

Auto renewal can be a risky option since health plans change from year to year. In a competitive marketplace, health insurers offer newer plans with better features. Consumers who shop for coverage are more likely to find a better deal in terms of plan benefits and monthly premiums. For 2017, shopping for coverage is not only beneficial but essential for some consumers. With several major providers bowing out of the marketplaces, enrollees could find themselves forced into different plans, a situation known as “health plan mapping.”

Plan mapping occurs when a carrier moves an enrollee to a similar plan because the person’s current plan has been discontinued. It’s not a new practice, but it has become more common thanks to the competitive nature of a post-ACA insurance market. When carriers innovate or update their plans from year to year, they simply map enrollees to a similar policy if those enrollees allow their plans to auto renew.

The practice itself isn’t necessarily a bad thing, but for some consumers, plan mapping may mean a higher monthly premium, a narrower network or different health care options. Next year, the marketplace may look very different due to the absence of major insurers like Aetna and United Healthcare. People who have plans with insurers that have cut ties with the exchange sites will be forced to choose a new policy — or have it chosen for them.

Under the Notice of Benefit and Payment Parameters for 2017 issued by the Department of Health and Human Services (HHS), the exchange sites will determine health insurance coverage for anyone whose plan no longer exists provided that the enrollee doesn’t come back to the site to select a plan. In other words, if you have a plan with one of the carriers that isn’t participating in the exchanges and you don’t choose a new plan during open enrollment, then the exchange site will choose one for you.

The wording used by the HHS makes it clear that the exchange site will do its best to find similar health plans, but this is no guarantee that a consumer will have comparable coverage — or a comparable monthly premium. In some instances, enrollees may be mapped onto different carriers entirely, which could impact network and availability. Prior to 2017, mapping consumers onto a different carrier was not allowed. This has changed for next year.

ACASignUps.net estimates that about 2 million exchange enrollees will be affected by insurer dropouts in 2017, most of whom have plans with United Healthcare and Aetna. Open enrollment begins Nov. 1 and runs through Jan. 31, 2017. Shopping for a new plan can result in lower premiums or better features. Consumers are encouraged to check the status of their health plans and browse for new coverage next year.

Resources:

http://acasignups.net/16/08/29/update-x2-ok-how-many-people-will-have-shop-around-fall

https://www.healthinsurance.org/obamacare/how-to-avoid-the-surprise-of-health-plan-mapping/

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5 Ways Trump Will Improve Obamacare

Election coverage for the 2017 presidential election promises to define the future of Obamacare and the health insurance industry. According to Donald Trump, he would dismantle the whole system and both the industry and its providers would no longer have to abide by the laws regulations. Without the Affordable Care Act, there would also be no individual mandate to require every American to have insurance coverage. After repealing the law, Trump intends to boost competition of insurers by allowing them to sell products across state lines, create more Health Savings Account options, and use block grants to fund state-run Medicaid programs. Trump healthcare and Hillary healthcare are at complete odds with each other.

  1. Trumpcare would immediately call for a repeal of the Affordable Care Act (ACA), removing the individual mandate and stopping the expansion of Medicaid program eligibility. Millions of people would become uninsured and there would be an economic penalty to pay until a solid replacement plan is put in force. Without regulations in place, quality and availability of insurance plans for those who could continue to afford them would also be impacted. Federal funding to states, communities, and providers would also be altered or withdrawn. Insurers would be caught in a situation of losing an estimated 12.3 million policyholders and have to offset predicted gains of 56 percent since 2010 along with anticipated losses of 25 percent for those who no longer have to carry insurance. They would do this through expected increased pricing, layoffs, consolidation, and even bankruptcy for less prepared companies. Those left would have to absorb the additional members and costs, increasing their financial burdens temporarily. Those still insured in the marketplace would see roughly an 8 percent increase in premiums.
  2. Donald Trump believes the market forces in the health care industry can absorb the changes through premium tax deductions and increased use of tax- free health savings accounts (HSA) limiting costs and need for private insurance coverage. Insurance companies would design new products and premiums. In addition, HSA funds would transfer to heirs without a tax penalty.
  3. In an effort to promote free enterprise, Trump would also allow the sale of health insurance across state lines and shift Medicaid from federal to state control. However, he would not require insurance companies to develop and sell products to every state or every population. It would naturally increase competition and decrease costs, possibly allowing smaller insurance providers to compete with larger ones. People would be able to comparison shop for prices on coverage, procedures, and exams. Because the insurance industry is also part of the banking and finance industry, there does seem to be a need for Federal regulations, but Trump has not addressed them. This goes against his general philosophy of government interference and reducing the countries dependence on public health programs. He would need to have congress repeal The McCarran-Ferguson Act passed by Congress in 1945 taking back the power for states to regulate insurance companies.
  4. Mr. Trump believes Medicare should be able to negotiate drug pricing and save $300 billion a year by allowing the purchase of drugs overseas. He wants to rework the Medicaid system somehow and still be able to provide coverage to those with pre-existing conditions, but on both those initiatives, he is unclear about the process or direction he would take.
  5. He believes the illegal immigrant population has put the US health care system under duress and, by restricting visas, he can reduce health care costs to state and local governments.

Donald Trump repeals the Affordable Care Act in order to base a health care system on a free market economy designed to balance out supply and demand, automatically decreasing costs to a reasonable level, insisting that the best social program is maintaining employment and reducing dependence on public assistance. Repealing Obamacare deregulates the health care industry once again, block grants for Medicaid give states a specific budget to control, Medicare can negotiate lower drug costs, and everyone has a choice to participate in coverage or not. Election coverage for Trump’s health care provisions are certain to be vastly different than Hillary Clinton’s healthcare plans.

Resources and Links:

Luhby, T., 2016. Trump’s Healthcare Plan: What He Promises and What it Really Says, http://money.cnn.com/2016/03/03/news/economy/trump-health-care/

Axelson, B., 2016. Donald Trump’s Healthcare Plan Revealed: 5 Fast Facts You Need to Know, http://www.syracuse.com/politics/index.ssf/2016/03/donald_trumps_health_care_plan.html

Appold, K., 2016. How Trump Would Change Healthcare. http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/how-trump-and-kasich-would-change-healthcare

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