Health Care MarketplaceNews & Research

Last County Covered for 2018

Paulding County in Ohio, the last county left without health insurance coverage, has just been picked up by CareSource. CareSource will offer plans that are available through individual insurance policies compliant with the Affordable Care Act (ACA), also known as Obamacare. CareSource has a long-standing history of interactions with Medicaid. Registration for 2018 coverage begins Nov. 1, 2017. In 2017, 334 people in Paulding County had Obamacare, and thanks to CareSource, they will have that option again in the upcoming year.

This has laid to rest the uncertainty that there will be counties left bare in 2018 after several large insurance carriers, such as Blue Cross Blue Shield, removed coverage options in over 40 counties across the country. These large corporations reported financial losses and expressed concern over the continued implementation of the ACA. They had difficulty appealing to younger, less expensive customers, and rural, underpopulated regions can make reimbursement rates difficult. No backup plan was officially in place to provide care for the bare areas.

President Trump and fellow Republicans have warned that the decreasing number of insurers offering exchange plans could force the ACA to implode, especially in counties with a low number of participants in Obamacare plans. CareSource and other companies offering care to the bare counties still have a month to change their minds. There is also uncertainty regarding the continuation of cost-sharing reduction payments, which help to subsidize the cost of health care premiums and out-of-pocket expenses for lower-income families.

News of continued ACA coverage in every county in America comes as a relief to many exchange customers. Beyond the individuals who will benefit directly from these plans, Cynthia Cox, an executive in a nonpartisan health-policy collaboration, believes that this shows the feasibility of Obamacare instead of its impending failure as feared.

CareSource CEO Pamela Morris has shared her company’s commitment to providing coverage for those who need it. The Ohio State Insurance division will be working with CareSource and other providers over the course of the next few weeks to confirm plans and premiums. There are four planned meetings to finalize details.

Coverage of these less populated counties also suggests that this is a viable market for companies like CareSource. CareSource, Centene, and other health care providers that offered coverage to the bare counties are showing a profit for the year, and they see a potential to profit in these neglected areas. They also may be eligible for government funding for cost-sharing benefits for lower-income families. Overall, the situation appears hopeful for the continuation of insurance coverage now that the last bare county has an insurance provider.

4 Good Reasons to Sign Up for Health Insurance

Open enrollment to sign up for health insurance starts on November 1 and runs through December 15 this year, allowing you just 45 days to decide on a plan and commit to your coverage for 2018. With all of the political hubbub surrounding healthcare reform, you might be asking if you even need coverage. The short answer is yes. Here are four good reasons to get covered for next year.

  1. The mandate is still in effect.
    The Affordable Care Act (ACA) mandate is still in effect for 2017 requiring everyone to carry some form of qualifying health insurance. Penalties for those who don’t comply with the law are higher this year, set at 2.5 percent of your taxable household income or a flat fee, whichever is greater. There is a chance that the IRS will not enforce the penalty, but this is far from being decided. In fact, the IRS has explicitly said that it will hold taxpayers accountable for having health insurance.
  2. Most people qualify for cost assistance.
    Currently, financial assistance for premiums and other medical costs are still available. Around 87 percent of exchange customers last year qualified for cost assistance, making premiums more affordable for most people who enrolled in Obamacare plans. If you’re not sure about buying health insurance because of the cost, know that you might be able to reduce your premiums as well as the amount that you have to spend out of pocket. New for 2018, customers can buy health insurance and apply for cost assistance using brokers instead of HealthCare.gov, so start here if you need guidance on how to get covered.
  3. Coverage is still guaranteed-issue for all applicants.
    Nothing has changed about the fact that under Obamacare, everyone who applies for health insurance can get it as long as they pay their premiums. Previous and current health problems don’t affect your ability to enroll, nor will they cost you more money in premiums under the current law. Whether you have a chronic condition, like high blood pressure, or a temporary and expensive one, like pregnancy, your premium rate will be set on factors other than health status (like age, where you live and plan availability). Take advantage of the ACA’s protections for people with pre-existing conditions to ensure that you and your loved ones are covered for 2018.
  4. You may have to pay a penalty in the future if you skip this year.
    In 2018, health insurance companies can require previous customers to pay back any unpaid premiums that they may have skipped if they lost or dropped coverage voluntarily in a prior year. How far insurers will take this remains to be seen, but signing up this year – and keeping your premiums current – ensures that you won’t have any extra fees to deal with when you re-enroll or try to find a new plan with the same company. As of right now, there are no additional penalties to worry about in the coming year other than the one that you’ll face if you don’t have coverage at all.

What Now?

With a little less than two months left until open enrollment starts in November, it’s time to think about your coverage options for 2018. Discuss your needs with your doctor and, if applicable, your family, and jot down the kind of coverage that you need and want. All ACA-compliant plans – which are any major medical plans sold on or off the marketplace after March 23, 2010 – cover a host of essential health benefits and include protections for consumers.

Don’t gamble with your health coverage if you don’t have to. A single catastrophic health issue affects more than the person who becomes ill or injured. It burdens the entire family emotionally and financially. While the future of healthcare reform is murky, the current law still stands. You will need health insurance to avoid a fine and ensure that you’re protected in case of emergencies. Stay ahead of the process by keeping an eye on healthcare news in the upcoming months, and get covered starting in November.

Americans Pay Obamacare Penalty in 2016 Despite Non-Enforcement by IRS

In a recent report to Congress, the IRS stated that 4 million tax returns filed for the 2016 calendar year included an individual mandate penalty, which averaged $708.00.

After President Trump was inaugurated and he released statements and signed an Executive Order that he would be working to repeal Obamacare right away, the IRS announced on February 15, 2017 that it would not enforce the tax penalty for 2016 tax returns. In previous years, if a tax return was submitted and it did not answer the following questions or submit the required forms, the return would be rejected until the information was provided.

  1. An individual mandate penalty amount should be assessed
  2. An individual in the household is exempt from having coverage under the law due to having coverage through an employer plan, due to all coverage options being unaffordable under the law, or due to some other predefined reason under the law
  3. The household is exempt from having coverage under the law due to the reported gross income being below the tax filing threshold
  4. Everyone in the household had coverage for the entire calendar year

After the IRS’ announcement on February 15th, it would accept returns filed that did not provide this information. Despite this, 2.6 million tax returns were prepared and filed in 2016 by tax professionals.

It’s unclear whether Obamacare will be repealed and replaced anytime soon, but if it is, the individual mandate penalty will certainly go with it. Despite this, the IRS included in its report that it is reconsidering whether to allow silent tax returns on this issue and may reverse course and require the information to be submitted so that it can collect the penalty from everyone who is uninsured in a calendar year.

White House will make CSR payments.

Despite President Trump’s warnings that he would let Obamacare implode if Congress didn’t pass a replacement plan and that the fastest way to an implosion is to withhold the CSR payments – or the cost-sharing reduction payments – due to insurance carriers this year, the White House announced on August 16th that it would make a payment to insurance carriers this month.

Under Obamacare, people who earned between 100-250% of the federal poverty level and who enrolled in a silver plan would get regular subsidies to pay their premiums and they would get an additional tax credit, which would be reimbursed to the insurance carriers, through these CSR payments.

According to the CBO, if the government didn’t pay the nearly $7 billion owed to insurance carriers for CSR payments this year, the cost of premiums would go up by 20% in 2018 and many insurance carriers would pull out of the market, which would leave 5% of the country living in an area with no health insurance plan options. Additionally, the federal deficit would increase by $6 billion next year if these payments weren’t made.

Although the GOP has failed to find a replacement plan that would work as well to stabilize the market, bring down the uninsured rate and bring down the costs of health insurance, it always understood that the CSR payments needed to be made to insurance carriers during the transition period in order to keep the immediate costs down and to keep insurance carriers in the marketplace. A number of people in Congress have commented recently that they hope to pass legislation soon to ensure that the CSR payments are made to insurance carriers for the immediate future.

Healthcare Reform: Why Can’t Democrats and Republicans Agree?

We all know that Republicans and Democrats have some very different core ideals which makes it difficult for them to agree on many topics- and healthcare is no exception. While Democrats want the federal government to administer and regulate healthcare, Republicans insist on private industry providing healthcare with as little interference from the government as possible.

In 2010, Democrats passed the Affordable Care Act with almost no Republican support. Since then, most right-wingers have been determined to overthrow the policy while Democrats insist that it’s the country’s best shot at a successful healthcare system. In the Senate today, Republican leaders are working to pass the Better Care Reconciliation Act of 2017 (BCRA) without any support from Democrats.

Of course, some more moderate individuals are often willing to come to a compromise on issues that strong right and left-wingers would otherwise never see eye to eye on. However, in general there are various core ideological reasons that Republican and Democratic leaders refuse to give up their positions on political issues, including healthcare reform. Many American citizens and leaders view being Republican or Democrat as a part of their identity. While this loyalty can have its advantages, blind loyalty can cause unnecessary conflict and an unwillingness to compromise. In order to get a better understanding of some of the topics at hand, let’s take a look at some of the major differences in opinions on healthcare between the U.S.’s 2 main parties.

Democratic Point of View

Since the Affordable Care Act became law, over 20 million Americans gained health insurance they hadn’t had before and the number of those not covered by insurance has been cut in half. With the passage of Medicare and the Children’s Health Insurance Program (CHIP) through the 1900’s, Democrats have stood by their belief that health insurance is a fundamental right of every American. They believe that government regulation and administration of healthcare is the safest way to ensure that quality insurance will be fairly distributed amongst the American people.

Though government regulation of healthcare is a basic belief of the Democratic party, some more extreme leftists believe that a single payer health program should be imposed which cuts out insurance companies and uses the country’s savings to pay for insurance for everyone. While this may sound ideal, it would be nearly impossible to make a reality in America.

Republican Point of View

In contrast, Republicans believe that the government should keep their hands off of health insurance and leave it to private industry. Many right-wingers view the Affordable Care Act as a violation of independence as its individual mandate causes increased taxation in order to cover subsidies. For this reason, many capitalists want to move away from Obamacare in order to preserve personal responsibility and and freedom from government regulation.

A Republican Senator of Kentucky, Rand Paul, has made it clear that he wants the Affordable Care Act to be repealed and has said that he will not support any new policy unless it gets rid of Obamacare altogether. He has also stated that he will not support the Better Care Reconciliation Act proposed by Republican leaders in June.

Healthcare is not only a political debate, but a social one as well. Abortion and contraception make up a piece of the healthcare puzzle. Republicans refuse to use taxpayer money to pay for these things while Democratic leaders believe that they are a basic, essential part of healthcare. Since some people believe that abortion and even contraception are morally wrong while others believe that women should have access to all options, it’s unlikely that a compromise will be reached on this issue anytime soon.

Some Republicans, mostly those with more moderate views, would like to keep Medicaid as it is. Medicaid is the country’s health insurance program for low income children and adults and those with disabilities. Without Medicaid, millions of Americans would be without health insurance. This is why many moderate republicans refuse to back the Better Care Reconciliation act as it plans to cut nearly $700 billion from the Medicaid budget.

What’s Wrong with the Affordable Care Act?

President Obama passed the Affordable Care Act (informally known as Obamacare) as an attempt to provide every American with affordable, quality healthcare coverage. The Senate passed the Affordable Care Act with 68 Democrats and 2 Independents voting in favor and 39 Republicans voting against. Although the overall goal of the act: providing affordable coverage for all, is an excellent goal, critics of the policy feel that Obamacare hasn’t reached its full potential. Some challenges faced by the act include:

  • Since millions of Americans received healthcare coverage for the first time, costs of insurance for others increased dramatically. Many Americans noticed a tax increase as the Affordable Care Act relies on taxes to fund coverage for lower income families.
  • The cost of premiums has increased as insurance companies raise their rates to afford coverage for all previously uninsured Americans.
  • Many insurance companies have chosen to leave the marketplace due to increased costs, leaving consumers with less choices.
  • In order to motivate Americans to acquire health insurance, the Affordable Care Act imposed a fine on uninsured individuals. This led to many Americans being surprised by an additional fee during tax season.
  • Some say the fine imposed on the uninsured wasn’t high enough to motivate young people to sign up for insurance. In order to succeed, the act will need more young, healthy, taxpaying people to balance out the cost of the less healthy, lower income individuals being supported by the taxes.
  • Many Americans simply don’t understand the Affordable Care Act. Obamacare uses a tiered system to differentiate between plans that offer different copays, coverage levels, deductibles and premiums. Especially the millions of Americans who have never had health insurance before, this system can be confusing and unapproachable.

Without a reform that addresses these issues, improvement will be complicated.

With each new leader and shift in power between the parties, healthcare is likely to change. It seems so recent that our country was undergoing a healthcare makeover with Obamacare, and now it may be happening again. Without the ability to compromise and negotiate reasonably, it will be impossible to create a plan that all Americans are satisfied with. Our hope is that leaders will be willing to meet in the middle and keep in mind what would truly be best for the American people.

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