Tuesday, December 1, 2015

ACA/Obamacare: Largest US Private Health Insurer Has Second Thoughts About On-Exchange Offerings

‘According to enrollment data, more than 500,000 Americans using the exchanges purchased plans from UnitedHealthcare. Those consumers will have to purchase new plans in 2017 should the insurance company leave the exchanges, Ed Haislmaier, a health policy expert at The Heritage Foundation, told The Daily Signal.

“What we’re seeing is that insurers are re-evaluating whether this is a good market to go into,” he said. “Some are expanding; others are having problems, and they pulled back. Over time, what you’ll probably see is fewer insurers offering coverage in the exchanges. We’re already seeing that, even though United expanded in 2015 and 2016, insurers offering coverage is down. It’s going to take a few years to play out.”

Compared to its competitors, UnitedHealthcare was slow to offer products on the exchange when Obamacare first went into effect in October 2013 and sold plans in just four states—Colorado, Maryland, Nevada, and New York—in 2014, according to the state-run exchanges and federal exchange, HealthCare.gov.

However, the insurer expanded its exchange coverage substantially in 2015 and 2016, selling plans in 22 states during the 2015 open enrollment period and 34 states during this year’s open enrollment period.

Competitors Aetna and Humana, by comparison, are offering coverage on the exchanges in 15 states.

Haislmaier said that insurers like UnitedHealthcare may not have prepared for how much plans sold on the exchanges would cost them.

“What you’re seeing is the market itself, and this is attributable to Obamacare, is turning out to be a market that’s predominately low-income individuals between 100 to 200 percent of the poverty line,” Haislmaier said. “They’re buying coverage, getting a substantial subsidy, but gravitating toward the low cost-sharing plans where they get extra subsidies. The enrollees have more of an incentive to use more health care, and that makes those plans more expensive [for the insurer].”

For insurers to profit from the coverage offered on the exchanges, Haislmaier said, they must narrow networks or raise prices, both of which impact consumers.

“The ones who have not narrowed the networks or have been behind the curve on pricing are having losses and reevaluating participation,” he said.’ - How Obamacare Could Limit Insurance Options for Americans in These 34 States, daily signal.com, 11/25/2015

Thursday, November 26, 2015

ACA/Obamacare: Failed Co-Ops and Unpaid Doctor/Hospital Bills

‘NEW YORK (AP) — The sudden collapse of the largest nonprofit insurance cooperative created by President Barack Obama's health care law is causing headaches in New York, especially for medical providers owed millions of dollars for treating the failed plan's patients.

More than 200,000 people insured through Health Republic Insurance of New York have until Monday to sign up with another company if they want to maintain coverage in December.

State regulators ordered the insurer to shut down at the end of the month because of severe financial problems. They are also investigating what they say were inaccurate financial filings by the company.

The closure - part of a wave of failures of the new co-ops nationwide - has been a big hassle for Health Republic policyholders, who have had to shop around quickly for alternative coverage.

The situation may be worse, though, for doctors, hospitals and other clinicians. They are legally obligated to continue treating Health Republic patients through the end of the month but have been given no assurances they will ever be paid for that care.

"I'm aware of at least two physicians who have gotten checks from Health Republic, and those checks have bounced," said Dr. Joseph Maldonado, president of the Medical Society of the State of New York.

Two groups that represent hospitals, the Health Care Association of New York State and the Greater New York Hospital Association, said their member facilities are already owed at least $150 million, not including care provided in much of November.

Medical practices are likely owed millions of dollars more. A survey of 800 doctors by the medical society found that 43 percent were owed money by the company. Nearly 8 percent reported being owed $25,000 or more. One practice of 22 physicians reported being owed more than $5 million, the society said.’ - Health Co-Op Failure Leaves Doctors Owed Millions, insurancenewsnet.com, 11/24/2015

Link to the entire article appears below:




Wednesday, November 25, 2015

ACA/Obamacare: When Insurance Theory Becomes Reality Theater

‘UnitedHealth Group, the largest insurance company in the U.S., on Thursday slashed its earnings outlook, citing new problems related to Obamacare, and told investors it may exit the program's exchanges.

"In recent weeks, growth expectations for individual exchange participation have tempered industrywide, co-operatives have failed, and market data has signaled higher risks and more difficulties while our own claims experience has deteriorated," Stephen J. Hemsley, chief executive officer of UnitedHealth Group, said in a press release.

The release added that, "UnitedHealthcare has pulled back on its marketing efforts for individual exchange products in 2016. The company is evaluating the viability of the insurance exchange product segment and will determine during the first half of 2016 to what extent it can continue to serve the public exchange markets in 2017."

In a conference call with investors, Hemsley offered a sober assessment of the exchanges' future viability. He said that claims data have been getting worse as time has gone on, and there's no evidence pointing toward improvement.

Asked about whether the company could sustain losses past 2016, he was blunt: "No. We cannot sustain these losses. We can't really subsidize a marketplace that doesn't appear at the moment to be sustaining itself."

The year 2017 is significant for insurers, because that's the year when several programs designed to mitigate risk for insurers through federal backstops go away. The hope was that those programs would act as training wheels for Obamacare in its first few years of implementation, but after that, the insurers were supposed to be able to thrive on their own. UnitedHealth's statement suggests otherwise.’ - Nation's largest insurer may exit Obamacare due to losses, Washington Examiner, 11/19/2015


Link to the entire story appears below:


Tuesday, November 17, 2015

ACA/Obamacare: Church and State

‘The latest objection to the Affordable Care Act before the U.S. Supreme Court won't derail President Barack Obama's federal health care law but could carve out an exception for religious nonprofits, attorneys and legal experts said.

The court said Friday it will hear challenges by the Catholic Dioceses of Pittsburgh and Erie and Geneva College, a Beaver Falls school affiliated with the Reformed Presbyterian Church, along with six other lawsuits from religious organizations around the country objecting to provisions in the federal health care law mandating the church and its affiliate agencies provide coverage for birth control or file a form opting out.

"This has nothing to do with the particulars of the issue, and that's why the court took it," said Bruce Ledewitz, a Duquesne University professor who studies religion and law.

"This isn't about abortion. It isn't about conception. It's not about Obamacare, either."

The court will instead consider whether the government has the right to dictate what religious nonprofits can and can't do, Ledewitz said.

Bishop David Zubik of the Pittsburgh diocese said the issue is one of religious freedom.

"The insurance mandate, which is one small provision of the Affordable Care Act, would require us to facilitate access to contraceptives, sterilization and abortifacients contrary to our teaching," Zubik said in a statement Friday. "We are encouraged that the Supreme Court will hear our case and are hopeful that they will rule to protect not only our religious liberty but that of all Americans."‘ - Supreme Court Agrees To Hear Church Groups’ ACA Challenge, insurancenewsnet.com, 11/07/2015

Link to entire article appears below:






ACA/Obamacare: Trouble in Paradise -or- The Disconnect Between Hawaii Health Connector and Healthcare.gov

‘Hawaii residents are taking over an hour on average -- and as long as four hours for non-English speaking people -- to apply for Obamacare health coverage via the federal marketplace, healthcare.gov.

On Sunday, Obamacare coverage in Hawaii switched to the federal marketplace from the Hawaii Health Connector, the state-based exchange that is ending operations completely in 2016. The Connector is contracted by the state to assist people signing up for insurance under the Affordable Care Act, or Obamacare, but didn't have enrollment numbers as of Friday. A spokesman for the Centers for Medicare & Medicaid Services, which oversees the federal exchange, said the government agency is not releasing enrollment figures at this time.

"Hawaii is at risk of being unable to process all re-enrollments. We are having significant challenges getting people enrolled on healthcare.gov," Jeff Kissel, the Connector's executive director, told board members at a meeting Friday. "Even if we put all the people we have on it we're not going to get done by Jan. 31. We told CMS we've got to have a contingency plan."

All of the roughly 40,000 Hawaii residents who got health insurance through the Connector must re-enroll on healthcare.gov as policies will not be automatically rolled over to the federal exchange. If a policyholder does not re-enroll, coverage will end Dec. 31. The 2016 enrollment period closes Jan. 31.

One of the major problems hindering enrollment is that automated identity verification is not working on healthcare.gov, Kissel said.’

Average enrollment time for individuals is taking about one hour and 15 minutes, while the time for those signing up over the phone through the federal call center is in excess of two hours, he said. - Hawaii Residents Face Long Delays In Applying For Health Coverage, insurancenewsnet.com, 11/07/2015

Link to the entire article appears below:


Monday, November 9, 2015

ACA/Obamacare: No Cadillac Plan for You! Tax for You! Maybe Not So Much…..

Reid and Pelosi have been talking since the spring with President Obama about repealing the “Cadillac tax” on employer healthcare benefits, a senior Democratic aide confirmed on Friday.”

“Both Reid and Pelosi have remained relatively quiet on the tax since the bill's passage in 2010. Even as dozens of Democrats signed onto bills in their respective chambers to repeal it, Reid and Pelosi stayed in the background, refraining from public statements on the efforts.

Powerful labor groups such as the AFL-CIO and the American Federation of Teachers vehemently opposed the Cadillac tax from the start. They say repeal needs to happen soon, before employers begin trimming back healthcare benefits.

Aside from the question of how to pay for repeal, the Democrats' biggest roadblock is the Obama administration.” - Reid, Pelosi pushing for repeal of ObamaCare's 'Cadillac tax', the hill.com, 11/06/2015

Link to the entire article appears below:


Thursday, November 5, 2015

ACA/Obamacare: Sticker Shock