Affordable Care Act Review

Affordable Care Act Review

Category Archives: Exchanges

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Developments February 6 – 10: Is the Price Right?

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
During the week reviewed, no new bill was introduced which, if passed, would repeal or replace the Affordable Care Act, and little else happened at the three main ACA enforcement agencies – DOL, HHS and IRS. Department of Labor The Department of Labor still has no Secretary and the nominee, Andrew Puzder, has not yet… Continue Reading

The End of the Beginning: Developments January 27 – February 5

Posted in Affordable Care Act, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
Nothing resembling a repeal/replace consensus bill emerged from any committee in either chamber during the survey period.  Instead, in a Fox News interview broadcast just before the Super Bowl, the President confessed that ACA repeal may require more than a year.  A concise summary by Peter Sullivan in The Hill is online here. Consistent with… Continue Reading

Hitch In the Giddy-up: Round-up of Developments January 19 – 27

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
As previously reported, § 2001 of the 2017 budget bill required all ACA repeal/replace bills to be filed and reported from assigned committees by Friday, January 27, 2017.  That didn’t happen.  Since our last posting, the bills listed below have been filed and assigned to committees, but no ACA bill has emerged from committee in either… Continue Reading

On Your Mark, Get Ready, to Go . . . Somewhere: Congressional Developments January 12-18

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Taxes
On January 13, the House passed the 2017 budget resolution (S. Con. Res. 3), which should be found on President Trump’s desk Monday morning.  As previously explained, this sets the stage for a filibuster-proof, budget reconciliation bill that can repeal and replace spending and tax provisions of the ACA. S. 106,  introduced January 12 by… Continue Reading

How’s This for a Dramatic Entrance?

Posted in Affordable Care Act, Exchanges, Taxes
As of Thursday morning, January 5, the general direction and pace of ACA repeal / replace legislation is discernible (details below), but the details are not.  News reports suggest that, despite persisting, material differences of opinion among members of the majority, leaders have committed to deliver an ACA bill to the new President by Monday,… Continue Reading

ACA Repeal Reality Check

Posted in Affordable Care Act, carrots, Coverage Mandates, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
We didn’t take ten weeks off because there was nothing to talk about.  Rather, we concluded around Labor Day that anything useful to be said about ACA compliance, pre-election, would be interpreted as political advocacy, so we decided to watch and wait.  The anti-ACA candidate won, and his party carried Congress, too.  That settles that,… Continue Reading

Stand Alone, Fixed-Indemnity Plans Are Back, Maybe

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Insurers and Brokers, Taxes
In Central United Life Ins. Co. v. Burwell, D.C. Cir. No. 15-5310 (July 1, 2016), a D.C. Circuit panel affirmed, 3-0, a trial court injunction barring enforcement of the 2014 HHS regulation permitting individual fixed-indemnity policies to be sold only as supplements to ACA minimum essential coverage. You’ve heard this theme before. The Public Health… Continue Reading

House v. Burwell: Insurer Cost-Sharing Subsidies Unauthorized

Posted in Affordable Care Act, Exchanges, Insurers and Brokers
A U.S. District Judge has ruled that HHS unlawfully has spent billions of dollars to reimburse insurers for cost-sharing reductions granted to individuals who bought health insurance through an ACA Exchange such as Healthcare.gov. U.S. House of Representatives v. Burwell, D.D.C. No. 1:14-cv-01967 (May 12, 2016). The Court stayed its ruling pending review by the… Continue Reading

ACA Myths That Just Won’t Die

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Private Employers, Taxes
Lawyers, politicians, economists, climate scientists, fad diet peddlers . . . we all know that it’s child’s play to persuade people of what they want to believe. Perhaps that explains the persistence of so many questionable beliefs about ACA compliance. Here are three examples. The Look –[way] back Measurement Method The ACA commands or allows employers… Continue Reading

How (and How Not) to Read This Blog

Posted in Affordable Care Act, Business Organizations, Community Health Needs Assessments, Coverage Mandates, Employee Leasing, Exchanges, Federal Contractors, Government Employers, Grandfathered Status, Independent Contractors, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes, Uncategorized
Nearly three years ago, having spent hundreds of hours immersed in ACA minutiae, we anticipated that clients would not react well to fees for services that consisted principally of telling them that they had asked the wrong question. So we decided, against tradition and much conventional wisdom, to sink lots of unpaid partner time into… Continue Reading

HHS 2017 Notice of Benefit and Payment Parameters

Posted in Affordable Care Act, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit
This is the annual hodge-podge of changes to the risk adjustment, reinsurance, and risk corridors programs, cost sharing parameters, cost-sharing reductions, and Healthcare.gov user fees, usually filling hundreds of Federal Register pages. Stuff gets buried deep, scattered among 45 CFR Parts 144, 146, 147, 153, 154, 155, 156 and 158. Yesterday (101 pages) was no… Continue Reading

Healthcare.gov: No 2015 Employer Subsidy Notices

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Private Employers, Taxes
On Friday afternoon, September 18, the Centers for Medicare and Medicaid Services (CMS) published a set of “Frequently Asked Questions Regarding the Federally-Facilitated Marketplace’s (FFM) 2016 Employer Notice Program.” The update is welcome for what it tells us about the subsidy certification appeal process beginning in 2016, summarized below. It’s troubling, however, for its confession… Continue Reading

Top Ten Healthcare.gov Subsidy Counties in Each SEC State

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Private Employers, Taxes
Why should you care? Subsidy certification of even one applicant claiming to be a full-time employee not offered affordable, qualifying 2015 coverage can cause the IRS to assess a non-deductible tax against the applicant’s alleged employer. Employers with low wage employees in a county with a high subsidy rate are most at risk. According to… Continue Reading

Will § 4980H Require Judicial Amendment Too?

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Private Employers, Taxes
Occasionally, a deep dive into a real world scenario opens our eyes to a plausible, alternate understanding of an important ACA term or rule.  Here’s one.  We’re embarrasssed to admit that our hours of study were provoked by what at first seemed to be a proverbial “stupid question.” Maybe there really aren’t any. Absent applicable transitional relief, most of which vanishes after 2015,… Continue Reading

Budgeting for Employer Mandate Tax Assessments

Posted in Affordable Care Act, Exchanges, Government Employers, Private Employers, Taxes
For October 1 fiscal year employers, it’s budget season. Calendar year employers aren’t far behind. Those doubting their employer mandate compliance need to accrue reserves for non-deductible assessments that the IRS may impose in the coming year. We can help you determine your maximum exposure but we can’t tell you that you have exposure, regardless… Continue Reading

Healthcare.gov Subsidies Trigger Employer Mandate Tax Assessments.

Posted in Affordable Care Act, Business Organizations, Coverage Mandates, Employee Leasing, Exchanges, Independent Contractors, Taxes
This morning, the Supreme Court of the United States, by a 6-3 margin, removed the last legal obstacle to employer mandate tax enforcement. Because the HHS had authority under Code § 36B to subsidize insurance plans bought through Healthcare.gov (according to an IRS rule), those subsidies properly will trigger Code § 4980H employer mandate tax assessments by… Continue Reading

King v. Burwell Forecast: Cloudy with a Chance of Panic

Posted in Affordable Care Act, Coverage Mandates, Employee Leasing, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
This is a compliance blog; we don’t do politics. But we can’t explain compliance consequences of the Supreme Court’s King v. Burwell opinion without acknowledging the political context. Here’s the June calendar of the Supreme Court of the United States.               Opinions are posted online on Monday or Tuesday, typically. As early as… Continue Reading

“CBO Says . . .”

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Taxes
It’s a Capitol Hill game. Anything that has any significant budgetary consequence may be lauded or condemned based on the Congressional Budget Office forecast of that consequence. So what has the CBO said about ACA subsidy payments, individual mandate and employer mandate penalties? We compared the CBO’s April 2014 Baseline with its January 2015 Baseline… Continue Reading

King v. Burwell Oral Argument – First Read of the Omens

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Insurers and Brokers, Private Employers
Apologizing to our readers for having advertised live audio that wasn’t, you really can find the Wall Street Journal’s live blog entries here.    The Court’s official audio and transcript may be available as early as March 6, according to some early estimations.  Based on accounts of observers who are commenting immediately, here are our first impressions of likely positions when… Continue Reading

Final HHS Notice of Benefit and Payment Parameters for 2016

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Insurers and Brokers
This is an annual regulatory publication that covers many Exchange and market reform initiatives. The early release that we read for this article was 474 pages long. You can read the more compact (129-page) Federal Register version here. These are our top ten take-aways. 10.  The 2016 annual cost sharing limits will be $6,850 for… Continue Reading

Hotel Healthcare.gov: Can You Ever Leave?

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Taxes
All of us over a certain age know the lyric from the Eagles’ Hotel California – “You can check out any time you like, but you can never leave.”  We’re receiving anecdotal reports that something similar may be true of www.healthcare.gov.  Most recently, we heard from a former executive who left her corporate job to launch a related consulting practice, happily so,… Continue Reading

CMS Approves Another Hybrid Medicaid Expansion – Indiana

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Providers - For Profit, Providers - Not-for-Profit
In a January 27, 2015 press release, the Centers for Medicare and Medicaid Services (CMS) announced approval of most of an ACA Medicaid expansion proposal called the Healthy Indiana Plan.  Here are highlights of approved elements: Begins February 1, 2015, funded 100% by HHS through 2016, the federal share to decline thereafter; Beneficiary contributions to “POWER” accounts… Continue Reading

HHS Notice of Benefit and Payment Parameters for 2016

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit
Running 324 pages, plus a six-page summary in its pre-release (easy to read) version this massive annual update will be published officially in the November 26, 2014 Federal Register.  Based on something like March Madness bracketology, we narrowed the large, attention-worthy field to these final four. No. 1: As previously threatened, HHS will amend 45 CFR § 156.145 to… Continue Reading