Tag Archives: health reform

A deeper look at the employer mandate and the work week

The employer mandate was pushed back for 2014 and is being phased in more gradually in 2015-16. What portion of the workforce does this affect?

And what’s going on with that “30-hour” work week? That’s how the Affordable Care Act defines full time, and the GOP has legislation (likely to pass the House in early March – far less likely in the Democratic-led Senate) that would change the definition to the more standard 40-hour week.

As we’ve pointed out before, you hear a lot of talk about how the Affordable Care Act will hurt small business. But if you report those claims, be careful of the definitions. Small businesses with fewer than 50 full time equivalent (FTE) workers are and have always been exempt from the employer mandate. They can, if they wish, get coverage through the new (but still fairly underdeveloped) SHOP exchanges. But whether they choose to and how much they contribute to their workers’ coverage is up to them. Continue reading

Understand role of catastrophic health plans and who’s eligible

ambulanceSo did the Obama administration let potentially millions of Americans buy the same kind of “junk” insurance policies that were being canceled because they didn’t meet new requirements of the health law? Not exactly.

In late December the White House said that anyone who had their plan canceled could, if they wished, get a “hardship exemption” from the individual mandate and purchase a catastrophic health plan (if such plans are available in their region).

These plans are far from generous. They aren’t designed to be. But they do have certain basic consumer protections that may meet the needs of some families. A big surge of individuals or families taking up this option could, however, hurt the overall exchanges if lots of healthy people take them. People covered under these plans could “count” toward the goal of getting 7 million Americans covered by the end of March 2014. But they don’t count as part of the exchange risk pools. They are apart. And the insurers fear that they will siphon off some of the healthier people that they need in the pool to keep costs sustainable. Continue reading

HealthCare.gov issues affect Medicaid enrollment

Here’s another HealthCare.gov problem – and a workaround – that haven’t gotten much attention.

People can apply for Medicaid (traditional or expanded) via the federal HealthCare.gov website. But the applications still have to get transferred to the states which have to process them to finalize enrollment in the actual state program. And it’s supposed to be done by Jan. 1.

Guess what? That was a problem. With all the website woes, the feds weren’t able to process that  information and had pushed back deadlines. Then, quietly, on the Friday of Thanksgiving weekend, CMS offered a transitional “administrative” fix through this federal policy guidance.

The states are allowed to use the minimal information on the so-called “flat files” to finalize the Medicaid status. The flat files had been pretty bare bones but CMS says expanded files will “include data elements such as: date of birth, Social Security number, eligibility category used for assessment or determination, and verification inconsistencies. The file will identify individuals who have been assessed or determined eligible for Medicaid and CHIP on the basis of modified adjusted gross income (MAGI).”

It would be good to check in with your state’s Medicaid director. Is this enough? Too little, too late? Will people be correctly enrolled in Medicaid by Jan. 1 – or will some be left uncovered, even if they did their part of the application process correctly?

Here’s a list of state Medicaid directors from the National Association of Medicaid Directors.

Covering health reform’s cancellation crisis

Image by Enokson via flickr.

Image by Enokson via flickr.

A few weeks into the cancellation crisis – some of which could be mitigated by the delay President Obama just announced – here’s what we know and what we don’t. In an upcoming post, I’ll highlight two very good stories exploring aspects of this.

Who’s affected?

The estimates on how many people are affected by plan cancellations vary widely. We’ve seen anything from “hundreds of thousands,” which is too low, to “up to 14 million,” which is too high. Continue reading

HHS releases enrollment numbers for marketplaces

The U.S. Department of Health and Human Services has released the much-anticipated numbers for the first month of enrollment in the ACA’s insurance marketplaces.

A quick breakdown from the press release:

  • 975,407 customers have gone through the process but have not yet selected a plan
  • 106,185 Americans selected health plans
  • 396,261 assessed or determined eligible for Medicaid or CHIP

The 28-page issue brief (PDF) from HHS has plenty of other numbers, including those for individual states and draws comparisons between the healthcare.gov rollout and the launch of other programs, including the Federal Employees Health Benefits Program, Medicare Part D, Massachusetts’ Commonwealth Care, and the Children’s Health Insurance Program.