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Health Care Policy

These are some of the most recent developments related to the availability and quality of health care to Americans.

Lobby99 takes a position that our federal health care policies must meet several criteria...

o They must provide access to quality and timely health care for all Americans
o The cost must be reasonable for the overwhelming majority of Americans (including the poorest)

For more...
o Read our discussion of health care in America.
o Read our discussion of the Affordable Care Act (Obamacare).

Health care policy has been subject to politics that seem to serve the interests of political parties and those you elect to represent you, rather than your interests. Visit our section we call Bad Politics to read about some of your representatives' actions.

Related Issues

ObamaCare: What you should know
Repealing (and Replacing?) Obamacare
Dismantling Obamacare
Obamacare Work Week
Health Care for All Americans
Understanding Health Care Policy

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Another Republican lawsuit threatens ObamaCare

2018-Nov-14By: Barry Shatzman

Just as the 2019 open enrollment period for ObamaCare is beginning, a court case could nullify the entire law - sending the country's health care policy into chaos.

The case stems from the 2017 tax law that effectively eliminated the mandate to purchase health insurance for 2019. Attorneys General from 20 states with Republican legislatures then filed the suit - claiming that the law - the Patient Protection and Affordable Care Act (PPACA) - is unconstitutional without the mandate.

Although the defendant in the case is the federal government, the Trump administration said it wouldn't fight the lawsuit.

The administration did say it does not want the entire law nullified. Rather, it only wants the provisions that guarantee protection for people with pre-existing conditions nullified.

With the government refusing to challenge the suit, attorneys general from 17 states with Democratic leadership have been allowed to intervene as defendants.

Previous lawsuits against ObamaCare include King v. Burwell and NFIB v. Sebelius.

Reimbursements for low-income coverage to stop

2017-Oct-12By: Barry Shatzman

The federal government will stop reimbursing insurance companies for providing reduced cost health care to those with low incomes, Trump administration officials announced.

The Patient Protection and Affordable Care Act (Obamacare) requires insurance companies to lower the out-of-pocket health care expenses paid by those with incomes less than 2.5 times the federal poverty level who purchase silver-level coverage on their state's Insurance exchange .

It also requires the federal government to reimburse the companies - a payment referred to as Cost-Sharing Reduction Subsidies.

Although the law calls for these payments, Congress has not appropriated money for them since 2014. President Barack Obama continued to make the payments, and Republican Congressional leaders sued his administration - claiming the payments were unconstitutional.

A judge ruled in favor of the House Republicans, but the payments were allowed to continue through the appeal process. The Trump administration continued to make the payments until this announcement.

Congress could ensure the payments continue simply by allocating the money.

Who will be affected

The law still requires insurance companies to provide the reduced costs to those who earn less than 2.5 times the federal poverty level. Insurance companies planned for this (Trump had been threatening since he took office to stop the payments) by increasing premiums for silver policies

Why are the increases only for silver policies? Obamacare requires premium increases be justified by increased costs. Since silver policies are the only ones eligible for the cost-sharing reduction, those are the only ones that will bear increased costs to insurance companies.

In spite of the increased premium costs, those with incomes less than 4 times the federal poverty level will not pay the extra costs. That's because Obamacare limits how much you are required to pay for health insurance. As premium costs increase, so does the subsidy.

In fact, if you're eligible for subsidies, you might actually see a decrease in your premium (it may even be free). That's because the subsidy amount is based on the cost of a silver plan. So your subsidy will be higher, even if you choose a different level. It may be enough to cover the full cost of a bronze plan. It also may make a gold plan more affordable. This might be a good option if you are eligible for a subsidy, but not for the cost-sharing reduction subsidy (if your income is between 2.5 and 4 times the federal poverty level).

Those with incomes more than 4 times the federal poverty level (and therefore not eligible for subsidies) likely will pay more. Without subsidies, a silver plan might be unaffordable. However, because premiums for other levels likely did not increase as much, upgrading coverage to a gold or platinum plan (which would pay for more healthcare expenses), or downgrading to a bronze one (which would have less expensive premiums), could mitigate the effects.

But the biggest losers will be taxpayers. An analysis by the Kaiser Family Foundation estimates that the government will pay at least 20 percent more to insurance companies in subsidies for premiums than it would have paid in the cost-sharing reduction subsidies.

Latest Obamacare repeal attempt pulled

2017-Sep-26By: Barry Shatzman

Senate Majority Leader Mitch McConnell has announced that the latest Republican attempt to kill the Patient Protection and Affordable Care Act (Obamacare) will not be brought to a vote before the Sept. 30 deadline.

For now, as with the case of prior failed attempts, Obamacare remains the national health care policy.

The deadline is significant because it is the last day the Senate could pass the bill this fiscal year using the special budget reconciliation process - meaning it needed only 50 votes to pass rather than the normal 60 votes.

Senate Republicans could attempt another reconciliation bill, but that could conflict with a tax code rewrite they plan to use the process for.

The bill was being rushed through the Senate in order to meet the deadline. As a result, there were no serious committee hearings on it and the Congressional Budget Office (CBO) did not have enough time to more than a preliminary analysis - which said that millions of Americans would lose access to health care each year.

It also had been changing up until the last minute, as Senate Republican leaders offered undecided Senators additional funding for their states in an attempt to secure their vote.

It appeared to have the support of most Republicans. However, when Sens.John McCain, Rand Paul, and Susan Collins announced they would not support it, it was doomed to fall short by at least one vote.

Senate giving Obamacare repeal big final push

2017-Sep-19  (Updated: 2017-Sep-26)By: Barry Shatzman

Senate Republicans are trying one more time to repeal the Patient Protection and Affordable Care Act (Obamacare).

The bill, sponsored by Sens. Lindsey Graham and William Cassidy, effectively would eliminate Obamacare and all of its protections. It would...

o Eliminate the mandate - the requirement to have health care coverage.

o End the subsidies that help people afford insurance policies.

o End Cost Sharing Reduction Subsidies that help insurance companies reduce out-of-pocket expenses for those with low incomes.

o End Medicaid Expansion.

These benefits of Obamacare would be replaced with block grants given to states. Each state would essentially be free to use the money to set up any type of health care system it wanted.

The amount of the block grants, however, would not be enough to cover the benefits Obamacare provides. Yearly increases in the grants would be linked to an index that does not increase as much as health care costs do each year. In 2020 - just two years from now - block grants would be 16 percent less than they would be under Obamacare, the Center for Budget and Policy Priorities (CBPP) estimates.

With less money, states would need to make choices. And insurance companies would make choices based on what a state does.

o A state could allow insurance companies to charge more to people with pre-existing conditions. Or - without a mandate to cover the expenses of covering sick people - insurance companies could increase rates for everyone.

o A state could end the requirement that insurance policies cover essential health benefits such as preventive care or maternity care. Those getting the care would need to pay more. Or insurance companies could increase premiums to cover those services.

o A state could choose to not provide cost sharing reduction subsidies. Then insurance companies would need to increase rates for everyone to cover those costs. Or... the state could eliminate the requirement that insurance policies make healthcare affordable to those with low incomes.

o A state could increase taxes on its residents - to raise enough money to pay for these benefits.

The bill would eliminate funding for Planned Parenthood, and not allow insurance policies to cover abortions.

Some of the taxes that help pay for Obamacare, such as the Medical Device Tax, would be eliminated.

The bill also would increase the amount someone could contribute to a Health Savings Account (HSA). Income deposited into HSAs is not taxed. This therefore would reduce taxes on those who can afford to pay for health care though these accounts. Those who cannot afford to pay for their own health care through HSAs would get no benefit from this.

Senate Republicans will try to pass this bill by Sept. 30 - the last day on which they can use the special budget reconciliation process to pass the bill without it being susceptible to a filibuster. It is before the Congressional Budget Office (CBO) is expected to complete its estimate on how many people would lose insurance - or the cost to those who keep it.

Update 2017-Sept-26: The CBO released a "preliminary analysis" of the Graham-Cassidy bill. It said "The number of people with comprehensive health insurance that covers high-cost medical events would be reduced by millions" for each year during the next decade (compared to Obamacare).

Sabotaging Obamacare could cause steep premium jumps

2017-Sep-14By: Barry Shatzman

If your health premiums soar next year, don't blame Obamacare. Blame attempts to sabotage it.

By the end of September, insurance companies need to submit to the government the plans they will offer on states' insurance exchanges.

They base those rates on how much they expect to spend on their policy-holders' health care. But health care is so expensive that some premiums would have to increase by more than half for a company to pay that bill while maintaining their profits.

That's where a few provisions of Obamacare kick in.

The Mandate

One of those provisions is the mandate - the requirement that everyone have health care coverage.

It's a compromise. Obamacare requires that coverage be available to anyone - regardless of any pre-existing conditions they might have. That increases an insurance company's costs, meaning they would need to charge sky-high premiums in order to keep making a profit. The mandate brings healthier people - with lower health care costs - into the system. That allows premiums to be lower (it also has the side benefit of ensuring that if anything does happen to one of those healthier people, they would be covered).

Congressional Republicans and President Trump have advocated eliminating the mandate. While those attempts failed, Trump has not indicated if he would enforce the mandate. Without this assurance of the extra income the mandate provides, insurance companies must raise premiums for those who do buy insurance.

Cost-sharing reduction subsidies

Even with subsidized premiums, other out-of-pocket expenses can make health care unaffordable to those with low incomes.

Obamacare helps by boosting the coverage (and thus reducing out-of-pocket costs) for those with incomes less than 2.5 times the Federal Poverty Level. These Cost Sharing Reduction Subsidies - paid by the government to insurance companies - allows insurance companies to provide this increased coverage (and maintain their profits) without increasing premiums.

President Trump has thus far allowed these payments to be made, but has threatened to stop them. If they are stopped, insurance companies would need to increase premiums in order to maintain the low-income cost reductions Obamacare provides.

With the deadline to submit plans by the end of September, insurance companies have said they will propose significantly higher rates if they do not have assurance that the payments will continue. They will not rely on statements by Trump. Congress, however, can authorize these payments. That would make it difficult for the president to withhold them.

Sabotaging enrollment

Last year, the open enrollment period to purchase insurance on exchanges ran from Nov. 1 thru Jan. 31. The Trump administration has cut that in half. This year it will run from Nov. 1 thru Dec. 15.

Anyone who doesn't buy insurance by Dec. 15 will be subject to the tax penalty (if enforced), but also will not be eligible for Obamacare benefits such as subsidies and guaranteed coverage.

You might know that now because you read it on the Lobby99 website. But a third of the people who rely on insurance navigators to apply for coverage don't have internet at home. And the navigators can't tell them - because the administration has not renewed funding for them. That funding ran out on Sept. 1, and might not resume until October.

Who gets hurt by premium increases?

The short answer - anyone who makes more than 4.5 times the Federal Poverty Level and buys their own insurance.

Slightly longer answer - for those who make less than 4.5 times the Federal Poverty Level, premiums are subsidized by the federal government. They will pay roughly the same amount regardless of premium prices. Those with incomes of more than 4.5 times the Federal Poverty Level do not receive subsidies - and therefore will pay the full amount of any increases.

Obamacare repeal attempts likely over at month's end

2017-Sep-01By: Barry Shatzman

The repeated attempts to repeal the Patient Protection and Affordable Care Act (Obamacare) likely will end Sept. 30.

The Senate parliamentarian ruled that attempts to use the budget reconciliation process to repeal major provisions of the law cannot go beyond that date - which is the end of the country's fiscal year.

The Senate is allowed one reconciliation bill per fiscal year. Senate Republicans could introduce another one in October to repeal Obamacare, but they are hoping to use the process to reduce taxes - mostly for corporations and wealthy Americans. Technically, they could combine the issues into a large bill, but that would make it much more difficult to pass with their slim majority.

They also could attempt to gut the health care policy with a regular bill. That, however, would be subject to a filibuster, meaning they would need support from at least a few Democrats.

House announces new attempt to repeal Obamacare

2017-Aug-11By: Barry Shatzman

Just when you thought it was safe to go back to the doctor...

A group of House Republicans is attempting to use a rarely used tactic to force another vote on repealing the Patient Protection and Affordable Care Act (Obamacare).

Rep. Mark Meadows and other members of the House's Freedom Caucus are hoping to get a majority of House members to sign a discharge petition on a bill that would repeal Obamacare, but provide nothing to replace it. It would delay implementation for two years - in order for Congress to come up with a replacement.

The bill was introduced in March, but was not acted on by House committees. If the discharge petition receives enough votes, the bill would be discussed and voted on by the full House.

A similar measure (known as a clean repeal) was introduced as an amendment to the American Health Care Act in the Senate. It failed by a vote of 45-55.

It also is a copy of a bill passed by both the House the Senate in 2015. It was vetoed by President Barack Obama.

Bipartisan group seeks to fix Obamacare problems

2017-Aug-05By: Barry Shatzman

A group of Republicans and Democrats in both the House and Senate have agreed to conduct inclusive talks on how to ensure the Patient Protection and Affordable Care Act (Obamacare) continues to help provide health care insurance for millions of Americans.

Republican attempts to repeal key components of the bill have failed - in part because the Congressional Budget Office (CBO) estimated that more than 20 million people could be left without health care coverage.

The timing is important. Insurance companies have until Aug. 16 to announce where they will offer coverage for 2018, and until Sept. 27 to commit to what insurance plans they will offer. Without knowing what costs the federal government intends to cover, they are likely to request higher premiums - or withdraw from certain markets altogether.

No bill has been introduced yet, and hearings in the Senate aren't expected to begin until September, according to Sen. Lamar Alexander.

A framework, however, has been publicized. A key provision would make it mandatory for the federal government to continue paying the Cost Sharing Reduction Subsidies - which make insurance and health care more affordable to those who earn up to 2.5 times the Federal Poverty Level.

Without these subsidies, insurance premiums would increase by 20 percent, according to the Kaiser Family Foundation. President Trump - who continues to express his desire for a complete repeal of Obamacare - has threatened to withhold the payments.

Other proposed components of the bipartisan compromise include...

o Creating a "stability fund" for states to use to subsidize coverage for those with chronic or pre-existing conditions.

o Reducing the requirement for businesses to provide health care insurance for their employees. Currently, companies with more than 50 employees who work 30 hours per week must provide insurance to those employees. Under the proposal, only companies who employ more than 500 employees who work 40 hours per week would be required to provide insurance.

o Repealing the Medical Device Tax.

o Making it easier for states to sell insurance across state lines.

In the House, the compromise is being propelled by representatives who refer to themselves as the Problem Solvers Caucus.

House Speaker Paul Ryan said through a spokesperson that he would not support such a compromise - and would remain focused on repealing Obamacare.

Senate fails to pass Obamacare repeal

2017-Jul-28By: Barry Shatzman

Senate Republicans narrowly failed to pass a version of the bill that would repeal crucial parts of the Patient Protection and Affordable Care Act (Obamacare).

Referred to as the Skinny Repeal amendment, the 8-page bill would have completely replaced the text of the bill passed by the House

Had the amendment passed, the Senate would have cast an additional vote to pass the bill. Because the bill would have been identical to the amendment, it likely would have passed with an identical vote. The House of Representatives then would have needed to pass that version before sending it to President Donald Trump for his signature.

After the amendment's rejection, Sen. Majority Leader Mitch McConnell signaled that Senate would no longer pursue a one-party attempt to repeal Obamacare.

That means for now, Obamacare remains the nation's health care policy. That does not mean it is safe.

While McConnell might have dropped the effort for now, the bill remains active. All that was voted down was an amendment to it. Under normal circumstances the distinction wouldn't matter because a new bill could always be drafted. This bill, however, was utilizing the budget reconciliation process - which is immune to a filibuster. Subsequent bills would not be allowed to use that process, and therefore would require the support of several Democrats.

Senate votes to debate Obamacare replacement

2017-Jul-25By: Barry Shatzman

After failing to build enough support for its own proposal to repeal the Patient Protection and Affordable Care Act (Obamacare), the Senate voted to debate the version passed by the House of Representatives.

The vote on the motion to proceed was 51-50, with Vice President Mike Pence casting the tie-breaking vote.

The vote merely allows the bill to be debated. Whatever the Senate ultimately votes on is virtually certain to contain significant differences from the House version.

The changes will be made through a series of amendments. Any Senator will be able to submit amendments. Each amendment will be voted on as to whether to incorporate it into the final version of the bill.

If that final version is passed by the Senate, a conference committee would convene to reconcile the differences.

Obamacare safe for now - but what next?

2017-Jul-18By: Barry Shatzman

Once again, for the foreseeable future, the Patient Protection and Affordable Care Act (Obamacare) will remain the national health care public policy.

Sen. Majority Leader Mitch McConnell announced that there were not enough votes to pass the Senate's bill that would have replaced Obamacare.

Only 50 votes were needed to pass the bill under the special procedure known as budget reconciliation. But of the 52 Senate Republicans, two (Susan Collins and Rand Paul) already had said they would not support it. After Sens. Mike Lee and Jerry Moran announced they would not support it, the bill had no chance to pass without support from some Democrats - who all opposed it.

Despite the bill's demise, Republican attempts to end Obamacare may continue.

Two options have been discussed - both of which would effectively end Obamacare without providing a replacement. Instead, Obamacare provisions would be phased out over two years - effectively giving Congress two years to come up with a replacement policy.

One option would be to keep the structure of Obamacare in place while eliminating all of the financial aspects. An identical bill - sponsored by then representative and now Health and Human Services Director Tom Price - was vetoed by President Obama. The Congressional Budget Office (CBO) estimated that more than 30 million Americans could have lost insurance coverage over the next decade had the bill become law.

Three Republican senators - Lisa Murkowski, Shelly Moore Capito, and Collins - have said they would not support the bill, meaning it would not get the 50 votes needed to pass.

The other option - a direct repeal of all Obamacare provisions - would not be eligible for the budget reconciliation process - and therefore would require 60 votes to pass.

There is no guarantee that, even under a deadline, Congress would agree to a new policy. In 2013, Congress was forced to implement budget cuts to every agency - known as the sequester - after a committee of representatives and senators could not agree on a budget by a self-imposed deadline.

Senate postpones vote on Obamacare replacement

2017-Jun-27By: Barry Shatzman

The Senate will not vote this week on a proposal to replace the Patient Protection and Affordable Care Act (Obamacare) as the nation's health care policy.

Details of the bill - which had been decided in secrecy by a handful of senators - were revealed on June 22. The Congressional Budget Office (CBO) analysis was not released until June 27. Yet Sen. Majority Leader Mitch McConnell said a vote on the bill would take place on June 29.

The CBO estimate was similar to that of the House version of the bill - that more than 20 million people who otherwise would remain insured under Obamacare would become uninsured over the coming decade.

The Senate is expected to resume discussion of their proposal in July.

Senate reveals Obamacare replacement

2017-Jun-22By: Barry Shatzman

The Senate has revealed its version of a bill to replace the Patient Protection and Affordable Care Act (Obamacare) as the nation's health care policy.

The House passed the bill in May, but the Senate had said it would propose changes. Those changes were arrived at in closed-door meetings with just a few Republican senators.

Similar to the House's American Health Care Act, the Senate's Better Care Reconciliation Act mimics some of Obamacare's provisions, but reduces financial help to older and poorer Americans, and weakens key protections for the less-healthy.

Those cuts to health care would increase the ranks of the uninsured by 20 million people over the next decade, the Congressional Budget Office (CBO) estimates. Most of the money saved from these provisions would go to health insurance companies and those earning more than $200,000 a year.

The law makes several critical changes to Obamacare...

o It eliminates the requirement for people to buy insurance (the mandate).

o It reduces the amount of assistance that helps people pay for insurance.

o It also lowers the income threshold to receive assistance. Obamacare provides this assistance for those who earn up to 4 times the federal poverty level (FPL), while this bill would help those who earn only up to 3.5 times the FPL.

o It severely cuts Medicaid.

o It eliminates taxes (mostly on those who earn more than $200,000 in a year) that were created by Obamacare to pay for the services it provides.

The bill would keep in place several key Obamacare protections - such as guaranteeing coverage for essential health benefits and guaranteeing those with pre-existing conditions could obtain coverage without being penalized.

Though those protections remain in the bill nominally, they are less secure and offer significantly less protection than Obamacare. That's because insurers would be permitted to offer policies that cover less than those required by Obamacare. So those needing more health care would find themselves paying either higher premiums or more out-of-pocket expenses than they currently do.

Although details of the bill were created in secrecy and just announced, Sen. Majority Leader Mitch McConnell says the Senate will vote on the bill in a week.

If the Senate passes their version of the bill, the differences between the two versions would need to be reconciled into a single bill by both houses of Congress before a final bill could be sent to the president for ratification.

Trump praises Universal Health Care system

2017-May-05By: Rob Dennis

Just hours after he celebrated the House of Representatives passing a bill that would take away health care from millions of Americans, President Donald Trump praised the universal health care system of another country.

Trump was meeting with Australian Prime Minister Malcolm Turnbull when he talked about the American Health Care Act. The Congressional Budget Office (CBO) estimated that a similar version of the bill would cause 24 million people to lose coverage over the next 10 years. The House passed the latest version before the CBO could estimate its effect. The bill still needs to pass the Senate in order to become law.

"Right now
Obamacare is failing. We have a failing health care," Trump said. "I shouldn't say this to our great gentleman and my friend from Australia, because you have better health care than we do."

Australia's system gives all of its citizens free access to health care paid for by the government.

In response to the president's praise of universal health care, Sen. Bernie Sanders - who has proposed universal health care bills - replied..

"Well Mr. President, you're right. In Australia and every other major country on earth that guarantee health care to all people, they don't throw 24 million people off health insurance. So maybe when we get to the Senate, we should start off with looking at the Australian health care system, or the Canadian health care system, which guarantees health care to all people - at a much lower cost per capita than we do."

House passes Obamacare replacement bill

2017-May-04By: Barry Shatzman

The House of Representatives has passed a bill to replace the Patient Protection and Affordable Care Act (Obamacare) as the nation's health care policy.

The American Health Care Act (AHCA) mimics some of Obamacare's provisions, but reduces financial help to older and poorer Americans, and weakens key protections for the less-healthy.

The cuts to health care would increase the ranks of the uninsured by 20 million people over the next decade, the Congressional Budget Office (CBO) estimates.

Most of the money saved from these provisions would go to health insurance companies and those earning more than $200,000 a year.

The law makes several critical changes to Obamacare, including....

o Eliminating the requirement for people to buy insurance (the mandate)

o The way health insurance policies are subsidized by the government

o Severely cutting Medicaid

o Eliminating taxes (mostly on those who earn more than $200,000 in a year) that were created by Obamacare to pay for the services it provides.

It originally had kept several key Obamacare protections in place - such as guaranteeing coverage for essential health benefits and guaranteeing those with pre-existing conditions could obtain coverage without being penalized.

Those protections remain in the bill nominally, but are less secure and offer significantly less protection than Obamacare.

That's partly because a group of Republicans had held out for a bill that did not include these protections. A compromise offered by Rep. Tom MacArthur allows states to reduce the protections.

The bill now will be discussed by the Senate. If the Senate passes a version of the bill, the differences between the two versions would need to be approved by both houses of Congress before a final bill could be sent to the president for ratification.

Planned Parenthood protection revoked

2017-Apr-13By: Barry Shatzman

President Trump has signed a bill revoking an Obama administration rule that would have prevented states from withholding certain federal funds from Planned Parenthood.

The funds, known as Title X funds, are used to provide family planning and related preventive services to those with low incomes. Several states have attempted to block those funds from going to Planned Parenthood, because one of the services they provide is abortion.

The money already could not be used to pay for abortions. All federal appropriations bills over the past four decades have included the Hyde Amendment, which explicitly prohibits it.

The potential effect of the rule was questionable even if it had remained in place. Just before it was to take effect, a federal judge blocked it.

Though states wanting to block Planned Parenthood from receiving funds now can try, it remains illegal to discriminate against them simply because they provide abortion services. Courts consistently have rebuked such efforts.

Because bill was passed using the Congressional Review Act, it was not subject to a Senate filibuster. Needing only a simple majority, the vote in the Senate was tied 50-50. Vice President Mike Pence cast the 51st vote to pass the bill.

House will pay Obamacare subsidies it fought to withold

2017-Mar-30By: Barry Shatzman

While Barack Obama was president, House Republicans did everything they could to avoid paying subsidies specified in the Patient Protection and Affordable Care Act (Obamacare) to make insurance affordable for low-income people.

The Cost Sharing Reduction Subsidies reduce deductibles, copayments, and out-of-pocket maximums for those who earn less than 2.5 times the Federal Poverty Level.

In 2014 House Republicans refused to appropriate the money. In 2015, when Obama paid the money anyway, they sued the administration. They claimed it was unconstitutional for Obama to spend the money because the House never appropriated it.

And they won. The only reason the subsidies continued is that the court allowed it while the administration was appealing the case.

When Donald Trump became president, everything flipped. Trump chose to continue the appeal, even though dropping it would have forced the subsidies to stop.

Now, after failing to pass a new health care policy to replace Obamacare, the same House Republicans that sued for the right to stop the payments and won say they will keep paying the subsidies for the foreseeable future.

Even so, House Speaker Paul Ryan says he will not drop the lawsuit.

Obamacare replacement pulled minutes before vote

2017-Mar-24By: Barry Shatzman

Minutes before the House of Representatives was to vote on the bill to replace the Patient Protection and Affordable Care Act (Obamacare) as the nation's health care policy, House Speaker Paul Ryan pulled it after realizing it would not have enough votes to pass.

Though Republicans hold the majority in the House, and virtually every Republican has expressed a desire to repeal Obamacare, many differed on the direction a replacement bill should go.

The American Health Care Act (AHCA) as originally introduced would have kept some parts of Obamacare in place - to some degree at least - such as...

o Providing government help to purchase health care insurance.

o Requiring insurance companies to charge the same for for anyone regardless of any pre-existing conditions.

o Prohibiting annual and lifetime caps.

o Requiring policies to cover basic health care needs such as mammograms and colonoscopies.

But subsidies would have been reduced and other protections relaxed. Various assessments, including one from the Congressional Budget Office (CBO), estimated that costs for poorer and older people would have soared. The bulk of the savings would have gone to those who make more than $200,000 a year. All while tens of millions of people who would have insurance under Obamacare would not have it under the AHCA.

All Democrats said they planned to vote against the bill.

A few Republicans said the cuts would be too extreme, and also planned to vote against it. Several, however, said they would not support the bill because the cuts didn't go far enough.

In last-minute negotiations between President Donald Trump and House Republican leaders, it was agreed that most of the Obamacare protections would be cut from the bill. That would have left the country's health care policy similar to what it was before Obamacare - with insurance being prohibitively expensive for sick, and very cheap policies available for those who are young and healthy, which would not have provided much help if they did get sick.

That would have lost votes of more moderate Republicans, however.

Though the bill remains active in the House (as it was not voted down), there are no known immediate plans to act on it. That keeps the Patient Protection and Affordable Care Act as the nation's health care policy for the foreseeable future.

Obamacare replacement would cut health care, benefit wealthy

2017-Mar-20By: Barry Shatzman

Republicans in the House of Representatives have introduced the bill they plan on using to replace the Patient Protection and Affordable Care Act (Obamacare) as the nation's health care policy.

The American Health Care Act already has been discussed in several House committees over the past few weeks, but it hadn't been formally introduced until now. The House plans to have a full vote on passage on March 23. It then would be considered by the Senate. If it passes the Senate, it would need to be signed into law by President Trump. Trump has said he would sign it.

The law makes several critical changes to Obamacare, including....

o Eliminating the requirement for people to buy insurance (the mandate)

o The way health insurance policies are subsidized by the government

o Severely cutting Medicaid

o Eliminating taxes (mostly on those who earn more than $200,000 in a year) that were created by Obamacare to pay for the services it provides.

The cuts to health care would increase the ranks of the uninsured by 20 million people over the next decade, the Congressional Budget Office (CBO) estimates.

Though that would reduce government expenditures, by eliminating the taxes that were funding the law, virtually all of the saved money would be returned to health insurance companies and those earning more than $200,000 a year.

Trump passes on first real chance to end Obamacare

2017-Feb-21  (Updated: 2017-Mar-05)By: Barry Shatzman

President Trump had his first real chance to can the Patient Protection and Affordable Care Act (PPACA). Instead, he kicked the can down the road.

In 2015, the Republican-led House of Representatives sued the Obama administration over Cost Sharing Reduction Subsidies paid to insurance companies. That money helps reduce premiums and deductibles for low-income people. Though the money is specified in the law, Congress had not allocated it since 2014. Therefore, House leaders claimed, the Obama administration violated the constitution by spending money Congress did not allocate.

The case is House v. Price (changed from House v. Burwell when Tom Price became Secretary of Health and Human Services).

In May 2016, a federal court judge agreed with the House leaders' argument and ruled against the administration. The administration immediately appealed, and the judge allowed the payments to continue during the appeal process.

With Trump now as the head of the administration, he had until late February to decide whether to continue the appeal or simply drop it.

Had he dropped it, the court's decision would have become permanent and payments to insurance companies would stop immediately. Unless Congress were to authorize the payments (with Trump's approval), several insurance companies either would need to increase premiums significantly or drop out of the marketplace - causing many to lose health care coverage.

The administration has until May 22 to decide its next steps, and to provide the court with status reports every three months afterward.

Trump order demands Obamacare changes. What changes?

2017-Jan-20  (Updated: 2017-Jan-24)By: Barry Shatzman

On his first day in office, President Trump issued an executive order stating the Trump administration's intent to seek the repeal of the Patient Protection and Affordable Care Act (PPACA) and give more control to individual states in setting health care policy.

A section of the order states the Health and Human Services (HHS) secretary and other agencies shall do everything within their legal powers to...

"...waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications."

The order contains no specific instructions, and it is unclear what it will (or even can) do.

For one thing, an executive order cannot repeal a law, so the PPACA still remains in place. For another, to issue a new regulation to alter how the law is implemented, an agency would need to go through a lengthy and detailed process.

For another thing, the PPACA is made up of a complex set of pieces that all work together.

For example, one of the quicker effects from the order could be a loosening of the requirements for an exemption to the mandate - resulting in many more people legally opting out of buying health insurance. The customers insurance companies lose likely would be among the healthiest - which likely would require them to increase premiums for their remaining customers.

But nobody knows if even that will happen. In spite of the confusion, the PPACA still is the nation's health care policy. Nothing has changed. You have the same coverage today as you had yesterday. It also means that anyone required to have insurance still faces a minimum $695 fine if they don't obtain it by Jan. 31.

Obamacare premium increases - the reality

2016-Oct-24  (Updated: 2016-Nov-17)By: Barry Shatzman

Monthly premiums for health insurance policies purchased on state insurance exchanges will increase by an average of 25 percent in 2017, the federal government reported.

Also, those who use the exchanges will find themselves with fewer choices. One in five will find only a single company offering policies.

The situation, however, doesn't mean the Patient Protection and Affordable Care Act (Obamacare) is not helping most Americans.

For one thing, most people don't pay the full premium they see listed on the exchange website. Most who earn less than 4 times the federal poverty level receive subsidies that pay a large part of their premium. After accounting for subsidies, about three-fourths of those using the exchange will be able to find a policy costing less than $100 a month, according to the Obama administration.

Not that this is perfect. To obtain the lower rate, someone likely would need to reduce their coverage - such as requiring a higher deductible and fewer choices of doctors. However, the Department of Health and Human Services estimates that the average person can reduce their premium by simply switching to the lowest-cost plan at the same policy level they already have.

Is Obamacare to blame?

Obamacare does not set insurance rates - insurance companies do. Obamacare actually limits those rates. Insurance companies must spend at least 80 cents of every premium dollar on actual health care. Only 20 percent of money from premiums can be used for salaries, marketing, etc. Obamacare also requires government approval for rate increases of more than 10 percent.

Evidence suggests that premiums would be much higher had Obamacare not been enacted. For employer provided insurance (where more than half of the non-elderly population gets their coverage), the Kaiser Family Foundation reports that in the years before Obamacare took effect...

o From 2001 to 2006, average family premiums rose 63 percent
o From 2006 to 2010, average family premiums rose 31 percent

In the past 5 years (with Obamacare), average family premiums rose 20 percent.

Supreme Court preserves Obamacare subsidies in all states

2015-Jun-25By: Barry Shatzman

If you benefit from insurance premium subsidies provided by the Patient Protection and Affordable Care Act (PPACA), you can keep receiving them even if your state uses the federal insurance exchange rather than one of its own.

The Supreme Court ruled in King v. Burwell that the subsidies are allowed by the law, in spite of the contentious phrase that assistance is available for health plans "... which were enrolled in through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act..."

The case was coordinated and funded by the libertarian think tank Competitive Enterprise Institute (CEI).

The government argued that many other parts of the law show that Congress intended for all exchanges to be treated equally. They have been treated equally - regardless of whether it was administered by the individual state or the federal government - ever since the law was implemented. No member of Congress who passed the law in 2010 has ever said it was their intent to treat the exchanges differently with regards to the subsidies.

In his majority opinion, Chief Justice John Roberts wrote...

"The combination of no tax credits and an ineffective coverage requirement could well push a State's individual insurance market into a death spiral. It is implausible that Congress meant the Act to operate in this manner...

Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter."

Obamacare exchange users will need to reconcile with IRS

2015-Mar-25By: Barry Shatzman

If you bought health insurance using the health insurance exchanges, you likely received a subsidy based on the income you stated. And chances are your estimate was off.

Only about 5 percent of those using the exchanges estimated their 2014 income correct, according to report from the Kaiser Family Foundation. If you estimated wrong, the Internal Revenue Service (IRS) wants to reconcile the miscalculation with the amount of assistance you received.

Just over half earned more than they estimated and will need to make up at least part of the extra financial assistance they received. Just under half overestimated their 2014 income. They will receive a refund for part of their premiums they should have received assistance on.

The concept is similar to the way tax refunds work. If you had more taxes withheld than the amount of tax you owe, you get a refund. If you didn't have enough withheld, you send a check to the IRS.

If your family's income or status changes during the year, you are supposed to inform your exchange so the amount of your subsidy can be adjusted. But it's your total income as a percentage of the poverty level at the end of the year that matters, so estimates still might be off. Even if you owe money, you might not have to pay back the full amount of the extra benefit you received. Unless you earned more than 4 times the federal poverty level, the amount you owe will be capped. If your income turned out to be below the poverty level, you will not be required to pay.

For more details on how this works and how it may affect you, read the Kaiser Family Foundation report.

Supreme Court hears case that could cost millions health insurance

2015-Mar-04  (Updated: 2015-Mar-05)By: Barry Shatzman

The Supreme Court heard oral arguments in King v. Burwell - a case that could have devastating effects on more than 10 million Americans.

The case will decide whether...

Anyone who purchases health insurance on an insurance exchange set up under the Patient Protection and Affordable Care Act (PPACA) is eligible for a subsidy to help pay the cost of the premium

or...

Subsidies are available only to those in states that operate their own exchange

Currently 34 states use the federal exchange, meaning that their residents would lose subsidies they now receive.

The Court is expected to announce a decision in June.

For a better understanding of this, including what you can do, read our explanations of the law and the court case.

Extended enrollment period for Obamacare insurance announced

2015-Feb-20By: Barry Shatzman

If you missed the Feb. 15 deadline for buying health care insurance, you likely will need to pay a penalty with your taxes next year. But you might have another opportunity to obtain coverage and avoid the penalty.

The Centers for Medicare & Medicaid Services has announced a special open enrollment period from March 15 through April 30 for people who may not have been aware of the consequences for not being insured.

The Patient Protection and Affordable Care Act (PPACA) requires every household which earns more than the federal poverty level to obtain health care insurance or pay a tax penalty. According to the federal agency, many people first became aware of the penalty when they went to file their taxes this year - and found out they owe it for not being insured in 2014. By that time, the deadline for obtaining insurance this year already had passed - meaning that they would...

o Owe another penalty when they file their taxes next year. The minimum penalty is 2 percent of household income, with a minimum of $325 per person.

o Not be able to purchase insurance on the insurance exchanges.

The extension will give those people a second chance to obtain insurance and avoid the penalty. They still will be required to pay a penalty for the months in which they were uninsured.

For more, read the USA Today story or visit ObamacareFacts.com.

House passes bill to relax Obamacare employer requirements

2015-Jan-09By: Barry Shatzman

The House of Representatives has passed a bill that could cost a million people their health insurance that currently is paid for by their employer.

The Save American Workers Act would change the rules for companies required to provide health coverage to their employees. Currently, companies with more than 50 employees are required to offer insurance to any employee who works at least 30 hours. The law would change that threshold to 40 hours.

Most workers would not be affected - since their company would provide health benefits as an incentive to hire the best people. However, the Congressional Budget Office (CBO) estimates that up to a million workers could see their work week reduced to 39 hours - meaning their employer would not have to offer them benefits.

These employees then would need to obtain their insurance through their state's health insurance exchange. Many of these policies will be subsidized by the federal government, costing taxpayers $5 billion a year over the next decade, according CBO estimates.

Companies with fewer than 50 employees are not required to provide health insurance. That would not change under the new law.

In order to become law, the bill also must pass the Senate, and then be signed by the president. President Obama has indicated he would veto it.

For more, read the New York Times story.

For more analysis and what you can do, read our discussion of this issue.

IRS wants you to reconcile your Obamacare subsidy

2015-Jan-02By: Barry Shatzman

If you purchased health care insurance on an insurance exchange and received a subsidy to help pay for it, that subsidy was based on the income you stated when you applied. If you got it right, you're fine.

But if you underestimated your income - whether unintentionally or intentionally - the IRS expects you to pay what you would have paid had you gotten it right (if you overestimated you will get credited for the amount you overpaid in premiums).

True, it's hard to know sometimes at the end of one year what you might earn the next. Even if it was an honest miscalculation, however, it was up to you to report changes in your circumstances - whether it's a change in income or family makeup.

One bit of help... if you still are eligible for a subsidy the most you will have to pay is $2,500.

The amount you received will show up in an IRS Form 1095-A, which will be mailed to you and also posted on your exchange account. You then will need to fill out Form 8962 that will reconcile what you actually received with what you should have received.

If that sounds complicated, then you might be interested in the issue we explained last year about IRS funding.

For more, read the CNN Money story.

Obamacare premium jumped? How to cure it.

2014-Dec-07By: Barry Shatzman

Have you noticed a large increase in your health insurance premiums for 2015? If you buy your insurance on one of the Patient Protection and Affordable Care Act insurance exchanges, there may be something you can do about.

The problem might not be the increased premium charged by your insurance company. Rather, it might be a reduced subsidy or tax credit from the government that helps you pay the premium.

The reason is that more companies are offering policies on the exchanges for 2015, and it's likely there are policies at the same metal level as yours that are less expensive. And the amount of help the government provides is based on the cost of policies. Therefore, cheaper policies mean less assistance.

To save money, go to the exchange and compare policies. You likely will find one from a different company with the same level of coverage - only cheaper.

You can get more details in this report from the Department of Health and Human Services.

You also can read more in this Washington Post story.

Note: We generalized when we said the amount of government help is based on the cost of policies. Technically, it is based on the second-cheapest silver policy. But that would have made our explanation a bit less clear.

Insurnace buyers on exchange not told of narrowed networks

2014-Jul-09By: Barry Shatzman

Many people signing up for health care insurance on exchanges set up under the Patient Protection and Affordable Care Act (PPACA) are discovering their doctor no longer is part of their provider network. And they're learning it the hard way - by receiving a bill for services they assumed were covered.

In order to save costs and offer lower premiums on plans they sell on the exchange, some insurance companies have been limiting the number of providers they include in their network. They also have been offering plans as Exclusive Provider Organizations (EPO), rather than Preferred Provider Organizations (PPO). While legal, many consumers either don't notice the changes or understand them.

A class-action lawsuit is charging that a large California insurance company did not even tell enrollees about the changes. It claims that Anthem Blue Cross did not tell enrollees that their is doctor not included in their narrower plan's network. Nor did they tell enrollees that their new plan was an EPO - which would not cover services provided outside of the network - until the deadline set by the PPACA for changing their plan had passed.

For more, read the Kaiser Health News story.

Senate bill would provide for health care to every American

2013-Dec-17By: Barry Shatzman

Sen. Bernie Sanders has introduced a bill that would guarantee health care for every American - and most people would pay less than what they pay now.

Here's how it would work...

o You go to the doctor - whether you're sick or for preventive care such as a checkup.

o You don't pay, and there is no insurance information to provide

o The doctor will be paid by the state he or she practices in.

This type of system is known as a single-payer system, because providers are paid by a single source (in this case their state government) rather than from a multitude of insurance companies.

The state would obtain the money to pay providers from the federal government, which would get it from a health care tax on employers and employees.

o Employers would pay 6.7 percent of wages to the tax.
o Anyone earning less than $200,000 in a year would pay 2.2 percent of their taxable income. Those with higher incomes would pay more.

Click here to read our explanation of the bill.

For more, read the Vermont Public Radio story.

President to allow people to keep existing health insurance policies

2013-Nov-15  (Updated: 2013-Nov-16)By: Rob Dennis and Barry Shatzman

Over the past few months, many Americans who purchase their own health insurance have received letters from their insurance company informing them that their policies would be canceled because they do not provide services required by the Patient Protection and Affordable Care Act (Obamacare).

Most Americans are not affected by this, since they will continue to be covered through their jobs, Medicare, or Medicaid. However, President Obama had stated repeatedly in the past that anyone who likes their existing policy would be allowed to keep it.

Obama announced on Nov. 14 that the required cancellations will be postponed for a year. Insurance companies now will be allowed to renew the sub-standard policies to those who already own them.

Many of the cancellation notices referred policy holders to alternative plans available through the same insurance company, and also suggested shopping for a policy on their state's or the federal health insurance exchange (marketplace).

It is possible that the new policy would cost more (though it would provide better protections). However, many Americans are eligible for subsidies if they purchase a policy using the insurance exchange - and those subsidies could reduce the cost to lower than what they pay now.

It's unclear what impact the president's announcement will have on whether someone keeps their existing plan...

o While people can keep their existing plans, they might not do so if a new plan would provide them with a cheaper and better alternative.

o Insurance companies are not required to continue to offer the existing plan. Even if they did, the plan may not cost the same (and would not be eligible for subsidies). In addition, insurance commissioners of some states say they do not intend to allow insurers to reinstate the policies, according to the New York Times.

The reversal by the president also may impact those who have not received notices or who already planned to find a new policy on the insurance exchange.

Unlike new plans - which must accept anyone regardless of their health - previous plans can limit enrollment to only the healthiest applicants. If too many of the healthiest people choose to keep their old policies (which would leave them at greater financial risk if they have an accident or get sick), that would raise the proportion of less-healthy people in the new plans offered on the exchanges. That would make the new policies less profitable to the insurance companies, who might increase premiums to ensure their profits.

The Affordable Care Act has built-in protections against this, however. The subsidies will make policies affordable for many young people - which could help make compliant policies a good deal for them. A lesser-known provision of the law also provides subsidies to insurance companies if they end up needing to pay excessive benefits. This could encourage them to keep premiums reasonable, in a attempt to capture a larger share of the market.

For more, read the Washington Post story or this New York Times story.

Update 11/15/2013: The House of Representatives approved a bill by Rep. Fred Upton that would allow people to buy the plans that don't meet Obamacare's higher standards, even if they don't already have such a policy. The bill still would need to be approved by the Senate and signed by the president in order to become law.

States refusing Medicaid expansion leave poorest uncovered

2013-Oct-02By: Barry Shatzman

Three out of every five currently uninsured poor people will remain uninsured under the Patient Protection and Affordable Care Act. And all for the same reason - they live in the wrong state.

Half of the country's states have refused to expand Medicaid to their residents in the donut hole - those who make too much to qualify for Medicaid but too little to qualify for subsidized insurance from the new health care exchanges.

Those states comprise about half of the country's population, yet they comprise 60 percent of the uninsured working poor.

This chart shows who qualifies for federal subsidies through the new health care exchanges...



o Those with incomes greater than the federal poverty level but less than four times that level are eligible for subsidies that will reduce the cost of their health insurance.

o Those earning more than four times the federal poverty level will pay the full cost.

o Those earning less than the federal poverty level are not eligible for subsidies.

The intent of the law was that those earning less than the federal poverty level would instead be eligible for Medicaid. However, as we previously reported, the states refused to expand their Medicaid programs to cover those who fall through the cracks even though it would cost them virtually nothing.

Each state determines the eligibility requirements for Medicaid. States that are not planning to expand Medicaid already have the most restrictive criteria. In some of these states, earning as little as $3,000 a year would be enough to disqualify you from Medicaid. Some provide no coverage for adults with no children.

For more, read the New York Times story

This map from the Kaiser Family Foundation shows which states have agreed to expand Medicaid coverage to those not eligible for subsidized insurance.

This chart shows the federal poverty guidelines used to determine eligibility for subsidies.

Obamacare opens for business October 1

2013-Sep-29By: Rob Dennis

Starting Oct. 1 you will be able to buy health insurance using online marketplaces created under the Patient Protection and Affordable Care Act (ObamaCare).

The marketplaces - referred to as exchanges - will allow individuals, families and small businesses to compare health care plans side-by-side and enroll. Coverage will begin in January 2014.

Most Americans are eligible to use the marketplaces. However, they are not required to do so. Those who are happy with their current insurer might not need to do anything. However, prices may increase because the new law requires new benefits that might not have been included in their current plan.

All plans now must offer minimum essential services, including...

o Prescription drugs
o Preventative and wellness services
o Outpatient care
o Emergency services
o Hospitalization
o Maternity and newborn care
o Pediatric services
o Mental health and substance use services
o Rehabilitation services
o Laboratory services

No plan can turn someone away or charge them more because they have a medical condition, and they can't charge women more than men for the same plan.

Plans will be presented in four categories - bronze, silver, gold, and platinum - to make it easier to compare prices, benefits and other factors. They are sold by private insurance companies, but the marketplaces are run either by the state or federal government.

Those who do use the marketplaces will fill out an application and see all the plans in their area. If they choose to provide basic information about household size and income, they'll find out if the federal government will pay part of their monthly premium. They'll also learn if they qualify for government programs such as Medicaid or their state's Children's Health Insurance Program (CHIP).

The cost of coverage compared to current costs is expected to vary based on the type of insurance states previously have been allowed to sell. Prices could go up in loosely regulated states, such as Indiana, Ohio, Florida and South Carolina, where insurance companies were allowed to sell bare-bones plans and exclude those with pre-existing conditions. Prices are expected to drop in states that already required comprehensive coverage such as New York.

Applications for coverage can be submitted online, by mail or in-person. The open enrollment will end March 31, 2014. Most people will not be able to buy insurance after that time. They also will be subject to a penalty tax.

For one look at how the cost of health insurance might be affected in your state, read this CNNMoney story.

To find the exchange you will need to use in your home state, click here.

Exchanges: Cheaper insurance but with fewer doctor choices

2013-Sep-22By: Barry Shatzman

When people begin using health insurance exchanges to buy insurance under the Patient Protection and Affordable Care Act, they are likely to find a good plan that costs them less than what they are paying now. But there may be a catch.

In order to offer lower-cost policies, some insurance companies are shrinking the network of providers you'll be able to use. This might result in an inconvenience when it comes to finding a doctor. But more than that, it might force patients needing a specialist in a certain field to find out outside of the insurance company's network - costing them much more money than one who is in their network

For more, read the New York Times story.

Administration delays Obamacare out-of-pocket protections

2013-Aug-20  (Updated: 2013-Aug-21)By: Barry Shatzman

A provision of ObamaCare that would protect Americans from having to spend their life savings on medical treatments has been put on hold for a year.

Beginning in January, the most an individual would have been required to pay for medical care in a year was $6,350 - no matter how costly their treatment became. No family would have been required to pay more than $12,700 in a year (not including insurance premiums).

However, full implementation of this out-of-pocket cap now will not take effect until January 2015.

According to the Obama administration, the technology used by some health plans was not ready to handle the new limits. The problem is that many use one company to handle medical benefits, and another to handle prescription drug benefits. And because the two systems don't communicate with each other, they argued, they could not keep track of how much someone spends in total.

The protection isn't completely going away.

Plans that don't separate medical and drug coverage still will be required to adhere to the out-of-pocket limit. Those that do administer them separately will be allowed to set the same limit for each - meaning that an individual's potential liability will double. However, if a drug plan currently has no out-of-pocket limit, no limit will be required until 2015.

For those who would spend less than $6,000 a year on medical expenses, the delay actually could save them money, as premiums could be lower than if the limits were in effect. But those with long-term illnesses such as cancer or Multiple Sclerosis that require expensive medicines will need to wait at least another year before being fully protected from extreme expenses.

For more, read this Kaiser Health News report and this CNBC story.

Here are some questions we are working to answer...

o Can someone with a plan through their work that is not subject to the out-of-pocket limit simply buy their own policy that has a limit?

o Why is it necessary that drug plans that previously had no out-of-pocket limit continue to not have a limit?

o What consultations took place between the Department of Labor and their technical experts regarding feasibility of adding up an individual's total expenses?

o Could a health plan be required to reimburse someone who incurs medical expenses that exceed the out-of-pocket limit?

Governent makes hospital prices public for first time

2013-May-08By: Rob Dennis and Barry Shatzman

If you've ever been in the hospital, you likely were shocked when you received the bill showing how much the hospital charged - even if your insurance company paid it. What do those prices really mean, and how do they compare to what another hospital might charge for the same thing? Now you can find out.

Hospitals used to consider their prices to be competitive secrets. But the government for the first time has released the prices they charge for the 100 most common inpatient procedures.

The data, provided by the Department of Health and Human Services, is the result of the Obama administration's hospital price transparency initiative. It show the average list prices in 2011 from more than 3,300 hospitals around the country.

Prices varied by up to triple for the same service. Average prices for some services at one nonprofit hospital in Miami were nearly double those of another nonprofit hospital across the street.

The prices don't necessarily reflect what the hospitals receive. The amounts that Medicare and Medicaid pay hospitals are fixed by the government, regardless of what price the hospital might show on its bill. Private insurance companies also negotiate lower costs with hospitals.

It is those who can afford it the least - those who are uninsured or have inadequate insurance - who pay the higher price.

The usefulness of the data is limited by the fact that few people shop for hospitals by price. Most go to a hospital that is in their insurance provider's network or that their doctor recommends.

For more, read the New York Times story

You can view a visual comparison of prices in this Washington Post article

The Centers for Medicare & Medicaid Services has provided all of the data in spreadsheet form. You can download it here.

Several states refusing funds to provide health care to neediest

2013-May-07By: Rob Dennis

Almost half of the 50 U.S. states are refusing the opportunity to provide medical care for 30 million of their poorest citizens, even though it would not cost them a single dollar.

Florida on Friday became the 15th state to reject the Medicaid expansion that is part of the 2010 Patient Protection and Affordable Care Act. Another nine states are leaning against the expansion.

Medicaid is paid for jointly by the federal government and the states. In most states, it covers only those with very low incomes, people with disabilities, pregnant women, and children.

The 2010 health care law (dubbed ObamaCare) would expand that coverage to include anyone making up to 138 percent of the federal poverty level - ranging from $15,856 for an individual to $32,499 for a family of four.

The federal government would pay the entire cost of the expansion for three years, and continue paying most of the cost after that.

To put it another way, they are rejecting free money that would benefit only those they represent who need it the most - people such as cashiers and construction workers.

Business groups have said the money would improve their states' economies. Hospitals have come out in support of the Medicaid expansion because the 2010 health care law reduced their compensation for treating the uninsured - assuming many of those people would be covered under the expansion.

The Obama administration had intended the expansion to be mandatory, but the Supreme Court ruled last year that states could opt out.

Some Republican governors did so, including Rick Perry of Texas, Bobby Jindal of Louisiana and Phil Bryant of Mississippi.

The governors of Florida, Ohio, Arizona and Michigan have stated they would accept the federal money, but the elected representatives in those state voted to reject it.

"While the federal government is committed to paying 100 percent of the costs, I cannot deny Floridians who need access to health care," said Gov. Rick Scott of Florida, where more than a million people would benefit from the expansion.

The American Legislative Exchange Council (ALEC), which drafts model state legislation to benefit its corporate funders, has called for the privatization of Medicaid for years. Its 2011 publication, The State Legislators Guide to Repealing ObamaCare, says the Affordable Care Act "presents states with good reason to opt out of Medicaid altogether."

For more, read the Washington Post story.

The following states have rejected or are expected to reject Federal money that would pay for health care for many of their poorest citizens...

o Alabama
o Florida
o Georgia
o Idaho
o Indiana
o Iowa
o Kansas
o Louisiana
o Maine
o Michigan
o Mississippi
o Missouri
o Montana
o Nebraska
o North Carolina
o Ohio
o Oklahoma
o Pennsylvania
o South Carolina
o South Dakota
o Texas
o Utah
o Virginia
o Wyoming

How to apply for health insurance under "ObamaCare"

2013-Apr-30By: Rob Dennis

The Department of Health and Human Services has released the final application forms for insurance exchanges established under the 2010 health care reform law.

The Patient Protection and Affordable Care Act, which established the exchanges, is expected to allow 30 million currently uninsured people to obtain health care. The new exchanges will start accepting applications Oct. 1 for coverage beginning in January.

Only people seeking coverage through an exchange will need to fill out an application. Most Americans will continue to be covered through their jobs, Medicare or Medicaid.

The new forms are simpler than draft application forms released last month. The final version of the basic form has been streamlined to five pages - down from 21 pages. Longer forms will be available for more complex cases.

Click on one of the new forms to view it...
Individual not requesting financial assistance
Individuals requesting financial assistance
Families

"Obamacare" means new terminology

2013-Apr-01By: Barry Shatzman

The 2010 Patient Protection and Affordable Health Care Act (dubbed ObamaCare) has introduced a new vocabulary to Americans. Some might have heard the terms preexisting conditions and recision for the first time, even though they might have been affected by them (the first is used to deny coverage, the second to revoke it once a person becomes seriously ill). Those terms will vanish, as the new law prohibits both practices.

The law introduced the term insurance exchanges - online marketplaces in each state to compare and purchase health insurance. You aren't required to use the exchange. However, if you are eligible for financial assistance (generally if your income is less than four times the poverty level), you'll need to go through the exchange to receive a subsidy.

It also introduced the term mandate, the requirement that everyone have a minimum level of health insurance coverage. If you choose not to buy health insurance, you will pay a minimum penalty of $95. In addition, if you don't purchase insurance by the end of March, you won't be able to purchase insurance on the exchange for the remainder of the year. This is to prevent someone from waiting to get sick before they obtain coverage.

For more about how the new health care law will work, read this Washington Post story.

Another key provision of the law is that the premiums a person pays cannot be affected by their health. They can increase only a their age increases. The rates for a 64-year-old typically can be 5 times those for a 21-year old. Under the new law, that rate can be only 3 times as high. There is a fear that this will cause premium rates for young people to be set artificially high in order to allow for higher rates for older people.

The Urban Institute published a study showing that this is not likely to happen. You can read their report here.

Insurance choices likely to be delayed a year

2013-Apr-01By: Barry Shatzman

The provision of of the Patient Protection and Affordable Health Care Act that would help provide affordable health insurance to small businesses and their employees likely will be delayed by a year.

Insurance exchanges are supposed to be a marketplace enabling employers to compare policies and purchase the one that meets their needs the closest. In most states, however, there likely will be just one plan until 2015.

The decision by the Obama administration will affect states that have not set up their own exchanges - but rather will rely on one run by the federal government. For states running their own exchanges, the requirement to offer multiple choices also will be delayed until 2015.

The exchanges are scheduled to open for enrollment in October, for coverage starting in January 2014. Some states, including California and Connecticut, still plan to offer a choice of policies (even though they are not required to do so until 2015).

The delays were requested by insurance companies, according to the New York Times.

For more, read the New York Times story.

Government releases forms for applying to insurance exchanges

2013-Mar-14By: Rob Dennis

The 2010 Patient Protection and Affordable Care Act, which established the exchanges, is expected to expand coverage to nearly 30 million uninsured people through health insurance exchanges.

The new exchanges will start accepting applications Oct. 1 for coverage beginning in January.

The Health and Human Services Department has released draft application forms that would be used to apply for benefits under President Obama?s health care reform program. Only people seeking coverage through an exchange will need to fill out an application; the vast majority of Americans will continue to be covered through their jobs, Medicare or Medicaid.

To see the form for those who are not seeking financial assistance, click here
To see the form for those who are seeking financial assistance, click here

Update: These forms have been replaced with simpified versions. Read more here.

Higher health insurance premiums face individuals

2013-Mar-14By: Barry Shatzman

Though most Americans will pay less for health care after provisions of the Patient Protection and Affordable Care Act take effect in January, there are many who will see their insurance premiums increase by 20 percent or more. Some premiums may double, the Associated Press reported.

The biggest price increases are expected for about 14 million people who buy their own insurance, as well as some employees of smaller companies.

Some of the additional premium costs will be offset by better coverage that pays a greater share of a patient's bill than current policies. Tax credits also will lower the burden for those who can least afford it.

Although insurance companies spent millions trying to defeat the 2010 bill - dubbed Obamacare - saying it would raise costs and disrupt coverage, it has led to a windfall for them.

Profits of the five largest for-profit health insurance companies expanded to more than 8 percent in the 18 months after the act became law, compared with less than 7 percent for the 18 months preceding it, a study by Bloomberg Government found.

In all, their profits increased by 61 percent from 2008 to 2011, in the middle of a recession, according to Sen. Dianne Feinstein, who has proposed a law allowing the secretary of the Health and Human Services Department to deny excessive rate increases. Currently, the department can review increases, but has no authority to deny them.

Such measures, though, don't address the root of the problem. The system in effect for Americans forces them to buy insurance from private companies - which by their nature maximize profits above other considerations. Yet health care is a basic human service that everyone will need to some degree or another during their lives.

Another option would give Americans the choice to buy their health care coverage through a government agency. Similar systems are used by every other industrialized country in the world. Such a measure was proposed for the Patient Protection and Affordable Care Act, but it was not included in the final bill.

For a fuller understanding of health care issues, including the "public option", read Lobby99's discussion.

To read more about the anticipated premium increases, read the Associated Press report and this New York Times story.

To read more about insurance company profits read this Bloomberg.com report.

New health care practices lowering costs

2013-Feb-12By: Rob Dennis

Health expenditures from 2009 to 2012 have grown at the lowest annual rate in the more than five decades since such record-keeping began, according to Altarum Institute's Center for Sustainable Health Spending. And The Congressional Budget Office said last week that spending on Medicare and Medicaid in 2020 will be $200 billion less than it projected three years ago.

If the slowdown persists, it could help reduce the federal budget deficit, ease unemployment and help stimulate the economy. Slowing the annual growth rate of health care costs by 1.5 percent would increase gross domestic product, translating to an extra $2,600 for a typical family of four, White House economists say.

Experts say the diminishing growth in health care costs is not just a result of the weak economy of recent years. Health care providers have tried to reduce wasteful treatments, and some insurers have offered financial incentives to reduce complications and rehospitalizations, according to the New York Times.

For more, read the New York Times story
Click here to read the White House's "economic case for health care reform"

World life expectancies increasing - U.S. lags behind

2012-Dec-13By: Barry Shatzman

Life exectancies throughout the world have increased over the past 20 years, according to a report from British health journal The Lancet.

Deaths from malnutrition and infectious diseases decreased. However, as people age, more are dying from diseases such as cancer and diabetes.

The smallest gains were found in the United States - especially for women.

For more, read the New York Times article

New medical care delivery model saves patients, money

2012-Sep-07By: Barry Shatzman

A model for delivering medical care - in which patients are cared for by a coordinated group of providers - is able to lower costs while simultaneously improving the outcomes of patients, according to a study published in the Journal of the American Medical Association.

For more, read the New York Times story.

Doctor shortage challenges increased coverage

2012-Jul-28By: Barry Shatzman

Although the Affordable Care Act extends coverage to many who are uninsured, and protects the coverage of those who currently are insured, a shortage of doctors threatens the ability of communities to provide the increased care.

For more, read this New York Times article.

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