Wednesday, November 26, 2014

360 More Pgs of PPACA Regs Released Fri. Before Thanksgiving | Improved Insurer 'Bailouts' & Easier Access to Indiv. Mandate Waivers on Armstrong & Getty

The Friday before Thanksgiving might actually be the quintessential "news dump Friday." Last Friday did not disappoint.  As much of the country tuned out and moved toward their holiday week, a number of huge stories slithered out under as much darkness as the 24-7 news cycle will allow.  Lois Learner's lostdeleteddestroyed IRS emails miraculously reappeared and the Benghazi Report surfaced.  But the quietest of them all may have been another flurry of regulatory actions on Obamacare.  We saw: 
  • Four new regulatory releases, including both final and proposed rules; 
  • Totaling 360 pages; and 
  • Disseminated by three federal agencies - IRS, HHS and CMS.  
Not much of what was done will impact employers directly and there are certainly no immediate action items to address.  But some of the moves clearly illustrate the Administration's continued effort to sweeten the pot to insurers and appease its constituency. Insurers continue to grow squeamish.  They are looking at meager enrollment numbers, unhealthier than anticipated enrollees and a growing political clamor to make changes to PPACA that would harm their bottom line - namely, a repeal of the employer and individual mandates as well as the Three Rs (Bailouts) Program

Here is a brief summary of what these releases did along with their wonderfully Orwellian headings, like "Premium Stabilization."  That sounds like an innocuous enough thing doesn't it?  Until you see that it means some bureaucrat could change your plan by increasing your deducible and copays in order to moderate premium increases and keep you from noticing that Obamacare is moving toward unaffordability at warp speed.  Sounds to me like Jonathan Gruber is still consulting on PPACA.  

  • To help in “Premium Stabilization” one set of proposed regulations will make it so that in an Exchange you are automatically defaulted to a lower premium plan with a higher deductible in order to keep from seeing how expensive plans have become.   
  • To help improve “Meaningful Access” another set of rule-makings will require that Exchanges, navigators and online brokers associated with the Exchanges provide “telephonic interpreter services in at least 150 languages.” 
  • Lower Cost-Sharing Limits for Certain Individuals: Lower cost-sharing limits (deductibles, copays, out-of-pocket maximums, etc.) are proposed for certain individuals with lower incomes. This is going to get extraordinarily complicated because these "cost sharing limits" aren't the premium support subsidies that are what we normally discuss.  Premium support is for persons between 100% and 400% of the federal poverty level.  These cost-sharing limits are an additional handout for persons between 100% and 250% of the federal poverty level. 
    • For individuals with household incomes between 100% and 200% of the federal poverty level, the proposed maximum is $4,250 for self-only coverage and $4,500 for family coverage. 
    • For individuals with incomes between 200% and 250% of the federal poverty level, the proposed maximums are $5,450 for self-only coverage and $10,900 for family coverage.  
  • "Hardship Considerations": To make it as easy as possible for the Administration’s constituency to get an individual exemption from Obamacare, hardships identified by HHS may be claimed on a Federal income tax return without obtaining a hardship exemption certification from the Exchange. Individuals seeking a hardship exemption that is not on this list can apply for an exemption through the Exchange.  Hence, they've removed another barrier to obtaining an individual exemption. Six hardships get this special treatment.  
    • These exemptions mainly relate to the cost of coverage exceeding certain thresholds for family members.  Or, 
    • If you are eligible for an Indian Health Plan. Or, 
    • If you live in a state that did not expand Medicaid. 
  • An update on “Affordability Percentages” for 2016.  I.e., a person asked to pay more than this percent of his annual, household income for insurance is off the hook for Obamacare because it will be deemed too expensive.  
  • Improved Bailout Terms for “Premium Stabilization.” 
    • For 2015 Insurers will get federal dollars for individual claimants who exceed $45,000 in claims as opposed to the originally planned $70,000. 
    • And it is proposed that in 2016 (to help soften the cost blow for what they are doing this year) they will raise that attachment point to $90,000. Does anyone else see this reduction getting punted down the road much like the Doc Fix?
    • HHS also says, “We reiterate our previous guidance that in the unlikely event of a shortfall in the 2016 benefit year, HHS will use other sources of funding” (Pg. 15 of the 324 PDF found here.) 
      • Translation: when the Three Rs program runs short on the planned taxes and fees already built in on various premiums and policies, HHS will do whatever is necessary to make sure its insurer partners get paid with federal dollars. 
I visited with Jack and Joe in the 9:00 AM hour today to eat unholy amounts of pie and other seasonal baked goods while discussing these latest PPACA regulatory releases.  

Below is the audio.  The Obamacare talk concludes by the 22 minute mark: