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October 18, 2013

Delaying the Reinsurance Tax Provision Has Been Removed From Legislation

Congress was looking to delay the reinsurance tax, a $63 tax on every health insurance plan enrollee on the marketplace which is collected and used to help insurers in the individual marketplace with high cost cases that reach beyond the catastrophic case fund and would reimburse them for 80% of costs for claims between $60,000-$250,000 per person. The reinsurance tax would help smooth the transition of million of insurers on the individual marketplace and keep insurance affordable. Since the marketplace is a new phenomenon, there are concerns that there will not be a balance between healthy individuals. Without the tax, premiums could increase by 10-15%. The reinsurance tax is only available to insurers in the individual marketplace.

Successful passing of the bill would have caused a delay in the collection of the reinsurance tax for at least one year. However, this provision was stripped from the bill, and the reinsurance tax will still be implemented.

October 18, 2013

Congress Had Ended the Shutdown-No Big Effect on the ACA

Congress has settled on legislation that agrees to finance the operations of the government until January 15, 2014 and raises the national debt limit through the middle of February, 2014. As a result, the government shutdown has officially been lifted as of October 17, 2013 and federal workers have finally returned back to work.

All healthcare provisions were stripped out of the bill, including the delay/repeal of the medical tax and reinsurance tax.The only specific health care provision left in the bill was the inclusion of new procedures for HHS to verify incomes of people who will obtain federal premium subsidies to buy health coverage through the marketplaces. The legislation failed to remove the sequestration cuts, which are detrimental to health insurance providers and all of Indian Country programs and services.


October 11, 2013

Health Insurance Marketplace Premiums for 2014

The Department of Health and Human Services (HHS) released a report on September 25, 2013 that summarizes the health plan choices and premiums that will be available in the health insurance marketplaces.

Nearly all consumers (about 95%) will have a choice of two or more health insurance issuers and nearly all consumers live in states with average premiums that are below earlier estimates. In states with federally facilitated exchanges or partnership exchanges, consumers will have an average of 54 qualified health plan choices. Premiums before tax credits are estimated to be more than 15% lower than projected.

Click here for a copy of the report.

September 4, 2013

Final Rule-Shared Responsibility for Not Maintaining Minimum Essential Coverage

The Internal Revenue Service (IRS) has issued a final rule for the shared responsibility provision for not maintaining minimum essential coverage under the Affordable Act (ACA)

See the final rule in the federal register here.

June 26, 2013

New Mexico Implements a Hybrid Health Insurance Marketplace

New Mexico will be implementing a “hybrid” health insurance marketplace, in which the state will enroll businesses onto the Small Business Health Options Program SHOP) while the federal government will enroll individuals on the federally facilitated marketplace. The Centers for Medicaid and Medicare Services (CMS) recently announced its intention to propose a hybrid option for establishing the health insurance marketplaces through proposed rulemaking. The new “hybrid” concept is only applicable for the 16 states (CA, CO, CT, DC, HI, ID, MA, MD, MN, NM, NV, NY, RI, VT, WA) that received conditional approval earlier in the year to establish a state health insurance marketplace. Other states must wait until 2015 to request approval for the hybrid arrangement through submission of a blueprint that will be specially developed. States that are trying to establish their own state based health insurance marketplaces are feeling the pressure of the looming October 1, 2013 deadline for open enrollment, and many are concerned that they will not be ready.

New Mexico announced that the state does not have enough time to implement a computer system for enrolling individuals, and New Mexico feels it is better equipped to enroll businesses onto SHOP, which is a smaller scale.  New Mexico plans to handle some of the responsibilities required for enrolling individuals on the health insurance marketplaces, such as providing outreach and education, determining health benefit plans, and regulating prices charged by private insurers for plans.