House to Vote to Repeal Individual Health-Care Mandate

Bloomberg News y Kathleen Hunter – Jul 11, 2013 8:45 AM PT.

House Speaker John Boehner said the chamber will vote next week to delay the 2010 health-care law’s requirement that most Americans carry health insurance.

At his weekly news conference today, the speaker said it’s not fair for President Barack Obama’s administration to keep that provision in effect while postponing enforcement of the requirement that businesses provide their workers with insurance.

“I believe it’s unfair to protect big business from Obamacare but not individuals and families,” Boehner said.

The

Republican-controlled House previously has voted 37 times to repeal or defund all or part of the Affordable Care

Act, enacted with

only Democratic votes. Republicans have sought to make the plan a symbol of government overreach.

The employer requirement is being delayed until 2015, the administration said last week

Starting on January

1, 2014, some health plans will need to include a certain set of benefits. These are called essential health benefits. The information below can help you learn what health care services are considered essential, which plans have to offer them and how your clients may be affected by them.

What are essential health benefits?

Essential health benefits are a set of 10 health care categories that plans for individuals and small businesses must

cover. If members go to a doctor or hospital in network, they pay what they would pay for in-network care. If they go to a doctor or hospital outside the network, they may have to pay the out-of-network cost, unless it is an emergency. If the plan does not cover care out of network, these services may not be covered out of Dessuten kan du ogsa lese litt om hvordan du kan spille bestenorskecasinos.com pa nett, helt trygt. the network. These benefits apply to plans for individuals and small businesses both inside and outside the exchanges.

What are the 10 essential health benefits categories?
• Outpatient services
• Emergency services
• Hospital stays
• Maternity and newborn care
• Mental health and substance abuse services, including behavioral health treatment
• Prescription drugs
•Rehabilitation services and devices like durable medical equipment and prosthetics
• Lab services
• Preventive and wellness services and, long-term disease management
• Pediatric services, including dental and vision care

Are grandfathered plans affected by essential health benefits?
A grandfathered health plan is a plan that was in effect on or before March 23, 2010, and certain changes have not been made to it since then. Grandfathered plans do not have to include all essential health

benefits.

Why is there a need for essential health benefits?
With essential health benefits, people who buy health insurance are assured they’ll have coverage of a full range of services.

Do limits apply to essential health benefits?
All plans or policies that began on or after September 23, 2010,will no longer limit how much they’ll pay out for essential health benefits in network. This applies to all plans and policies, except grandfathered individual health insurance plans.

Do essential health benefits have to be included in all plans on January 1, 2014?

No. The essential health benefits must be included in plans for individuals and small businesses on the first day of the plan year on or after January 1, 2014. The requirement does not apply to grandfathered plans or plans for large businesses. If an essential health benefit is covered as part of a plan, there cannot be dollar limits on the benefit.

The Washington Post by Sarah Kliff and Sandhya Somashekhar –

July 5, 2013:

The Obama administration announced Friday that it would significantly scale back the health law’s requirements that new insurance marketplaces verify consumers’ income and health insurance status.

Instead, the federal government will rely more heavily on consumers’ self-reported information until 2015, when it plans to have stronger verification systems in place.

The delay comes after a Tuesday announcement that the federal government would postpone for one year a requirement that employers with 50 or more full-time workers provide health coverage.

“I think that Health and Human Services is doing the best that it can under the circumstances,” said Sara Rosenbaum, a health policy professor at George Washington University.

The verification systems are meant to determine who qualifies for new benefits under the Affordable Care Act. The law includes tax subsidies to purchase health insurance for Americans who earn less than 400 percent of the poverty line, about $45,000 for an individual.

Those earning less than 133 percent of the poverty line — about $15,000 — will qualify for Medicaid coverage in the District and 23 states that have decided to expand the program.

The federal government also needs to know who receives health insurance coverage from an employer. Consumers who receive affordable health insurance from their company under a policy that costs less than 9.5 percent of their income do not qualify for tax credits under the Affordable Care Act.

New regulations published Friday scaled back the federal government’s role in determining whether information submitted to new health marketplace is accurate.

After encountering “legislative and operational barriers,” the federal government will not require the District and the 16 states that are running their own marketplaces to verify a consumer’s statement that they do not receive health insurance from their employer.

“The exchange may accept the applicant’s attestation regarding enrollment in eligible employer-sponsored plan . . . without further verification,” according to the final rule.

The federal government will, however, conduct an audit for the states where it is managing the new insurance Web portal.

The rule also scaled back states’ responsibilities to double-check the income levels that consumers

report, which determine any tax subsidy they receive.

While initial regulations had proposed an audit of each consumer who reported an income significantly lower than what federal records indicated, the final rule scaled that back to an audit of a statistically significant sample of such cases.

For individuals who are not part of that sample, “the Exchange may accept the attestation of projected annual household income without further verification,” it said.

It

is not unprecedented for the government to use the honor system in situations in which it collects data on millions of individuals, said Timothy S. Jost, a law professor at Washington and Lee University in Lexington, Va., and a consumer advocate. For example, people are expected to report their cash tips to the Internal

Revenue Service as income.

“An awful lot of the economy is a cash economy,” he said. “If we had to verify every statement that was made to the IRS, our economy would collapse.”

In addition, lying on the exchange form carries with it a penalty of as much as $25,000. An individual who fibbed on his income would also have to pay back the extra subsidies when filing a tax return for 2014.

Still, Jost said, Friday’s rule shows that the government is in “triage mode. They have tried to figure out what they need to do right now and what they can delay until later. And they are very low on resources.”

Ian Spatz, a senior adviser at Manatt Health Solutions, agreed.

“As crunch time is coming, they’re just muddling through and figuring out short cuts,” he said. “It might not be elegant, but this is how they’re trying to make the law work.”

(CNN) – The requirement that businesses provide their workers with health insurance – a key provision contained in President Barack Obama's sweeping health care law – will be delayed by one year, the Treasury Department said Tuesday. The delay came after business owners expressed concerns about the complexity of the reporting requirements, the agency said in its announcement. Under the Affordable Care Act, businesses employing more than 50 full-time workers that don't provide them health insurance will be penalized. “We recognize that the vast majority of businesses that will need to do this reporting already provide health insurance to their workers, and we want to make sure it is easy for others to do so. We have listened to your feedback. And we are taking action,” Mark J. Mazur, assistant secretary for tax policy, wrote in a post on the Treasury Department's website. He said the extra year before the requirement goes into effect will allow the government to assess ways to simplify the reporting process for businesses. Penalties for businesses not providing health coverage to employees will now begin in 2015. Supporters of the employer mandate note that most employers already provide health insurance to full time workers, and downplay the effect the requirement would have on small businesses, citing figures showing the vast majority of small businesses employ fewer

than 50 workers. But opponents claim the employer mandate is a potential job killer, saying businesses near the 50-worker cutoff will be unlikely to ramp up hiring if it means they're required to provide employees health insurance.

Obama's administration has previously expressed openness to making the health care law easier to implement, and acted to shorten applications for health insurance on government-run exchanges from 21 pages to three. Republicans have continued to attack the measure as confusing and bad for business, and voted again to repeal the law this spring. Some Democrats have also voiced concern about the roll-out of the health law – Sen. Max Baucus, a key Democrat who helped craft the legislation, expressed serious anxiety in April about its rollout. “The administration's public information campaign on the benefits of the Affordable Care Act deserves a failing grade. You need to fix this,” Baucus told Health and Human Services Secretary Kathleen Sebelius at a hearing.

“I just see a huge train wreck coming down,” he added later

July 1, 2013

On Wednesday, the Supreme Court overturned the Defense of Marriage Act. Back in 1996, President Clinton signed DOMA into law, explicitly defining marriage in the United States as a union between a man and a woman. By ruling the 1996 law unconstitutional this week, SCOTUS established that same-sex marriages sanctioned by individual states will now be recognized by the federal government. Prior to the ruling, same-sex couples could not take advantage of federal rights extended to married couples, such as shared benefits, Social Security benefits or inheritance rights, like opposite sex couples could. Now, in the nine states across the country and the District of Columbia that allow for same-sex marriage, all married couples will enjoy the same federal rights, including those related to healthcare.

Clearly, the DOMA ruling has some health-reform implications, as it impacts determinations as to who is eligible for Medicaid and who is eligible for federal health insurance premium and cost-sharing subsidies within the

exchanges. Overall family income as it relates to the Federal Poverty Level is the key factor in determining eligibility for federal assistance; the poverty line varies by size, gradually increasing as the family grows larger. Now, with the federal government recognizing same sex marriages as one family unit and not individuals, their eligibility determinations could change. For example, if one person in a same-sex marriage is earning below the FPL and the other earns more, their salaries are now added together and the person earning below the FPL will no longer be eligible for federal healthcare-purchasing assistance.

The ruling also has implications for employer-sponsored group benefit plans. When DOMA was the law of the land, a same-sex couple had to pay more for workplace health coverage even if they were legally married – because the partner’s health benefits were treated as taxable income. The change in the law now raises a couple of key questions for employers. First, how do employers now treat the taxability of employer-sponsored benefits for same-sex spouses that are already on the

group plan? Is there an immediate change in the tax treatment of benefits, and how is that handled with IRS? Also, what about employers with locations and employees in multiple states? A same-sex employee that was legally married in one state now must be treated as legally married in all. If the employer did not previously offer benefit to same-sex couples but did offer coverage to spouses, now they must extend coverage offers to legally married same-sex spouses.

But when will the same-sex couples be able to enroll their spouses in their health plans? As we know, employees usually have to wait until open enrollment before enrolling a spouse in their health plan unless there’s a “qualifying life event.” If the Supreme Court decision is treated as qualifying life event, employees may be able to add their spouses to their health plans pretty soon. Right now, though, we need to watch for guidance from the IRS and HHS fully implementing DOMA, so stay tuned.