When the COVID-19 pandemic struck last year, the Affordable Care Act (ACA) acted as a critical safety net. As millions faced job and income loss in the face of a growing threat of infection and disease, Medicaid, expanded under the ACA in most states, and the law’s health insurance marketplaces provided coverage and financial assistance. Notably, states sprang into action…
…did in 2019, several major health insurers reported reduced profits or even losses in the fourth quarter of 2020. Humana posted a $274 million loss, a record for the insurer. Centene reported a $12 million loss in its fourth quarter and subsequently announced it will cut 3,000 employees from its staff. Other insurers including Aetna and UnitedHealth had a decrease…
…Further, the Court concluded that Congress did not intend for self-employed individuals with no employees to be considered “employers” under ERISA. The Trump administration appealed that ruling, and the case has been pending for over a year. The Biden Administration can Foster Stability for the Small-group Market To protect consumers, small businesses, and providers (who often face significant financial losses…
…recent job loss or receipt of unemployment benefits, receipt of failure to file notices due to IRS backlogs in processing income tax returns, and policies discouraging enrollment among eligible immigrants. Due to both general and pandemic-related difficulties experienced by many consumers during the 2021 Open Enrollment period, Navigators advocated for reopening the federal marketplace for an additional enrollment period. Navigators…
…to fully subsidize COBRA premiums for Americans who lost their employer sponsored insurance. As talks for another COVID-19 relief package ramped up last fall, AHIP again highlighted the need for temporary COBRA funding as job losses and furloughs continued. KFF estimates that COBRA subsidies could cost the government $106 billion, while many of those opting for COBRA would be passing…
…patients in a limited Medicaid benefit to pay for testing with a 100% federal match, but the process can be cumbersome and to date only 17 states have adopted it, according to Kaiser Family Foundation. In the remaining states, and as a backstop for uninsured patients not picked up by the Medicaid option, FFCRA and subsequent legislation established a $2…
…“no wrong door” approach that is currently in place, which helps ensure that consumers enroll in the coverage program for which they are eligible, whether it be Marketplace, Medicaid, or CHIP. Additionally, a main purpose of the Marketplace is to provide a single, one-stop-shop for all available qualified health plans (QHPs). When the options for enrollment are scattered across different…
…enrollment opportunity. Some events that trigger a special enrollment opportunity are: Loss of minimum essential coverage or other qualifying coverage. For example, if you lose your employer-sponsored coverage because you quit your job, were laid off, or if your hours were reduced. This also includes “aging off” a parent’s plan when you turn 26 or if you lose student health…
…hours at work were cut back due to the COVID-19 pandemic, resulting in a temporary loss of income. Can I qualify for premium tax credits? Possibly. If you are already enrolled in a marketplace plan (either through HealthCare.gov or your state’s marketplace), you should report the change in income. If you previously qualified for premium tax credits, and your income…
…comprehensive cap on both in-network and out-of-network prices could encourage more broad price reductions, but policymakers may have more difficulty ensuring compliance among providers who attempt to circumvent this measure. Fiedler finds that providers may respond to a loss of negotiation power by seeking other allowances from insurers, such as by demanding higher prices for other services, using alternative payment…
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