ACA Risk-Adjusted Payments Halted after Judge’s Ruling

UPDATE: On Tuesday, July 24, the Trump administration restored the risk-adjusted payments to prevent “chaos” in the health insurance market. Risk-adjusted payments, a principal component of the Affordable Care Act (ACA, or Obamacare) that seeks to level the playing field among insurers, have been put on hold by the Centers for Medicare and Medicaid Services […]

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IRS Preparing to Send 2016 Obamacare Penalty Notices

Even as many applicable large employers (ALEs) grapple with Employer Shared Responsibility Penalty (ESRP) letters from 2015, the Internal Revenue Service (IRS) is preparing to issue more such letters — known as Letter 226-J — for 2015, with still more coming later this year for 2016. Still down the road later this year, the agency […]

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CMS Proclaims a ‘Death Spiral’ for Unsubsidized Obamacare Policyholders

Though the actual number of open enrollment Obamacare policyholders who paid their premiums the first month rose over 2017 by 3 percent — standing at 10.6 million people for 2018 — those seeking policies who didn’t qualify for subsidies fell by as much as one-third in many states, the Centers for Medicare and Medicaid Services […]

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CHIP Survives Senate Rescission Vote

A move by the Trump administration to claw back nearly $15 in spending from the massive March 23 budget bill has failed in the Senate in a vote eerily similar to last summer’s vote on repealing the Affordable Care Act (ACA). The rescission measure would have hit the Children’s Health Insurance Program (CHIP) hardest at […]

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Trump DOJ Announces It Will No Longer Defend the ACA in Court

Faced with a challenge by 20 attorneys general in a federal court in Texas, the Affordable Care Act (ACA) is going to trial with no defense from the Trump administration’s Department of Justice (DOJ). The case rests on the constitutionality — or unconstitutionality — of the health care act now that the individual mandate has […]

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New Jersey Institutes Statewide Obamacare Individual Mandate

New Jersey has become the second state to legislate an individual Obamacare-like health care mandate following the lead of Massachusetts, which instituted its mandate in 2006 when it passed Romneycare. The New Jersey mandate replaces the financial penalty for not having health insurance that Republicans in Congress repealed in December. In 2015 some 189,000 New […]

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U.S. to Spend $685 Billion on Health Care Coverage for Those Under 65 in 2018

The federal government subsidizes health insurance for most Americans through a variety of programs and tax provisions. In 2018, net subsidies for non-institutionalized people under age 65 will total $685 billion, the Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) estimate. That amount includes the cost of preferential tax […]

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HHS Disapproves Ohio’s Request to Eliminate ACA Individual Mandate in State

The Department of Health and Human Services (HHS) has rejected a waiver request from the Ohio Department of Insurance (ODI) to eliminate the Affordable Care Act (ACA) individual shared responsibility mandate in the state. As originally written, that provision of the ACA requires all Americans to have health insurance or pay a fine, but as […]

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IRS Resumes Sending Out ACA Penalty Notices for 2015

The Internal Revenue Service (IRS) has begun issuing new Affordable Care Act (ACA) penalty notices for calendar year 2015. The notices are officially called Employer Shared Responsibility Payment (ESRP) notices, or what the IRS refers to as Letter 226-J. Under the ACA, Applicable Large Employers (ALEs), generally those companies with 50 or more full-time employees […]

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CMS Administrator Reaffirms Opposition to Medicaid Caps

At a health care symposium this week, Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), reaffirmed her agency’s commitment to keeping Medicaid available to its recipients without any lifetime limits or caps. Her statement follows her earlier rejection of a request by Kansas to cap Medicaid services in the state. “We’ve indicated […]

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