states can decide whether to apply the same regulatory requirements to health plans both inside and outside the exchanges. Federally operated marketplaces don’t have this flexibility, however, because they can regulate only the health insurance plans sold through the exchanges.
If outside plans sold coverage that wasn’t as comprehensive but was cheaper than those in the federal exchanges, sicker people might gravitate toward the federal marketplaces, resulting in adverse selection. “Over time, the coverage sold through exchanges will thus become more expensive as the sicker population incurs more claims — deterring more people from buying coverage through the exchange,”This is what happens when amateurs in DC attempt to regulate an industry they do not understand. Of course, that has never stopped them before . . .
“Because HHS will be operating the exchange in 25 states, it will be difficult for the agency to tailor an exchange to meet each state’s unique insurance market needs,”And this never occurred to them before?
South Dakota Gov. Dennis Daugaard, a Republican, has said he wants to continue to review the situation, but “in our state, a lot of decisions can’t be made until the federal government’s fiscal house is put in order,” Dr. Heinemann said. Daugaard has indicated that he is reluctant to commit to an exchange and spend state dollars on one until he’s seen what happens with the budget sequestration process that is set to make automatic across-the-board cuts to government spending starting March 1.Well yeah, but the federal government never runs out of money, right? I mean, PCIP is still around and that is a federally funded and run health insurance program.
Tens of thousands of Americans who cannot get health insurance because of pre-existing medical problems will be blocked from a program designed to help them because funding is running low.
Obama administration officials said Friday that the state-based “high-risk pools” set up under the 2010 health-care law will be closed to new applicants as soon as Saturday and no later than March 2, depending on the state.
But they stressed that coverage for about 100,000 people who are now enrolled in the high-risk pools will not be affected.
Initial fears that as many as 375,000 sick people would swamp the pools and bankrupt them by 2012 did not pan out. This is largely because, even though the pools must charge premiums comparable to those for healthy people, the plans sold through them are often expensive.
Asked why the administration has not requested additional money from Congress to keep the program open — admittedly a tough sell in the current political and budgetary environment — Cohen said, “My responsibility is to work with the appropriation we have.”
About 129 millionpeople nationwide have a medical condition or prior illness that would make it hard for them to buy their own insurance plan.
Among those stunned by Friday’s news was a 61-year-old Virginia woman who is battling stage-four breast cancer. The woman, who asked to be identified by her middle name, Joyce, because she wants to keep her illness private, is self-employed and had bought her own insurance for years.
Late in 2010, however, the insurer that Joyce was using pulled out of Virginia. She was healthy at the time. But when she applied to other companies, she was told that because she had been diagnosed with — and successfully treated for — an earlier breast cancer, she was ineligible for coverage.
More than 300,000 people are now covered through special plans for people with pre-existing conditions — about 100,000 in pools created by the health law and more than 200,000 in older, state-run pools.
The federal plan was designed from the start to be temporary and to shut down as soon as the exchanges open.
But many states had planned on moving their high-risk pool populations into the exchanges slowly to mitigate the shock to the individual market. But now, the state high-risk pools may offload as many people as they can onto the exchanges as soon as they open in 2014 or risk losing a piece of that $20 billion pie.
Some actuaries say it won’t make much of a difference as millions of people start getting covered; other studies see this population boosting premiums significantly in the individual market. One Indiana study projected premiums would rise by up to 45 percent.
HHS says the reinsurance program will keep premiums on the individual market 10 percent to 15 percent lower than they would be without it. But even some supporters of the law believe the impact will be significant.
"We’ll bring down costs by changing the way our government pays for Medicare, because our medical bills shouldn’t be based on the number of tests ordered or days spent in the hospital — they should be based on the quality of care that our seniors receive," the president said.
However, fiscal diets for giant entitlement programs such as Medicare and Social Security should not be so severe that they put the burden of deficit reduction mainly on seniors and the middle class "while asking nothing more from the wealthiest and most powerful,"
Obama said. Earlier this week, his administration announced that it opposed the idea of raising the eligibility age of Medicare from 65 to 67 years, a measure supported by Congressional Republicans.
Just check out this official website outlining the premiums for Medicare recipients. Premiums for Medicare Part B (which covers services like lab tests, surgeries and doctors’ visits) range from $99.90 to $319.60 per month and prescription drug coverage costs wealthier beneficiaries $66.40 more per month than it does for those who receive the standard benefit.
Hospices—health care facilities for the terminally ill—along with other Medicare providers are facing Medicare pay cuts. Of the $716 billion in payment reductions, hospice care was hit by a $17 billion payment cut from 2013 to 2022.
San Diego Hospice recently laid off 260 workers, closed a 24-bed hospital, and has recentlyfiled for Chapter 11 bankruptcy. San Diego Hospice’s financial condition is attributed mainly to reduced Medicare reimbursement, fewer patients, and a federal audit that hurt the center’s reputation.
Another provider, Delaware Hospice, had to lay off 52 workers, citing lower federal reimbursement as the cause. “The decision,” said CEO Susan Lloyd, “is a direct result of a consequential decline in census and the need to position the organization to meet additional changes and challenges that the hospice industry anticipates with health care reform.”
"The preamble to the proposed rule suggests several ways in which this could be done, but the basic idea is that the TPA would take responsibility for providing coverage, and in turn contract with an insurer in the individual market to provide the coverage. The insurer would in turn pass the cost of the coverage (which now will be a real cost since the insurer has no responsibility for covering maternity or any other health care costs) on to a federally facilitated exchange (FFE), which would offset the cost through a reduction in user fees — in other words, the insurer would receive a reduction in the user fee it otherwise owes to the FFE to cover both its costs and any administrative costs incurred by the TPA."That's just the summary. Where to begin....
"Insurers providing contraceptive coverage would be responsible for notifying plan participants and beneficiaries of the availability of the coverage using language found in the proposed regulation. The notice would be provided separately from any other plan information, generally on an annual basis."There starts the excessive administrative fee. Apparently single males would also need to be offered this policy and notice?
