Legislative Report
Important Dates:
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Invest a few days for your industry and livelihood!
January 8th, Early Bird Registration Ends for Capitol Conference
February 3 & 4th FAHU Day on the Hill in Tallahassee.
Register now at the FAHU.org website.
Reserve your room at the Hotel Duval.
February 24th through February 26, Capitol Conference
Issues to be aware of courtesy of your association NAHU!
Race to the Finish:
Although the deadline to pay has passed as of January 3, the government is not sure how many applications submitted on
www.healthcare.gov actually made it through to the Insurance carriers. Make sure your clients are aware of this issue before they drop their existing coverage. Note it is not just the Federal Exchange that is having this problem, many of the state exchanges are having similar issues!
What to Expect in 2014
We’ve been talking about 2014, or as we like to call it, the year of requirements, since March of 2010. Now that it’s finally here, what can we actually expect from this monumental health reform year?
- Coverage Kicks In: Millions of Americans have been signing up, or attempting to sign up, for a health insurance plan since the exchanges opened on October 1, 2013. Those lucky people can now take advantage of their health plan and the related federal subsidies.
- Individual Mandates Get Real: The mandate is here and if you’re not enrolled in a qualified health plan either via the individual market or through an employer or other group plan by March 1 you can expect a bill for $95 or 1% of your income, whichever is higher, to arrive on your doorstep later this year, unless you fall into one of the excepted categories, of course.
- Insurance Exchanges: In every state must be up and running. Obviously “up and running” is a loose term.
- Insurance Subsidies: Premium tax credits and cost-sharing reductions kick in for those who are eligible.
- Medicaid Expansion Begins: The Supreme Court ruled to expand the program. As a result, in 2014 as many as 3.9 million more low-income Americans will have access to the public assistance program.
- Small Business Tax Credit: Under PPACA, small businesses are eligible to apply for a small business tax credit that would help purchase health coverage for their employees. The credit is supposed to expand to more businesses. The catch: very few small businesses actually qualify for the credit and now they can only use it to buy SHOP exchange coverage.
- Individuals and Businesses take the HIT: The new national premium tax, which will ultimately be a pass through fee from the insurer to all consumers of fully insured individual and group health insurance, goes into effect. The tax will collect $8 billion in 2014, increasing to $14.3 billion in 2018 and increasing based on premium trend thereafter.
- Ninety-Day Maximum Waiting Period: This requirement for all employer plans goes into effect.
- Cost-sharing Limits: Group health plans, including self-funded plans, may not have out-of-pocket costs that exceed the annual HSA contribution maximum.
- Annual or Life Time Limits are No More
- Greater Wellness Discounts: Employers may now offer a discount of up to 30% for employee participation in a wellness program.
Numbers on the Rise
The enrollment numbers are in and while the Administration’s goal of three million people was not met, they got close, kind of. As of January, the Administration reports that 2.1 million people had enrolled in an insurance plan through the exchange. In the month of December alone, 1.6 million people were able to enroll–quadruple the amount of October enrollments. In addition to the 2.1 million who have selected an exchange plan, 3.9 million people have been determined eligible for Medicaid and the Children’s Health Insurance program (CHIP).
But when you read the fine print of the Administration’s announcement you learn that the 2.1 million number reflects the number of people who have selected a plan, not those that have actually paid for it.
Birth Control Back on the Chopping Block?
Back in November, the Supreme Court of the United States decided that it would hear a pair of cases from for-profit companies challenging the provision of PPACA that requires employers to provide a health insurance plan that covers contraception with no cost sharing for employees. On New Year’s Eve, Justice Sonia Sotomayor presented a different angle to this series of cases–religious organizations. Sotomayor, a liberal but Catholic justice, appointed by President Barack Obama in 2009, asked the White House to file a brief by last Friday morning responding to her different challenge of contraception coverage for for-profit religious companies. While waiting for the White House’s response, Justice Sotomayor issued a temporary injunction prohibiting the Administration from enforcing the birth control requirement against an order of Colorado nuns, the Little Sisters of the Poor Home for the Aged (the group who originally filed a suit against this requirement) and other related groups.
PPACA distinguishes three types of organizations: religious employers, for-profit corporations and non-profit groups affiliated with religious organizations but not owned or controlled by them. Religious employers such as churches are exempt from the contraception requirement. For-profit organizations are not exempt and non-profit organizations with a religious affiliation fall somewhere in the middle–they can get a temporary waiver so that they do not have to provide contraception coverage themselves but they must sign a certification allowing insurance companies to do so for their employees (how this works in a self-funded plan is anyone’s guess). Sotomayor’s challenge disputes whether the certification amounts to conduct that violates such groups’ religious faith
The White House has issued a brief on the issue and asked the court not to block the rule for the Denver nursing facility as the facility is run by nuns and considered to be a church, therefore exempt from the provision in the first place. The Justice Department agreed with this ruling. Sotomayor must now decide to dissolve the case or take it to the other justices who could decide to review the whole case. Whichever path she chooses, the contraception debate is still far from over. Several organizations who disagree with the contraception mandate have filed and intend to bring the issue before the court. If the Little Sisters of the Poor Home for the Aged case doesn’t make it to a full Supreme Court review, it is likely that others of a similar nature eventually will
Regulations Don’t Celebrate Holidays
In case you were doing some last minute shopping and missed it, on December 16 the IRS released moreregulatory guidanceconcerning health plan benefits for same-sex couples impacted by this summer’s Supreme Court ruling that overturned the Federal Defense of Marriage Act. This notice provides guidance on the application of the rules under section 125 of the Internal Revenue Code relating to cafeteria plans, including health and dependent care flexible spending arrangements and section 223 of the Code relating to health savings accounts (HSAs) and how those two provisions relate to the participation by same-sex spouses in certain employee benefit plans following the Supreme Court decision in United States v. Windsor.
Just ten days later, HHS marked Boxing Day by making it the due date for comments on its most recent proposed exchange regulation, the Patient Protection and Affordable Care Act Notice of Benefit and Payment Parameters for 2015. This marks the second year in a row that HHS has decided to celebrate the second day of Christmas with a massive regulatory deadline and we have to say we would have preferred coal. Nevertheless, your NAHU staff worked together and submittedthis holiday greetingto Marilyn Tavenner in the nick of time!
