Money Trouble: Some Health Insurance CO-OPs in Financial Trouble

Much of the focus on health insurers under the Affordable Care Act (ACA) has centered on larger health insurance companies. In an effort to expand the number of health plans available to the public, the ACA also created the Consumer Operated and Oriented Plan (CO-OP) Program. The program is administered by the Centers for Medicare and Medicaid Services (CMS) at the Department of Health and Human Services (HHS). The ACA further directed HHS to make loans to these CO-OPs to assist with their establishment and …

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Accommodations for Contraception Coverage Exemptions Replace Subsidies As The ACA Story of the Week

In recent months, the main event in the challenges against the Affordable Care Act centered on the subsidies provisions in the ACA. The Supreme Court decided this matter in King v. Burwell. In July 2015, there were two additional key developments related to the provision requiring employers to provide contraception coverage.

On July 14, 2015, the 10th Circuit Court of Appeals in Little Sisters of the Poor Home v. Burwell held that the self-certifying procedure in place for religious not-for-profits to take advantage …

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SCOTUS: Affordable Care Act Subsidies Apply to Federal Exchanges

On June 25, 2015, in a 6-3 opinion written by Chief Justice John Roberts, the United States Supreme Court held that the subsidies available in the Affordable Care Act apply to participants in both state and federal healthcare exchanges. A key component of the Affordable Care Act (i.e., the part that helps make this insurance affordable) is tax subsidies for those who qualify under the income requirements stated in the Act. Language in this provision, according to the petitioners and the dissent, appeared to limit …

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U.S. GAO Study Analyzes Market Share Among Health Care Enrollees

The Patient Protection and Affordable Care Act (PPACA) requires the GAO to study competition and market concentration in the health insurance market. This study examined the individual, small group, and large group health insurance markets prior to the implementation of key PPACA provisions that went into effect in 2014 and that could have an effect on competition and market concentration among health insurers.

The study found that while several insurers participated in each state’s individual, small group, and large group health insurance markets in 2013, …

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Californians – “Insurance on My Mind”

California voters had insurance on their minds during the mid-term elections with at least two insurance-related questions on the ballot.

The first was Proposition 45, entitled the “Healthcare Insurance. Rate Changes. Initiative Statute.”  If approved, this initiative would have required the state’s Insurance Commissioner to approve any rate increases for individual and small group health insurance plans before those rate hikes took effect.  If the state’s Insurance Commissioner determined that a rate hike was unreasonable or excessive, the commissioner could veto the hike.  The proposition’s …

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SCOTUS Grants Cert on ACA Tax Subsidy Case

On Friday, November 7, 2014, the U.S. Supreme Court agreed to hear King v. Burwell, one of the cases about who is eligible for the tax subsidies in the Affordable Care Act (ACA).  These subsidies are a critical part of the legislation as they are designed to help make health insurance affordable.  As we discussed in a prior post, at least two U.S. Circuit Courts of Appeal have issued different interpretations on this language.

In King v. Burwell, the 4th Circuit …

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Higher Deductible Plans Are the New Black and Speaking of Enrollment . . .

With 2014 wrapping up, attention is quickly turning to the benefits enrollment period for 2015 including enrollment for health insurance.  A new survey out by Towers Watson, the National Business Group on Health, and PriceWaterhouseCoopers provides a glimpse into how employers are thinking about these benefits.  One conclusion is that, for health insurance, higher deductible plans are the new black.

Since the passage of the Affordable Care Act (ACA), one of the big questions is what, if any, impact its passage would have on employer-provided …

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Obama Administration Files Proposed Rules on ACA Preventative Services Coverage–Seeks Input on Logistics

The Obama Administration has filed an Interim Final Rule seeking input on the logistics of obtaining an accommodation and in defining eligible organizations with respect to coverage for preventative services under the ACA.

The new interim final regulations establish another option for an eligible organization to avail itself of the accommodation. Under the IFR, an eligible organization may notify the Department of HHS in writing of its religious objection to contraception coverage. HHS will then notify the insurer for an insured health plan, or the …

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Obama Administration Seeking Full D.C. Circuit Rehearing to Address Obamacare Circuit Split; Plaintiffs in Fourth Circuit Seek Cert from Supreme Court

On Friday, August 1, the Obama Administration filed its much anticipatedpetition for rehearing en banc with the D.C. Circuit in Halbig v. Burwell.  The petition asks for the full D.C. Circuit bench to reconsider and overturn the original ruling by the three judge panel based on a what the Administration has characterized as a misconstruction of the statutory language at issue.

The D.C. Circuit’s three judge panel determined that the Affordable Care Act provision permitting subsidies unambiguously restricts its applicability only to state-based …

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Courts Split on ACA Health Insurance Subsidies: Highlights Differences in Statutory Interpretation

On July 22, 2014, two U.S. Courts of Appeals highlighted both the science and the art of statutory construction and interpretation — and came to very different conclusions. These courts were asked to consider an IRS rule (26 C.F.R. § 1.36B-2(a)(1)) associated with a section of the Affordable Care Act that provides tax credits (subsidies) for those who purchase health insurance under the exchanges. The central issue was whether the relevant provision of the ACA (26 U.S.C. 36B(c)(2)(A)(i)) (the provision), which provides that subsidies would …

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