Last week, Ann Doss Helms wrote an article for the Charlotte Observer about Luis Lang, a SC man with diabetes who will go blind if he doesn’t get eye surgery in the near future. In a nutshell, Luis Lang is a Republican who opted to ignore the ACA’s individual mandate in 2014, and he also… Read more about The Luis Lang story – an update and my own thoughts
Archives for 2015
Grumpy Cat and the Health Wonks
Steve Anderson hosted the Health Wonk Review this week at Medicare Resources, and it’s not to be missed. It features Grumpy Cat, but despite the grumpy theme, you might just LOL. And ponder something that “could turn your frown that was upside down back the way it was” One of my favorites in this edition… Read more about Grumpy Cat and the Health Wonks
Health Wonkery – replacing Obamacare, covering undocumented immigrants, and much more
Joe Paduda did an excellent job with the latest edition of the Health Wonk Review over at Managed Care Matters. My favorite post in the HWR comes from Tim Jost, writing at Health Affairs. His article, about what would replace the ACA if it were repealed, is an excellent read. Jost digs deep into the… Read more about Health Wonkery – replacing Obamacare, covering undocumented immigrants, and much more
A new job is not a qualifying event for a SEP
Now that open enrollment is over, the only way people can enroll in individual health plans is with a qualifying event. This applies both on and off the exchange. Outside of open enrollment, individual/family health insurance is only for sale if you’ve got a special enrollment period triggered by a qualifying event. So what constitutes… Read more about A new job is not a qualifying event for a SEP
What if your coverage gap spans two calendar years?
Last week, I wrote a post detailing exactly how the ACA’s “short coverage gap” exemption works. In a nutshell, as long as your gap in coverage is less than three months long and you maintain coverage for the rest of the year, you don’t have to pay a penalty for being without coverage. In that… Read more about What if your coverage gap spans two calendar years?
A dependent child’s income and MAGI for Medicaid/subsidy eligibility
For many of our clients, income and subsidy eligibility determination have replaced medical underwriting as a source of confusion when enrolling in a new health insurance policy. If your income is above 400% of the poverty level (for current enrollments, that’s anything above $46,680 for a single person, and $94,500 for a family of four), it… Read more about A dependent child’s income and MAGI for Medicaid/subsidy eligibility
Short Gap in ACA coverage – IRS Says Three Months is Too Long
One of the exemptions from the ACA’s individual mandate penalty is for people who have a short gap in ACA coverage. According to the IRS regulations (see page 53654), there’s no penalty as long as the “continuous period without minimum essential coverage is less than three full calendar months and is the first short coverage… Read more about Short Gap in ACA coverage – IRS Says Three Months is Too Long
House Approves Medicare SGR Replacement; Senate to Vote in Two Weeks
Last week, the US House of Representatives overwhelmingly approved HR2, the legislation to repeal the Medicare Sustainable Growth Rate (SGR) and eliminate the need for an annual “doc fix”. The bill also extends the Children’s Health Insurance Program for another two years, and provides $7 billion in funding to support community health centers (this simply keeps community health center… Read more about House Approves Medicare SGR Replacement; Senate to Vote in Two Weeks
Spring Break Health Wonkery
Jennifer Salopek hosted the Health Wonk Review this week at Wing of Zock, and there’s lots of good weekend reading in this spring break edition. Several posts stood out as excellent – here are some of my favorites: Shea McCarthy has an excellent piece at Healthcare Lighthouse, explaining the SGR deal that overwhelmingly passed the… Read more about Spring Break Health Wonkery
Colorado clarifies that grandmothered plans must end by December 31 – is exchange revenue a factor?
Last week, Colorado regulators announced that they won’t allow transitional (“grandmothered”) health plans to renew again at the end of this year, and that all non-ACA-compliant plans (unless they’re grandfathered) will end no later than December 31, 2015 and will need to be replaced with ACA-compliant coverage. Grandfathered Plans Grandfathered plans are those that were… Read more about Colorado clarifies that grandmothered plans must end by December 31 – is exchange revenue a factor?
Health wonks in the melting snow
Brad Wright hosted the Health Wonk Review today at Wright on Health, and it’s an outstanding edition. It also has a cheery series of pictures that beautifully illustrate the transition from winter to spring – nicely done Brad! There are so many great articles in this edition, it’s hard to pick a favorite. But there are… Read more about Health wonks in the melting snow
No Tax Season Special Enrollment Period In Colorado
A few weeks ago, the federal government announced that people in the 37 states that use Healthcare.gov would have access to a tax season special enrollment period (SEP) if they were unaware of the ACA’s penalty for being uninsured, and found out about it at the time they filed their taxes – which could be up to… Read more about No Tax Season Special Enrollment Period In Colorado
A Tenth Anniversary Health Wonk Review at Health Business Blog
Health Business Blog was one of the sites we used to read even before we started our own blog in 2006 – and we’ve been reading it ever since. It’s turning ten this weekend (where does the time go?!) and to celebrate, David hosted the Health Wonk Review this week. There are lots of great… Read more about A Tenth Anniversary Health Wonk Review at Health Business Blog
2016 Open Enrollment finalized, plus a special enrollment period in 40 states
Be ready!
Gaming Obamacare isn’t as easy as it sounds
Yesterday, The Federalist published an article titled Five Easy Ways To Game Obamacare. It’s an interesting article, but we thought it might be helpful to add detail about some of the problems with the strategies mentioned. Gaming Obamacare may turn out to be more costly and difficult than you imagine. Buy nine, get three free The idea here is that… Read more about Gaming Obamacare isn’t as easy as it sounds
Create a special enrollment period for those who file taxes after February 15 and owe a penalty
Open enrollment ended yesterday, but there are widespread extensions in most exchanges through the end of this week or even the end of the month in some states. Connect for Health Colorado shared a tweet and facebook update Sunday evening, clarifying that for anyone who had begun the enrollment process but didn’t have it finished by… Read more about Create a special enrollment period for those who file taxes after February 15 and owe a penalty
Take heart – there’s plenty of good stuff in this HWR
Peggy Salvatore hosted the Valentine’s Day edition of the Health Wonk Review, and you don’t want to miss it. Here are some of my favorites in this week’s HWR: Writing at Health Affairs, Ron Pollack from Families USA demonstrates the ways that the context of the ACA clearly makes subsidies available in every state. SCOTUS is… Read more about Take heart – there’s plenty of good stuff in this HWR
Out-of-network care, emergencies, and balance billing
A couple years ago, I wrote a post about balance billing from out-of-network providers in emergency situations. Then a few days ago, we got an email from a reader who wondered if anything had changed since then, as her husband had been in a car accident and the emergency department physician was out-of-network, despite the ED… Read more about Out-of-network care, emergencies, and balance billing
Super Bowl Health Wonkery
Jason Shafrin hosted the Super Bowl edition of the Health Wonk Review today – be sure to check it out. I think my favorite entry in this edition is from Roy Poses at Health Care Renewal. If you pay attention to healthcare headlines, you’ve probably seen the headlines about the “miracle” cure for Hepatitis C…. Read more about Super Bowl Health Wonkery
Cost of Obamacare is 20% less than we thought
Good news! The cost of Obamacare is less than we thought. Yesterday, the CBO released their comprehensive ten-year budget and economic outlook report. It’s 177 pages, and addresses all aspects of the federal budget and deficit, including Obamacare. Back in 2010, the CBO predicted that the the ACA would cost the federal government $759 billion in… Read more about Cost of Obamacare is 20% less than we thought
Kicking off 2015 with the latest from all the wonks
Vince Kuraitis hosted the first Health Wonk Review of 2015 – the “shake the winter blahs” edition – at his eCareManagement Blog, and it’s full of great articles. Some of my favorites in this edition: Roy Poses, writing about the “miracle” Hepatitis C drugs and reminding us – as always – to focus on evidence…. Read more about Kicking off 2015 with the latest from all the wonks
Expanding Medicaid was the right move in the 80s and still is today
When the ACA was signed into law almost five years ago (time flies!), one of its cornerstones was the expansion of Medicaid in every state, to cover everyone with incomes up to 133% of the poverty level (plus a 5% income disregard, which essentially makes the threshold 138% of poverty). That was to be implemented… Read more about Expanding Medicaid was the right move in the 80s and still is today
Healthcare spending is 17% of GDP; we should expect it to be a major line item in household budgets
This USA Today article by Laura Ungar and Jayne O’Donnell is well worth reading. In a nutshell, it’s all about rising deductibles, and the impact they have on consumers’ ability to pay for health care. The facts are sobering: wages have been flat for decades, with the inflation adjusted average hourly wage only increasing by… Read more about Healthcare spending is 17% of GDP; we should expect it to be a major line item in household budgets