For anyone interested in seeing decision-making on the ACA in action, our Exchange will be broadcasting two committee meetings via the link in the OP on Tuesday, July 10 at 9:30am and 11:30am Pacific .
If you work for exempted company and buy a subsidized silver plan for your family. Lets say the subsidy was 5000 dollars. Since your company was exempted from the mandate are they still billed for this subsidy.
How does the ACA effect those of us with health savings accounts and/or high deductible plans?
Is their any estimates to what a gold, silver, or bronze insurance will look like?
Also is their any estimate to how much these subsidies will cost the federal government.
Where is the funds to pay for these subsidies from, assuming your employer is exempt or has a waiver.
I am also very disappointed to learn undocumented immigrants will not qualify for these subsidies. Are any states planning to give undocumented immigrants the subsidies out if their own pocket. It is nice that California will a at least give them Medicaid, which I think would include most of them.
The metal levels will vary by state and will partially be based on the Essential Health Benefits your state chooses as well as the three most popular currently offered in the state (as determined by CCIIO).
On the flip side "undocumented immigrants" will also not be subject to the individual mandate.
I don't know of any state planning on footing the subsidy out of their own pocket. Given the budget problems of most states I doubt any state could afford it.
Interesting. What will happen if you need to be covered in an out of state area? Are the hospitals obligated to cover the cost at the rate determined under the metal plan of your state of residence or will there be 'out of state' charges similar to the 'out of network' charges now. If so, are those defined/limited by the ACA or will that likely vary by state as well?
Btw - big thanks for doing this:thumbsup:
Remember that if you're traveling and no network providers are available you're supposed to be able to go out of network and have your provider cover it as if it were in-network. The out-of-network surcharge is only supposed to apply when you voluntarily go out of network.
Thanks - I didn't know if that would carry over or not now that entire states could be 'out of network'
Do people earning below the poverty level have to purchase insurance or pay a tax penalty?
Do people earning below the poverty level have to purchase insurance or pay a tax penalty?
Your state has to allow Navigators, that's a federal requirement of the ACA. Navigators are supposed to be the "community outreach" people who can reach groups traditionally underserved by the agent/broker model.
That being said, states have a lot of leeway in how they set up their individual Navigator programs. I know our state has had requests from hospitals to allow them to have Navigators on staff for that very situation, but the licensure, education, continuing education, and accountability (fines, censure, E&O coverage, etc.) are all things that have yet to be determined.
It would not surprise me if some states think that having Navigators in hospitals is a wonderful idea and other states think that it will be a huge conflict of interest.
Is their any estimates to what a gold, silver, or bronze insurance will look like?
If you are under 133% of the poverty level and your state won't participate in the new Medicaid rules, best to get the hell of of that state and moved to a civilized one that will.
That assumes that you CAN uproot yourself and any family you may have. For a lot of people, it simply isnt an option. This is one of my lamentations about the ACA ruling not resting on the commerce clause. It took the teeth out of the medicare expansion. Many working poor will be left out.
So far, I've seen that Texas, Florida, Wisconsin, and a few other states have publicly stated that they would opt out entirely, or at least wait until after November to attempt ANY action with regards to ACA compliance or the medicare expansion.
Does anyone have a more concise list of what states' stated courses of action might be with regard to exchange setup and the medicare expansion under the ACA?
That assumes that you CAN uproot yourself and any family you may have. For a lot of people, it simply isnt an option. This is one of my lamentations about the ACA ruling not resting on the commerce clause. It took the teeth out of the medicare expansion. Many working poor will be left out.
So far, I've seen that Texas, Florida, Wisconsin, and a few other states have publicly stated that they would opt out entirely, or at least wait until after November to attempt ANY action with regards to ACA compliance or the medicare expansion.
Does anyone have a more concise list of what states' stated courses of action might be with regard to exchange setup and the medicare expansion under the ACA?
Just a point, it's Medicaid, not Medicare. An important difference exists.
I haven't a list yet because, in my opinion, until someone actually does something to opt out of the Medicaid expansion or exchanges it's just a bunch of bloviating.
Concerning the Medicaid expansion, a state may opt in to the expansion, at which point the state voluntarily amends its Medicaid eligibility criteria (Medicaid eligibility is determined by states and not the fed) to 133% of the FPL (138% in practice since Medicaid ignores the first 5% of income). If it does so then the fed will pick up 100% of the cost of the new enrollees for the first 3 years. After that the fed pays for ~90% of costs for 4 or 5 years. After that no promises have been made, but most states expect funding to settle around 50-50 (it's currently 41-59 for existing Medicaid eligibles).
For states that are considering opting out, there are several considerations:
1) The long-term costs will run into the hundreds of millions to billions once 2020 rolls around and the funding promises evaporate;
2) If a state opts in the fed only picks up the extra cost for medical care. All of the ancillary administrative costs of the expansion (IT resources, SHIP/CHIP caseworkers, etc) will be split 50-50, meaning that the expansion is not free even in the short-term; and
3) Even if a state opts out Medicaid rolls are expected to increase due to the mandate. If someone is eligible for Medicaid today their costs will only be paid 50% by the fed regardless of expansion since technically they are not a "new" Medicaid eligible person.
Concerning the exchanges, a state really has 4 options, only three of which are viable:
1) Create their own exchange. This is appealing because it allows states to control almost everything but is unappealing because the long-term cost must be borne by the state and the feds haven't been timely in issuing advice or regulations. The ACA was extremely vague in many respects, intentionally, with the understanding that CCIIO and HHS would fill in the gaps later. Well... they're not filling in the gaps very quickly so implementation is next to impossible.
2) Create a FFE (Federally Facilitated Exchange). The feds come in and basically set up the exchange infrastructure but the states get to retain certain critical roles such as consumer protection. Most states considering not setting up an exchange should go this route.
3) Punt. Do nothing. The federal government will set up an exchange, likely a national one, and you get stuck with the results. The advantages are that you can (maybe) avoid some costs and have the political feather or thumbing your nose at the ACA but pretty much everything else is a disadvantage. You don't keep any oversight, you lose your ability to regulate your market, you have to start from scratch if you ever decide to take the exchange back, your citizens are hurt quite a bit by federal incompetence, etc.
The fourth option is for two or more states to team up to create a "regional" exchange, but pretty much nobody expects that to happen since it has drawbacks similar to #1 and #3 without many of the advantages.
Do you know what states out of California expands Medicaid to undocumented immigrants, just wondering if California is the only one?