QSEHRA Revives Employer Payment Plans For 2017

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On December 13, 2016, President Obama signed the 21st Century Cures Act into law. Called “the most important bill of the year,” the bipartisan Act makes changes to a wide range of healthcare issues. These include allocating billions for cancer research, easing the FDA drug approval process, and allowing doctors to test medical devices without a patient’s informed consent in certain situations. One item that will be of interest to finance and human resource professionals at small employers ...

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Republicans Unveil ACA Alternatives

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As the Republican presidential primary race is heating up, the candidates’ plans to repeal and replace Obamacare are receiving increased attention.

Wisconsin Governor Scott Walker announced his plan to repeal and replace Obamacare, “The Day One Patient Freedom Plan,” at a factory in Minnesota on Tuesday. His plan includes a number of policy proposals that have long been popular among conservatives, including tort reform, selling health insurance across state lines, and Medicaid block grants for the states. One of ...

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GAO Probe Focuses on Healthcare.gov Fraud

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The nonpartisan Government Accountability Office (GAO) reported to Congress last Thursday that it has concluded an undercover investigation into the fraud detection capabilities of the federal health exchange website, www.healthcare.gov.

The GAO’s Director of Forensic Audits, Seto Bagdoyan, told the Senate Finance Committee that his investigators submitted applications for eighteen fictitious individuals last year. Of those eighteen, eleven successfully enrolled in a subsidized health insurance plan. And of those eleven, six were flagged as suspicious and terminated ...

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ACA Subsidies Upheld

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This morning, the U.S. Supreme Court issued its opinion in the case King v. Burwell. The Court ruled 6-3 that individuals who purchase health insurance through the federal exchange, www.healthcare.gov, can received subsidies based on their income.

The plaintiffs in the case argued that only individuals who purchased coverage through a state-based exchange should be eligible for subsidies because the text of the Affordable Care Act (ACA) says subsidies are available to people who enroll through an ...

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Getting to Know Form 1095-A

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If you enrolled in a Qualified Health Plan (QHP) through the public Health Insurance Marketplace last year, you may have recently received a new document from the Internal Revenue Service (IRS) called Form 1095-A. Form 1095-A is a tax form that is sent by the Marketplace to allow consumers to complete Form 8962, which they will use to calculate their premium tax credit and reconcile it with any advance payments of the premium tax credit they may have received.

If the ...

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2015 Exchange Rates Impact Subsidies

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Public Exchange rate changes in SE WI

With the second season of public exchange open enrollment in full swing, it is now possible to analyze changes in plan costs from year to year. Of all the plans on the public exchange, the one with the biggest effect on the rest ...

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SCOTUS Decision Looms Over 2015 Benefit Strategies

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On November 7, the U.S. Supreme Court agreed to hear another challenge to the Affordable Care Act. In 2012, the Court upheld the constitutionality of the law’s requirement that individuals obtain health insurance or pay a penalty and limited the Federal government’s ability to withhold funding for states that did not expand eligibility for Medicaid. This new case is perhaps not as significant as the 2012 case, but employers should still be aware of how its outcome could affect their ...

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Conflicting Appeals Court Rulings have Little Effect on Subsidies…For Now

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Two U.S. appeals courts came down on different sides of the fence as to whether the Affordable Care Act allows the federal government to provide subsidies to consumers purchasing health insurance on public exchanges run by the federal government.

Halbig v. Burwell ruled subsidies were not available on the federal exchange, and hours later King v. Burwell ruled the IRS had the discretion to issue subsidies on federal exchanges as the law was ambiguous.  In all likelihood, this issue will be decided by ...

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Healthcare Musings from Jim Mueller

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Baby boomers on Medicare, lower income consumers receiving subsidies for health insurance via the Affordable Care Act, and the expansion of Medicaid means the federal government is more involved in health care than ever.  These massive shifts in health care economics are not new topics for blogs or commentary; however, an article titled “Government Money Often Doesn’t Add Up” in the July 10, 2014 edition of the Milwaukee Journal Sentinel compelled me to ask if this is the direction we ...

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The Lesser Known Problem with Subsidies

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Generally called “subsidies”, there are actually two different subsidies available to consumers depending on their income level within the Affordable Care Act’s public exchange.  Premium assistance tax credits and cost-sharing reductions.  Cost-sharing reductions are available to help consumers with the out of pocket expenses for treatment or services.  There is a wide range of how different insurance plans pass these cost-sharing subsidies onto the consumer.  Most plans choose to lower deductibles or out of pocket maximums.

An analysis by Avalere Health ...

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