Trump signs executive order against Obamacare

WASHINGTON -- President Donald Trump on Friday signed an executive order aimed at limiting the "burden" of the Obamacare health law that the incoming US leader has vowed to repeal.

During the signing in the Oval Office, Trump's chief of staff Reince Priebus described the order as aimed at "minimizing the economic burden" of the 2010 Affordable Care Act, "pending repeal."

Doing away with Barack Obama's signature domestic achievement is a top priority for Republicans, who control both chambers of Congress and, since Trump's inauguration Friday, the White House.

In their view, Obamacare -- which aimed to ensure healthcare for the millions of Americans who are neither covered by public insurance, nor by their employers -- marked a costly drift toward socialized, European-style medical care.

Until lawmakers are able to repeal Obamacare, "it is imperative for the executive branch to... take all actions consistent with law to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market," the executive order said.

The order instructs the US health secretary and other departments and agencies to "exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act" that imposes a fiscal burden or other cost on a state, on consumers, on insurers or on a range of healthcare providers.

Trump has pledged to start undoing the divisive health law on his first day in office, while also declaring it inconceivable that poor Americans are locked out of coverage.

The president has said the law should be repealed and replaced "simultaneously," a stiff challenge given the complexity of America's vast health care system.

Obamacare added more than 20 million people onto insurance rolls, lowering the percentage of Americans without coverage from 16 percent in 2010 to 8.9 percent last year.

Republicans are pledging a repeal of Obamacare -- which has been blamed for sharply rising insurance premiums -- and rapid votes on a replacement bill in order to prevent gaps in coverage and reassure a restless insurance industry.

Only one third of the US population is covered by public insurance -- either Medicare, for those over age 65, or Medicaid for the poorest Americans.

Half of all Americans are insured through their employers, according to the Kaiser Family Foundation, while about seven percent are covered through the so-called individual market, which serves those who are self-employed or are employees without coverage through work.

Obama's solution rested largely on requiring that everyone be insured, and providing federal subsidies to those who cannot afford coverage.

Republicans deemed the first requirement too coercive, and the latter too costly.

source: interaksyon.com

Small Firms’ Offer of Plan Choices Under Health Law Delayed

WASHINGTON — Unable to meet tight deadlines in the new health care law, the Obama administration is delaying parts of a program intended to provide affordable health insurance to small businesses and their employees — a major selling point for the health care legislation.

The law calls for a new insurance marketplace specifically for small businesses, starting next year. But in most states, employers will not be able to get what Congress intended: the option to provide workers with a choice of health plans. They will instead be limited to a single plan. 

The choice option, already available to many big businesses, was supposed to become available to small employers in January. But administration officials said they would delay it until 2015 in the 33 states where the federal government will be running insurance markets known as exchanges. And they will delay the requirement for other states as well. 

The promise of affordable health insurance for small businesses was portrayed as a major advantage of the new health care law, mentioned often by White House officials and Democratic leaders in Congress as they fought opponents of the legislation. 

Supporters of the law said they were disappointed by the turn of events. 

The delay will “prolong and exacerbate health care costs that are crippling 29 million small businesses,” said Senator Mary L. Landrieu, Democrat of Louisiana and the chairwoman of the Senate Committee on Small Business and Entrepreneurship. 

In the weeks leading up to the passage of the health care legislation in 2010, Ms. Landrieu provided crucial support for the measure, after securing changes to help small businesses. 

The administration cited “operational challenges” as a reason for the delay. As a result, it said, most small employers buying insurance through an exchange will offer a single health plan to their workers next year. 

Health insurance availability and cost are huge concerns for small businesses. They have less bargaining power than large companies and generally pay higher prices for insurance, if they can afford it at all. 

The 2010 law stipulates that each state will have a Small Business Health Options Program, or SHOP exchange, to help employers compare health plans and enroll their employees. 

One of the most important tasks of the exchange is to simplify the collection and payment of monthly premiums. An employer can pay a lump sum to the exchange, which will then distribute the money to each insurance company covering its employees. 

The Obama administration told employers in 2011 that the small business exchange would “enable you to offer your employees a choice of qualified health plans from several insurers, much as large employers can.” In addition, it said, the exchange would “consolidate billing so you can offer workers a choice without the hassle of contracting with multiple insurers.” 

Exchanges are scheduled to start enrolling people on Oct. 1, for coverage that begins in January. However, the administration said that the government and insurers needed “additional time to prepare for an employee choice model” of the type envisioned in the law signed three years ago by President Obama. 

D. Michael Roach, who owns a women’s clothing store in Portland, Ore., said the delay was “a real mistake.” 

“It will limit the attractiveness of exchanges to small business,” he said. “We would like to see different insurance carriers available to each of our 12 employees, who range in age from 21 to 62. You would have more competition, more downward pressure on rates, and employees would be more likely to get exactly what they wanted.”

John C. Arensmeyer, the chief executive of Small Business Majority, an advocacy group, said that the delay of “employee choice” was “a major letdown for small business owners and their employees.” 

“The vast majority of small employers want their employees to be able to choose among multiple insurance carriers,” Mr. Arensmeyer said. 

Small Business Majority supported Mr. Obama’s health care law. 

That support was invaluable to Democrats who pushed the bill through Congress. Representative Nancy Pelosi of California, who was speaker at the time, cited the group’s research as evidence that “small businesses will benefit from health insurance reform.” 

However, in recent weeks, insurance companies urged the administration to delay the employee choice option. 

“Experience with Massachusetts has demonstrated that employee choice models are extremely cumbersome to establish and operate,” the health insurer Aetna said in a letter to the administration in December. 

Insurers said that the administration was partly responsible for the delay because it did not provide detailed guidance or final rules for the small-business exchange until last month. 

Businesses with up to 100 employees will be able to buy insurance in the exchanges. In 2014 and 2015, states can limit participation to businesses with 50 or fewer employees. Companies with fewer than 25 workers may be able to obtain tax credits for up to two years of coverage bought through an exchange. 

States can open the exchanges to large employers in 2017. 

A few states running their own exchanges, including California and Connecticut, said they planned to offer an employee choice option next year, though it was not required by the federal government. 

A stated goal of the 2010 law was to increase “consumer choice” and stimulate competition among insurers. 

The law makes it easier for consumers to compare health plans by defining four standard levels of coverage, ranging from the least to the most generous. The law says an employer can pick a level of coverage and then allow employees to choose among all the health plans available at that level. 

source: nytimes.com

Insurance Rebates Seen as Selling Point for Health Law

Lucia Harkenreader’s check landed in her mailbox last week: a rebate of $456.15 from her health insurance company, with a letter dryly explaining that the money came courtesy of the federal health care law.

“It almost looked like junk mail,” said Ms. Harkenreader, a tax accountant in Mountain Top, Pa., who said she did not love the overall law but was pleased at the unexpected windfall. “If this is part of Obamacare, I’m happy that somebody is finally coming down on the insurance companies and saying, ‘Look, let’s be fair here.’ ”

The law requires insurers to give out annual rebates by Aug. 1, starting this year, if less than 80 percent of the premium dollars they collect go toward medical care. For insurers covering large employers, the threshold is 85 percent.

As a result, insurers will pay out $1.1 billion this year, according to the Department of Health and Human Services, although most of it will not go to individuals. The average rebate will be $151 per household, with the highest in Vermont ($807 per family), Alaska ($622) and Alabama ($518). No rebates will be issued in New Mexico or Rhode Island, because insurers there met the 80/20 requirement.

Although the percentage of insurance companies that owe rebates this year is relatively small, about 14 percent, many giants of the industry are on the list. They include Aetna, Cigna, Humana and UnitedHealthcare.

President Obama is highlighting the rebates as a tangible early benefit of the legislation; on the day the Supreme Court upheld the law as constitutional last month, he said millions of Americans would see rebates because their insurance companies had “spent too much on things like administrative costs and C.E.O. bonuses, and not enough on your health care.”

So is your check in the mail? Don’t count on it.

Self-insured employers, which cover more than half the nation’s workers, are exempt from the new rule, as are Medicare and Medicaid. And of the 75 million people in health plans subject to the rule, only about 17 percent, or 12.8 million, will get rebates this year, according to the Obama administration.

Many who buy coverage directly from insurers, like Ms. Harkenreader and other self-employed people, are receiving checks. But in most cases rebates are being sent to employers, who can chose to put them toward future premium costs instead of distributing them to workers.

“I’ve been trying to explain that to people — that very few people would be getting a check,” said Timothy S. Jost, a law professor at Washington and Lee University who is an expert on the health care law.

Still, he and others say the rebate provision could prove a potent selling point for a law that remains unpopular with many Americans, not to mention a well-timed tool for the Obama re-election campaign. Premiums — and anger toward insurance companies — keep rising: the cost of employer-sponsored family health plans jumped by 9 percent last year to more than $15,000, according to the Kaiser Family Foundation.

For Ms. Harkenreader, 53, who is putting a son through college, the rebate helps soothe the frustration she feels toward her insurer, Golden Rule, which is owned by UnitedHealthcare.

“It seems like the health insurance companies really just don’t have any consideration for the cost out here,” said Ms. Harkenreader, who pays about $480 a month for a high-deductible plan, up from $400 last year. “What costs have gone up to justify that rise in premium? I’d love to know. Did you give your people a raise? I guess your light bill went up?”

Professor Jost said he had heard “quite a bit of anecdotal evidence of insurers giving really low premium increases this year” — a sign that the rebate rule might already be having an effect. (This year’s rebates are based on the share of premiums that went to administrative costs in 2011.)

Amber Wagner of St. Peters, Mo., said that in addition to a rebate of $143, she had gotten word from her insurer, Anthem, that her premium rate would drop starting next month.

“It does make sense,” Ms. Wagner, 29, said of the rebate rule. “Why should they get to spend all this money on advertising and lining the pockets of people who own the company and make me pay more?”

Insurance companies say the rebate requirement does not address swiftly rising medical costs, which they say are the main reason premiums keep going up.

“Placing an arbitrary cap on administrative costs is going to do nothing to make health care more affordable,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, the industry trade group. “There’s a lot of misinformation out there.”

Critics also say the rule could drive insurers with high administrative costs out of some markets if they are not given more time to meet the 80/20 standard, potentially leaving customers in the lurch. That concern factored into a decision by the Department of Health and Human Services to allow insurers in several states to spend a higher portion of premiums on overhead for now. Those states are Georgia, Iowa, Kentucky, Maine, Nevada, New Hampshire and North Carolina. Eight other states sought but were not granted a reprieve.

Employers can put the rebates toward future premium costs, share them directly with workers or use them to enhance benefits. Insurers have the option of directly reducing future premiums instead of sending out rebates.

In Kentucky, the Floyd County commissioners voted last week to distribute the county’s rebate of $169,748.78 from Humana to county employees as a surprise. The 260 employees will soon receive checks, although Stephen Bush, the board president, said the amounts have yet to be determined. Those who paid higher premiums will probably get more, he said.

“It’s probably been five, seven years since they’ve gotten a raise,” Mr. Bush said. “If they want to use it for premiums, they can. But if they’re living paycheck to paycheck or it’s a difficult time, they have that opportunity to use it for whatever they want.”

Robert Blendon, a health policy professor at Harvard, said that while the rebates might win over some opponents of the law, they were too limited to have much impact. Polls have found that most people believe the law will drive premiums up.

“My view is the number is too small,” Professor Blendon said. “Most people have already come to some judgment about the law and they are moving on to other things.”

source: nytimes.com