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Obama Administration races to meet key ACA deadline
World Report
Obama Administration races to meet key ACA deadline Despite delaying some provisions of the Affordable Care Act, the US Government says it is on target to begin enrolling millions of Americans in the law’s new health coverage. Susan Jaffe reports.
www.thelancet.com Vol 382 August 17, 2013
But Obama Administration officials and their supporters are far from discouraged. “Let me be clear”, US Health and Human Services (HHS) Secretary Kathleen Sebelius told reporters on Aug 5. “We are on target and ready to flip the switch on Oct 1.”
“...federal officials continue to fend off Republican attacks on the law...” She backed up her assertion by unveiling what will become the first step in enrolment: a “My Account” web page at www.healthcare.gov is now available for people who live in states with a federally run marketplace so that people can create a passwordprotected individual account that will store application information. The “one-stop” application will be used to purchase coverage through the insurance marketplace, qualify for tax credits or subsidies, or to apply for coverage from government health programmes for low-income families, including Medicaid. Several private contractors have also been hired to work on the programme: a Virginia-based company will be hiring some 9000 workers to staff a health insurance marketplace call centre and a British company, Serco, won a contract worth nearly US$1·2 billion to help process applications. But earlier this month, the HHS Inspector General, an independent watchdog agency, found that security tests were running behind schedule for the data network needed to transfer and verify information among government offices and insurers. Although the network does not store sensitive information, it connects to the Internal Revenue Service and other
agencies that possess confidential income and other data. At the same time the Obama Administration is racing to meet the Oct 1 deadline, it has decided to delay some provisions of the health law. Employers with 50 or more workers will not have to report until 2015 whether they provide their employees with health insurance, effectively delaying the insurance mandate, which fines violators $2000–3000 per employee. In addition, critics have questioned whether delays in income verification will result in some consumers receiving financial assistance for which they are not eligible. Some delay is unavoidable, since most applicants’ 2014 income cannot be completely verified until they file their 2014 tax return. If income tax returns or other government data later find that beneficiaries are ineligible, they may have to refund to the government the amount they should not have received. Those who provide false information may also face civil or criminal penalties. A lesser known provision, allowing insurers to charge smokers higher premiums than non-smokers, will also be modified next year.
Published Online August 15, 2013 http://dx.doi.org/10.1016/ S0140-6736(13)61723-7 See Online for video
Getty Images
Less than 7 weeks before millions of Americans begin enrolling in the new health insurance plans offered under President Barack Obama’s landmark Affordable Care Act (ACA), critics claim that his Administration isn’t ready and will preside over a monumental failure and a waste of taxpayer dollars. Starting Oct 1, state or federally run online competitive insurance marketplaces will begin selling dozens of private health insurance policies that provide at least the “essential health benefits”, including maternity care, required under the law. Tax credits and premium subsidies will reduce the cost for some small businesses and lowincome families when coverage begins on Jan 1, 2014. The law mandates nearly every adult to carry health insurance and every employer with 50 or more employees to offer coverage. Insurers will not be able to turn away people with pre-existing health conditions, cancel coverage when beneficiaries need expensive treatment, or charge women higher premiums than men, among other requirements. While federal officials continue to fend off Republican attacks on the law (unabated despite Obama’s reelection and the Supreme Court’s ruling upholding most of the law) they are also trying to complete work on the system needed to help Americans choose and enrol in an insurance plan and to determine their subsidy eligibility. They are also mounting an outreach campaign to explain the programme’s benefits to a sceptical public, an effort that has been hobbled by congressional Republicans’ refusal to provide sufficient funding. And in states that won’t run an insurance marketplace on their own, the federal government is running one for them or in partnership with them—an unexpectedly large responsibility that now encompasses 34 states.
The Obama Administration announced the delay of the employer mandate in July
585
Corbis
World Report
Kathleen Sebelius
586
The Administration has said the decision to suspend the employers’ reporting requirements came in response to complaints from business associations and large employers claiming that details were lacking about what should be reported, leaving little time to comply. Since about 95% of the US employers affected by the requirement already offer health insurance, the delay is not considered to pose a serious setback. Although federal officials portrayed the delays as a conciliatory measure intended to ease compliance for business, opponents disagreed. The changes are viewed as just another reminder of a deeply flawed programme. “How can we believe that other provisions deemed inconvenient by the Administration, such as verifying that someone is actually eligible for taxpayer funded subsidies, won’t be labelled as too complex to administer and simply be ignored?” Joe Pitts, a Pennsylvania Republican, asked Marilyn Tavenner, head of the Centers for Medicare and Medicaid Services, one of the agencies responsible for implementing the law, during a 3-hour congressional committee hearing on Aug 1. “American taxpayers’ dollars should be protected and not hastily spent on a law that may not be ready for prime time.” Colorado Democrat Diana DeGette came to Tavenner’s defense, reminding her colleagues that “the Affordable Care Act is the law of the land and it is already bringing benefits to millions of Americans”. And she named just a few: 8000 young adults in her Denver-area district are able to stay on their parents’ health plans until age 26 years, nearly 7000 seniors in the Medicare programme have saved $9·3 million on prescription drugs, and thousands are already saving money on their insurance bills due to a provision that limits insurance company administrative costs. Nationwide, HHS estimates that this provision alone saved 77·8 million consumers $3·4 billion
in 2012 by requiring insurers to spend at least 80 cents of every dollar received in premiums on delivering health care. Companies that failed to do so last year will pay rebates to 8·5 million consumers. “I think it’s our job, as elected representatives of our constituents, to go out there and tell people…they can have these benefits and get the insurance they need and save money”, said DeGette.
“...’the Affordable Care Act is the law of the land and it is already bringing benefits to millions of Americans’.” But many Americans still know little about the law. In April, 42% of Americans did not know that the ACA was still in effect, and nearly half of those polled said they did not know how it would impact their families, according to a poll by the Kaiser Family Foundation, an independent health research organisation. Its June poll found that 43% still had negative views of the law. “As our polling and other research shows, people kind of know something is happening on Oct 1 but they’re not sure if it will work for them”, said Karen Pollitz, senior fellow at the Kaiser Family Foundation. “And there is all this counter messaging going on: people still think it’s been repealed...it will be bad for them, and their rates are going up 400%.” Sebelius said she wished she had the marketing resources Hollywood spends to publicise a new movie or Apple puts into launching a new product. Instead, Congress turned down a request for additional funding and the across-the-board budget cuts known as sequestration have meant her agency has “to figure out ways to make our resources stretch farther”. She noted that there are also many “eager and engaged” patient advocacy, community, and church groups, health-care providers, hospital associations, and others who are helping get the word out.
The health law provides grants to pay “navigators” to assist people in the enrolment process but without additional state contributions, there may not be enough to meet the need. Sebelius, a former Kansas insurance commissioner, said the navigators have a unique role in providing unbiased information because they are not trying to sell anything. “It’s such a huge step forward in the whole insurance market.” In the remaining weeks, state insurance regulators will be reviewing policies that will be offered in the insurance marketplaces, and verifying that premiums rates and other details comply with the law. In states with federally run marketplaces, the federal government will approve premiums. So far, next year’s insurance premiums in 11 states will be on average nearly 20% lower than Congressional Budget Office estimates. In New York, rates will drop an average of 53% for individually purchased plans offering the highest level of coverage. Yet in Ohio, the state insurance commissioner is predicting large rate hikes and said the delays underscore the need to halt implementation. Ohio is one of the states that is not running its own insurance marketplace, and has rejected federal funds for consumer assistance and for expansion of Medicaid coverage for low-income families after appealing to the Supreme Court to overturn the ACA. “Now is the time to stop moving forward with implementation of this flawed law and instead give states the flexibility necessary to provide consumers and small businesses with more choices and lower costs”, Ohio’s Lieutenant Governor and insurance commissioner Mary Taylor told The Lancet. 2 weeks ago, the Republican-led US House of Representatives passed legislation to repeal the law—for the 40th time—a largely symbolic measure that, without support from Democrats, will not impede the countdown to Oct 1.
Susan Jaffe www.thelancet.com Vol 382 August 17, 2013
Obama Administration races to meet key ACA deadline Despite delaying some provisions of the Affordable Care Act, the US Government says it is on target to begin enrolling millions of Americans in the law’s new health coverage. Susan Jaffe reports.
www.thelancet.com Vol 382 August 17, 2013
But Obama Administration officials and their supporters are far from discouraged. “Let me be clear”, US Health and Human Services (HHS) Secretary Kathleen Sebelius told reporters on Aug 5. “We are on target and ready to flip the switch on Oct 1.”
“...federal officials continue to fend off Republican attacks on the law...” She backed up her assertion by unveiling what will become the first step in enrolment: a “My Account” web page at www.healthcare.gov is now available for people who live in states with a federally run marketplace so that people can create a passwordprotected individual account that will store application information. The “one-stop” application will be used to purchase coverage through the insurance marketplace, qualify for tax credits or subsidies, or to apply for coverage from government health programmes for low-income families, including Medicaid. Several private contractors have also been hired to work on the programme: a Virginia-based company will be hiring some 9000 workers to staff a health insurance marketplace call centre and a British company, Serco, won a contract worth nearly US$1·2 billion to help process applications. But earlier this month, the HHS Inspector General, an independent watchdog agency, found that security tests were running behind schedule for the data network needed to transfer and verify information among government offices and insurers. Although the network does not store sensitive information, it connects to the Internal Revenue Service and other
agencies that possess confidential income and other data. At the same time the Obama Administration is racing to meet the Oct 1 deadline, it has decided to delay some provisions of the health law. Employers with 50 or more workers will not have to report until 2015 whether they provide their employees with health insurance, effectively delaying the insurance mandate, which fines violators $2000–3000 per employee. In addition, critics have questioned whether delays in income verification will result in some consumers receiving financial assistance for which they are not eligible. Some delay is unavoidable, since most applicants’ 2014 income cannot be completely verified until they file their 2014 tax return. If income tax returns or other government data later find that beneficiaries are ineligible, they may have to refund to the government the amount they should not have received. Those who provide false information may also face civil or criminal penalties. A lesser known provision, allowing insurers to charge smokers higher premiums than non-smokers, will also be modified next year.
Published Online August 15, 2013 http://dx.doi.org/10.1016/ S0140-6736(13)61723-7 See Online for video
Getty Images
Less than 7 weeks before millions of Americans begin enrolling in the new health insurance plans offered under President Barack Obama’s landmark Affordable Care Act (ACA), critics claim that his Administration isn’t ready and will preside over a monumental failure and a waste of taxpayer dollars. Starting Oct 1, state or federally run online competitive insurance marketplaces will begin selling dozens of private health insurance policies that provide at least the “essential health benefits”, including maternity care, required under the law. Tax credits and premium subsidies will reduce the cost for some small businesses and lowincome families when coverage begins on Jan 1, 2014. The law mandates nearly every adult to carry health insurance and every employer with 50 or more employees to offer coverage. Insurers will not be able to turn away people with pre-existing health conditions, cancel coverage when beneficiaries need expensive treatment, or charge women higher premiums than men, among other requirements. While federal officials continue to fend off Republican attacks on the law (unabated despite Obama’s reelection and the Supreme Court’s ruling upholding most of the law) they are also trying to complete work on the system needed to help Americans choose and enrol in an insurance plan and to determine their subsidy eligibility. They are also mounting an outreach campaign to explain the programme’s benefits to a sceptical public, an effort that has been hobbled by congressional Republicans’ refusal to provide sufficient funding. And in states that won’t run an insurance marketplace on their own, the federal government is running one for them or in partnership with them—an unexpectedly large responsibility that now encompasses 34 states.
The Obama Administration announced the delay of the employer mandate in July
585
Corbis
World Report
Kathleen Sebelius
586
The Administration has said the decision to suspend the employers’ reporting requirements came in response to complaints from business associations and large employers claiming that details were lacking about what should be reported, leaving little time to comply. Since about 95% of the US employers affected by the requirement already offer health insurance, the delay is not considered to pose a serious setback. Although federal officials portrayed the delays as a conciliatory measure intended to ease compliance for business, opponents disagreed. The changes are viewed as just another reminder of a deeply flawed programme. “How can we believe that other provisions deemed inconvenient by the Administration, such as verifying that someone is actually eligible for taxpayer funded subsidies, won’t be labelled as too complex to administer and simply be ignored?” Joe Pitts, a Pennsylvania Republican, asked Marilyn Tavenner, head of the Centers for Medicare and Medicaid Services, one of the agencies responsible for implementing the law, during a 3-hour congressional committee hearing on Aug 1. “American taxpayers’ dollars should be protected and not hastily spent on a law that may not be ready for prime time.” Colorado Democrat Diana DeGette came to Tavenner’s defense, reminding her colleagues that “the Affordable Care Act is the law of the land and it is already bringing benefits to millions of Americans”. And she named just a few: 8000 young adults in her Denver-area district are able to stay on their parents’ health plans until age 26 years, nearly 7000 seniors in the Medicare programme have saved $9·3 million on prescription drugs, and thousands are already saving money on their insurance bills due to a provision that limits insurance company administrative costs. Nationwide, HHS estimates that this provision alone saved 77·8 million consumers $3·4 billion
in 2012 by requiring insurers to spend at least 80 cents of every dollar received in premiums on delivering health care. Companies that failed to do so last year will pay rebates to 8·5 million consumers. “I think it’s our job, as elected representatives of our constituents, to go out there and tell people…they can have these benefits and get the insurance they need and save money”, said DeGette.
“...’the Affordable Care Act is the law of the land and it is already bringing benefits to millions of Americans’.” But many Americans still know little about the law. In April, 42% of Americans did not know that the ACA was still in effect, and nearly half of those polled said they did not know how it would impact their families, according to a poll by the Kaiser Family Foundation, an independent health research organisation. Its June poll found that 43% still had negative views of the law. “As our polling and other research shows, people kind of know something is happening on Oct 1 but they’re not sure if it will work for them”, said Karen Pollitz, senior fellow at the Kaiser Family Foundation. “And there is all this counter messaging going on: people still think it’s been repealed...it will be bad for them, and their rates are going up 400%.” Sebelius said she wished she had the marketing resources Hollywood spends to publicise a new movie or Apple puts into launching a new product. Instead, Congress turned down a request for additional funding and the across-the-board budget cuts known as sequestration have meant her agency has “to figure out ways to make our resources stretch farther”. She noted that there are also many “eager and engaged” patient advocacy, community, and church groups, health-care providers, hospital associations, and others who are helping get the word out.
The health law provides grants to pay “navigators” to assist people in the enrolment process but without additional state contributions, there may not be enough to meet the need. Sebelius, a former Kansas insurance commissioner, said the navigators have a unique role in providing unbiased information because they are not trying to sell anything. “It’s such a huge step forward in the whole insurance market.” In the remaining weeks, state insurance regulators will be reviewing policies that will be offered in the insurance marketplaces, and verifying that premiums rates and other details comply with the law. In states with federally run marketplaces, the federal government will approve premiums. So far, next year’s insurance premiums in 11 states will be on average nearly 20% lower than Congressional Budget Office estimates. In New York, rates will drop an average of 53% for individually purchased plans offering the highest level of coverage. Yet in Ohio, the state insurance commissioner is predicting large rate hikes and said the delays underscore the need to halt implementation. Ohio is one of the states that is not running its own insurance marketplace, and has rejected federal funds for consumer assistance and for expansion of Medicaid coverage for low-income families after appealing to the Supreme Court to overturn the ACA. “Now is the time to stop moving forward with implementation of this flawed law and instead give states the flexibility necessary to provide consumers and small businesses with more choices and lower costs”, Ohio’s Lieutenant Governor and insurance commissioner Mary Taylor told The Lancet. 2 weeks ago, the Republican-led US House of Representatives passed legislation to repeal the law—for the 40th time—a largely symbolic measure that, without support from Democrats, will not impede the countdown to Oct 1.
Susan Jaffe www.thelancet.com Vol 382 August 17, 2013