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Health plan costs - misc

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[Opinion] The Problem of Doctors' Salaries
"The United States pays more than twice as much per person for health care as other wealthy countries. We tend to blame the high prices on things like drugs and medical equipment, in part because the price tag for many life-saving drugs is less than half the U.S. price in Canada or Europe. But an unavoidable part of the high cost of U.S. health care is how much we pay doctors -- twice as much on average as physicians in other wealthy countries." (Politico)
[Opinion] The Biggest Health Issue We Aren't Debating: Unaffordable, High Deductibles
"High deductible plans, which require people to pay large amounts out of pocket before their medical bills are covered, are a good deal for some middle and upper income people. But many lower and moderate income Americans simply don't have $1,500 to $3,000 to pay for the colonoscopy that might save their life, or a stress test that might reveal the heart disease which is the cause of their chest discomfort." (Drew Altman, via Axios)
CVS Buyout of Aetna Could Come This Month
"Dow Jones reported that the deal is being driven by the possibility of Amazon entering the pharmacy business. The deal could help CVS make better use of its retail space, selling insurance, drawing blood and other services Amazon couldn't easily match[.]" (
[Guidance Overview] Massachusetts Issues Proposed Regs Implementing Employer Medical Assistance Contribution (EMAC) Supplemental Contribution
"Beginning with the first calendar quarter of 2018, any employer who employs six or more employees in any quarter is subject to the EMAC Supplement for each such quarter.... An EMAC supplement payment is required for each quarter commencing in 2018 if one or more of an employer's employees received health insurance coverage either through the MassHealth agency or through ConnectorCare for a continuous period of at least fourteen days." (Mintz Levin)
Small Business Owners Search for Ways to Avoid Large Health Premium Increases
"[I]nsurance brokers are inundated with current and would-be clients looking for help in finding some type of health insurance they can afford. Many of them are entrepreneurs, small business owners and early retirees who have purchased plans on the individual market and are now getting a look at premiums for next year that in some cases are running 70 percent higher ... Employers who continued to fund group coverage plans are also seeing increases." (
Employers Working to Keep Health Costs for Employees Down
"Two-thirds of employers (66%) say their company is extremely/very aware of the potential changes to health care policy coming out of Washington D.C., and more than one-quarter (26%) of employers report that the most common fear among their employees is losing health care due to a pre-existing condition." (PLANSPONSOR)
Obamacare Insurers Rack Up $12.3 Billion in Losses from Risk Program
"Some $27 million collected under the [ACA] risk corridors program in 2016 will be used to continue paying back claims from 2014 ... 2016 claims, less payments attributed to profitable insurers, totaled about $3.5 billion for 2016 in the individual market, and $469.7 million in the small group market." (Bloomberg BNA)
2018 Medicare Parts A and B Premiums and Deductibles
"The standard monthly premium for Medicare Part B enrollees will be $134 for 2018, the same amount as in 2017.... CMS estimates that the Medicare Advantage average monthly premium will decrease by $1.91 (about 6 percent) in 2018, from an average of $31.91 in 2017 to $30. More than three-fourths (77 percent) of Medicare Advantage enrollees remaining in their current plan will have the same or lower premium for 2018." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Fifth Annual Transamerica Survey: Employers Hold Steady in Time of Uncertainty (PDF)
91 presentation slides. "Companies are less likely in 2016 (13 percent) and 2017 (13 percent) than they were in 2015 (18 percent) to say they stopped providing health insurance in the past year....31 percent of employers have made changes in the past 12 months to health benefits they offer.... [E]mployers report they changed plan options (29 percent) or implemented a wellness program (27 percent).... [O]ne in six (17 percent) say they reduced or eliminated company contribution to cover costs for healthcare benefits (other than health insurance) and 13 percent say they did the same to cover cost for health insurance.... [T]hree out of four employees say they are satisfied with the health insurance plan and other benefits their company offers." (Transamerica Center for Health Studies)
Improving Health Plan Quality, Satisfaction, and Lowering Costs: What's in Your Five-Year Plan?
"The top two won't be a surprise to anyone with responsibility for managing a health program: taking action to manage high-cost claims and spending on specialty drugs. But the third on the list -- with 70% of large employers citing it as important or very important -- was unexpected: a focused strategy for creating a culture of health." (Mercer)
Middle-Class Families Confront Soaring Health Insurance Costs
"With the deadline for a decision less than a month away, consumers are desperately weighing their options, dismayed at the choices they have under the [ACA] and convinced that political forces in Washington are toying with their health and well-being." (The New York Times; subscription may be required)
Keys to Successful Business and Community Health Collaboration (PDF)
"[A] growing number of business leaders are investing in the health of their employees, but they also increasingly recognize the importance of engaging in efforts to create a culture of health in the communities they serve and to address concerns such as community access to health care and healthy food, emotional health issues, obesity, and graduation rates -- all factors that contribute to community health." (Health Enhancement Research Organization [HERO])
ACA Risk Corridors Update: Administration Releases 2016 Amounts, Paving the Way for Litigation Over Amounts Owed
"CMS's [Nov. 15] announcement makes obvious that HHS is still woefully short on these payments, stating that 'HHS will use 2016 benefit year Risk Corridors collections to make additional payments toward 2014 benefit year payment balances.' ... [T]he announcement enhances the chances that the appeals court will reach a decision on the merits. Although the briefing for the appeal is now compete, the parties are still waiting for a date for oral argument, and the court is not likely to issue a decision until well into next year." (Faegre Baker Daniels)
[Guidance Overview] Massachusetts Proposes Regs for Employer Tax Assessments to Help Offset State Costs
"Beginning with the first quarter of 2018, employer medical assistance contributions (EMAC) included in unemployment insurance payments will increase from a maximum of $51 per employee to $77 per employee. In addition, a new $750 supplemental employer assessment will apply for each non-disabled employee who declines employer-sponsored health insurance and instead enrolls in MassHealth or buys coverage on Massachusetts' health insurance marketplace for a continuous period of at least 14 days." (Lockton)
While Litigation Proceeds, Outstanding Risk Corridor Payments Mount
"According to [one source], 2016 has added $3.978 billion to the debt owed to insurers and yielded only $27 million more in payments from insurers, which will be used for payments toward the amounts owed for 2014.... The insurer losses were thus less in 2016 than in 2015, although more than 2014. Among the biggest losers for 2016 were Humana of Georgia ($104 million); Blue Cross/Blue Shield Illinois ($116 million); Oscar of New York ($107 million); Blue Cross/Blue Shield of Texas ($168 million); and Select Health of Utah ($144 million)." (Health Affairs)
[Official Guidance] Risk Corridors Payment Charges for the 2016 Benefit Year (PDF)
21 pages. "HHS is announcing issuer-level risk corridors payments and charges for the 2016 benefit year. Because 2015 benefit year collections were insufficient to pay 2014 benefit year payment balances in full, HHS will use 2016 benefit year risk corridors collections to make additional payments toward 2014 benefit year payment balances. [A table] shows risk corridors payments and charges calculated for the 2016 benefit year, by State and issuer, and the amount of anticipated 2016 risk corridors collections that HHS expects to pay for issuers that have 2014 benefit year payment balances." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Guidance Overview] Healthcare Reform: Questions and Answers for Employers
165-page compilation of Q&As covering all aspects of the ACA. Updated through Nov. 14, 2017. (Arthur J. Gallagher & Co.)
Employees Wary of Narrow Networks? Here's How to Win Them Over
"Only 7% of self-insured employers offer narrow networks to their employees.... 38% of the biggest (5000+ employee) firms operate what are known as high-performance networks.... Employers should be completely transparent about how they construct their networks.... Employers need to aggressively combat the misconceptions surrounding narrow networks.... Patient access must be protected.... employers need to ensure that the high-performers in their network are, in fact, high-performers." (mpirica)
OPM Withdraws Proposed Rule on Health Care Premiums for Some Feds
"On the eve of open enrollment for 2018, the Office of Personnel Management announced that it is withdrawing a proposed rule that would have required some federal employees to keep paying their health insurance premiums when they are on unpaid leave.... Currently, agencies generally pay for the entirety of FEHBP premiums for employees on leave without pay. Employees then repay their portion of the insurance contribution when they return to work." (Government Executive)
President Taps Ex-Pharma Executive Azar as HHS Secretary
"President Donald Trump on Monday said he is nominating former pharmaceutical executive and industry lobbyist Alex Azar to serve as U.S. Health and Human Services secretary, saying Azar would push to lower the price of medicines. Republicans as well as the lead lobby groups for drugmakers and health insurers welcomed Azar as an experienced hand who could help overhaul the world's most costly healthcare system." (Reuters)
How Does Health Care Fare in Congress' Attempts to Simplify the Tax Code?
"While the direct impact of tax reform on health care costs is still unknown, the federal budget resolution passed last month recommends a $1.8 trillion reduction in health care spending, including a $1.3 trillion cut to non-Medicare health programs and another $473 billion cut to Medicare over the next 10 years.... [A]ny decrease in public funding for health care will likely shift expenses to privately sponsored health insurance coverage." (The Alliance)
[Guidance Overview] Massachusetts Issues Draft Regs for Employer Medical Assistance Contributions
"In 2018 and 2019, the [Employer Medical Assistance Contribution (EMAC)] contribution per employee will increase to 0.51% of the employee's wages each year from the current rate of 0.34%, up to the annual wage cap of $15,000 per employee. This increases the potential maximum cost to $77 per employee per year from the current $51 per employee per year." (ML Strategies)
Description of the Chairman's Mark of the 'Tax Cuts and Jobs Act'
253 pages. "The Senate Committee on Finance has scheduled a markup on November 13, 2017, of ... the 'Tax Cuts and Jobs Act' ... This document ... provides a description of the Chairman's Mark[.]' " [Includes descriptions of employer fringe benefit provisions at page 97; executive compensation provisions at page 125, and retirement savings provisions at page 177. JCT has also released a report of estimated revenue effects of the legislation.] (Joint Committee on Taxation [JCT], U.S. Congress)
Breaking Down Employer Cost Experience in 2017
"[M]ore small employers -- those with 10-499 employees -- reported steep increases than mid-sized and large employers (500 or more employees). That's not surprising, given that the majority of small employers are fully insured and typically have fewer resources to devote to managing their health benefits. In addition, in smaller groups, a few large claims can have an outsized impact on per-employee cost in a given year." (Mercer)
How Many of the Uninsured Can Purchase a Marketplace Plan for Less Than Their Shared Responsibility Penalty?
"Just over half (54%) of uninsured individuals who are eligible to purchase a marketplace plan with or without a subsidy would better off financially if they purchased a bronze plan rather than remaining uninsured. Of the 10.7 million people who are currently uninsured and eligible to purchase marketplace coverage, around 7.7 million people will be subject to the shared responsibility penalty. Most of these people will have access to at least some subsidies (6.3 million) to purchase a Marketplace plan." (Henry J. Kaiser Family Foundation)
CBO Report: Repealing the Individual Health Insurance Mandate -- An Updated Estimate (PDF)
"The analysis underlying this estimate incorporates revised projections of enrollment in health insurance, premiums, and other factors ... CBO and JCT estimate that repealing that mandate starting in 2019 -- and making no other changes to current law -- would have the following effects: [1] Federal budget deficits would be reduced by about $338 billion between 2018 and 2027. [2] The number of people with health insurance would decrease by 4 million in 2019 and 13 million in 2027.... [3] Nongroup insurance markets would continue to be stable in almost all areas of the country throughout the coming decade. [4] Average premiums in the nongroup market would increase by about 10 percent in most years of the decade[.]" (Congressional Budget Office [CBO])
CBO to Publish Updated Estimate of Effects of Repealing the Individual Mandate
"CBO will publish an updated estimate of the effects of repealing the individual mandate ... In that document, CBO and the staff of the Joint Committee on Taxation estimate that repealing that mandate starting in 2019 would reduce federal budget deficits by $338 billion between 2018 and 2027 relative to CBO's most recent baseline.... The agencies are in the process of revising their methods to estimate the repeal of the individual mandate. However, because that work is not complete and significant changes to the individual mandate are now being considered as part of the budget reconciliation process, the agencies are publishing this update without incorporating major changes to their analytical methods." (Congressional Budget Office [CBO])
Employer Premiums Rise Nearly 7% in 2017 as Employees Absorb More of Health Insurance Cost
"Almost three-quarters (72.6%) of prescription drug plans have four or more tiers, while 27.4% have three or fewer tiers. Even more surprising is that the number of six-tier plans has surged, accounting for 32% of all plans, when only 2% of plans were using this design only a year ago." (Wolters Kluwer Law & Business)
Humana Files Suit to Recover Hundreds of Millions in Risk Corridor Payments
"The Humana case follows a string of similar lawsuits over the past year alleging that the government violated Section 1342 of the [ACA] and breached an 'implied-in-fact' contract by failing to make risk corridor payments for 2014, 2015, and 2016. Humana seeks damages and other relief, including an award of interest on unpaid payments, litigation expenses, and attorney's fees." (Carlton Fields)
Factors Associated with Increases in U.S. Health Care Spending, 1996-2013
"Increases in U.S. health care spending from 1996 through 2013 were largely related to increases in health care service price and intensity but were also positively associated with population growth and aging and negatively associated with disease prevalence or incidence. Understanding these factors and their variability across health conditions and types of care may inform policy efforts to contain health care spending." (The JAMA Network)
Premiums Rise 6.6% on Employer-Sponsored Health Plans, Up from Five-Year Trend
"[T]wo states saw record premium increases for employer-sponsored programs in 2017: 24% in Connecticut ... and 14% in New York ... Employee premiums for all employer-sponsored plans rose from an average $509 in 2016 for single coverage to $532 in 2017 and from $1,236 to $1,272 for family coverage (a 4.5% and 3% increase respectively). The average annual total costs per employee increased from $9,727 in 2016 to $9,935 in 2017." (HealthLeaders Media)
Value-Based Care Growing as a Way to Reduce Employer and Employee Health Costs
"Providers, namely hospitals and large regional health care systems, are increasingly being asked by payers to accept at-risk reimbursement, where payment is heavily influenced by the quality and outcome of patient care." (PLANSPONSOR)
Reference-Based Pricing -- Not Just for Large Groups Anymore
"The objective is to motivate participants to search for the most cost-effective provider of care since the member is responsible for charges above the set reference-based pricing level.... For small employers, this could be viewed as an improvement over traditional plans since members can visit any medical provider." (Frenkel Benefits)
[Guidance Overview] A Step Toward 'Replace' Without the 'Repeal': The Trump Administration Re-Regulates Obamacare
"This year's [Proposed Notice of Benefits and Payment Parameters] is more sweeping in scope than its predecessors, covering not only Exchange-specific policies, such as the Navigator program and Qualified Health Plan (QHP) certification, but also policies that impact the wider commercial small group and individual insurance markets -- like essential health benefits, medical loss ratio and rate review rules. However, a number of hot-topic areas are not addressed, including Section 1332 state innovation waivers (for which CMS shares jurisdiction with the Department of Treasury), segregation of abortion funds, and language access standards for Exchanges, QHP issuers and web-brokers. Comments to the proposed rule are due on November 27." (Faegre Baker Daniels)
Defunding CSRs: Challenges and Options in the Reconciliation Process (PDF)
"Issuers should anticipate that reconciliations will take place for 2017 since there were advance payments paid for the benefit year, although no specific timing -- either periodicity or dates -- are noted. This implies that CMS could change the timing of the reconciliations to be different than the historical timelines, or potentially put it off indefinitely. The regulations note that issuers must submit the information to HHS when required, so issuers should proactively anticipate that there will be a reconciliation at some point of the advance payments that have been paid in 2017." (Wakely Consulting Group)
Employer Strategies Tame Healthcare Cost Growth
"The average total health benefit cost per employee rose a modest 2.6% in 2017. Of course, behind the average, actual experience ranged from flat or decreased cost for over a fourth of employers to increases of greater than 10% for more than a third.... 'Transparency tools' (now offered by 82% of employers with 500+ employees) help consumers compare healthcare prices and quality, while telemedicine provides a low-cost alternative to an office visit (offered by 71%).... In 2017, 30% of all covered employees enrolled in a high-deductible consumer-directed health plan (CDHP). That's nearly flat from 2016." (Mercer)
[Opinion] The Ugly Consequences of Single-Payer Health Care
"Last year, two separate analyses ... came to the same conclusion: The Sanders 'single-payer' bill is going to cost the American people far more than the senator and his academic and congressional allies claim, and the taxes to finance this massive enterprise are going to be huge." (The Heritage Foundation)
[Guidance Overview] California's Move to Protect the Innocent from Balance Billing
"AB 72 says that, unless the patient agrees otherwise in writing, the out-of-network doctor is required to accept, as payment in full, what he or she would have received had he or she been an in-network doctor.... The new law allows an out-of-network doctor to ask the patient for his or her agreement to pay the doctor a larger amount. But the doctor must ask for this consent in writing, at least 24 hours before providing treatment, and can't do it when the patient is being admitted to the facility or just before undergoing a procedure." (Lockton)
[Opinion] The Deception Behind Those In-Network Health 'Discounts'
"Don't insurers have a natural incentive to keep provider prices down, even if they don't end up paying the list price? In fact, no -- at least not since the [ACA] ... established a 'medical loss ratio,' which requires insurers ... to spend at least 80 cents of every premium dollar on medical expenses.... Insurers can continue to attract customers with the promise of steep discounts through their PPO plans -- and providers can continue to ratchet up their prices.... Since insurance costs are merely a derivative of health-care costs, the result has been a steady rise in insurance costs for millions of working families." (The Wall Street Journal; subscription may be required)
Factors Underlying CBO's Long-Term Outlook for Federal Health Care Spending
25 presentation slides, Nov. 1, 2017. "CBO projects that federal spending on the major health care programs would grow larger than spending in any other category if current laws generally remained unchanged. Spending on those programs would account for 40 percent of federal noninterest spending in 2047, compared with 28 percent today. Two factors explain the projected growth in spending on major health care programs: aging and rising health care costs per person (also known as excess cost growth)." (Congressional Budget Office [CBO])
Obamacare's Rising Premiums Will Hurt the Middle Class the Most
"For some lower-income people in Obamacare, the rising premiums President Donald Trump has talked so much about will barely be felt at all. Others, particularly those with higher incomes, will feel the sharp increases when insurance sign-ups begin Wednesday." (Bloomberg)
Status Reports in DC Cost-Sharing Reduction Case Highlight Stakes Going Forward
"The House of Representatives filed this case in 2014 to stop the Obama administration from reimbursing insurers for reductions in cost sharing that the insurers are required to provide individuals with incomes below 250 percent of the federal poverty level.... On October 30, the administration and the House filed a joint status report asking that the stay of the case be continued yet again while they continue to discuss the disposition of the case in hopes of filing a motion 'in furtherance of those efforts in the coming weeks.' They request, in essence, that the case be put off once again." (Health Affairs)
Insurer Participation Down, Premiums Up in Uncertainty-Plagued Marketplaces
"On October 30, 2017, the [HHS] Assistant Secretary for Planning and Evaluation (ASPE) released a report ... [which] documents ... [that] insurer participation in the exchanges is down for 2018 from 2017 and premiums, particularly the benchmark silver plan premiums, are up dramatically. Advance premium tax credits (APTC), however, are also up sharply, and most consumers who purchase coverage through the exchange may find that coverage costs less than last year after APTC are applied. There is evidence that individual insurance market performance has been stabilizing during 2017." (Timothy Jost, in Health Affairs)
Delays Likely for New Health Taxes as Companies Brace for Impact
"A fee on health care providers and a 2.3 percent tax on the sale of medical devices such as surgical equipment and MRI machines take effect in 2018. A 40 percent excise tax on parts of high-cost health plans -- the 'Cadillac tax' -- is to follow two years after. Those dates leave employers in a tricky limbo: preparing for a tax that may be delayed again." (Bloomberg BNA)
[Guidance Overview] Executive Order on Health Care; Discontinuation of Cost-Sharing Subsidies in the Marketplaces (PDF)
"Although the executive order states obtaining coverage through an AHP will allow employers to avoid many costly ACA requirements, it does not list the specific requirements that will no longer apply.... [Anticipated agency] guidance should expand an employer's ability to offer HRAs and allow HRAs to be used with non-group coverage. The goal is to allow employees, especially those that work for small businesses, more options for financing their health care." (Marsh & McLennan Agency LLC)
[Guidance Overview] IRS Announces Increased Health FSA Maximums and Increased PCORI Fees (PDF)
"The indexed annual [health FSA] limit for 2018 plan years is $2,650.... [If] an employer wants to increase the maximum to $2,650 as of January 1, 2018, there are several options depending on the current stage of the open enrollment process[.]" (Marsh & McLennan Agency LLC)
[Guidance Overview] Final Rules Issued on San Francisco's Health Care Security Ordinance Employer Spending Requirement
"The [Health Care Security Ordinance (HCSO)] requires employers to spend a minimum amount on health coverage ($2.83 per hour in 2018 for large employers) for their San Francisco employees who regularly work eight or more hours per week. The spending requirement rules, initially issued in 2007, were revised to address interim amendments to the HCSO and, in particular, the irrevocability requirement added to the HCSO in 2014. The irrevocability requirement was added to clarify that dollar-denominated accounts (such as HRAs) that were then being used to satisfy the employer spending requirement of the HCSO could not be forfeited." (Morgan Lewis)
[Official Guidance] Text of CMS Draft 2019 Actuarial Value Calculator Methodology (PDF)
25 pages. "The AV Calculator represents an empirical estimate of the [actuarial value (AV)] calculated in a manner that provides a close approximation to the actual average spending by a wide range of consumers in a standard population. This document is meant to detail the specific methodologies used in the AV calculation. This document is revised from the 2018 version to incorporate updates in the draft 2019 version." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
'Cadillac Tax' Will Hit Majority of Employer Plans
"The threshold amounts for 2020, unless Congress further delays or repeals the tax, are expected to be $10,900 for employee-only coverage and $29,400 for all other coverage, including family coverage ... [T]here are many possible ways to reduce aggregate group health plan costs to avoid the Cadillac tax, such as by scaling back major medical coverage, subject to the ACA's limitations[.]" (Society for Human Resource Management [SHRM])
Tension Between High-Deductible Health Plans and Payment and Delivery Reform
"As HDHPs are growing, employers and health plans have made a push toward population-based reforms, which require providers to take on financial risk for their patients' care. And from what we know, providers are not willing to assume financial risk for a patient population unless they are set up to manage and coordinate care, including primary and secondary preventive care that keeps their patients out of the hospital.... [R]eforms on the consumer side and the provider side are on a collision course." (Health Affairs)
Employer Premiums Rise Nearly 7% in 2017; Employees Absorb More of the Health Insurance Cost
"Premium renewal rates for employer sponsored health insurance rose an average of 6.6% -- a significant increase from the five-year average increase of 5.6% ... Connecticut saw a 24% increase in premiums in 2017, up to $655 from $530; New York also saw a large increase of 14%, up to $712 in 2017 over $624 in 2016.... Arizona and Washington [saw] 2% and 10% decreases, respectively." (United Benefit Advisors)
State of Washington Office of the Insurance Commissioner: Individual Health Insurance Market Stabilization Analyses (PDF)
65 pages. "Washington's individual health insurance market has shown symptoms of destabilization in recent years, including double digit premium increases and threats of areas with no or very low issuer participation.... This document will discuss the potential policies that were considered, the pros and cons of the approach, the effects of the different policies on the 2019 individual market, and the implications of the policies." (Wakely Consulting Group, LLC)
ACA Silver Plan Premiums Jump an Average of 34%
"The 34 percent average increase is for silver plans in states using Premiums also are going up by double digits for plans with different levels of coverage, including bronze (18 percent), gold (16 percent), and platinum (24 percent). Many states had higher increases for silver plans, the most commonly purchased. Only three states will see declines." (
CBO Sees Small Savings, No Significant Coverage Effects from Alexander-Murray ACA Proposal
"The CBO projects that the legislation would reduce the deficit by $3.8 billion over the 2018-2027 budget window and would not substantially change the number of people with health insurance coverage.... The CBO believes that the changes that the stabilization package would make in [ACA] section 1332 state innovation waiver rules would not have a significant net budgetary effect." (Health Affairs)
Federal Judge Denies Bid to Force Feds to Resume ACA Subsidies
"U.S. District Judge Vince Chhabria wrote that 'the emergency relief sought by the states would be counterproductive.' He said the vast majority of states have already prepared for the termination of the payments and already 'devised responses that give millions of lower-income people better health coverage options than they would otherwise have had.' " [State of California v. Donald J. Trump, No. 17-5895 (N.D. Cal. Oct. 25, 2017)] (Kaiser Health News)
Federal District Court Provides Updates for Proceedings in CSR Case, State of California v. Donald J. Trump
"Due to the level of interest in this case, this web page has been created to notify journalists and interested members of the public of important news and information about access to proceedings and to case information." (U.S. District Court for the Northern District of California)
CBO Cost Estimate: The Bipartisan Health Care Stabilization Act of 2017
"CBO and the staff of the Joint Committee on Taxation (JCT) estimate that implementing the legislation would reduce the deficit by $3.8 billion over the 2018-2027 period relative to CBO's baseline. The agencies estimate that the legislation would not substantially change the number of people with health insurance coverage, on net, compared with that baseline projection." (Congressional Budget Office [CBO])
[Official Guidance] IRS Taxpayer Advocate Service Provides Self-Help Tools to Assist Taxpayers with Complex ACA Requirements
"Whether the taxpayer is an individual or employer, [the Taxpayer Advocate Service has] several tools available to assist in estimating credits and payments related to the ACA. Keep in mind that they only provide estimates, rather than accurate calculations, to use as a guide in making decisions regarding the taxpayer's tax situation.... Tools for Individuals: The Premium Tax Credit (PTC) Change Estimator ... Individual Shared Responsibility Provision (ISRP) -- Payment Estimator ... Tools for Employers: Employer Shared Responsibility Provision (ESRP) Estimator ... Small Business Health Care Tax Credit (SBHCTC) Estimator." (Taxpayer Advocate Service, Internal Revenue Service [IRS])
Out-of-Pocket Spending Increased for Employees in Large Group Plans
"About one in four people (24 percent) covered by large employer plans spent more than $1,000 out-of-pocket on health care in 2015, an increase of seven percentage points from 17 percent in 2005 ... About one in 10 people in such plans (12 percent) paid more than $2,000 out-of-pocket in 2015[.]" (Wolters Kluwer Law & Business)
Congressional Leaders Propose Bicameral Agreement to Pair ACA Reforms with Temporary CSR Extension
"The agreement ... includes: [1] Funding for CSRs through 2019, with pro-life protections. For 2018, carriers must meet certain conditions to receive CSRs.... [2] Relief from the individual mandate from 2017-2021.... [3] Relief from the employer mandate from 2015-2017. Employers would be exempt from penalties if they did not provide coverage based on requirements of the mandate. [4] Expansion of HSAs to increase the maximum contribution limit." (Employers Council on Flexible Compensation [ECFC])

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