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It's Back! A New BRCA. But Will It Be Enough? PDF Print E-mail
Written by Ellen Breslow   
Sunday, 16 July 2017 00:00
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The first version didn’t have enough support in the Senate, so it was back to the drawing board. Now we have a new bill—but will this one get the necessary votes? Senators Susan Collins (R-Maine) and Rand Paul (R-Ky) have already said it doesn’t do enough. Can it squeak through the Senate? Let’s look at some of these changes, and a possible alternative:

The biggest change, designed to sway conservative votes, was pushed by Ted Cruz (R-Tex.). It allows insurance companies to offer catastrophic plans, thereby circumventing the ACA’s “minimum essential benefits” rule. These plans would charge sicker people more than healthy people and permit individuals to select only the benefits they need, as long as the insurance companies offer at least one plan that complies with the ACA standard.

The bill also allocates an additional $45 billion to combat the opioid crisis which has hit some states especially hard. Senators Shelley Moore Capito (R-W. Va.)  and Rob Portman (R-Ohio)  indicated that the lack of funding for this crisis was a key reason that they objected to the original BRCA. Whether this will provision will be adequate to secure their votes remains to be seen.

The future would brighten significantly for Health Savings Account (HSA) owners. Not only would there be an increase in the contribution limits, but these accounts could also be used to pay health insurance premiums. The idea is to encourage more people to fund HSAs by expanding the benefits of these accounts.

What if this bill doesn’t pass? Enter Lindsay Graham (R-S.C.) and a newer compromise version of the BRCA. The idea behind this version of the bill is to appeal to Republicans as a replacement plan and  to sell it to Democrats as a repair plan. It would keep all of Obamacare’s taxes except for the Medical device tax, and would allocate $110 billion in federal health care funding to states. Also included is an ending to the individual and employer mandates, however it retains protection for people with pre-existing conditions. The bill will most likely be offered as an amendment to the second version of the Senate bill.

These days, it’s hard to follow health care. Let’s hope it gets easier soon.





Last Updated on Sunday, 16 July 2017 05:54
ACA, AHCA, BCRA: What’s In It For Me? PDF Print E-mail
Written by Ellen Breslow   
Saturday, 24 June 2017 00:00
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The door has finally opened and the Senate draft bill, the Better Care Reconciliation Act, has emerged.  So far, a host of conservative and moderate Senators have indicated that they won’t vote for it. The draft is broadly the same as the House bill with some notable modifications.  What make the BCRA different and what is in it for you?

One of the most widely publicized provisions in both is the elimination of the individual mandate. People would no longer be required to purchase health insurance or face an IRS penalty. The Trump administration has already directed the IRS to ease up on the enforcement of the mandate. Although the mandate is generally disliked, the idea is to spread the risk to the insurers and reduce the cost of the plans to all. Without the mandate, it is likely that costs will rise.

If you’re under age 26, you could stay on your parents’ health insurance plan. This popular provision of the ACA is part of both the House bill and the Senate draft. Keeping young adults on employer sponsored health plans does help to limit the premium increases.

If you’re under age 65, aren’t covered by an employer plan and are looking for health insurance, things could get a little dicey.  In the AHCA, you would see tax credits to pay premium based on age, not income, and max out at $4,000, much less than under the ACA.  The oldest people under age 65 could be charged five times more than the youngest people, unlike the ACA where the maximum is three times more. Depending upon the state, the percentage could be even higher. In the Senate draft, the oldest people under age 65 would pay five times more than the young people. Subsidies to help pay for insurance would end at income of 350 percent of the poverty level, with adults age 59-64 paying up to 16.2 percent of income. Health insurance would become significantly more expensive for those under 65 should either of these bills become law.

Under the ACA, those individuals with pre-existing conditions must be covered and can’t be charged more. That would change under either the House bill or the Senate draft.  Under the AHCA, states would be able to secure permission to let insurers charge more for some pre-existing conditions, and exclude some people altogether. The BCRA requires the insurance companies accept everyone regardless of health status. That said, states would be allowed to reduce coverage, thereby limiting “essential health benefits”. This would give insurers some leeway in what they offer in their plans and possibly change what they charge consumers.

In order to fund various ACA provisions, a 3.8 percent wealth tax has been imposed on corporations and investment income for those individuals with $200,000 in modified adjusted gross income (MAGI) and couples filing jointly with $250,000 in MAGI. Both the House bill and the Senate draft would repeal this tax.


These are just a few of the alternative provisions of ACA, AHCA, and BCRA, that could impact you and your family. While it is unlikely that either of these bills will pass in their present form, you should keep up-to-date with what’s happening. Open enrollment is just around the corner and you’ll have decisions to make.

Last Updated on Saturday, 24 June 2017 11:20
No Repeal, No Replace: Still Talking PDF Print E-mail
Written by Ellen Breslow   
Wednesday, 29 March 2017 00:00
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The dust is settling on last Friday’s embarrassment and House Republicans are vowing to come with a new plan that will pass muster with all Republican groups, including the Freedom Caucus. Speaker Paul Ryan has urged members to refocus their energy on finding an acceptable alternative.

But what does this mean for us? Will Obamacare explode, as President Trump has insisted? Is it in flux? How do individuals plan for health care going forward?

With respect to a choice of plans at health insurance exchanges, this will depend on where you live. Generally, big cities will have more options than rural areas where there are fewer people looking for coverage. The selection is dwindling, but most likely there will be one insurer in every marketplace. Hard to say what will happen in 2018, but it is likely that it will be much like 2017. Insurers generally have to decide by spring if they will offer plans on an exchange. Participants won’t know for certain until early next fall.

The Health and Human Services Department (HHS), which oversees Obamacare, has proposed some changes with an eye towards stabilizing state health insurance exchanges. One adjustment involves taking a closer look at the special enrollment period where individuals under certain circumstances such as marriage or the birth of a child, are allowed to sign up outside of the open enrollment dates. Insurers have reported that people are just waiting until they need care, so closer monitoring of this special enrollment period should be done. HHS is also proposing that insurers be permitted to design cheaper plans for younger people who may not need much health care but want to be covered in the event of injury or illness. These plans would encourage younger, and usually healthier individuals, to enroll thereby evening out the claims insurers pay out to those who use their coverage.

While the choice of plans is certainly dwindling, the marketplaces aren’t expected to “implode” next year.


Given the differing agendas, not to mention the alternative facts and fake news, it’s hard to believe anything and to predict with any confidence whether Obamacare will implode or struggle along in the next year or two.

Last Updated on Wednesday, 29 March 2017 09:33
What's Repealed and What's Replaced? PDF Print E-mail
Written by Ellen Breslow   
Friday, 05 May 2017 00:00
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The Republicans have repeatedly said that they intend to repeal and replace the Affordable Care Act with better health care for everyone. But just exactly what is the difference between Obamacare and the new GOP plan? Will it really benefit anyone?

It will benefit adult children under the age of 26. As is currently the case with the ACA, parents will be able to continue to cover them under their health insurance plan. No need to repeal or replace.

This bill will not benefit older adults—those age 50-64—who aren’t covered by an employer sponsored health insurance plan and are looking for coverage. Under Obamacare, insurers would be permitted to charge their oldest customers only three times as much as they charged their youngest customer. The Republican House bill would change that: Insurers would be allowed to charge as much as five times as much as they charge their youngest customers. In addition, the states could petition the federal government to make that ratio higher.

Then there’s the individual mandate. Individuals would no longer have to pay a penalty if they don’t have health insurance. Although that probably seems like a good thing to some younger people who don’t want to pay a penalty for being uninsured, this provision doesn’t mean that they are blameless. Should they remain uninsured for more than two months and then buy coverage, there would be a 30% increase in their premiums. Clearly, the idea is that although the penalty is gone, it doesn’t make sense to wait until you’re sick to purchase coverage.

Perhaps the most widely publicized provision of this plan is the “continued” coverage for pre-existing conditions. While it seems like pre-existing conditions are covered and insurance companies are required to sell health care to these individuals, access to and the cost of this coverage will change drastically. States would be permitted to opt out of the requirement for insurers to cover people with pre-existing conditions and set up high-rise pools for these people instead. The bill also provides for $8 billion of additional funding over five years for these potential pools. Prior to the ACA, many states maintained these high-risk pools; yet often individuals were unable to get into the pools and were therefore forced to look to the individual health insurance market for coverage. Needless to say, the cost was often prohibitive.  Given the likely size of these pools, the additional funding amount would not be adequate to insure reasonable priced coverage.

Obamacare tax subsidies would now become tax credits dependent upon the individual’s age. Those people under 30 would be eligible for a $2000 credit, with the amount increasing on a sliding scale to $4000 for those over 60. The size of the tax credit would increase with the family size to a maximum of $14,000.  These amounts would decrease with increases in household income.


Of course there is more to this bill. And the Senate has already indicated that this bill is unacceptable to them and they will have their own version. In other words, the ACA has not yet been repealed and replaced. Stay tuned.

Last Updated on Friday, 05 May 2017 11:13
How Does the American Health Care Act Impact Me? Obamacare Lite? PDF Print E-mail
Written by Ellen Breslow   
Tuesday, 07 March 2017 00:00
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That depends on how and where you obtain your health insurance. Or if you purchase health insurance. This bill is shorter than Obamacare (so far, anyway) 166+ pages versus 2000+ pages, but there will be some significant impact on individuals and business owners.

First, let’s see what the Act retains that will benefit individuals. One of the most important components of the ACA is the pre-existing condition policy. Insurers will continue to be required to cover people regardless of pre-existing medical conditions in addition to barring the companies from charging more based on health history. Also being kept: the provision that children can stay on their parents health insurance policies until age 26. The requirement that all insurers offer ten essential health benefits including maternity care and preventative services will stay in effect. The American Health Care Act will continue the prohibitions on annual and lifetime limits; insurers can’t set a limit on how much they pay to cover an individual.

What has garnered the most attention for individuals is the repeal of the individual mandate. This will mean that people who go without health insurance will no longer have to pay a penalty. A possible downside to this change is that healthy, younger people may go without health care which can drive the price up for sick individuals who do seek coverage. To offset this possibility, the plan proposes a “continuous coverage incentive” designed to charge individuals a 30 percent penalty for lapses in health insurance coverage.

The employer mandate, the requirement that larger companies must provide affordable insurance to their employees or face financial penalties, is part of the repeal section. Not repealed but postponed: the Cadillac tax (40 percent excise tax on plans where premiums are $10,200 for individuals or $27,500 for families annually) scheduled for 2020, now 2025.

Premium subsidies will change, too. Subsidies will be distributed by using age, instead of income as a way to calculate how much individuals will receive. Subsidies for out-of-pocket expenses, also known as cost-sharing subsidies provided by the federal government under the ACA to assist some people pay deductibles and co-payments will be repealed in 2020.

Older individuals may see an increase in their premiums. Under the ACA, health insurance plans could only charge older participants three times what they charged the youngest participants. Under the proposed legislation, insurers would be allowed to charger older participants five times as much as younger participants.

A key benefit for individuals and families is the proposed expansion of Health Savings Accounts. An important savings vehicle for participants in high deductible plans, under current law, in 2017, an individual can contribute $3,400 and a family $6,759 on a tax deductible basis to Health Saving Account. The American Health Care Act would allow substantial increases in contributions to these accounts. Beginning in 2018, the basis limit will be at least $6,550 for an individual and $13,100 for a family. Spouses will be permitted additional contributions.


Certainly, there will be more to come. Stay tuned.

Last Updated on Tuesday, 07 March 2017 15:47
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