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Daily Archives: November 24, 2014

Obama Officials Seek To Clarify Abortion Coverage Rules

The Obama administration is seeking to clarify rules for the coverage of elective abortion in health insurance exchanges. That is the issue that almost scuttled the Affordable Care Act before it became law.

A complicated compromise that got the final few anti-abortion Democrats to agree to vote for the measure in 20Ǫ required every exchange to include health plans that do not cover abortions except in the cases of rape, incest or a threat to the life of the pregnant woman. Plans that do offer abortion other than in those cases are required to segregate funds and bill for that abortion coverage separately.

marketplace abortionBut that did not happen, at least not in the first year of exchange coverage. Twenty-three states passed laws banning coverage of elective abortions in all the plans offered on the exchange. A Government Accountability Office report in September looked at the 27 remaining states and found that in five every plan covered elective abortions. And many failed to separately bill for the abortion coverage, as the law required.

Asked about the report in October, Health and Human Services Secretary Sylvia Burwell insisted that no money is being improperly spent.

“There are no federal funds being used for abortions except, as the law states, cases of rape or incest or questions of the life of the mother,” she said. With regard to the specifics of the GAO report, “it’s one where we believe we need to ensure the law is being enforced, and right now [the Centers for Medicare & Medicaid Services] is working on the ways we’re going to communicate with states and insurers.”

This KHN story can be republished for free (details).

A huge proposed regulation issued last Friday that outlines health plan standards for񎧠 seeks to make abortion coverage rules clearer.

The regulations, among other things, specify ways in which insurers can assess and collect separate payments for abortion coverage, which must total at least $1 per month.

But anti-abortion groups are complaining that the guidance in the new rules does little to address the bigger problem: It is still extremely difficult  for the average consumer to tell which plans include elective abortion coverage and which do not.

“It’s just not easy to find and it should be,” said Chuck Donovan, president of the Charlotte Lozier Institute, an anti-abortion research group.

“I know websites can be tricky,” he said. “But you can do these things with a checkmark and a box and I wish that they’d just come up with something simple two years ago as part of the upfront disclosure from the insurance companies.”

In an effort to make the information more widely available, the Lozier Institute has been doing the work itself, contacting individual insurance companies and their customers to discern which plans do and do not offer elective abortion. The resulting website, obamacareabortion.com, was unveiled last week in conjunction with the Family Research Council, another anti-abortion group.

Donovan said the project is still in progress because information has been difficult to find, even with direct calls and individual scouring of companies’ policy summaries. “They don’t always know” if abortion is covered, he said. In some cases, he said, “we’re finding contradictory information.”

But he insists that it’s imperative for consumers to know which plans cover abortion and which do not. “I’ve heard the argument that it stigmatizes the [abortion] coverage, but it’s kind of a settled thing that this is controversial,” he said. “I don’t think it does anything other than let people act in alignment with their conscience while we’re sorting out bigger issues.”

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HHS Formally Moves To Close Loophole Allowing Plans Without Hospital Benefits

The Obama administration took another step to close what many see as a health-law loophole that allows large employers to offer medical plans without hospital coverage and bars their workers from subsidies to buy their own insurance.

“It has come to our attention that certain group health plan designs that provide no coverage of inpatient hospital services are being promoted,” the Department of Health and Human Services said in proposed rules issued late Friday.

Under the new standard, companies with at least 50 workers “must provide substantial coverage of both inpatient hospital services and physician services” to meet the Affordable Care Act’s threshold for a “minimum value” of coverage, the agency said.

As reported previously by Kaiser Health News, insurance analysts were surprised this summer to learn that HHS’ online calculator for determining minimum value approved plans without inpatient benefits.

adding machine 570

Responding to aggressive marketing by consultants, numerous lower-wage employers had already agreed to offer the low-cost plans for 2015 or were considering them.

Because a calculator-approved plan at work makes employees ineligible for tax credits to buy more comprehensive insurance in the law’s online marketplaces, consumer advocates feared the problem would trap workers in substandard coverage.

Large employers aren’t required to offer the “essential health benefits” such as hospitalization, physician care and prescriptions that the law orders for plans sold to individuals and smaller employers.

But few expected the official calculator to approve insurance without inpatient benefits. Meeting the minimum-value standard spares employers from penalties of up to $3,120 per worker next year.

HHS also proposed granting temporary relief to employers that have already committed to calculator-approved plans without hospital coverage for 2015. It also would allow workers at those companies to receive tax credits in the marketplaces if they choose to buy insurance there instead.

For 2016, no large-employer plan will meet the minimum-value test without inpatient benefits, HHS proposes.

“A plan that excludes substantial coverage for inpatient hospital and physician services is not a health plan in any meaningful sense and is contrary to the purpose” of the minimum-value standard, the agency said.

“Minimum value is minimum value,” said Timothy Jost, a consumer advocate and Washington and Lee University law professor who welcomed the change. “Nobody ever imagined that minimum value would not include hospitalization services.”

This KHN story can be republished for free (details).

As it said it would, Calculator-tested plans lacking inpatient coverage, designed by Key Benefit Administrators and others, have drawn strong interest from large retailers, restaurant chains, staffing companies and other lower-wage employers seeking to control costs, benefits consultants say. Typically the coverage costs half as much as major-medical insurance including hospital benefits.

Edward Lenz, senior counsel for the American Staffing Association, said the trade group has no problem with requiring hospitalization to meet the minimum-value standard for 2016. But it will seek more leeway for employers that had moved to implement plans without inpatient benefits for 2015.

“Many employers were well along the road” to committing to such plans but delayed signing contracts after Kaiser Health News reported that the administration might move against them, he said. Rather than punishing such companies for their caution, HHS should allow them to temporarily offer such coverage next year, he said.

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Viewpoints: Dismantling Health Law ‘Piece By Piece’; Democrats Are ‘Own Worst Enemy’

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State Highlights: Md. Medicaid To Provide Gender Transition Services; Ill. To Refunds Retiree Health Care Money

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Lawsuits: Medicare Advantage Plans Boost Payments By Claiming Sicker Patients

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Scrutiny Of Morcellator Tool Halts Its Use

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Reports Depict Failed Mental Health System

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After Kaci Hickox Furor, No One Else Flying In To N.Y.C. Area Has Been Quarantined

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Patients’ Costs Mount When Oncologists Work For Hospitals

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House Oversight Panel Calls On Gruber, Tavenner To Testify On Health Law Claims

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