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Busy week in health care reform

By Jay MacDonald ·
Friday, December 14, 2012
Posted: 10 am ET

It has been a busy week on the 'Obamacare' beat. Here's what happened in health care reform while you were out holiday shopping.

Sebelius firm on full Medicaid expansion

While Congress and the White House tried to summon enough seasonal cheer to reach a fiscal cliff compromise, Health and Human Services Secretary Kathleen Sebelius dumped coal in the stockings of anti-Obamacare governors who had hoped to cash in without fully expanding Medicaid.

Last summer, the U.S. Supreme Court ruled that the Affordable Care Act could not force states to expand Medicaid, the federal-state health insurance insurance safety net for low-income Americans. What HHS did instead was offer states a sweet deal: expand your Medicaid program to anyone who earns up to 133 percent of the federal poverty level, now set at roughly $15,000 for individuals and $30,000 for a family of four, and the feds will pay 100 percent of the expansion costs in 2014 through 2016, sloping to 90 percent in 2022 and thereafter.

Despite the attractive terms, nine states, including Texas and South Dakota, refused the offer outright while others asked Sebelius if they could set the bar somewhat lower than 133 percent and still take advantage of the terms.

The answer was an unequivocal no; states that only partially expand Medicaid won't receive the 100 percent matching funds.

While there is no deadline for states to expand Medicaid, the full-ride funding is available only for 2014, 2015 and 2016.

Pre-existing conditions fee could cost you

Large employers recently learned that they will face a $63-per-employee fee designed to provide a financial cushion for health insurance companies that must insure people with pre-existing health conditions for the first time under Obamacare. Don't be surprised if your boss passes most or all of that fee on to you.

The Obama administration says the temporary assessment, which will be levied on about 190 million employer-sponsored and individual health plans over three years starting in 2014, will raise about $25 billion.

The funds will be administered by HHS to help insurers weather the hard-to-predict cost of covering pre-existing conditions in the initial years. Insurers will be prohibited from denying coverage to those with pre-existing conditions beginning on Jan. 1, 2014.

Obamacare saved consumers $1.5 billion in 2011

A new report from the Commonwealth Fund finds that consumers reaped $1.5 billion in savings last year, the first full year in which key Obamacare provisions aimed at controlling runaway health care spending kicked in.

Roughly $1.1 billion of the savings came in the form of rebates from insurers who failed to meet the new medical loss ratio, or MLR. It requires insurers to spend at least 80 percent of your premium directly on your care rather than on executive bonuses and administrative costs. In addition to issuing rebates, the companies responded to the MLR by cutting overhead and, in some cases, reducing profits, according to the study.

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Retired Chief
December 14, 2012 at 1:38 pm

Like the other vet said, mine went up of course too. Along with the job suppressing part making employers only want to hire part time workers making it impossible for me to find a full time job, the whole program is a lose/lose for those of us who pay taxes. Even military retirement gets federal income taxes and unfortunately, is just not enough to pay bills to make up for losing my job. Thanks again for a bad law and a weakening of defense which has cost me and 9 others where I used to work our jobs.

December 14, 2012 at 1:37 pm

I knew this "pre-existing conditions" would come back to bite us. The bill specifies that insurance companies must cover you, not that you get to pay the same premiums as everyone else and enjoy super-exorbitant care on the backs of those who actually take care of themselves and make good choices in life.

People with pre-existing conditions should pay premiums commensurate with their disease processes. Simple as that. People without pre-existing conditions shouldn't have to pay a DIME extra.

Major Dad
December 14, 2012 at 1:08 pm

I'm retired military and my health care insurance went up and since the BO care shove am having an issue getting the hospital to bill correctly.

They shoved this bill down every tax paying American's throat and all we are doing now is chocking because the idiots who wrote the bill were too stupid to read it first.

And oh yeah, in Mass we now have a fake Indian as a senator elect who says she is fighting for the middle class and all I've seen is increase in and bank fees. What, the middle class don't have bank fees?

Stupid is as stupid does....

Nelson Stradling
December 14, 2012 at 12:48 pm

My wife is self-employed( clean's houses) and her insurance went from $286/ month to $5o2/month since the new law went in place. I do not know if the is just in the state of washington or all over the US.
Non US people here are still getting FREE health care. Why are they getting care and those of us who live and worked all our lives have to pay extra.

December 14, 2012 at 12:23 pm

my health care costs have not risen since obamacare, before the costs rose out of control and for no reason except to give the providers more profit

December 14, 2012 at 12:17 pm

"Roughly $1.1 billion of the savings came in the form of rebates from insurers who failed to meet the new medical loss ratio, or MLR"

The rebate is a joke! My husband had paid for health insurance, through his employer, for all of 2011. He was laid off in April, 2012 and received a letter from the insurance company about the rebate. He called and was told that the employer decides what to do with the rebate. He never saw a dime so how was that a savings to us???? I've only see my costs go up and I don't see that ending anytime soon!

Ray Yates
December 14, 2012 at 12:06 pm

This program is not very well thought out. My wife and I are in our mid 70s. We do not quality for any kind of help. We live on social security. When we get through paying all our bills ther is not very much left. Because help is based on gross income ours togeather is too much for any kind of help. We have not seen any savings that the health care program has provided. We think the health care bill is a lot of hot air and will help very few people most will have to pay more costs.

Thank you for reading this

December 14, 2012 at 12:01 pm

"A new report from the Commonwealth Fund finds that consumers reaped $1.5 billion in savings last year, the first full year in which key Obamacare provisions aimed at controlling runaway health care spending kicked in."

all I saw was my employer increasing my co-pay due to the overall cost of insurance rising.

the "savings" referred to in this dubious report and further contrived by the contributing editor are spurious, or fake.

most people with common sense smell a rat when they read this stuff. But, they are either too busy to follow up on their premonition or mistakenly give too much credence to the source. Bad mistake in this day and age since the media peddlers have an AGENDA. And, it probably doesn't match your personal agenda.

Don't be a sheep! Question the source!

Ms Dale Gallaway
December 14, 2012 at 11:54 am

Do we know which states declined to expand Medicaid? Thank you

keith levine
December 14, 2012 at 11:35 am

It is very misleading to state consumers saved $1.5 billion because of rebates from insurance companies due to provisions in Obamacare.
Most people saw a rise in their healthcare premiums in excess of 25%.
By most accounts, these increases will continue in order to offset all the other mandates of Obmacare.