Tagged Medicaid

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! If you’ve been able to tear your attention away from the soap opera that is the ever-escalating (and public and messy!) feud between HHS Secretary Alex Azar and CMS Administrator Seema Verma, you’re a better person than I. (But hey, I’m not alone — the White House itself is apparently riveted by the drama).

The week kicked off with reports that Verma had filed a claim for $47,000 worth of jewelry and other property that was stolen while she was on a work trip. Then came the accusations that HHS leaked the story and then came more accusations that Verma leaked the info that eventually brought down former HHS Secretary Tom Price.

They were both called to a meeting at the White House and told to make nice. (Oh, to have been a fly on that wall …). Because as fun as it is to watch the drama unfold, the feud seems to be derailing President Donald Trump’s health agenda during a time when that is a less-than-ideal thing to happen.

The Washington Post: Infighting Between Alex Azar, Seema Verma Stymies Trump Health Agenda


OK, onward to the rest of the news of the week before I risk turning into a Page Six gossip column.

House Democrats passed a sweeping drug-pricing bill that would allow Medicare to negotiate drug prices, among other things. Like most bills these days, its purpose is more political than anything else — it will live a full life on the 2020 campaign trail long after it’s killed in the Senate.

The New York Times: House Votes to Give the Government the Power to Negotiate Drug Prices

Stat: Drug Pricing Bill Is a Sneak Peek at Democrats’ 2020 Campaign Message

It was all around not a great weak for drugmakers. The industry was spitting mad at what they deemed was an “unforced error” from Trump that “was a reflection of the weakness of the negotiating skills of the president.” The error? Trump stripped a 10-year exclusivity provision for biologics from the new trade deal with Mexico and Canada.  The blow to pharma is just the latest reminder that they can’t assume any wins just because a Republican is in the White House.

Stat: With New Trade Deal, Trump Deals a Blow to Drug Makers


The government’s word was on trial at the Supreme Court this week when the justices heard arguments over the health law’s “risk corridor” program. It was a slice of the financial carrot to get insurers to participate in the risky marketplaces, but then Congress stripped the funds from the budget. Insurers — who say they’re owed $12 billion — were less than pleased. The justices seemed sympathetic to the insurers, with Justice Stephen Breyer summing it up well: “Why doesn’t the government have to pay its contracts just like everybody else?”

Reuters: U.S. Supreme Court Justices Lean Toward Insurers on $12 Billion Obamacare Claims

And speaking of the health law, the IRS inadvertently ran an experiment on the importance of health coverage when it sent a letter to the nearly 4 million people who were fined because they didn’t have insurance. The letter prompted people to enroll and thus that little letter saved about 700 lives.

The New York Times: The I.R.S. Sent a Letter to 3.9 Million People. It Saved Some of Their Lives.

Back to the Supreme Court: The justices decided to leave in place a Kentucky law that requires physicians to show and describe ultrasounds to patients seeking abortions. The law requires the physicians to continue with the process even if the patient objects and shows signs of distress.

Reuters: U.S. Supreme Court Leaves in Place Kentucky Abortion Restriction

Side note: The story below is less about abortion and more about congressional committees and their inner workings, but I found it a fascinating read (at least for all you wonkish types out there).

Politico: Impeachment Committee’s Rancor Forged by Decades of Abortion Battles


South Carolina is the latest state to be granted a waiver to add work requirements to its Medicaid program. It’s the 10th one so far, but the move is still notable. That’s because, unlike other states, South Carolina never expanded the Medicaid to begin with. That means that the work-age population on its Medicaid rolls is made up almost entirely by poor mothers. Research also suggests that research found the population subject to the new requirements is disproportionately black.

The New York Times: South Carolina Is the 10th State to Impose Medicaid Work Requirements


What a roller-coaster ride this year has been for surprise medical bills. It seemed like low-hanging fruit that even in this particular Congress everyone could agree was bad. But alas, we can always find something to argue about, and progress stalled when lawmakers couldn’t agree on how to solve the problem. Then after months of stagnation, a new deal emerged (which the White House backs). How did they manage that? They actually *gasp* compromised between two of the strategies.

Bills under $750 would be paid at a default price; ones over that could be brought to arbitration, and the final price decision would be binding.

But wait, the ride isn’t over. The House Ways and Means Committee released its own version that would at first let insurers and doctors try to work out payment on their own before an arbitration system kicked in. However it all shakes out, it’s certainly not the easy bipartisan win that was expected.

The Associated Press: White House Backs Emerging Deal on Consumer Health Costs

The Hill: Ways and Means Committee Announces Rival Surprise Medical Billing Fix


South Bend, Ind., Mayor Pete Buttigieg released a list of clients he worked with during his tenure at McKinsey, a powerhouse consulting firm that has drawn fire lately for its work with the Trump administration’s immigration plans. One of Buttigieg’s clients was Blue Cross Blue Shield of Michigan, which eventually went on to lay off about 10% of its workforce. Buttigieg defended his work for the insurer, saying he was focused on administrative costs and cutting overhead expenses.

The New York Times: How Pete Buttigieg Spent His McKinsey Days: Blue Cross, Best Buy, U.S. Agencies


There was nothing particularly notable about Dr. Stephen Hahn’s confirmation process, but I’d be remiss if I didn’t include the fact that the Senate approved him as the new FDA commissioner. Hahn during his hearing sidestepped lawmakers’ attempts to pin him down on e-cigarettes, but any concerns about how he’d handle the epidemic weren’t enough to sink his ship.

The Associated Press: Senate OKs Trump’s FDA Nominee Despite Unclear Vaping Agenda

The FCC approved switching to a three-digit number (988) for the National Suicide Prevention Lifeline. Considering how clunky the old one (800-273-TALK ) was, the change has advocates celebrating. It was interesting that the FCC report had to note that the increase in costs associated with the presumed increase in calls would be offset by avoiding medical expenses such as hospitalizations or emergency department visits.

CNN: FCC Unanimously Approves Proposal for New 3-Digit Number As Suicide Prevention Hotline

A group of doctors carried out a three-day protest in front of a Border Patrol regional headquarters in San Diego. They were demanding that the agency offer flu vaccines to detained migrants — an issue made even more relevant by the fact that three children have died in U.S. custody because of the illness. But Border Patrol says it doesn’t make sense to vaccinate all the people who move through the system.

The Associated Press: Doctors End Protest to Demand Flu Vaccines for Migrants


That’s it from me! Have a great weekend.

Related Topics

Cost and Quality Courts Elections Health Care Costs Health Industry Insurance Medicaid Pharmaceuticals Public Health The Health Law Uninsured

Californians Without Health Insurance Will Pay A Penalty — Or Not

Californians, be warned: A new state law could make you liable for a hefty tax penalty if you do not have health insurance next year and beyond.

But some of you need not worry: The law contains several exemptions that will allow certain people to avoid the penalty, among them prisoners, low-income residents and those living abroad.

“It will be really important that people get clear guidance and instruction to make sure they don’t inadvertently pay a penalty when they are eligible for an exemption,” says Laurel Lucia, director of the Health Care Program at the University of California-Berkeley’s Center for Labor Research and Education.

California’s penalty is modeled on the one originally in the federal Affordable Care Act. Congress eliminated the federal penalty, effective this year.

The Golden State will join Massachusetts, New Jersey, Rhode Island, Vermont and Washington, D.C., in requiring their residents to have health coverage and dinging those without it.

Most types of insurance, including Medi-Cal, Medicare and employer-sponsored coverage, will satisfy California’s coverage requirement. People who purchase insurance for themselves and their families, either through Covered California, the state’s health insurance exchange, or the open market, will have until Jan. 31 to buy a health plan for 2020.

If you aren’t covered and owe a penalty for 2020, it will be due when you file your tax return in 2021. The penalty will amount to $695 for an adult and half that much for dependent children. Some people with higher incomes instead will have to pay 2.5% of their income, which could make their penalty quite a bit heftier.

Penalty payments are expected to raise $317 million in the first year they are collected, according to the state Legislative Analyst’s Office. The money will help pay for new state subsidies intended to make insurance more affordable for some people.

You won’t have to pay the penalty if you are uninsured for three consecutive months or less during the year, or if you are incarcerated or are Native American. Likewise, if you are in the U.S. illegally.

General hardship exemptions also are available if you are facing personal or family difficulties, including homelessness, domestic violence, bankruptcy, eviction or the consequences of a natural disaster.

And you’re off the hook if your household income is below the threshold for filing a tax return. This was the most common exemption from the federal penalty, according to Internal Revenue Service data based on 2016 returns. It might be even more popular under the California law, since the state’s filing threshold is higher than the federal one, Lucia says.

You can also claim an exemption if you would have to spend more than 8.24% of your income on insurance premiums in 2020. This so-called affordability exemption was also among the most common under the federal law.

How you claim an exemption depends on the type you are seeking.

Covered California will handle three types of exemptions: religious conscience, general hardship and affordability. Each will require filling out a different application, and the applications will be available starting in January, says James Scullary, an exchange spokesman.

For other exemptions, you’ll need to apply when you file your 2020 return with the Franchise Tax Board in early 2021. A tax board spokeswoman promises that “our tax forms and instructions will include information for all exemptions claimed on the tax return.”

You can also apply to the tax board for an affordability exemption when you file your return.

Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research, says the 8.24% threshold to qualify for the affordability exemption is too high and pushes many middle-class families to pay a penalty even when they are hard-pressed to buy insurance.

Steven Morelock, a resident of Los Angeles, paid hundreds of dollars in federal penalties for several years because he felt too financially stressed to plunk down $250 a month for a high-deductible health plan. He was already shelling out nearly half of his $2,500-a-month salary in rent alone.

“I would have had to change my habits very dramatically,” says Morelock, 41, a labor organizer. “It would have cut the amount of money I had for non-fixed costs by about half.” He finally got employer-sponsored insurance late last year.

Another exemption that has stirred some debate is for membership in a health care sharing ministry — an association of religiously like-minded people, primarily Christians, who cover one another’s medical costs.

Legislators and others who opposed including this exemption in California’s law argued that the ministries are subject to little regulatory scrutiny, the coverage they offer is limited, and it’s not guaranteed. More recently, concerns have arisen about sham ministries engaged in deceptive business practices.

Dr. Dave Weldon, president of the Alliance of Health Care Sharing Ministries, acknowledges some of the limitations and says the organizations he represents “all counsel their members that this is not insurance, there’s no contract, there’s no obligation to pay.”

Bob Stedman, pictured with his wife, Teresa Stedman, and four of their five children, says his family was exempt from the federal tax penalty because of their membership in a health care sharing ministry. He plans to take the same exemption under the new California law. (Courtesy of Bob Stedman)

Bob Stedman, 55, says he and his family were exempt from the federal penalty every year because of their membership in Samaritan Ministries International. The Lake Forest, Calif., resident plans to take the same exemption under the California law.

Stedman figures he’s saving about $1,000 to $1,500 a month in premiums compared with regular insurance, and was pleased when the $50,000 bill he received following a stroke was heavily discounted by the hospital and then almost entirely covered by other ministry members. And knowing his money is not being used to finance abortions, which most commercial health plans in California are required to cover, gives him “the benefit of a clear conscience,” he says.

Weldon says the exemption is warranted on those grounds alone. “This nation has a long history of religious accommodation,” he says.

If you’re not sure whether you might qualify for an exemption, you can get more information from Covered California or the tax board.

Contact Covered California at www.coveredca.com or by phone: 800-300-1506. For the tax board, log on to www.ftb.ca.gov or call 800-852-5711.

But don’t limit yourself to those two agencies. Insurance agents and tax preparers across the state are trying to master the details of the new law, and they can help.

For a list of insurance agents whose help is free, log on to the Covered California website and click on “find help” or go to the website of the National Association of Health Underwriters (www.nahu.org) and hit “find an agent.” The California Society of Tax Consultants (https://www.cstcsociety.org/) and the California Society of CPAs (www.calcpa.org) can help you find a tax preparer.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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