Category Archives: Obamacare

Dems stop bill seeking oversight of Colorado health exchange bonuses

Connect for Health Colorado has a friend with Democrats – Dems stop bill seeking oversight of Colorado health exchange bonuses – The Denver Post.

The state House Health, Insurance and Environment Committee on Thursday killed a Senate bill that would have required legislative approval of any pay bonus given to employees of the state health insurance exchange.

The Democrat-controlled committee voted 7-6 along party lines to indefinitely postpone Senate Bill 52, a three-line bill giving the Legislative Health Benefit Exchange Implementation Review Committee oversight over bonuses for all 40 to 50 employees of Connect for Health Colorado.

Bill co-sponsor Jon Keyser, R-Morrison, said Coloradans are required to pay a fee for a system that hasn’t been working properly, and it was reasonable for the legislative committee to have oversight of any federal taxpayer dollars paid out as bonuses.

“The (exchange) board of directors may view this as intrusive, … but sunshine is the best disinfectant,” Keyser said.

Sunshine would be good as Connect for Health is not a transparent organization. However I find this final paragraph most offending…

But committee Democrats defended the exchange’s performance as impressive— starting from scratch in a complex regulatory environment, they said. Another layer of review of employee compensation on top of review by the exchange board, which itself is appointed by the legislature, is unnecessary, said committee chairwoman Rep. Beth McCann, D-Denver.

I’m sorry, the Democrats live in an alternate universe. The exchanges performance is not impressive, no way now how. Most disappointing was the lack of improvement from 2014 to 2015 and the screw-ups in the Shared Eligibility System (SES) and auto-renewal.

SES was supposed to seamlessly take subsidy eligible applicants from Connect for Health Colorado to the Colorado PEAK (Medicaid) website where they applied for Medicaid and back again once a determination was made. Applying for Medicaid is necessary step if you wish to receive a subsidy on a monthly basis. If the applicant was accepted for Medicaid, then they were done. If they were denied, Medicaid determined their premium assistance, along with a case number and authorization number and in an ideal world they were returned to Connect for Health Colorado to resume shopping. It was expected that an immediate determination and a seamless shopping experience would occur for 80% of applicants. I think I had ONE applicant where that actually worked.

This process was riddled with errors, not the least of which is the Medicaid application itself, which I will hasten to point out is NOT under Connect for Health Colorado’s jurisdiction.

The auto-renewal process was supposed to make it easy to simply let an insured’s policy renew. Unfortunately, if an insured went into Connect for Health to shop for plans and simply followed their nose, the auto-renewal was cancelled without notice to the consumer. There WAS a way to shop where the auto-renewal wasn’t cancelled but a typical consumer would have no idea how to do that.

These two issues were major disappointments. Other issues were almost no improvements to the broker or consumer shopping experience (i.e. website interaction). Yes, there were some improvements and some were of note but there were so many other issues that could have been addressed with just a little programming time.

As a broker, I moved as much business that was not subsidy eligible off the exchange that I could. If you are NOT subsidy eligible and don’t expect to become eligible during the year (i.e. how secure is your job…) then there is absolutely NO reason to use Connect for Health Colorado.


Playing the Obamcare game to your advantage

Tempting – Five Easy Ways To Game Obamacare.

  1. Buy None, Get Three Free (months that is)
  2. Understate Your Income
  3. Are You Sure You Use Tobacco?
  4. Buy it. Change it. Use it. Drop it.
  5. Pay The Tax for Being Uninsured

The conclusion…

As the Obamacare abyss continues, it will be more likely that people will look toward these mechanisms to avoid paying the high premiums. It should be noted that, although not all of these options are necessarily ethical, they all fall within the law.

We should also note: since when has government said anything about Obamacare it has ethically presented to the public? (emphasis added)



Subsidy Verification in the ACA: Complexity Creating Taxpayer Risk

Subsidy Verification in the ACA: Complexity Creating Taxpayer Risk | Testimony | American Action Forum.

Great article by the American Action Forum exploring the complexity of the Obamacare subsidy.  The following subjects are examined:

  • Complications of the Subsidy Eligibility Provisions in the Affordable Care Act
  • The Affordable Care Act Increases Burdens on the Tax Code and on Taxpayers
  • Income Verification and Risks to the Federal Budget

The conclusion, which I agree with 100% is:

The process for verifying eligibility and receiving subsidies is far too complex to rely on such tenuous information. The enrollment period is over, and those that applied to receive subsides are currently receiving them in some form, and these individuals will be asked to provide an answer for inaccuracies in a system bound for error and fraudulent payments. Not only does this impact the taxpayer, but it could unnecessarily increase federal spending through inaccurate subsidy payments – both unintentional and fraudulent.

The additional burden of reporting health insurance status and payments through the tax filing process could create large liabilities for taxpayers, and increases the complexity of the federal tax system. The Treasury Inspector General even testified that the IRS will have difficulty implementing fraud prevention measures imposed on the agency until the system is more robust.[xxvii]

With the 2015 open enrollment season just around the corner, the administration should be ensuring that proper verification systems are in place and do away with the self-attestation honor system that leaves taxpayers liable and the encourages additional spending at the federal level. The current subsidy eligibility system places too heavy of a responsibility on the individual, the employer and the federal budget.

Wish I’d discovered this analysis sooner. It’s safe to say that the administration did little to ensure that the proper verification systems are in place.


Treasurey makes $3 billion in Obamacare payments without authorization.

Do first, ask forgiveness later – Treasury won’t explain decision to make $3 billion in Obamacare payments |

What’s tricky is that Congress never authorized any money to make such payments to insurers in its annual appropriations, but the Department of Health and Human Services, with the cooperation of the U.S. Treasury, made them anyway.


The argument that annual appropriations are required to make payments is also backed up by a report from the Congressional Research Service, which has differentiated between the tax credit subsidies that Obamacare provides to individuals to help them purchase insurance, and the cost-sharing payments to insurers.

Well until Congress gets some gonads (excuse me ladies, or not…) it’s quite obvious that annual appropriations are not required.

Why do we even have a Congress with Obama as President? They are getting more and more irrelevant by the day. The scary thing is there’s “nothing wrong with that” from a Democratic perspective.


IRS: Obamacare Penalty Exemptions

Individual Shared Responsibility Provision – Exemptions: Claiming or Reporting.

There are a myriad of ways to avoid the Obamacare penalty. No better place to go but the enforcer, the IRS.

  • Coverage considered unaffordable
  • Short coverage gap
  • Income below the return filing threshold
  • Citizens living abroad and certain noncitizens
    • must be out of country at least 330 days
  • Members of a health care sharing ministry
  • Members of Indian Tribes
  • Incarceration
  • Members of certain religious sects
  • Aggregate self-only coverage considered unaffordable
  • Gap in coverage the beginning of 2014
  • General Hardship
  • Coverage considered unaffordable based on projected income
  • Determined ineligible for Medicaid in a state that did not expand Medicaid coverage (income dependent)
  • Resident of a state that did not expand Medicaid (Income dependent)
  • Unable to renew existing coverage
  • Gap in CHIP coverage
  • AmeriCorps coverage
  • Limited benefit Medicaid and TRICARE programs that are not minimum essential coverage

Details provided at the link.


Will Only Suckers Pay The ObamaCare Tax Penalty?

Be careful out there… Will Only Suckers Pay The ObamaCare Tax Penalty? –

The SRP (Shared Responsibility Payment – Ed) is a clumsy euphemism for the ObamaCare individual mandate tax penalty, which is $95 or 1% of household income, whichever is greater, for those who didn’t have insurance in 2014. That increases to the greater of $325 or 2% of income for those who don’t have insurance this year, and then to $695 or 2.5% of income the year after that.

The mandate and the tax penalty behind it are core elements of the health law, but it’s becoming increasingly apparent that they are relatively toothless. There are dozens of exemptions available, some of which require no paperwork. It can be far less complicated to avoid the ObamaCare tax penalty than pay it. And the already overworked Internal Revenue Service has little authority to collect any unpaid penalty taxes due.

This has led industry analyst Robert Laszewski to ask “is there really an individual mandate?”

And here’s how easy it is to avoid the penalty?

Penalty complexity. When filling out the new Form 1040, taxpayers can check a box indicating that they had “full-year coverage.” Anyone who checks this box doesn’t have to pay the penalty, fill out any additional forms or submit any evidence of coverage, leaving it to the IRS to determine whether they were properly insured.

Those who don’t check this “full-year coverage” box, in contrast, must locate a complicated worksheet in a separate instruction booklet to determine the size of their penalty. The worksheet requires taxpayers to indicate each month that they, their spouse or dependents didn’t have government-approved insurance, and then do a series of calculations to see what they owe.

Some tax professionals admit that there is little to keep someone from just checking the box and avoiding the extra hassle and cost of figuring out the penalty, even if they didn’t technically meet the requirement for “full-year coverage.”

All that said, my motto is “don’t mess with the IRS!”



Obamacare subsidy clawbacks commonplace

H&R Block analysis: Most ObamaCare customers paying back portion of subsidies | Fox News.

Too much subsidy:

An analysis by tax-preparer H&R Block found that to date, 52 percent of those who enrolled in Affordable Care Act coverage are paying back part of their premium tax credits.

On average, they’re paying back $530, reducing the average refund by 17 percent.

H&R Block reports that most clients are answering truthfully as to whether they had coverage in 2014, as required by the law. Those who didn’t have coverage are paying an average $172 penalty.


Treating Medicaid patients is charity work.

Treating Medicaid patients is charity work. This bill proves it..

The enthusiasm for expanding Medicaid coverage to the previously uninsured seems misplaced. Improved “access” to the health care system via Medicaid programs surely cannot result in lasting coverage. In-network physicians will continue to dwindle as their office overhead exceeds meager reimbursement levels.

In reality, treating Medicaid patients is charity work. The fact that any physicians accept Medicaid is a testament to their generosity of spirit and missionary mindset. Expanding their pro bono workloads is nothing to cheer about. (emphasis added) The Affordable Care Act’s “signature accomplishment” is tragically flawed – because offering health insurance to people that physicians cannot afford to accept is not better than being uninsured.

After all, improved access to nothing … offers nothing. Inviting physicians to work for less than minimum wage so that politicians can crow about millions of uninsured Americans now having access to health care, is ridiculous. Medicaid expansion is widening the gap between the haves and the have-nots. The saddest part is that the have-nots just don’t realize it yet.

To the consumer, Medicaid seems like a gift. It will work for awhile until it breaks. Also, the consumer is very trusting that their past medical health is a good predictor of their future health. If for some reason, that turns out not to be the case, do you believe you or your spouse or children are getting the best treatment from the Medicaid system?


Everything you wanted to know about MAGI

MAGI is Modified Adjusted Gross Income. MAGI is important because it is the income that is used to determine subsidy eligibility. I have a one page document courtesy of UC Berkeley Labor Center that is a great starting point and is sufficient for most people.

For those of you that have more complex situation or are simply curious. the best resource I have found is The Advocate’s Guide to MAGI by the National Health Law Program. It is almost 100 pages of in depth information on determining MAGI for complex situations.

Download (PDF, 1.65MB)


Avoid the health exchange if you’re NOT subsidy eligible… Here’s why

Video: ObamaCare exchange not allowing addition of newborns to policies « Hot Air.

Let’s just say it’s one giant PITA.

Actually, no it wouldn’t be “more affordable” for families already paying for family coverage, which would likely be most of those seeking to add a newborn to their policy. And if they don’t qualify, then it’s a moot point anyway. That eligibility could have been determined through the ObamaCare exchange, had it been properly designed to deal with additions of newborns.

Instead, thanks to the run-around requires, families end up running out of time to add their newborns to their policies — and health insurers can’t step in and assist them any more:

Sure enough, CHIP denied her baby. Now when she turns to the marketplace to try and add her daughter, they turn her away.

“They denied us, saying we went over our time limit and there was no evidence we tried adding her to our insurance,” Maggie said.

Maggie says she protested sending marketplace workers copies of their own emails promising to extend the window but it did no good.

One executive from a Utah insurer says anyone who gave birth in 2014 will have the same problem, and it’s mystifying to Shaun Greene. “Insurance companies have been doing that for years,” Greene told KUTV about adding newborns to policies. “It’s not difficult.” Not until government takes it over, that is. (emphasis added)

I have not endured this particular situation in Colorado but have had some that are similar. However, I can say that Connect for Health Colorado is pretty good at creating incident numbers and allowing enrollment once the situation is resolved.

In Colorado, and apparently with, almost any issue that isn’t a “straight enrollment” ends up being delayed. In the minds of the consumer, they are dumbfounded by the apparent incompetence. I have had two cases of adding family members, neither one has gone smoothly. In one situation, the family member was added the day after the enrollment was done. It took over 40 days and a plea to Connect for Health management to get this resolved.

This Rube Goldberg of a healthcare law boggles the mind.

If you’re not subsidy eligible, DO NOT use the exchange. In this case, it serves no purpose. However, if you are subsidy eligible or you might be, you MUST use the exchange if you want to preserve you eligibility. Even if you don’t want an advanced subsidy (monthly payments), you must use the exchange to claim your subsidy at the end of the year on your tax return.




CMS Announces Special Enrollment Period for Tax Season

Press release: CMS Announces Special Enrollment Period for Tax Season.

The Centers for Medicare & Medicaid Services (CMS) announced today a special enrollment period (SEP) for individuals and families who did not have health coverage in 2014 and are subject to the fee or “shared responsibility payment” when they file their 2014 taxes in states which use the Federally-facilitated Marketplaces (FFM). This special enrollment period will allow those individuals and families who were unaware or didn’t understand the implications of this new requirement to enroll in 2015 health insurance coverage through the FFM.

For those who were unaware or didn’t understand the implications of the fee for not enrolling in coverage, CMS will provide consumers with an opportunity to purchase health insurance coverage from March 15 to April 30.  If consumers do not purchase coverage for 2015 during this special enrollment period, they may have to pay a fee when they file their 2015 income taxes.

Those eligible for this special enrollment period live in states with a Federally-facilitated Marketplace and:

  • Currently are not enrolled in coverage through the FFM for 2015,
  • Attest that when they filed their 2014 tax return they paid the fee for not having health coverage in 2014, and
  • Attest that they first became aware of, or understood the implications of, the Shared Responsibility Payment after the end of open enrollment (February 15, 2015) in connection with preparing their 2014 taxes.

The special enrollment period announced today will begin on March 15, 2015 and end at 11:59 pm E.S.T. on April 30, 2015.  If a consumer enrolls in coverage before the 15th of the month, coverage will be effective on the first day of the following month.

Colorado Residents call Chris at 303.495.3045 for assistance!

Share sends out 800K incorrect 1095 forms

Amateur hour (day/year) – HHS extends Obamacare enrollment, says 800K filers got bad subsidy info.

The Obama administration says it sent about 800,000 customers the wrong tax information, and officials are asking those consumers to delay filing their 2014 taxes.

The tax error disclosed Friday is a self-inflicted injury that comes on the heels of what President Barack Obama had touted as a successful enrollment season, with about 11.4 million people signed up.

California, which is running its own insurance market, just announced a similar problem affecting about 100,000 people in that state.

You can’t make this stuff up.


Obamacare Penalties lead to possible open enrollment

Democrats Beg Obama to Bend Obamacare Rules to Avoid Tax Penalties for Millions – Breitbart.

Reps. Sander Levin (D-MI), Jim McDermott (D-WA), and Lloyd Doggett (D-TX) have strongly requested a special sign-up for the uninsured who will all be hit with a $325 fine or two percent of their income (whichever is higher) for failure to enroll in 2015. In 2016, the Obamacare tax penalty will be an average $1,100, reports the Associated Press. For 2014, the Obamacare tax was $95 or one percent of income.

“Open enrollment period ended before many Americans filed their taxes,” the three lawmakers said in a statement. “Without a special enrollment period, many people (who will be paying fines) will not have another opportunity to get health coverage this year.”

They passed the law to find out what was in it, and they didn’t see this coming?


Only 3 Shopping Day Left!

Times running out to sign up for Obamacare – Yahoo Finance.

What happens if you miss the health insurance deadline?
If you’re not eligible for Medicaid or don’t qualify for an exception and you miss the health insurance deadline, you could face a financial penalty. If you’re worried about being without insurance, know that you’ll be able to sign up for coverage of some sort after the deadline, but what’s available will be only short-term or temporary health insurance, which doesn’t have to offer the “essential benefits” of Obamacare.