Yesterday, October 12, 2017, the White House press office announced that the administration will no longer be reimbursing insurers for the cost-sharing reductions they are legally required to make for low-income individuals. The Affordable Care Act requires insurers to reduce cost sharing for individuals who enroll in silver plans and have household incomes not exceeding 250 percent of the federal poverty level. These provisions reduce the out-of-pocket limit for these enrollees—particularly for those with incomes below 200 percent of poverty—and sharply reduce deductibles, coinsurance, and copayments. The reductions cost insurers around $7 billion a year currently. ...[T]he ACA requires the federal government to reimburse insurers for these reductions. This is not a bailout. It is rather a statutory obligation of the federal government to pay insurers for services they have provided as required by law. In 2014, the House of Representatives sued the Obama administration in House v.
Read More
...To ensure compliance with the employer responsibility requirement and to assist verification of compliance with the individual responsibility requirement, the ACA requires large self-insured employers and insurers who cover employee benefit plans to file reporting forms annually with the Internal Revenue Service, and to annually provide full-time employees with statements regarding their coverage. These reports can also be used to verify whether individuals who apply for premium tax credits are in fact ineligible for affordable minimum-value coverage, which would disqualify them from assistance.(The IRS has recently released the forms used for this reporting: the final 2017 1095-B insurer reporting and 1095-C large employer reporting forms, as well as the 1095-A reporting forms used by marketplaces to report individual coverage.)These reporting requirements are quite burdensome for employers.
Read More
