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Letting Employers Off the Hook

— by Rich Dunn, NVRDC 2nd Vice Chairman

H.R. 2575, the “Save American Workers Act” (which is a bill, not an act), would change the definition of “full time” under the ACA from 30 to 40 hours, allowing employers to evade the health care mandate entirely simply by lowering hours worked to 39½. Needless to say, this bill has zero chance of ever becoming law while Barack Obama is president.

H. R. 2575:  To amend the Internal Revenue Code of 1986 to repeal the 30-hour threshold for classification as a full-time employee for purposes of the employer mandate in the Patient Protection and Affordable Care Act and replace it with 40 hours.
1. Short title
This Act may be cited as the Save American Workers Act of 2014.
2. Repeal of 30-hour threshold for classification as full-time employee for purposes of the employer mandate in the Patient Protection and Affordable Care Act and replacement with 40 hours
(a) Full-Time equivalents
Paragraph (2) of section 4980H(c) of the Internal Revenue Code of 1986 is amended—
(1) by repealing subparagraph (E), and
(2) by inserting after subparagraph (D), the following new subparagraph:
(E) Full-time equivalents treated as full-time employees
Solely for purposes of determining whether an employer is an applicable large employer under this paragraph, an employer shall, in addition to the number of full-time employees for any month otherwise determined, include for such month a number of full-time employees determined by dividing the aggregate number of hours of service of employees who are not full-time employees for the month by 174.
(b) Full-Time employees
Paragraph (4) of section 4980H(c) of the Internal Revenue Code of 1986 is amended—
(1) by repealing subparagraph (A), and
(2) by inserting before subparagraph (B), the following new subparagraph:
(A) In general
The term full-time employee means, with respect to any month, an employee who is employed on average at least 40 hours of service per week.
(c) Effective date
The amendments made by this section shall apply to months beginning after December 31, 2013.
Passed the House of Representatives April 3, 2014.

It’s not clear that this bill would necessarily make a lot of difference in the real world, since 98% of large employers already provided health coverage to their full time employees before the ACA imposed the mandate, but it has become so expensive that if one company did it, others might follow to stay competitive.

But even without this change, some companies might decide to just pay the penalty and dump their employees on the exchange, where the subsidies would (like food stamps) amount to just another layer of corporate welfare. The penalty (around $2,000 per employee) is far lower than the cost of health care (around $10,000 per employee).

To keep their employees whole, companies dropping health coverage could increase wages by the amount of their subsidized exchange premiums. Or even a little more. In that scenario, both the employer and the employee would come out ahead, but exchange premiums would inevitably rise to pay for the subsidies. This is an inherent flaw in the ACA. Employer penalties are way too low.

On April 3rd, H.R. 2575 (raising the “full time” threshold to 40 hours) passed House 248 to 179, with these 17 “Republicrats” voting Aye:

Aye   D   Barber, Ron AZ 2nd
Aye   D   Sinema, Kyrsten AZ 9th
Aye   D   Bera, Ami CA 7th
Aye   D   Costa, Jim CA 16th
Aye   D   Murphy, Patrick FL 18th
Aye   D   Bishop, Sanford GA 2nd
Aye   D   Barrow, John GA 12th
Aye   D   Lipinski, Daniel IL 3rd
Aye   D   Schneider, Bradley IL 10th
Aye   D   Delaney, John MD 6th
Aye   D   Peterson, Collin MN 7th
Aye   D   McIntyre, Mike NC 7th
Aye   D   Schrader, Kurt OR 5th
Aye   D   Gallego, Pete TX 23rd
Aye   D   Cuellar, Henry TX 28th
Aye   D   Matheson, Jim UT 4th
Aye   D   Rahall, Nick WV 3rd

Rep. Amodei and the GOP’s House of Cuts

ACA Medicaid Expansion—Why did some States Opt-Out?

ObamaCare Medicaid Expansion was one of the biggest milestones in health care reform. ObamaCare’s Medicaid expansion expanded Medicaid to our nations poorest in order cover nearly half of uninsured Americans. The law previously required states to cover their poorest or lose federal funding to Medicaid (federal funding covers 90-100% of state costs) until the supreme court ruling on ObamaCare.  After the ruling, states could opt-out of the ACA Medicaid Expansion, and as Republican-led states did, it left millions of poor working families without coverage.

Under the ACA (Affordable Care Act, e.g., Obamacare), a new national Medicaid income eligibility level was established at 138% of the Federal Poverty Line.  (That 138% amount is about $15,400/year for an individual; $32,000/year for a family of 4.)  States that opted out of the ACA Medicaid expansion are projected to drive up insurance costs drastically in their states, potentially drive hospitals out of business, and save relatively little, if anything at all.

The ACA Medicaid expansion attempted to bring some uniformity across the nation to how Medicaid is administered.  Prior to 2013, every State had different eligibility requirements based on income, age, gender, dependents, and other state-specific requirements.  Starting in 2014, all states that expanded Medicaid have uniform eligibility requirements.  Those that did not, still have their previous requirements, and left millions of poverty-ridden people without effective healthcare options.

Read more about the ACA Medicaid Expansion here.

On a side note:

Today in the House of Representatives,219 Republicans voted to pass Rep. Paul Ryan’s “Path to Poverty” budget that would REPEAL the Affordable Care Act and turn Medicaid into a block grant to States.  Please note that a “block grant” is a large sum of money granted by the US Government to various State Governments, with only general provisions as to the way that money is to be spent.  It’s very easy to re-task that money into a slush fund with which to pay for other pet and ideological projects at the expense of those in desperate need.

The ACA Has Spurred The Largest Expansion In Health Coverage In America In Half A Century

Yesterday marked the last day of the six-month open enrollment period for people to get insurance coverage through the state and federal marketplaces. Despite technical challenges and staunch ideological opposition, it has already been a huge success with over six million people enrolling. But in the last several days, the interest in signing up and the outreach efforts to those not yet covered has reached new heights.

Take a look at the final surge by the numbers:

  • 9.5 Million: Number Of Uninsured That Now Have Insurance Thanks To The ACA. A new analysis of enrollment data has found that almost ten million people who were previously without health insurance now are covered. The report estimates that two million have enrolled in private coverage on the new marketplaces; about 4.5 million previously uninsured people have gained public coverage through Obamacare’s Medicaid expansion; and about three million previously uninsured young people are now covered on their parents’ insurance plans. The law, as written by the Los Angeles Times, “has spurred the largest expansion in health coverage in America in half a century.”
  • 10 million: Number Of Visits To Heathcare.gov In The Past Week. The Washington Post tallied 8.7 million in the past week through Monday morning, with 2 million visiting this weekend alone. Today, the Department of Health and Human Services tweeted that there had been another 1.2 million visitors just by noon–”record volume.”
  • 125,000: The Number Of Concurrent Users On Healthcare.gov On Monday. An unprecedented level of traffic on the website has led to an unprecedented number of people using the site to sign up for health insurance.
  • 4,000: Number Of Grassroots Events To Help People Enroll In March. For all the money spent over the airwaves, grassroots organizing was a huge component of outreach efforts to get people signed up for coverage. Events took place all over the country, with a focus on reaching the uninsured to make sure they had the information they needed to enroll.
  • 300: Number of Radio Interviews Administration Officials Have Given In The Past Six Weeks. While there have been enormous efforts to use new media to promote the law, good old-fashioned radio has been a go-to source for top White House officials: from Chief-of-Staff Denis McDonough and Senior Adviser Valerie Jarrett to President Obama himself.
  • 49 Percent: Public Support For The ACA. According to a ABC News/Washington Post poll out today, support for the law is at 49 percent, its highest level in months. Back in November, just 40 percent supported and 57 percent opposed the law; today the picture looks much different:

BOTTOM LINE: If there’s any indication that the Affordable Care Act is in high demand, this is it. The law is working, it’s here to stay, and it’s delivering on its promise to provide quality, affordable health coverage that will be there when consumers need it most. Conservatives will continue their repeal-at-all-costs agenda, but the success of these past six months will make it harder because people do not want to go back to the way it was.


This material [the article above] was created by the Center for American Progress Action Fund. It was created for the Progress Report, the daily e-mail publication of the Center for American Progress Action Fund. Click here to subscribe.

The Ryan Budget Is a Broken Record of Failed Trickle-Down Economics

By Anna Chu and Harry Stein

For the past three years, House Budget Committee Chairman Paul Ryan (R-WI) has been trotting out the same conservative, top-down policies that have failed the nation’s middle- and working-class families, seniors, and the economy. The House Republican budget is built around the tenet that nearly everyone else must sacrifice in order to continue to give billions of dollars in tax breaks to millionaires, big corporations, and Big Oil. At every turn, the House Republican budget reveals its vision of an economy and government that only works for the wealthiest individuals and special corporate interests at the cost of everyone else.

Now for the fourth consecutive year, the House Republican budget proposes dismantling traditional Medicare and slashing investments that drive our economy, all while cutting taxes for the rich and protecting taxpayer subsidies for big businesses and oil companies. The American people have seen this before, and we know how it ends—with millionaires, big corporations, and Big Oil as the only ones who are better off. Everyone else gets left behind, and our economy only gets weaker. Read more.

Paul Ryan’s Budget Makes Wild New Claims About Obamacare

— BY IGOR VOLSKY, ThinkProgressPaul Ryan

CREDIT: AP

As Obama administration moves closer to meeting it original goal of enrolling 7 million people in the Affordable Care Act’s new insurance marketplaces, Rep. Paul Ryan (R-WI) has released a budget that repeals the law and asks Congress to “pursue patient-centered health-care reforms that actually bring down the cost of care by empowering consumers.”

And while this new Fiscal Year 2015 budget borrows heavily from previous versions, the April 1st release is far more critical of Obamacare. In a possible preview of the GOP’s election-year rhetoric, this year, Ryan warns — in almost apocalyptic terms — that the law “will undermine the private insurance” and “the competitive forces of the marketplace.” He even argues that it would “eventually lead to a single-payer system.” Here is a comparison between last year’s blueprint and Tuesday’s release:

Fiscal Year 2014: Repeal the health-care law’s exchange subsidies

The new law couples these subsidies with a mandate for individuals to purchase health insurance and bureaucratic controls on the types of insurance that may legally be offered. Taken together, these provisions will weaken the private-insurance market. Exchange subsidies take the health-care market in the wrong direction, breaking what’s working at a time when policymakers need to fix what’s broken. Government mandates will drive out all but the largest insurance companies. Punitive tax penalties will force individuals to purchase coverage whether they want it or not. Further, the law does not condone any policy that would require entities or individuals to finance activities or make health decisions that violate their religious beliefs.

This budget repeals the President’s onerous health-care law. Instead of putting health-care decisions into the hands of bureaucrats, Congress should pursue patient-centered health-care reforms that actually bring down the cost of care by empowering consumers.

Fiscal Year 2015: Repeal the Exchange Subsidies Created by the New Health-Care Law.

The new law couples these subsidies with a mandate for individuals to purchase health insurance and bureaucratic controls on the types of insurance that may legally be offered. Taken together, these provisions will undermine the private insurance market, which serves as the backbone of the current U.S. health-care system. Exchange subsidies will undermine the competitive forces of the marketplace. Government mandates will drive out all but the largest insurance companies. Punitive tax penalties will force individuals to purchase coverage whether they choose to or not. Further, this budget does not condone any policy that would require entities or individuals to finance activities or make health decisions that violate their religious beliefs. This budget provides for the repeal of the President’s onerous health-care law for this and many other reasons.

Left in place, the health law will create pressures that will eventually lead to a single-payer system in which the federal government determines how much health care Americans need and what kind of care they can receive. This budget recommends repealing the architecture of this new law, which puts health- care decisions into the hands of bureaucrats, and instead allowing Congress to pursue patient centered health-care reforms that actually bring down the cost of care by empowering consumers.

Interestingly, while Ryan goes to great lengths to criticize the ACA’s “government mandates” and the supposed decision to leave “health- care decisions into the hands of bureaucrats,” he praises this very same kind of government-control elsewhere in the budget.

For instance, in discussing his plan to allow future retirees the choice of private insurance through his “premium support” proposal, Ryan promises that “the Medicare program and its benefits will remain as they are, without change.” For future retirees, Ryan proposes an Obamacare-like exchange that will feature private insurers providing Medicare-like plans. However, Ryan tasks the government with policing the plans private insurers offer “to avoid cherry-picking, and to ensure that Medicare’s sickest and highest-cost beneficiaries receive coverage.” Just four pages earlier, Ryan criticizes such government intervention in the exchanges.

Republicans have already voted to repeal the Affordable Care Act in full or in part at least 51 times and on Monday, House Speaker John Boehner (R-OH) doubled down on his commitment to hold more repeal votes. “House Republicans will continue to work to repeal this law and protect families and small businesses from its harmful consequences,” he said. “We will also continue our work to replace this fundamentally-flawed law with patient-centered solutions focused on lowering health care costs and protecting jobs.” House leadership has also pledged to introduce a unified alternative to the health care law, although they have not provided a timeline for drafting or debating that measure.


This material [the article above] was created by the Center for American Progress Action Fund. It was created for the Progress Report, the daily e-mail publication of the Center for American Progress Action Fund. Click here to subscribe.

Observing LGBT Health Awareness Week

A statement by HHS Secretary Kathleen Sebelius

LGBT Health Awareness Week is an important time to bring attention to the unique health needs of lesbian, gay, bisexual, and transgender (LGBT) Americans and to highlight the progress we’ve made in our work to ensure LGBT Americans have the same rights and protections as other Americans, especially through implementation of the Affordable Care Act.

It’s critical for the LGBT community and all Americans to remember that Monday, March 31 is the last day of open enrollment and those who miss out can’t get covered through the Marketplace until 2015.

Access to affordable care has long been an obstacle to good health and financial security for the LGBT community and all Americans.  On average, LGBT Americans suffer from higher rates of cancer, obesity, HIV/AIDS and mental illness than the rest of the nation. For those with chronic conditions such as HIV/AIDS, dollar caps on annual and lifetime coverage meant astronomical bills and debt for many in the community.

But thanks to the Affordable Care Act, it is a new day. Lifetime and annual dollar caps are a thing of the past and no one can be denied coverage based on their health history.

Legally married couples are treated equally when it comes to coverage or financial assistance, no matter who they are married to.  And, for the first time, Marketplace coverage is now affordable for the LGBT community and Americans all over the country.

Remember: Monday, March 31 is the last day of enrollment – that’s only five days left to get everyone covered who still needs it.

This Administration is committed to improving the health of all Americans, including LGBT Americans, and we look forward to continuing this work during LGBT Health Awareness Week and beyond.
###

Government Teams Recovered $4.3B in FY2013 and $19.2B over the Last 5 Years

Attorney General Eric Holder and HHS Secretary Kathleen Sebelius today released the annual Health Care Fraud and Abuse Control (HCFAC) Program report showing that for every dollar spent on health care-related fraud and abuse investigations through this and other programs in the last three years, the government recovered $8.10.  This is the highest three-year average return on investment in the 17-year history of the HCFAC Program.

810The government’s health care fraud prevention and enforcement efforts recovered a record-breaking $4.3 billion in taxpayer dollars in Fiscal Year (FY) 2013, up from $4.2 billion in FY 2012, from individuals and companies who attempted to defraud federal health programs serving seniors or who sought payments from taxpayers to which they were not entitled.  Over the last five years, the administration’s enforcement efforts have recovered $19.2 billion, up from $9.4 billion over the prior five-year period.  Since the inception of the program in1997, the HCFAC Program has returned more than $25.9 billion to the Medicare Trust Funds and treasury.

These recoveries, released today in the annual HCFAC Program report, demonstrate President Obama’s commitment to making the elimination of fraud, waste and abuse, particularly in health care, a top priority for the administration.  This is the fifth consecutive year that the program has increased recoveries over the past year, climbing from $2 billion in FY 2008 to over $4 billion every year since FY 2011.

The success of this joint Department of Justice and HHS effort was made possible in part by the Health Care Fraud Prevention and Enforcement Action Team (HEAT), created in 2009 to prevent fraud, waste and abuse in Medicare and Medicaid and to crack down on individuals and entities that are abusing the system and costing American taxpayers billions of dollars.

“With these extraordinary recoveries, and the record-high rate of return on investment we’ve achieved on our comprehensive health care fraud enforcement efforts, we’re sending a strong message to those who would take advantage of their fellow citizens, target vulnerable populations, and commit fraud on federal health care programs,” said Attorney General Eric Holder.  “Thanks to initiatives like HEAT, our work to combat fraud has never been more cooperative or more effective.  And our unprecedented commitment to holding criminals accountable, and securing remarkable results for American taxpayers, is paying dividends.”

“These impressive recoveries for the American taxpayer are just one aspect of the comprehensive anti-fraud strategy we have implemented since the passage of the Affordable Care Act,” said HHS Secretary Sebelius.  “We’ve cracked down on tens of thousands health care providers suspected of Medicare fraud. New enrollment screening techniques are proving effective in preventing high risk providers from getting into the system, and the new computer analytics system that detects and stops fraudulent billing before money ever goes out the door is accomplishing positive results – all of which are adding to savings for the Medicare Trust Fund.”

The new authorities under the Affordable Care Act granted to HHS and the Centers for Medicare & Medicaid Services (CMS) were instrumental in clamping down on fraudulent activity in health care.  In FY 2013, CMS announced the first use of its temporary moratoria authority granted by the Affordable Care Act.  The action stopped enrollment of new home health or ambulance enrollments in three fraud hot spots around the country, allowing CMS and its law enforcement partners to remove bad actors from the program while blocking provider entry or re-entry into these already over-supplied markets.

The Justice Department and HHS have improved their coordination through HEAT and are currently operating Medicare Fraud Strike Force teams in nine areas across the country. The strike force teams use advanced data analysis techniques to identify high-billing levels in health care fraud hot spots so that interagency teams can target emerging or migrating schemes as well as chronic fraud by criminals masquerading as health care providers or suppliers. The Justice Department’s enforcement of the civil False Claims Act and the Federal Food, Drug and Cosmetic Act has produced similar record-breaking results.  These combined efforts coordinated under HEAT have expanded local partnerships and helped educate Medicare beneficiaries about how to protect themselves against fraud.

In Fiscal Year 2013, the strike force secured records in the number of cases filed (137), individuals charged (345), guilty pleas secured (234) and jury trial convictions (46). Beyond these remarkable results, the defendants who were charged and sentenced are facing significant time in prison – an average of 52 months in prison for those sentenced in FY 2013, and an average of 47 months in prison for those sentenced since 2007.

In FY 2013, the Justice Department opened 1,013 new criminal health care fraud investigations involving 1,910 potential defendants, and a total of 718 defendants were convicted of health care fraud-related crimes during the year.  The department also opened 1,083 new civil health care fraud investigations.

The strike force coordinated a takedown in May 2013 that resulted in charges by eight strike force cities against 89 individuals, including doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $223 million in false billings. As a part of the May 2013 takedown, HHS also suspended or took other administrative action against 18 providers using authority under the health care law to suspend payments until an investigation is complete.

In FY 2013, the strike force secured records in the number of cases filed (137), individuals charged (345), guilty pleas secured (234) and jury trial convictions (48). Beyond these remarkable results, the defendants who were charged and sentenced are facing significant time in prison – an average of 52 months in prison for those sentenced in FY 2013, and an average of 47 months in prison for those sentenced since 2007.

In March 2011, CMS began an ambitious project to revalidate all 1.5 million Medicare enrolled providers and suppliers under the Affordable Care Act screening requirements. As of September 2013, more than 535,000 providers were subject to the new screening requirements and over 225,000 lost the ability to bill Medicare due to the Affordable Care Act requirements and other proactive initiatives.  Since the Affordable Care Act, CMS has also revoked 14,663 providers and suppliers’ ability to bill the Medicare program. These providers were removed from the program because they had felony convictions, were not operational at the address CMS had on file, or were not in compliance with CMS rules.

HHS and the Justice Department are leading historic efforts with the private sector to bring innovation to the fight against health care fraud. In addition to real-time data and information exchanges with the private sector, CMS’ Program Integrity Command Center worked with the HHS Office of the Inspector General and the FBI to conduct 93 missions to detect, investigate, and reduce improper payments in FY 2013.

From May 2013 through August 2013, CMS led an outreach and education campaign targeted to specific communities where Medicare fraud is more prevalent.  This multimedia campaign included national television, radio, and print outreach and resulted in an increased awareness of how to detect and report Medicare fraud.

To read today’s report visit http://oig.hhs.gov/publications/docs/hcfac/FY2013-hcfac.pdf

For previous years’ reports visit https://oig.hhs.gov/reports-and-publications/hcfac/index.asp

For more information on the joint DOJ-HHS Strike Force activities, visit: www.StopMedicareFraud.gov/.

ACA: Still Enrolling for Health Insurance through March

There are still 45 days for Nevadans to enroll in affordable health coverage through our state’s new insurance marketplace, the Nevada Health Link.

As the final deadline approaches, we anticipate being as busy as ever. Ramirez Group Enrollment Assisters are enrolling people at locations ​throughout the state during the week, and hosting enrollment fairs during the weekends at Nevada JobConnect offices.

If you or anyone you know hasn’t enrolled in health insurance yet, give us a call at 702.530.5249.

SOTU Fact Check Alert

 The official Republican response to President Obama’s State of the Union — delivered on national television to millions of people — by Rep. Cathy McMorris-Rogers centered around a FAKE Obamacare horror story.


That’s right, the story that Republican Rep. Cathy McMorris Rodgers told to the nation about “Bette in Spokane” facing a premium increase of “nearly $700” under the Affordable Care Act was a lie. This comes after a long string of false Obamacare horror stories from John Boehner and his Republican cronies.

We can’t continue letting these House Republicans get away with blatantly misleading the American people. Here’s the facts on McMorris-Rogers’s tall tale in her State of the Union response:

  • The Spokesman Review reported that “Bette in Spokane” was not forced to pay $700 more a month.
  • In fact, she had other, cheaper health care options available in Washington through the health exchanges — she simply chose not to avail herself of those options.
  • Bette never spoke with McMorris Rodgers’s office to tell the whole story.

When Republicans in Congress mislead the American people, it’s up to us to call them out and demand they set the record straight.