Patient Protection and Affordable Care Act

The Chicago Tribune reports on how a "little-known" provision in the Medicaid health-insurance expansion is going to increase the practice of the government asserting liens on patients' assets to recoup expenditures on medical costs: "The issue arises because of a provision in the long-standing laws governing Medicaid that compel states to recoup certain medical costs after a person dies, either via liens placed on an individual's home or claims on their assets." Liens are not asserted in private insurance policies bought on state-based insurance exchange.

The Tribune reports that new Medicaid patients could face liens even if they don't seek medical care: "In another twist, all new Medicaid patients in Illinois were placed into so-called managed-care programs, in which the state pays insurers on a per-member per-month basis. That means people like Rosato will be racking up health care costs even if they don't seek any medical care. In theory, that money could all come out of their estates once they die."

Some states, included Oregon and Washington, have tweaked their regulations to apply recovery efforts only to long-term care, The Tribune further reports. However, Illinois has not.

The Centers for Medicaire & Medicaid Services said it will provide guidance to states sometime soon.

The Republican governor of Utah has announced an expansion of Medicaid, Huffington Post reports. Many Republican states have resisted the expansion of Medicaid under Obamacare as too expensive. But Governor Gary Herbert "pointed to the 60,000 individuals in the state who will gain coverage under the state's expansion of the program, saying it's 'not fair' to leave them without a solution," Huffington Post further reports.

The Medicaid expansion was a key part of ensuring that lower-income Americans, including many working poor, would get health-care coverage under the new mandate that all Americans have health insurance. But the U.S. Supreme Court said that the expansion could not be mandated to the states by the federal government. That has left it up to the states on whether they'll accept federal dollars to implement the expansions.

While only 24 percent of people purchasing health insurance through the federal exchange are between the age of 18 and 34 (which is 14 percentage points lower than what the law needs to keep premiums low), The Washington Post's Ezra Kkein reports that younger, healthier people tend to sign up only when the penalty is about to hit. This enrollment behavior happened when Massachusetts rolled out its state insurance exchange. " Obamacare's enrollment pattern looks a whole lot more like Massachusetts than I would've thought given the disastrous launch and the challenging political environment," Klein blogs. Open enrollment ends April 1.

As health-care expands in an effort to cover all Americans, the Medicaid expansion could mean that more people over the age of 55 will face liens being placed on their assets for their care, according to a report in BenefitsPro. "Washington and many other states, including California, Florida and New York, interpret the [federal] regulations to mean that they should use liens to try to recover any money spent by Medicaid on any care for people ages 55 and older, not just for long-term care specifically," BenefitsPro also reports. But regulators in Washington issued an emergency rule to limit lien recoveries only to Medicaid funds spent on long-term care in order to reduce a disincentive for people to sign up for health-care coverage, BenefitsPro concludes

The Washington Post reports that 2.1 million people have signed up for health-insurance policies, about half through the federal exchange and about half through the state exchanges.  Federal officials are also confident the 2.1 million figure means more Americans, rather than fewer, now have health-care coverage starting Wednesday since it 'certainly outpaces anyone who may have lost a plan' this year," The Post further reports.

United Press International has this roundup of cases to watch when the U.S. Supreme Court reconvenes January 13: "The big dog in the rest of the Supreme Court term which ends when the justices 'rise; for the summer recess -- when the supreme backsides leave their comfortable rocking chairs behind the bench -- is the challenge to the Affordable Care Act's contraception mandate. The case demonstrates a Washington fact: The Supreme Court often influences how the average American lives as much or more than Congress or the White House. The justices agreed to settle the dispute over the Affordable Care Act's contraception mandate -- whether the health of women covered is dispositive, as the Obama administration argues, or whether the owners of for-profit businesses may use religious objections to avoid providing contraception insurance."

Advocates say that some plans offered through the Obamacare online insurance exchanges are offering skimpy drug coverage for expensive conditions like AIDS, cancer and other chronic conditions, The Washington Post reports. One advocate, John Peller, vice president of policy for the AIDS Foundation of Chicago, told The Post: '“The fear is that they are putting discriminatory plan designs into place to try to deter certain people from enrolling by not covering the medications they need, or putting policies in place that make them jump through hoops to get care.'"

The issues are, advocates told The Post, that: "The plans are curbing their lists of covered drugs and limiting quantities, requiring prior authorizations and insisting on 'fail first' or 'step therapy' protocols that compel doctors to prescribe a certain drug first before moving on to another — even if it’s not the physician’s and patient’s drug of choice."

America's new health law is beating projections on how much it will cost, The New York Times reports, "with both the Medicaid expansion and the subsidies for private insurance plans ending up less expensive than anticipated." The main reason is the slow economy as well as deductibles and copays that discourage consumers from undertaking some health care.
 

President Obama's administration is still reeling from the failure to have the federal health-insurance exchange up and running for consumers to shop for health insurance (ahead of the deadline for when the insurance mandate kicks in). There could be further repurcussions if the Internal Revenue Service is not ready to enforce the requirement that all Americans secure health insurance, The Washington Post reports.

The issues include, The Post reports, that: "Besides lacking coverage information that would help the agency enforce the 'individual mandate,' the IRS also is hamstrung in penalizing those who do not sign up. The lawmakers who drafted the health-care law intentionally barred the IRS from using its customary tools for collecting penalties — liens, foreclosures and criminal prosecution. The only means of collecting the fine is to essentially garnish tax refunds for people who overpaid their taxes."

One of the criticisms of the Obamacare rollout is some consumers' health care insurance policies are being canceled because they don't comply with minimum requirements. Replacement policies are more expensive. Self-employed lawyers are among those whose costs are increasing, The Washington Post reports: "If the poor, sick and uninsured are the winners under the Affordable Care Act, the losers appear to include some relatively healthy middle-income small-business owners, consultants, lawyers and other self-employed workers who buy their own insurance. Many make too much to qualify for new federal subsidies provided by the law but not enough to absorb the rising costs without hardship." The costs are going up due to increased benefits and increased coverage for sicker people, The Post also reported.