Archive for the ‘Affordable Care Act’ Category

Thousands Set to Lose Obamacare Coverage

Friday, February 13th, 2015

Up to 200,000 people are expected to lose their Obamacare coverage after failing to produce documented proof of their citizenship or legal residence in the United States, The Fiscal Times reports.

In August of last year, the American government mailed letters to over 310,000 people demanding proof of their status as a legal U.S. resident. Of those original 310,000, nearly 112,000 never responded, and were officially taken off of the coverage policy in September 2014, according to The Fiscal Times.

Currently, those at risk of losing their healthcare coverage are the population of potentially ineligibles who responded to the August letter from the federal government, but never produced sufficient proof of their status as a legal resident of the United States. If officially deemed unqualified for insurance, their coverage will be officially cut off on February 28th.

The push to eliminate all ineligible applicants from the Obamacare roster comes as the federal government is trying to finalize the official list of coverage recipients before the healthcare application deadline ends this Sunday, says The Fiscal Times. As of last week, there were over 9.9 million reported beneficiaries of the healthcare program through a combination of the state and federal systems. That number is expected to fall, of course, as the last-minute ineligible candidates are invalidated.

Aside from determining who ought to be terminated from their coverage policies, the government, and specifically the Internal Revenue Service, must determine whether or not they are going to reclaim the money that they gave to subsidize the majority of the aforementioned 200,000 unqualified persons, nearly all of whom received significant financial aid and healthcare benefits in 2014.

After they finalize the whittling-down of the unqualified enrollees due to residency status, the government must also shift their attention to sorting out discrepancies related to people who recorded erroneous information about their income. Having accurate income levels on the applications of enrollees is imperative to efficiently apportioning Obamacare’s funds, since the money granted via subsidies is directly proportional to a recipient’s income level.

After all is said and done, the Obamacare roster will be significantly smaller than its current 9.9 million that currently have policies on both the federal and state exchanges. As of now, the government has only been working on revising the list of federal beneficiaries. It still has yet to shift its focus to the recipients on the state exchange systems.

ACA: Employer Deadline Approaching

Tuesday, October 14th, 2014

While mid-size employers (those employing 50-99 full-time employees) have another year of breathing room, employers with 100 or more employees are quickly closing in on a large Affordable Care Act deadline.

The ACA’s Employer Shared Responsibility provision goes into effect on January 1, 2015 for large employers. By that date, those employers must offer a qualifying health insurance plan to at least 70 percent of their employees and dependents. A qualifying policy must:

  • Be affordable – cost less than 9.5 percent of an employee’s salary
  • Provide “minimum value” – cover the benefits considered by the ACA to be “minimum essential coverage”

The threshold for policy offerings rises to 95 percent of eligible employees in 2016.

Employers that do not offer a qualifying policy will be subject to fines: for non-coverage, they will owe $2,000 per full-time employee after the first 30. In addition, employers will be assessed a fine of $3,000 per full-time employee who qualifies for a subsidy on the healthcare marketplace. MI Health Answers offers a simple graphic to break down the Employer Shared Responsibility provision.

While consultants studying the implementation of the ACA estimate that most employers will eventually comply or do already, there are still many business owners nationwide who are weighing the costs of alternatives to providing qualifying policies. Options include cutting personnel and employee hours to remain exempt or paying applicable penalties.

Some employers fear that they will face penalties if their employees choose other, more affordable coverage; however, the benchmark for determining whether a policy qualifies as affordable is the law and not the actions of eligible employees.

Is your company facing the healthcare deadline, and are you prepared to offer the required coverage to your employees? If cost is keeping you from complying with the employer mandate, healthcare factoring can provide the necessary cash flow to cover the expense. PRN Funding has more than a decade of experience navigating the healthcare industry and can help you access the working capital you need to cover all of your employees. Visit us to learn more about healthcare factoring and apply today.

Many Employers to Offer “Skinny” Insurance Plans in 2015

Tuesday, August 26th, 2014

According to a survey by the National Business Group released earlier this month, as many as 16 percent of large employers will seek to minimize their healthcare costs next year by offering low-benefit, or “skinny”, plans to their employees.

The companies that will offer skinny plans versus fully ACA-compliant plans were not identified by their industries in the survey; however, traditionally companies with a high percentage of low-wage employees have taken the most advantage of those plans. Skinny plans are considered “minimum essential coverage” by ACA standards by virtue of being employer-provided, but are often lacking other key features that roll into that distinction.

Skinny plans allow employers to avoid a penalty by simply offering a plan, and purchasing one allows the employee to avoid individual mandate penalties by enrolling in a healthcare plan with lower premiums. Unfortunately, the benefits to individuals end there. Some plans cover nothing but preventive care, and all plans feature exorbitant deductibles that can make actually seeking care an unaffordable option should the employee ever require it.

Another significant blow to employees at these companies is that they will not qualify for subsidies to purchase better coverage on state or federal exchanges because their employer offers an ACA-compliant plan, regardless of whether they enroll in that plan or not.

The effect of skinny plans on healthcare costs to providers and vendors remains to be seen.

PRN Funding offers a variety of customized healthcare factoring solutions to healthcare vendors in order to cover operating costs – including providing insurance. To learn more about healthcare factoring or medical receivables factoring and apply for service, contact PRN Funding today.

Should Voluntarily Uninsured Patients Lose Charity Care?

Wednesday, August 20th, 2014

Now that the Affordable Healthcare Act’s healthcare marketplaces and policies are in effect, hospitals are considering whether those who decline health coverage should benefit from charitable care.

The issue of whether to discontinue charity care for the voluntarily uninsured is tricky and, according to some, more a question of whether their denial of insurance indicates unwillingness to pay or an inability to pay. Some patients fall into the gap between Medicaid coverage and affordable subsidized care, while others who may be eligible for subsidized insurance are still unable to afford the high deductibles featured in lower-tier plans.

Other questions include whether patients were aware of available coverage options or if they were able to sign up during open enrollment. On the other hand, a significant though unsubstantiated concern about charitable care programs is that uninsured patients will be dissuaded from enrolling in a healthcare plan if they know that charitable care is an option. This could result in greater financial difficulty for hospitals receiving less government assistance to cover uninsured patients, particularly in states that declined Medicaid expansion.

For the moment, many hospitals are considering the effects of a change and have therefore not made any updates to their charitable care policies. Hospitals that have changed their programs have done so in a number of ways:

  • Reducing income threshold for additional assistance
  • Requiring a “nominal” contribution for care
  • Requiring patients to apply for coverage before they can benefit from charitable care (note: this is an existing practice in most hospitals)
  • Disqualifying aid to patients that refuse to enroll in coverage for which they are eligible (including Medicaid)

Regardless of hospitals’ decisions, all hospitals are required to clearly state their charitable care policies in compliance with the ACA and they must make “reasonable efforts” to qualify patients for aid before pursuing them for collections.

As hospitals absorb the financial changes of full ACA implementation, healthcare vendors must be prepared for any changes in payments. PRN Funding’s dynamic healthcare factoring options help healthcare vendors working with hospitals, doctors’ offices, and other healthcare facilities to shore up their cash flow by converting open invoices into immediate cash. Contact PRN Funding today to learn how healthcare factoring can help your company and to get started right away.

Federal Court Rulings Could Threaten ACA Subsidies

Wednesday, July 30th, 2014

Two divergent Circuit Court rulings last week on the legality of ACA subsidies could spur the Supreme Court to consider the case, with potentially lethal implications for the law’s mandates.

The Affordable Care Act provides for subsidies, or tax credits, to qualifying individuals purchasing healthcare plans on an online exchange. These subsidies have since been given to consumers on both state-run and federal exchanges, greatly increasing the ability of those individuals to purchase coverage that would otherwise be too expensive.

In two separate cases, Halbig v. Burwell (D.C. Circuit panel) and King v. Burwell (Fourth Circuit, Texas), judges considered whether the ACA’s rule on subsidies is applicable to all qualifying individuals or only those who purchased their insurance on state-run exchanges. Last Tuesday, each court handed down a decision based on its interpretation of the rule in question.

The Fourth Circuit ruled that the subsidy should be available to all consumers, whether their state’s exchange was state-run or federally administered. Their ruling is based on the legal doctrine of deference, which allows federal agencies to carry out a law as it sees fit if the language is ambiguous. The D.C. Circuit, however, relied on a literal reading of the law’s text to limit subsidy qualification to only the states that run their own exchanges.

Before the issue proceeds to the Supreme Court, the Department of Justice will request a review of the ruling by D.C.’s three-judge panel by the entire D.C. Circuit bench. It is possible that an en banc review will overturn the panel’s decision and bring the ruling in line with the Fourth Circuit.

This ruling has critical implications for not only the availability of subsidies, but also the individual and employer mandates of the ACA. Only 14 states chose to create their own healthcare exchanges; if the Supreme Court steps in and upholds the original D.C. ruling, as many as 90 percent of individuals in the other 36 states lose access to an affordable health care option.

Those who will be unable to purchase an affordable plan will also be exempt from the individual mandate, including the significant demographic of young and healthy consumers that are necessary to balance insurance costs. Furthermore, employers in the affected states may be exempt from their mandate.

As with other provisions of the ACA in dispute, it will likely be some months before there is a concrete decision. We will provide updates as they become available.

PRN Funding’s competitive healthcare factoring services transform the cash flow of healthcare vendors in a number of sectors. Contact us to learn how healthcare factoring can help you cover operating costs such as insurance and to get started today.

Would “Copper” Healthcare Plans Actually Be Worthwhile?

Friday, July 11th, 2014

Several months ago, Senator Mark Begich (D) of Alaska proposed that the Obama administration add a new tier to the Affordable Care Act’s available healthcare plans. While the administration and other legislators weigh the benefits, significant potential issues have presented themselves.

The new “copper” plans would feature lower premiums than those for bronze plans – currently the least expensive full coverage available – and would cover 50 percent of consumers’ health costs. Patients would be required to pay the balance out of pocket. Copper plan subscribers would likely have a higher spending limit on out-of-pocket expenses than the current $6,350 individual/$12,700 family cap but would also be eligible for tax credits and subsidies.

Higher out-of-pocket costs are just one major concern with the idea of copper-level plans. Another associated issue is whether copper plans would be able to offer lower prices and still offer the comprehensive coverage required by the ACA. Jay Angoff of the Department of Health and Human Services questions whether passing on half of the cost of care to consumers can legitimately constitute “decent coverage”.

Furthermore, enrollment statistics through the March 31 deadline this year indicate that consumers are not particularly fond of low premium-high deductible plans. Approximately 65 percent of consumers chose subsidized or unsubsidized silver plans in the marketplace, while only 20 percent enrolled in bronze plans. Enrollment in catastrophic plans was even lower, at only two percent.

Copper plans would also pose a threat to healthcare spending in facilities and systems, turning back the reductions in spending reported by many systems thanks to newly enrolled patients. As copper plans are meant to attract young adults and others who have found even the bronze plans to be unaffordable, the risk of defaulting on higher deductibles is akin to the risk of non-payment by uninsured patients.

If the administration allows the creation of copper plans, consumers should expect to wait until at least the 2016 enrollment period to see these plans for purchase on the marketplace.

Does your healthcare company need more working capital to provide quality health coverage to your employees? Healthcare factoring helps vendors working with hospitals and other healthcare facilities to close the cash flow gap and invest in their business and employees – including in their health. Read more about PRN Funding’s healthcare factoring programs and contact us to begin today.

2015 Health Insurance Rates Vary by State

Wednesday, July 9th, 2014

As health insurance companies begin establishing premium rates for the 2015 enrollment year, some insurers are pursuing substantial hikes while others are proposing modest increases and even some reductions.

Increases proposed by CareFirst in Washington, D.C. range from as little as four percent for higher-tier plans to more than 24 percent for a catastrophic plan. Other providers are also proposing mixed updates to increase certain plan premiums and reduce others. At the same time, UnitedHealthcare is proposing a reduction in all of their rates. Meanwhile, the average increase in New York is around 13 percent according to the state’s Financial Services Department.

Rate proposals in these and other states appear to be heavily tied to a number of factors, including the number of buyers who chose plans on different tiers during this year’s open enrollment period and the rising cost of medical care. Many insurers are attempting to compensate for larger populations of sick patients who use more care and for differences in health care markets.

However, some states’ proposals are more encouraging for consumers. Georgia, for example, has one statewide provider on their healthcare exchange but will welcome two more for the 2015 enrollment period. In addition, the current provider – Blue Cross and Blue Shield – has proposed statewide rate decreases.

Initial rate proposals are typically revised downward during pre-approval reviews by state regulators, so it is unlikely that the highest rates among those reported will go through as proposed. Also, patients who qualify for federal insurance subsidies through the healthcare marketplace will likely see those subsidies rise to match any rate increases.

Small business owners are likely to see at least modest increases in healthcare rates for 2015, among other rising costs of care. If you need a boost in working capital to meet these expanded operating costs, healthcare factoring with PRN Funding can close the gap. Explore the many healthcare factoring options for your company and contact us today to get started.

Healthcare Sector Adds Jobs in May

Friday, June 6th, 2014

Despite nationwide reports of healthcare systems eliminating jobs, the sector added 34,000 jobs last month according to the Bureau of Labor Statistics.

The healthcare sector has added jobs for 131 consecutive months, or nearly 11 straight years, despite the recession and fears that the Affordable Care Act would cause the sector to shrink. Last month’s growth was twice the standard rate at nearly three percent, most of which was concentrated in ambulatory services.

One element of continuing job growth is the increase in demand for services created by larger numbers of insured patients. At the same time, the decrease in uninsured patients due to marketplace policies and Medicaid expansion has reduced healthcare spending for charity care and covering self-pay patients.

Year over year spending has dropped significantly from 2007-2008 levels, but has remained consistent over the last several years.

PRN Funding offers healthcare factoring solutions to a variety of companies in the healthcare sector. If a lack of working capital is keeping your company from hiring the staff you need, learn how healthcare factoring can transform your cash flow and help your healthcare company compete. Contact us today to get started!

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Insurance Premiums Will Rise in 2015 – But Not by Much

Monday, May 26th, 2014

Virginia insurance carriers have already filed their plan adjustments for 2015, indicating expected rate increases.

Early predictions of 2015 insurance rates had insurers raising premiums by exorbitant amounts to compensate for higher costs and restrictions imposed on their fee structures by the Affordable Care Act, as well as the greater health needs of previously uninsured enrollees who obtained healthcare during the open enrollment period. However, if Virginia filings are representative of how the nation will go then average rate increases will fall short of expectations.

Average increases will not apply equally to policyholders across the board, and range from just above three percent to nearly 15 percent depending on the provider. Those averages, meanwhile, will vary greatly in their individual application. Some providers are adjusting for average enrollee ages that skew higher, as age is one factor that allows them to differentiate. Providers are no longer able to price their premiums based on the enrollee’s current health unless s/he is a smoker.

Some states such as Washington may release their 2015 rates within the next several weeks, though most will complete their projections by the end of the summer.

Rising insurance rates are nothing new but may precipitate slow payments and other rising costs of healthcare. If you need to close the gap between service and payment in your healthcare company, consider PRN Funding’s comprehensive healthcare factoring programs. We work with healthcare vendors providing services to hospitals and other medical facilities – learn more and apply to get started today!

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Survey: ER Visits Increase During Early 2014

Friday, May 23rd, 2014

A survey completed by the American College of Emergency Physicians shows that emergency room visits have increased since January 1.

Approximately 46 percent of ER respondents noted an increase in patient visits and another 27 percent reported constant rates. Nearly a quarter of respondents reported decreased patient visits. According to the survey, the patient demographic is shifting toward fewer patients with private insurance but more patients with Medicaid coverage. The increase is also not restricted to certain states or any geographic area.

While proponents of the Affordable Care Act hoped that the law would decrease ER visits by expanding insurance coverage, studies of Oregon’s and California’s healthcare system overhauls in the last several years indicate that the expectation may have been unrealistic. At the same time, the survey suggests that the ACA has in fact played a role in the shifting numbers over the last three months.

The first and most significant reason is that coverage does not equal or lead to access. Many newly insured patients have little access to a primary care physician or clinic for regular care, either because they are not informed about their options or because PCPs in the area are already overwhelmed with volume. The Association of American Medical Colleges estimates that the PCP-patient gap will reach 30,000 next year and continue growing after that.

Emergency care is equally difficult to access in many states. The American College of Emergency Physicians released their 2014 Report Card which gave 21 states an F rating in the “Access to Emergency Care” category.

That said, patients who do have access to emergency rooms – insured or uninsured – may choose the setting because they cannot be turned away; because they are experiencing potentially serious symptoms; or because they need immediate care when other providers are unavailable (that is, on evenings and weekends).

A potentially significant drawback of the ACEP’s survey is the limited number of respondents: many states had too few responses to register as a percentage of the total responses, and in the top participating state – California – only 10 percent of facilities submitted responses. This indicates a great deal of missing data that could impact the survey’s findings. In addition, the survey’s focus on only the first three months of 2014 makes it insufficient to make any far-reaching assumptions about continuing trends.

If ER visits continue to increase it could create greater demand for healthcare vendors to cover staffing and equipment shortages. PRN Funding’s healthcare factoring programs can prepare your healthcare company for future growth by giving you immediate access to working capital. Learn more about our healthcare factoring services and apply today to get started!

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