ACA: Enrollment Passes 8 Million, Uninsured Rate Lowest Since 2008

The Obama administration announced last month that enrollments in the ACA exchanges topped eight million.

As of April 19, 8.019 million people had signed up for Obamacare plans – an impressive national average despite a large disparity between individual state enrollments. Some states missed their enrollment targets by a wide margin, while others more than doubled their goal.

In addition to marketplace policies, 4.8 million consumers enrolled in Medicaid plans in their states between October 1 and April 19, and nearly five million consumers purchased policies outside the exchanges. Altogether, the administration estimates that up to 18 million consumers have purchased new healthcare policies during the six-month enrollment period measured.

While some consumers may have been previously insured, a majority of marketplace users who requested subsidies self-reported that they did not have insurance when they applied. Further evidence is in the numbers: a Gallup poll reports that the uninsured rate by the end of the first quarter is down to 13.4 percent, the lowest level since the recession began in 2008 and down from 17.3 percent in January.

Health care executives presented preliminary payment information to the House Energy and Commerce oversight subcommittee last week that shows between 80 and 90 percent of new premiums are paid, well above the 67 percent reported by members of the same committee the week prior.

PRN Funding offers healthcare factoring solutions to help providers control costs – including health care. Learn more about our healthcare factoring services and apply for a free factoring quote today!

Enhanced by Zemanta

New Obamacare Plans Result in Drug-Cost Sticker Shock

With the rollout of Obamacare, many patients with chronic illnesses are taking advantage of the new healthcare law. However, these patients, who are projected to be some of the biggest beneficiaries of the new initiative, may encounter sticker shock with drug costs. Under the new law, out-of-pocket expenses associated with the new exchanges could vary widely.

The new healthcare act enables patients with pre-existing conditions to obtain affordable coverage. Additionally, these patients can’t be penalized with higher rates than healthier participants. In terms of out-of-pocket expenses, the maximum set for individuals is $6,350, and $12,700 for families. Once these amounts are reached, insurers will then pick up the full tab.

Nevertheless, patients taking costly prescription drugs are more likely to reach these levels fast. While certain medications for serious conditions can cost thousands of dollars a month, some plans under the new exchanges may place as much as 50 percent of the cost on patients. Basically, plans with lower monthly premiums require patients to bear higher portions of drug costs.

In addition to premiums, many other factors impact drug costs for patients. Among these factors is a drug’s tier, or level of coverage. Tiers vary from plan to plan, and can be classified into different categories: generic, brand, preferred and specialty drugs. In order to determine tiers, insurers and drug manufacturers negotiate prices for each particular drug. Drug costs are greatly impacted by these tiers, which can make all the difference in patient costs.

As a result, high price tags and costly co-pays are associated with high-tiered drugs. According to insurance-industry experts, many businesses are anticipating larger numbers of sicker, costlier patients to sign up for the exchanges. This trend could lead to financial troubles if an inadequate number of healthier customers sign-up and balance out those costs. Regardless, insurers are not allowed to impose higher charges on chronically ill patients. Therefore, in order to keep monthly premiums lower, patients are forced to pay more for high-tier drugs.

Obamacare Sign-Ups Booming After Website Fix

Ever since the Obamacare enrollment site was revamped, sign-ups for the new healthcare plans have been on the rise. In November alone, nearly 100,000 people elected coverage through Additionally, when compared to the enrollment numbers from October, about four times as many people enrolled for Obamacare coverage via federal exchanges last month.

Although the numbers are impressive, the Obama administration said it is still far from reaching its original goal. Marilyn Tavenner, the administrator for the Centers for Medicare & Medicaid Services, previously reported that the administration had set their hopes for reaching 800,000 total enrollees throughout the months of October and November.

In October, more than 100,000 people enrolled for healthcare coverage under Obamacare. The majority of the enrollees came from state-run exchanges, while only about 27,000 signed up for coverage through the federal website,

Nevertheless, thanks to the recent website fix, 29,000 Americans were able to enroll in healthcare coverage throughout the past few days. The number of sign-ups is higher than those tracked from October, providing evidence that enrollment via is rising as a result of the massive repairs completed on the site. Furthermore, administration officials reported that they had achieved their deadline for fixing the healthcare enrollment site, making it readily accessible for the vast majority of users.

Meanwhile, younger uninsured Americans are still hesitant to enroll. Currently, less than one-third of them say that they plan to sign-up for healthcare coverage under the new marketplace, according to a new poll. If this data remains relevant, tremendous problems could be in store for the new healthcare law.

The Affordable Care Act is highly dependent upon younger, healthier enrollees who can help keep coverage costs down by offsetting costs for older, sicker individuals. Nevertheless, a poll released by the Harvard Institute of Politics revealed that only 29 percent of uninsured Americans between the ages of 18 and 29 said they would definitely or likely sign-up for coverage through the healthcare exchanges.

Obama: Individuals May Keep Cancelled Insurance Policies for Now

Obamacare established new standards for health insurance coverage in the U.S. As a result, millions of Americans were presented with policy cancellation notices, forcing many people to drop their current coverage and opt for a new health insurance plan. In order to help alleviate this troublesome situation, the president made an announcement yesterday that his administration would not enforce the Obamacare provisions that led to policy cancellations throughout the country.

Therefore, individuals who were in favor of their current coverage plans may be able to keep them for another year. However, once midterm elections are complete, plans that are not in accordance with the new healthcare law will get canceled again.

The new transitional policy introduced by the administration will enable people who were happy with their insurance to remain on their current plans, as long as their policies were effective on Oct. 1 of this year. Furthermore, another stipulation for this newly-enacted policy is that insurers provide free advertisements for their competitors on Obamacare’s online exchanges.

Aside from the 25 million Americans who opt for their own coverage through the individual market, several employees covered by employer-based insurance will also encounter cancellations. Currently, 156 million people obtain healthcare through their employers.

In addition to this particular provision, there are many other  aspects  of Obamacare that will not be enforced yet, such as postponing the employer mandate for a year. These and other unilateral actions are being announced by the White House, since the administration wants to avoid the potential for Congress to pass legislative amendments to the new healthcare law.

In order for this cancellation fix to actually work, insurers must find some way to rush their old products into the marketplace by January 2014. This will be extremely difficult for insurers to pull off. Since new reimbursement rates for 2014 would have to be negotiated with doctors and hospitals, insurers would have to submit these plans to state insurance regulators in order to obtain approval.

Despite the proposed cancelation fix, a new Gallup poll released this week revealed an increase in disapproval rates for the Affordable Care Act, rising from 47 percent to a high of 55 percent. Additionally, the president’s overall approval ratings have fallen between the high 30s and 40s.

Even with the change, the administration is leaving it up to each individual state to determine whether or not residents can keep coverage plans that are not in accordance with the new healthcare initiative. As a result, state insurance commissioners, along with other health policy experts, have established the fact that insurance plans will greatly vary across the country.

Can Obamacare Help Physician Shortages?

As more Americans opt for health insurance under Obamacare, a scarcity in primary-care physicians may be prevalent. According to recent research, the new healthcare initiative introduces primary care models that may actually alleviate physician shortages. As a result, the shortage of physicians could be eliminated through the use of nurse practitioners and physician assistants.

Recently, researchers at RAND Corporation said that by increasing the number of patient-centered medical homes and health centers managed by nurses, the number of shortages among primary-care physicians could drop by 50 percent or more in the U.S. by 2025. Many of the new primary care models enacted by the Affordable Care Act call for increased interactions between nurse practitioners, physician assistants and their patients, ensuring that they are taking medications regularly, eating well, and abiding by their doctor’s orders.

With the introduction of accountable care programs and organizations, hospitals and health systems are adding several new nurse practitioners to their staff in order to ensure efficient operations. While several health plans are linking to ACOs, these organizations are rewarding healthcare providers for working as a team to help manage costs and provide quality care. Additionally, by grouping all medical care providers together under a single entity, nurses and other caregivers are used to help control care for several patients.

As a result, if the ACOs obtain better results, providers within the organizations will divide up the profits saved with the health plans. Several private health insurance companies, including Aetna, Cigna, Wellpoint, UnitedHealth Group and Humana are connecting with ACOs and patient-centered medical homes. In addition to these efforts, many large drugstores across the country, including Walgreens and CVS, are connecting with medical care providers to help manage patient treatment plans with both nurse practitioners and pharmacists in their clinics.

Although Obamacare may help alleviate physician shortages, physicians must continue to manage their finances effectively in order to ensure the success of their practice. Physician factoring can be the key to increasing your cash flow. Thanks to same-day funding and immediate cash advances, physicians can easily take care of increased overhead costs resulting from the recession. Instead of waiting for payments from private insurers, doctors can accelerate their cash flow by taking advantage of physician factoring services. Learn more about medical factoring for private practice physicians by requesting a quote online today.

Health Coverage under Obamacare May Prove Costly to Individual Buyers

With the introduction of new healthcare reforms enacted by the Affordable Care Act, many Americans covered by health insurance in the individual marketplace will be forced to enroll in new coverage plans. People will be required to opt for new insurance since many of these plans are not in accordance with newly established standards set by the new healthcare law. As a result, many insurers will be forced to either tack on benefits, or cancel policies altogether.

The new offerings are associated with higher rates for individual buyers, since coverage is more comprehensive and must be available to individuals affected by pre-existing conditions. Nevertheless, several insurers have managed to maintain lower rates by providing plans with higher deductibles and minimal benefits. Additionally, these insurers could be pickier in the approval process by only selecting the healthiest applicants.

As more and more people have been receiving policy cancellation notices paired with new offerings provided by their insurer for 2014, the sticker shock has brought on increased feelings of aggravation among those impacted. Many are unhappy with the options offered in the  marketplace. Some face climbing premiums and costly increases in deductibles. Some report their current deductibles of $1,500 are expected to rise to $5,000 under Obamacare for similar policies.  It isn’t just deductibles, visits to the doctor and prescriptions are also subject to increase.

Nevertheless, a small number of existing plans will become grandfathered. In order to obtain this status, two qualifying factors must be met. First, members must have been enrolled in these policies before the passage of the ACA back in March 2010. Additionally, no significant policy changes should have been made to the plans until now, ranging from alterations in co-pays and deductibles to coverage costs.

Currently, Blue Cross Blue Shield is one of the major healthcare providers within the individual insurance marketplace, as well as the exchanges. Kim Holland, the trade group’s executive director of state affairs, said that the majority of existing individual plans offered by Blue Cross will soon be altered or discontinued. As a result, some customers will be forced to enroll in new coverage plans.

Although customers may receive letters indicating significant increases in premiums, they won’t exactly know what to expect in regards to payments until they actually explore the exchange. Generally, if an individual brings in less than $46,000 a year or $94,200 for a family of four, federal subsidies will be available to decrease monthly expenses.

Online Health Exchanges Will Take a Month to Fix

After a laundry list of glitches have made it difficult – if not impossible – for consumers to use the online health exchanges, the Obama administration has announced a repair timetable that will have the sites fully operational by the end of November.

The administration has hired private firm Quality Software Services Inc. to fix the more than 100 issues with the exchange server that have frustrated consumers since the exchanges opened October 1. QSSI, an arm of UnitedHealth Group, is one of three contractors originally engaged to create the system. Among the reported issues are inaccurate reports and the failure of as many as 30 percent of consumers to successfully complete the enrollment process.

Though the proposed timeline is shorter than originally anticipated, it still cuts very close to the December 15 deadline for purchasing coverage to begin January 1. As a result, many lawmakers have called for extending the individual mandate deadline or deferring penalties for non-enrollment. The current deadline to avoid a tax penalty is March 31.

Issues with the exchange have frustrated consumers who are already unsure about the impact of the ACA and have prompted criticism from both sides of the aisle. The Obama administration is facing political fallout as well as a public relations quagmire: Health and Human Services Secretary Kathleen Sebelius has been called upon to step down, and President Obama has addressed ongoing concerns with varying success.

Troubleshooter Jeffrey Zients remarked that the exchanges will “get better” by the week until it “will work smoothly for the vast majority of users” at the end of November.

Consumers should be prepared for a shortened enrollment period if an extension is not enacted. If you are one of the millions who will purchase insurance on the exchange, PRN Funding can provide the cash flow you need to be ready when the exchanges are fully functional. Learn more about our healthcare factoring programs and contact us today to get started.

Who is to Blame for Healthcare Exchange Glitches?

The rollout of online health exchange site at the beginning of the month has been stymied with glitches preventing millions of consumers from creating accounts or completing the enrollment process, along with as many as 100 additional flaws found in the system. Testimony before a panel convened by the House of Representatives has provided an object of public blame for these glitches: contractor from Canadian firm CGI Group Inc.

Cheryl Campbell, senior VP of the unit responsible for site design, testified before the House that more time should have been devoted to end-to-end testing and refused to give a set date for the site to be fully functional. Campbell claimed that the Centers for Medicare and Medicaid Services – the Health and Human Services agency responsible for the health exchanges – made the final decision to take the site live despite inadequate testing. She also testified, however, that CGI did not make a recommendation to delay the site launch.

Other contractors testified that they were only given two weeks to perform testing, far shorter than the industry standard of months. Each contractor maintained that they fulfilled their part of the project and disavowed responsibility for the final product, and none could provide a definitive date for the glitches to be resolved.

Experts in the tech world, meanwhile, have suggested that the issues with could be a technical “black swan” event, or a project that faces out-of-control costs and extreme consequences that could spell failure – in this case, a failure for the Obama administration. President Barack Obama has publicly decried the situation, claiming “Nobody’s madder than me.”

Testimony will continue throughout the week and possibly into next week, but the administration has already appointed a contractor to repair the site as quickly as possible.

PRN Funding’s factoring programs for healthcare vendors provide necessary cash flow to invest in offering quality healthcare goods and services to healthcare providers nationwide. Contact us to find out how healthcare factoring can save your company from creating its own “black swan”.

Enhanced by Zemanta

Obamacare vs. Employer Insurance: Which is Better?

Ever since Obamacare was introduced, employees have been debating whether or not their employers’ insurance plan is the best option for obtaining affordable healthcare coverage. Although employees may have the ability to comparison-shop for better coverage plans among the new online exchanges, there are still plenty of nuances involved in the selection process. As a result, trying to sift through all the available options and picking the best plan to suit your particular situation can be a tedious task.

Although the new healthcare exchanges under Obamacare will be accessible to everyone, the marketplace will operate through two different sites, depending upon where you live. In 34 states, the exchanges will be available on, a federally-run website. However, 16 states, including the District of Columbia, will operate their own independent exchanges. Regardless, even if your employer already provides health coverage, there are no rules saying you can’t purchase coverage on your state’s exchange.

If employees decide to abandon their employers’ plan and enroll in coverage through the new marketplace, they may not be eligible to receive some of the benefits provided to the uninsured. The only instance where employees could be deemed eligible for receiving government subsidies is when their employer’s coverage is determined unaffordable or inadequate under the new healthcare law. Because these subsidies help people pay for their insurance, they are one of the most attractive incentives available with the new state exchanges.Keep in mind, employees earning over $40,ooo annually, won’t likely qualify for subsidies.

Opinions differ when it comes to choosing the best coverage plan for employees. According to E. Denise Smith, a professor of health care management at Gardner-Webb University in Boiling Springs, N.C., there really would be no advantages to abandoning healthcare plans provided by employers. She also mentioned that employers would not be required to offer payment assistance if their employees opted for an exchange plan.

A senior vice president for health policy at Jackson Hewitt, expressed a similar point of view. He believes that employees may not be able to find better coverage than their work-based plan among the new marketplaces. Additionally, he advises employees to thoroughly evaluate their current employer-based plans, and consider factors such as whether or not dental and vision care are covered. Obamacare plans are not required to cover dental and vision.

In regards to employee eligibility for Obamacare, many of the requirements imposed on employers had been postponed until 2015. However, companies were still expected to offer notice to their employees no later than Oct. 1, letting workers know whether or not their current coverage would be viewed as affordable under the new law. Despite this expectation, the U.S. labor Department said that employers would not be charged with penalties for failure to notify their employees. Regardless, the delayed employer mandates will require businesses with a workforce of at least 50 full-time employees to provide health coverage to their workers, as well as their dependent children, in 2015. However, employers will not be obligated to offer insurance to workers’ spouses.

ACA: Healthcare Coverage in the Online Marketplace

Now that federal and state online healthcare exchanges are live, questions are swirling about the available coverage for eligible consumers. How much will it cost? What will it cover? What if I don’t sign up?

The marketplaces will vary from state to state, even those run by the federal government at Variations include plan availability and pricing, Medicaid eligibility, and how the exchange itself is run.

However, there are consistent policies that will apply to consumers in all fifty states and the District of Columbia:

  • All plans will cover, at a minimum, ten benefits defined by the ACA as “essential.”
  • Five levels of coverage will be available with sliding price scales, from Catastrophic (only the most basic disaster coverage) to Platinum (plan pays 90 percent of costs)
  • No plan’s availability or price can be affected by pre-existing conditions
  • If you are not otherwise exempt, you will face an increasing annual fine for not having insurance…
  • BUT you may be eligible for tax credits or rebates to lower premiums and out-of-pocket costs, in some states by as much as half

Young people will absorb higher premiums than are currently available in every state on the federal exchange, though this goes hand-in-hand with the more comprehensive plans that will replace currently available coverage. In addition, older and sicker consumers who purchase coverage through the marketplace will benefit from lower premiums that are unaffected by pre-existing conditions or a dodgy medical history, as noted above. In all, healthcare pricing will depend on where you live, your age, and current tobacco use.

Tax subsidies for purchasing insurance are dependent on household income and the availability and cost of qualifying employer-provided insurance.

PRN Funding can help small to mid-sized healthcare vendors who do not qualify for tax subsidies to purchase insurance through their state’s marketplace. Healthcare factoring gives vendors immediate access to cash through the sale of their receivables, which they can then use to cover premiums and other expenses. Read more about PRN Funding’s factoring services.