Dem Single-Payer Fight Set to Shift to Battle Over Medicare ‘Buy-In’

Image result for Dem Single-Payer Fight Set to Shift to Battle Over Medicare ‘Buy-In’ images

Source: The Hill

Momentum is building among House Democrats for a more moderate alternative to single-payer health-care legislation.

The legislation, which would allow people aged 50 to 65 to buy Medicare, is being championed by Rep. Brian Higgins (D-N.Y.), who supported House Minority Nancy Pelosi (D-Calif.) for Speaker in exchange for a commitment to work on his bill when Democrats take control of the House early next year.

“We agreed in principle to get this done,” Higgins told The Hill.

Higgins told The Hill that Pelosi’s support of his buy-in legislation was the key to switching his position on her Speakership.

Higgins said he wasn’t promised a vote on the legislation, just a commitment that he will be the point person of the effort to shepherd it through the legislative process.

“It’s got to be scored, go through committee. It’s got to do a lot of things,” Higgins said. “We fell short of a vote in committee [with Republicans in control]. So now that changes.”

Under Higgins’s plan, anyone aged 50 to 64 who buys insurance through the health-care exchanges would be eligible to buy in to Medicare.

It would also apply to people with employer-sponsored insurance and allow employers to pay Medicare premiums on their behalf — a feature that could expand the number of older working individuals who select the buy-in option.

Hillary Clinton offered a similar proposal when she ran for president in 2016. Former President Bill Clinton also proposed expanding Medicare in 1998 by allowing certain workers between the ages of 55 and 65 to buy Medicare. Those workers had to either lack insurance or be retired or laid-off.

Rep. Frank Pallone Jr. (D-N.J.), the likely chairman of the Energy and Commerce Committee next year, said he thinks a Medicare buy-in should be on the agenda next year.

“We certainly would consider a Medicare buy-in,” Pallone told The Hill. “I think we’ve got to wait and see what the caucus wants to do and what the committee wants to do, but I’ll just say it’s certainly something we should consider.”

“Medicare for all” supporters are energized after sweeping Democratic victories in the midterm elections, however, and see the Medicare buy-in bill as too small a step.

“We are dead set against any buy-in or public option,” said Kenneth Zinn, political director of National Nurses United. “Our goal as RNs is to ensure a universal system of guaranteed health care for everyone and this does not accomplish that. I would urge Congress to reject it.”

Zinn said private insurance shouldn’t have any role in health coverage moving forward. A single-payer plan covers everyone, regardless of income, and eliminates copays, deductibles and premiums. It also eliminates private insurance.

Rep. Pramila Jayapal (D-Wash.), who is co-chair of the Medicare for All Caucus in the House, told The Hill said she has spoken with Higgins and expressed her concerns about his bill.

“We have to be careful not to perpetuate the system we have,” Jayapal said.  “I would prefer to have a reduction of the age of Medicare so that more people could qualify but not a buy-in, because that continues the problems that we have right now.”

Jayapal added that lowering the eligibility age “would be an appropriate way to go where we’re taking a step forward towards a system that will ultimately cover everybody.”

Still, she said with Democrats in control of the House, there will be more of an “exchange of ideas” than there has been previously.  

Higgins said a Medicare buy-in is quicker and cheaper to implement than single-payer. It can also be a bridge to Medicare for all, he said.

“I support the exploration of Medicare for all, but you have to be well balanced and practical about this. Establishing a brand-new health insurance program is going to take time,” Higgins said.

Adam Green, co-founder of the Progressive Change Campaign Committee, said he supports giving everyone the option to buy in to Medicare, and thinks the legislation from Higgins will start a conversation. He wants a “buy-in for all” to be the “new floor” in the debate.

“It’s ironic that it took a conservative Democrat to jumpstart the momentum for Medicare buy-in but now that it’s there, there will be a huge push for Medicare option for all,” Green said. 

“It’s jumpstarting the concept of a buy-in in 2019 and will lead to momentum of a buy-in for every family and small business.”

Democrats Winning Key House Leadership Jobs Have Taken Millions From Pharma

Image result for Democrats Winning Key House Leadership Jobs Have Taken Millions From Pharma images

Source: Kaiser Health News

Three of the lawmakers who will lead the House next year as Congress focuses on skyrocketing drug costs are among the biggest recipients of campaign contributions from the pharmaceutical industry, a new KHN analysis shows.

On Wednesday, House Democrats selected Rep. Steny Hoyer of Maryland to serve as the next majority leader and Rep. James Clyburn of South Carolina as majority whip, making them the No. 2 and No. 3 most powerful Democrats as their party regains control of the House in January.

Both lawmakers have received more than $1 million from pharmaceutical company political action committees in the past decade. Just four members of Congress hold that distinction, including Rep. Kevin McCarthy of California, whom Republicans chose as the next House minority leader earlier this month.

Adding Rep. Nancy Pelosi, the California Democrat expected to be the next speaker, the three-person House Democratic leadership team has collected more than $2.3 million total in campaign contributions from drugmakers since the 2007-08 election cycle, according to KHN’s database.

High drug prices surfaced as a major campaign issue in 2018. With almost half of Americans saying they were worried about prescription drug costs last summer, many Democrats told voters they’d tackle the issue in the next Congress. But the large amount of money going to key Democrats, and Republicans, raises questions about whether Congress will take on the pharmaceutical industry.

In the past decade, members of Congress from both parties have received about $81 million from 68 pharma PACs run by employees of companies that make drugs and industry trade groups.

Brendan Fischer, who directs federal reform programs at the nonpartisan Campaign Legal Center, said drugmakers, like other wealthy industries, “shower money” on congressional leaders who are mulling legislation that could affect the pharmaceutical industry.

“Both Democrats and Republicans have discussed taking action on prescription drug prices, and drug companies likely expect that big contributions will help them maintain access to, and influence over, powerful lawmakers,” he said.

McCarthy, who has close ties to President Donald Trump, has received more than $1.08 million from drugmaker PACs since 2007. According to the latest data, which runs through September, he received about $250,000 this election cycle.

The fourth lawmaker to top $1 million is Sen. Richard Burr, a North Carolina Republican who serves on both the Senate Committee on Health, Education, Labor and Pensions and the Senate Committee on Finance. North Carolina is also home to a number of research universities and drugmakers’ headquarters.

While campaign contributions may seem tantalizing as a metric for influence, industries are not necessarily buying votes with their cash. More likely, they are buying access — a sizable donation from a drugmaker’s PAC may increase the chances its lobbyists get a meeting with an influential lawmaker, for example.

Clyburn, who like Hoyer has served as a top Democratic leader since 2007, has received more from drugmaker PACs over the past decade than any other member of Congress — more than $1.09 million. During the 2018 election cycle, he received at least $170,000, despite trouncing his Republican opponent in his safely Democratic district.

A party leader and the highest-ranking African-American in Congress, Clyburn has had ties to the pharmaceutical industry over the years. In 2013, he was a featured speaker at a conference hosted by PhRMA, the industry’s leading trade group. The conference was held at the James E. Clyburn Research Centerat the Medical University of South Carolina, a hub for biopharmaceutical research.

This fall, Hoyer topped the million-dollar mark in drugmaker PAC contributions over the past decade, collecting more than $1.02 million since 2007 and more than $128,000 this election cycle.

“Mr. Hoyer’s positions on legislation are based on what is in the best interest of his constituents and the American people, and he has made it clear the new Congress will tackle rising health care and prescription drug costs,” said Mariel Saez, a Hoyer spokeswoman.

Clyburn, McCarthy and Pelosi’s offices did not respond to requests for comment.

Pelosi, in contrast to her deputies, has received nearly $193,000 total from drugmaker PACs the past decade. In the month before the midterm elections, she intensified her calls for action to control drug prices, saying on Election Day that she believed Democrats could find “common ground” with Trump on addressing the problem.

Senior committee members also tend to draw huge sums from the industries they oversee. Rep. Frank Pallone of New Jersey, the Democrat who is expected to chair the House Committee on Energy and Commerce, received nearly $169,000 this election cycle from drugmaker PACs, according to KHN’s database. Since 2007, he has collected more than $840,000.

Similarly, Rep. Greg Walden, the Oregon Republican who is finishing his term as chair of the committee, received $302,300, the most of any member this election cycle in contributions from drugmaker PACs.

By contrast, Rep. Elijah Cummings — the Maryland Democrat who is expected to head the House Committee on Oversight and Government Reform — has attracted minimal drugmaker cash, receiving just $18,500 since the 2007-08 election cycle. He has made it clear that he intends to target pharmaceutical companies next year as he investigates climbing drug costs.

Editorial: How Newsom, California Should Approach Single-Payer

Image result for Editorial: How Newsom, California Should Approach Single-Payer imagesSource: Mercury News

A single-payer health care system may yet prove to be the best alternative for California and the nation. But Gov.-elect Gavin Newsom should make clear that the Legislature shouldn’t waste time on any legislation in 2019 unless it includes a prudent financial plan that makes sense for California consumers, health care providers and business interests.

Newsom called for installing a single-payer system during his campaign but has been tamping down expectations since July — with good reason. California can’t possibly make it work unless Congress and the president cooperate.

The federal government would need to turn over to the state all the Medicare and Medicaid money it spends in California. That’s about $200 billion annually. How far do proponents think they will get as long as Republican Mitch McConnell is Senate Majority Leader and Donald Trump sits in the White House?

Until there’s a viable financial plan, the governor should instead prioritize other pressing California issues that demand immediate attention, including tax reform, wildfires and paying down pension debt.

Meanwhile, single-payer proponents should use 2019 to bring together the broadest range of interested parties possible to explore the issue in detail. It’s the best way to bring forward a credible plan that can win widespread support throughout the state and in Washington, D.C. It also would serve to put health care front-and-center, where it belongs, in the 2020 presidential campaign.

Warren Buffett has it right when he says “the ballooning costs of health care act as a hungry tapeworm on the American economy.”

In 2000, the United States spent only $4,881 per person on health care. That equals $7,312 in today’s dollars. Today, the United States spends $11,193 per person, or more than $3.3 trillion a year.

]Health care accounts for roughly 18 percent of the U.S. economy. The United States cannot expect to compete on the global level when its major Western competitors spend on average only $5,169 per person on health care, or less than 10 percent of their economies. Especially when those same competitors enjoy better outcomes than their American counterparts.

Ultimately, this is a problem that requires a national solution. Jeopardizing state finances is not the way to solve it. California shouldn’t waste time as it did earlier this year debating SB 562, Sen. Ricardo Lara’s single-payer plan. Assembly Speaker Anthony Rendon killed the effort, accurately calling it “woefully incomplete.”

appalling that the state Senate passed the legislation despite, as Rendon noted, failing to address such critical issues as financing, delivery of care, cost controls and the need for federal cooperation. Keep in mind that if California were to adopt a single-payer plan, it would mean, for example, that nearly 6 million senior citizens would no longer be covered by Medicare.  They would instead be placed under the new state plan along with every California resident. That level of change demands a broad, transparent public debate before passage and implementation.

California has made great strides under the Affordable Care Act in bringing down the number of uninsured residents, but the state and the nation clearly need major changes to get health care costs under control. Further exploration of the merits of a single-payer system has merit, but California’s new governor should only move forward when a prudent financial plan with broad support in Washington and Sacramento that has been developed and fully vetted.

Without an Obamacare Penalty, Many are Planning to Drop Health Plans. The Consequences Could be Dire

Image result for Without an Obamacare Penalty, Many are Planning to Drop Health Plans. The Consequences Could be Dire imagesSource: Los Angeles Times

Dana Farrell’s car insurance is due. So is her homeowner’s insurance — plus her property taxes. It’s also time to re-up her health coverage. But that’s where Farrell, a 54-year-old former social worker, is drawing the line.

“I’ve been retired two years and my savings is gone. I’m at my wit’s end,” said the Murrieta resident. So Farrell plans — reluctantly — to drop her health coverage next year because the Affordable Care Act tax penalty for not having insurance is going away.

That penalty — which can reach thousands of dollars annually — was a key reason that Farrell, who considers herself healthy, kept her coverage. Now, “why do it?” she wonders. “I don’t have any major health issues and I’ve got a lot of bills that just popped up. I can’t afford to pay it anymore.”

Farrell is among millions of people likely to dump their health insurance because of a provision in last year’s Republican tax bill that repeals the Obamacare tax penalty, starting in 2019, by zeroing out the fines.

The Congressional Budget Office estimated that the repeal of the penalty would move 4 million people to drop their health insurance next year — or not buy it in the first place — and 13 million in 2027.

Some people who from the start hated the Affordable Care Act, or Obamacare as it is often called, will drop their coverage as a political statement. For people such as Farrell, it’s simply an issue of affordability.

Since Farrell started buying her own insurance through the open market in 2016, her monthly premium has swelled by about $200, she says, and she bears the entire cost of her premium because she doesn’t qualify for federal ACA tax credits. Next year, she says, her premium would have jumped to about $600 a month.

Instead, she plans to pay cash for her doctor visits at about $80 a pop, and for any medications she might use — all the while praying that she doesn’t get into a car accident or have a medical emergency.

“It’s a situation that a lot of people find themselves in,” said Miranda Dietz, lead author of a new study that projects how ending the penalty will affect California.

As of March, 88% of Covered California’s 1.4 million enrollees received financial help in the form of tax credits. People such as Farrell, though, whose incomes are too high to qualify for tax credits, are especially vulnerable, says Dietz, a research and policy associate at the UC Berkeley Center for Labor Research and Education. They must pay the entire premium themselves.

Premiums, even for a bronze plan with a deductible of more than $6,000, are enormous in some cases, Dietz said. “The state’s done a great job of implementing the ACA,” she said, “but there are still Californians who just find insurance out of reach.”

Up to 450,000 more Californians may be uninsured in 2020 as a result of the penalty ending, and up to 790,000 more by 2023, boosting the state’s uninsurance rate for residents under 65 to 12.9%, according to the study. The individual market would suffer the biggest losses.

Covered California, the state health insurance exchange, predicts that enrollment in the individual market — both on and off the exchange — could drop by 12% next year, said agency spokesman James Scullary.

Exchange officials also blame the end of the penalty for 3.5% out of a total 8.7% average increase in premiums, because the departure of some healthy people from the market will lead to a sicker and costlier insurance pool.

Health insurance can be difficult to afford, but going without it is a “bad gamble,” Scullary said. Keep in mind: More than 22,000 Covered California enrollees broke, dislocated or sprained arms or shoulders in 2017, and 50,000 enrollees were either diagnosed with — or treated for — cancer, he explained.

“We know that none of those people began the year thinking, ‘This is when I’m going to break my arm,’ or ‘This is the year I get cancer,’” he said.

If you’re considering dropping your plan and risking the devastating financial consequences of an unexpected medical expense, check first to see if you can lower your premium. “A big mistake for people is to look at the notice they get for their current health insurance and see it’s going up a lot and then throw up their hands and decide they’re going to go without,” said Donna Rosato, a New York-based editor at Consumer Reports who covers healthcare cost issues.

“Before you do that, look at other options,” she said.

The most important thing to do is seek free help from a certified insurance agent or enrollment “navigator.” You can find local options by clicking on the “Find Help” tab on Covered California’s website, www.CoveredCA.com.

Next, see if you can qualify for more financial aid. For instance, if your income is close to the threshold to qualify for tax credits through Covered California or another Obamacare insurance exchange — about $48,500 for an individual or $100,000 for a family of four this year — check with a financial professional about adjusting it, Rosato suggests. You might be able to contribute to an IRA, 401(k) or health savings account to lower the total, she says.

Beyond that, be flexible and willing to switch plans, she advises. Consider different coverage levels, both on and off health insurance exchanges. If you’re in a silver-level plan (the second-lowest tier), you might save money by purchasing a less expensive bronze-level plan that has higher out-of-pocket costs but would protect you in case of a medical emergency.

This year, Farrell got a clean bill of health from her doctor after a round of tests. She’s nervous about being without coverage next year, but feels she doesn’t have a choice.

“It’s going to be the first time in my life I’m not going to have insurance,” she said.

More Pay? Nah. Employees Prefer Benefits

Image result for More Pay? Nah. Employees Prefer Benefits images

Source: Employee Benefit Adviser

Workers across the country say you can’t put a price on great benefits, according to a new survey.

By a four-to-one margin (80% to 20%), workers would choose a job with benefits over an identical job that offered 30% more salary with no benefits, according to the American Institute of CPAs, which released the results of its 2018 Employee Benefit Report, a poll this spring of 2,026 U.S. adults (1,115 of whom are employed) about their views on workplace benefits.

“A robust benefits package is often a large chunk of total compensation, but it’s the employees’ job to make sure they’re taking advantage of it to improve their financial positions and quality of life,” said Greg Anton, chairman of the AICPA’s National CPA Financial Literacy Commission. “Beyond the dollar value of having good benefits, employees gain peace of mind knowing that if they can take a vacation without losing a week’s pay or if they need to see a doctor, they won’t be responsible for the entire cost.”

Employed adults estimated that their benefits represented 40% of their total compensation package, according to the study. The Bureau of Labor Statistics, though, states that benefits average 31.7% of a compensation package. Still, workers in the report see benefits as a vital part of their professional lives.

“Despite overestimating the value of their benefits as part of their total compensation, it is concerning that Americans are not taking full advantage of them,” Anton said. “Imagine how employees would react if they were not 100% confident they could get to all the money in their paycheck. Leaving benefits underutilized should be treated the same way. Americans need to take time to truly understand their benefits and make sure they’re not leaving any money on the table.”

Other notable findings from the report include:

  • 63% of employed adults believe that being their own boss is worth more than job security with an employer, while 18% added that they will likely start or continue their own businesses next year.
  • Millennials were the most likely generation to believe that being their own boss is worth more than job security. They were also the most likely generation to start their own businesses.
  • 88% of employed adults are confident they understood all the benefits available to them when they were initially hired at their current job. However, only 28% are “very confident” they are currently maximizing all of their benefits.
  • When asked which workplace benefits would help them best reach their financial goals, 56% of adults said a 401(k) match or health insurance, with 33% citing paid time off and 31% citing a pension.
  • Baby boomers favor health insurance and having a 401(k) match more than younger generations, while 54% of baby boomers also prioritized a pension, versus only 16% of millennials.
  • Millennials put the highest priority on work-life balance benefits, such as paid time off, flexible work hours, and remote work.

For the full report, visit the AICPA’s 360 Degrees of Financial Literacy site here.

Democrat to Introduce Bill Extending Health care to Undocumented Immigrants, Pressuring Newsom

Assemblyman Joaquin Arambula | AP Photo

Source: Politico

A Democratic assemblyman will introduce a bill Monday to expand health coverage to all undocumented immigrants in California, a move that could pressure Gov.-elect Gavin Newsom into acting on his chief campaign promise of creating a universal health care system in the state.

The bill by Assemblyman Joaquin Arambula (D-Fresno) would allow undocumented immigrants over the age of 19 to enroll in Medi-Cal, the state’s low-income health care program should they meet income requirements. It would have a price tag of $3 billion per year, according to early estimates.

Roughly 60 percent of the remaining 3 million uninsured Californians are undocumented immigrants who qualify for Medi-Cal but are unable to fully participate in the program because of their immigration status.

Arambula, a former Central Valley emergency room doctor, told POLITICO he sees health care as “a human right” and hopes, through his bill, that Newsom will immediately take up the charge of covering everyone, including those living in the country illegally. He’s introducing the bill on the first day of the 2019-20 legislative session.

“What I have seen through my lifetime, working on the front lines of health care, is gross inequality … people whose lives are threatened or ruined because of their inability to access health care,” Arambula said. “I hope the incoming administration will be bold in trying to be a beacon for the rest of the United States … and show that here in California, we can do what every other industrialized nation does, which is provide health care as a human right.”

It’s Arambula’s second attempt at expanding health care for undocumented adult immigrants. He authored a similar bill this year, but it died in the state Senate. Gov. Jerry Brown declined to fund it in the state budget.

California already allows undocumented immigrants, up to age 19, to enroll in full-scope Medi-Cal. Undocumented adults qualify for limited Medi-Cal coverage — pregnancy and emergency room care.

Expanding the program to all undocumented, low-income adults would come at a cost of $3 billion per year from the state general fund, according to a May analysis by the Assembly Appropriations Committee. Extending coverage to undocumented adults age 26 or younger — a cohort that mirrors the college-age citizen population that benefited from the health care expansion under Obamacare — would cost nearly $500 million per year, according to a separate analysis by the Senate Appropriations Committee, which examined amendments Arambula sought earlier this year.

A companion bill in the Senate, authored by state Sen. Ricardo Lara (D-Bell Gardens) that sought to expand Medi-Cal to undocumented adults ages 65 and older would have cost $200 million per year, according to an Assembly fiscal analysis.

Under California’s Medi-Cal expansion under the Affordable Care Act, the state has cut its uninsured rate to 7.2 percent, a 10-point drop since before Obamacare took effect — larger than any other state in the country, according to the latest data available from the U.S. Census Bureau. If California were to expand care to the undocumented, its uninsured rate would drop to roughly 3 percent, rivaling only one other state in its coverage success.

Massachusetts, which has long had a state-based individual mandate, has the lowest uninsured rate in the nation at 2.8 percent, according to a 2017 Census Bureau report.

California residents qualify for Medi-Cal under income limits set by the federal government. A single person must earn $16,395 per year or less, according to the state Department of Health Care Services. A couple qualifies if its combined income is $22,108 or less. For a family of four, the threshold is $33,354 per year.

Brown has dismissed calls to expand health care to all undocumented immigrants, expressing reluctance to absorb recurring costs to the state budget out of concern the state will soon face a recession. While California is expected to have nearly a $15 billion surplus next fiscal year, the state can only increase the permanent budget by about $3 billion before risking eventual deficits, according to the Legislative Analyst’s Office.

Newsom, however, promised throughout his campaign he will be California’s “health care governor” and said he’d make universal health care a top legislative priority if elected. He has since sought to tamp down expectations, telling POLITICO in a previous interview that he doesn’t expect to take the step toward covering all undocumented immigrants immediately.

“There will not be that money. I don’t expect there to be that money,” he said in the previous interview. “It would be fiscally irresponsible to spend 3-plus billion dollars until we assess the budget, and taking away rainy day reserve when we should be adding to it.”

Arambula argued it’s far costlier not to provide access to preventive services, forcing people to seek care in the emergency room where patients are often dealt the most expensive bills, or delay care altogether.

“What we should be doing is making smarter, more efficient decisions on our budget that invest in people … prevent disease and keep people healthy,” he said. “I’m looking to our next administration to provide some leadership on this issue and hoping our discussion around health care will motivate the next governor to work on this crucial issue.”

Arambula, co-chair of a special 2018 Assembly committee formed by Speaker Anthony Rendon to study the prospects of a government-financed, single-payer system, echoed the catchphrase of the California Nurses Association and other strong single-payer advocates in characterizing health care as a human right.

He said health care is as much a right as providing an education for every child, but suggested that California cannot enact single-payer under President Donald Trump — a point Newsom has made repeatedly.

“I look forward to hopefully a new federal administration that would be willing to discuss what health care reform looks like and how it can be a partner to California,” Arambula said. “I believe that our role and responsibility in government is to take care of those less fortunate than ourselves.”

IRS Extends Form 1095 Distribution Deadline to March 4

Image result for IRS Extends Form 1095 Distribution Deadline to March 4 images

Source: SHRM.org

On Nov. 29, the IRS extended the original Jan. 31, 2019, deadline for employers to distribute 2018 Forms 1095-C or 1095-B to employees. They now have until March 4, 2019, to get employees those forms.

By filing Forms 1095-C with the IRS and providing employees with copies, employers with 50 or more full-time or equivalent employees show they offered eligible employees health coverage that was compliant with the Affordable Care Act (ACA). For smaller organizations, self-insured employers or insurance companies file and distribute Forms 1095-B.

The relief was communicated in IRS Notice 2018-94. The IRS has extended the Jan. 31 deadline for distributing ACA information-reporting forms for the past two years.

“In language identical to the extension from the last two years, the IRS states the reason for the extension is because they ‘have determined that a substantial number of employers, insurers, and other providers of minimum essential coverage need additional time beyond the Jan. 31, 2019, due date to gather and analyze the information and prepare the 2018 Forms 1095-B and 1095-C,’ ” explained Brian Gilmore, lead benefits counsel and vice president at ABD Insurance and Financial Services in San Mateo, Calif.

As in the last two years, he added, there was no extension to the standard deadline for employers to file copies of Forms 1095-B and 1095-C (and transmital Forms 1094-B and 1094-C) with the IRS “because they again found ‘no similar need,’ ” Gilmore noted.

Looming Deadlines

Recently, the IRS published final forms and instructions to help employers prepare for next year’s reporting on the health coverage they offered employees in 2018.

The critical 2019 filing deadlines for forms that detail 2018 coverage are now as follows:

ACA Requirement Deadline
Paper filing with IRS Feb. 28
1095 forms delivered to employees March 4 (extended from Jan. 31)
Electronic filing with IRS April 1

Source: IRS.

Employers that file 250 or more information returns with the IRS must file the returns electronically.

“Employers should not count on any additional extensions and should work diligently to complete their reporting forms on time,” said Danielle Capilla, director of employee benefits compliance at Alera Group, an insurance and financial services firm.

Many employers may prefer to distribute the 1095 forms by Jan. 31 alongside the W-2 tax forms, which are due to employees by that date.

“Employers that are ready to go by the original deadline should not hesitate to go ahead,” advised Capilla.

A Hard Deadline

The deadline relief is automatic and does not depend on an employer or insurer requesting it. But “as a result of this automatic 30-day extension, the 30-day extension that would normally be available on a showing of good cause is not available,” said Ethan McWilliams, senior compliance analyst at Lockton, a benefits brokerage and consultancy based in Kansas City, Mo. “That is, the March 4 deadline is a hard deadline.”

Again, there is no extension to the deadline to file 1095 forms with the IRS. These are still due by Feb. 28, 2019, for employers filing on paper and by April 1, 2019, for employers filing electronically. Employers filing at least 250 Forms 1095-C with the IRS must do so electronically unless they obtain a waiver.

Employers may obtain a guaranteed 30-day extension on the deadlines for filing with the IRS by submitting Form 8809 on or before those deadlines.

Good-Faith Relief

In addition, the IRS said it will continue to apply to 2018 filings the same “good-faith” approach to employer ACA filings that applied to filings for the 2015, 2016 and 2017 calendar years. “This relief applies only to incorrect and incomplete information reported on Form 1095-C or 1095-B, and not to a failure to timely furnish or file the forms, although the IRS may excuse penalties for failing to furnish or file upon a showing of reasonable cause,” McWilliams said.

Employees Filing Taxes Early

“Come tax day 2019, employees must show whether they or their family members had minimum essential coverage on Line 61 of their individual tax returns,” said John Duval, president and CEO of Fuse Workforce Management, a compliance software firm. “Form 1095-C helps employees complete their individual tax returns by providing important information regarding their health coverage for the previous calendar year.”

However, said Greta Cowart, an attorney at law firm Winstead in Dallas, “some employees may be ready to file their federal income tax returns before they receive their Form 1095-C or 1095-B. [So] the IRS indicated that they may file their income tax returns without the forms” by relying on statements or other information from their employer or insurance carrier indicating that they received ACA-compliant health coverage in 2018.

Changes for Future Years

The Tax Cuts and Jobs Act effectively repealed the mandate that individuals must have health coverage that meets the ACA’s minimum standards for health insurance or pay a tax penalty. The repeal takes effect in 2019. The IRS is now studying whether employees must receive forms showing they had ACA-compliant coverage when filing future tax returns, Gilmore said, adding, “It is not clear what purposes that portion of the ACA reporting requirements would serve after repeal of the individual mandate.”

With Federal Public Charge Rule Pending, California Braces For Possible Medi-Cal Exodus

Image result for With Federal Public Charge Rule Pending, California Braces For Possible Medi-Cal Exodus images

Source: Capital Public Radio

A draft Trump administration rule that would penalize immigrants seeking green cards for accessing social services — including Medicaid — could cause thousands of kids to lose their health insurance, some advocates fear.

The proposal says people applying for legal permanent residency may be turned away if they’re deemed a “public charge,” meaning someone who’s become dependent on government assistance. There’s a laundry list of benefits that could be held against applicants, including housing assistance, food stamps and most Medicaid services.

The Department of Homeland security says the rule will “promote immigrant self-sufficiency” and “protect finite resources.”

California health advocates worry that legal citizens from mixed-status families who are entitled to Medi-Cal may drop their insurance for fear of negatively impacting their loved ones’ applications.

Kimberly Chen with the California Pan-Ethnic Health Network said even though undocumented children have been entitled to Medi-Cal since 2016, there’s confusion around what the proposed federal penalty means.

“Perhaps the kids are citizens and the parents are permanent residents,” she said. “Maybe they’re fearful that their use of Medi-Cal to get themselves healthy, that that would endanger their whole family’s’ ability to become citizens in the future.”

Advocates are also worried the draft rule will keep some people from enrolling in Covered California this year, even though only Medicaid would be included in the proposal.

An analysis from the nonprofit Institute for Community Health shows that as many as 455,000 California kids could leave their insurance plans for fear of endangering an undocumented family member. They got the number by tallying the 1.3 million children who get care through the Medi-Cal program and live with at least one non-citizen parent, then applying disenrollment rates of 15 to 35 percent.

If these patients drop their coverage but continue accessing medical care, hospitals worry they’ll have to foot the bill.

The California Hospital Association is bracing for an estimated $5 billion loss in federal reimbursements —  $2.9 billion for citizen patients who leave their plans for fear of endangering a non-citizen family member, and $2.2 billion for non-citizens. These estimates are based on 2016 enrollment and reimbursement rates.

The association is requesting that the federal Department of Health Services asking them to withdraw the proposed rule. Comments on the proposal end Dec. 10.

IRS Issues New Tax Deductibility Limits for Long-Term Care Insurance

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Source: Think Advisor

Traditional tax-qualified long-term care insurance policies now have new tax deductibility limits, according to the IRS.

Premiums for tax-qualified long-term care insurance policies are considered a medical expense, according to the American Association for Long-Term Care Insurance, and for an individual who itemizes tax deductions, medical expenses are deductible to the extent that they exceed the current amount required to meet the individual’s adjusted gross income (AGI).

Neither hybrid nor linked benefit (life plus LTC or annuity plus LTC) policies qualify for the deductions. However, individual taxpayers can treat premiums paid for tax-qualified long-term care insurance for themselves, their spouse or any tax dependents (such as parents) as a personal medical expense, according to AALTCI’s website.

The new 2019 limits for traditional LTC insurance premiums (that can be included as “medical care”) are as follows: If the policyholder’s attained age before the close of the taxable year is 40 or younger, $420 in premiums are deductible, unchanged from 2018. For policyholders 41 to 50, the limit is $790, versus $780 in 2018.

For those 51 to 60, the limit is $1,580, up from $1,560 in 2018, while for those 61 to 70, the limit is $4,220, up from $4,160. The largest deduction, for those more than 70 years old, is $5,270, up from $5,200.

Jesse Slome, executive director of AALTCI, points out in an email that older policyholders can benefit from the “potential of a $5,270 qualifying expense (deductible)” for a single person, or up to a $10,540 expense “for a couple where one spouse now has big medical/dental/vision bills.”

More information on LTCI and taxes is available from AALTCI’s website.

Amazon Private Label Healthcare Offerings Grow

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Source: Healthcare Dive

It remains to be seen how disruptive Amazon will be in the prescriptions space now that it has its own online pharmacy. The company snagged PillPack, which focuses on delivering individualized rolls of presorted medicines to people who manage multiple daily medications.  

It now looks like Amazon is revving up for expansion of PillPack, Jeffries says, citing a new prescribing license in Washington state and licenses pending in Indiana and New Mexico. The pharmacy also has postings for pharmacy technicians and packaging and shipping jobs at its Phoenix distribution center.

“We feel that the strategic significance of the WA Rx license is especially intriguing, suggesting that AMZN is possibly laying the groundwork to leverage the PillPack asset with its own employees before rolling out a full nationwide offering,” Jefferies says.

Amazon is steadily pushing further into healthcare, planting its footprint in a range of product and service areas.

Amazon Web Services, the company’s cloud business, announced last week that three of its most popular services — Amazon Translate, Amazon Comprehend and Amazon Transcribe — are now HIPAA-eligible. That brings to six the number of HIPAA-eligible AWS machine learning services in its catalog of offerings. The other three are Amazon Polly, Amazon SageMaker and Amazon Rekognition.

The eCommerce giant has also secured a patent for a feature that would enable Alexa, Amazon’s voice-activated technology, to detect when a user is feeling ill and recommend an OTC remedy for them to try.

And last month, Amazon announced it would begin selling glucose monitors and blood pressure cuffs direct to consumers via a partnership with Arcadia Group. The devices and supporting apps will be marketed under the “Choice” label and can be purchased without prior authorization.

Amazon also formed a company with J.P. Morgan Chase and Berkshire Hathaway to redesign how healthcare is delivered to their U.S. employees.

Last Updated 12/05/2018

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