July 22, 2014 – July 28, 2014

Appellate Courts Divided on Marketplace Tax Credits: Two federal appellate courts (the D.C. Circuit and 4th Circuit) issued conflicting rulings on July 22 regarding whether enrollees in states with federally facilitated marketplaces (FFM) are allowed to receive tax credits under the Affordable Care Act (ACA). Both cases revolve around unclear language in one section of the ACA. Consumers get to keep their tax credits and coverage as this judicial process continues.

Internal Revenue Service (IRS) Issues Guidance on Premium Tax Credits and Tax Filing: On July 24, the IRS released final and temporary regulations allowing married victims of domestic violence and spousal abandonment to receive premium tax credits while filing taxes separately. Furthermore, the new regulations include updates to the index for calculating marketplace premium tax credits for the 2015 plan year. The IRS also released a number of draft tax forms (Forms 8962, 1095 A-C, 1094 B-C, 8941, and 8965) for individuals, insurers, and employers to report coverage and claim exemptions, and determine individuals’ and small businesses’ final tax credit amount or the fine for not having coverage. If this final premium tax credit for an individual does not match the advanced payments of premium tax credits that a consumer received throughout the year from the marketplace, he/she will either get an additional refund or have to pay back the extra tax credits.

Comment Period Ends on Proposed Rule and Guidance on 2015 Redetermination and Renewal Process: Comments on the Center for Medicare and Medicaid Services’ (CMS) proposed rule and accompanying guidance on the redetermination and renewal process for 2015 marketplace coverage were due July 28. Enroll America submitted comments and recommendations on the proposed rule to improve the redetermination and renewal processes for consumers.

New Analyses Find Uninsured Rate Has Declined: A new study in the New England Journal of Medicine offers the best evidence to date on the ACA’s effect on the uninsured. It estimates that 10.3 million Americans gained health insurance since the start of the initial open enrollment period. Taking pre-open enrollment trends and uninsured rates into account, the study finds that the pattern of insurance uptake since October matches what would be expected if the ACA were driving the increase in enrollment. The researchers also found improvements in consumer-reported access to care: more consumers reported they had a personal doctor and fewer reported difficulty affording medical care in 2014 compared with prior trends. At the state level, the Montana office of the insurance commissioner estimates that the uninsured rate dropped from around 20 percent to 16.9 percent, and Hawaii’s insurance commissioner announced that the state’s uninsured rate fell to less than 6 percent from 8 percent.

State updates

  • New Mexico:Last Friday, the state health insurance marketplace’s governing board voted 11-1 to use HealthCare.gov for another year rather than use the state-based site for enrollment. Through the next open enrollment period, consumers will continue to use the federal site to sign up for coverage, and the federal portal will continue to process eligibility determinations.
  • Washington State: Some consumers who signed up for coverage and paid their premiums through the Washington Healthplanfinder have found that those payments did not go through to the health insurer. The marketplace estimates that the payment-management issue has affected around 6,000 user accounts, and is currently processing manual month-to-month fixes for individuals while working with IT contractors to resolve the underlying problem.
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