When Obama administration defined the groundwork for the Patient Protection and Affordable Care Act, it defined a clause that would cover the needs of people who most require the benefits and protections of a health insurance plan. This clause was that of Medicaid expansion, which asked states to expand their Medicaid coverage to cover people up to 138 percent of the federal poverty line. However, not all states were in favor of this move, as these states felt that this would put undue stress on the already financially struggling Medicaid program. Almost all these states were GOP led.

After a fight in the Supreme Court that weighed this mandate of the ACA, the expansion was deemed optional, and ACA lost a major edge. In states that chose not to expand the Medicaid program, a gap in coverage was observed for people between 100 – 138 percent of the federal poverty line. Following this, states that did not move for the expansion faced several new challenges. One new challenge is wreaking havoc on the economics of Medicaid – hospitals have more unpaid medical bills in states which chose not to expand Medicaid.

As per a report available from the Department of Health and Human Services, the decline in the number of uninsured will benefit hospitals by as much as $5.7 billion in unpaid hospital bills. However, if you drill down into this number, the states that have expanded Medicaid are experiencing a better outcome. The 25 states that did the expansion will have about $4.2 billion less in unpaid bills, which is about a 25 percent decrease. On the other hand, the states that didn’t expand will have only $1.5 billion less in unpaid bills, which is a 9 percent decrease. As evident from the report, that is a stark absolute and relative decrease.

In simpler words, the report shows that there is a direct, explainable correlation between Medicaid expansion and the quality of health insurance coverage for that state. For instance, the report exhibits that a lesser number of people are going to hospitals without health insurance or any other means to pay for the treatment they seek. The decrease is all round, but it is more prominent and more substantial in states which decided to expand Medicaid.

Another takeaway from this report is that the expansion has had a direct effect on the number of uninsured in the state, especially in the low-income group. The study estimates that about 10.3 million people have newly acquired health insurance under Obamacare, and that 7.9 million more people have newly enrolled in Medicaid or the connected CHIP program after Obamacare rolled out. Another 7.3 million people have acquired health insurance under public exchanges through the law. Contrary to this, the states that decided not to go for Medicaid expansion have about 4.8 million uninsured, who would have otherwise been eligible for coverage under expanded Medicaid.

Amid this, hospitals are trapped in a precarious situation. Even after endorsing the ACA for ensuring that more people get health insurance and fewer patients are unable to pay for hospital care, they are stuck with large bills that they are unable to play. Hospital groups in Texas and Florida even tried to lobby for Medicaid expansion after the Supreme Court ruling came out last year, but to no avail. With such high amount of unpaid bills and available information making Medicaid expansion a viable option, hospitals are keeping their fingers crossed in the hopes of a Medicaid expansion in their state.

In the light of these new numbers and changing sentiments, some states are finally moving toward Medicaid expansion. Pennsylvania and New Hampshire are two of the new entrants in the Medicaid expanded state list, making the count 27 plus District of Columbia. The Obama administration is already trying to make more states sign on for expansion, and it looks like the available studies and collated data point to one single claim – Medicaid expansion can fill in the gaps left in states and help them realize the true worth of Obamacare. Collectively, the administration and available facts might be able to coerce even the most solid Republican states into expanding Medicaid in a short period of time from now.

As the second open enrollment period has been posting strong enrollment numbers and a wider acceptance of the law, there is a surprise winner in the falling, or stable in some cases, Obamacare premiums. As opposed to experts and the Administration’s guesses, the premiums for most insurance plans across states are either falling or staying constant, with only a few states recording premium increases in just a few plans. Read more

2014 is out of the way and tax season has gripped the country. This time, however, Americans have a new tax filing aspect to consider – the Affordable Care Act. This is the first year when the law requires everyone to have health insurance at the time of tax filing, unless they are exempt from the requirement. For most people, proving they have health insurance will be as simple as checking a box on the tax return, while others might have to show the proof that guarantees exemption from the law. In any case, this year’s tax filing requirement will be slightly different from last year, and this is what it will look like. Read more

Immigrants have long been a matter of concern for the Obama Administration. From the unknown number of undocumented immigrants in the country to the high number of uninsured in the immigrant population, the Obama Administration has been thinking of finding a way to handle both of these issues. A little earlier this year, the Obama Administration issued a notice to people who had not submitted sufficient documentation to qualify for subsidies and health insurance through the federal marketplace. Now in a big decision, the administration has decided that immigrants who are connected to U.S. citizens or permanent residents in a filial relationship and living in the country for at least five years will be allowed to work and pay taxes. However, the same ruling says that these immigrants will not be eligible for any kind of federal subsidies, whether it is ACA subsidies, Medicare or food stamps. Read more

Other than attracting American population with better health insurance coverage at subsidized rates, Obamacare had another central goal – transforming the health insurance mechanism for small employers and their employees. The employer-provided health insurance segment is a primary means of coverage for a large number of the American population, and the state of insurance is not very heartening in this domain. With the Affordable Care Act acting as a catalyst for change, public and private exchanges are seeing a surge in enrollments as employers and employees reconsider their health coverage strategy. Let’s take a look at the outcome of the implementation of law across different systems of employee enrollment.

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The Federally Facilitated Marketplace, aka healthcare.gov,  is gearing up for a new challenge that could have widespread impact on everyone who has enrolled with subsidized health insurance through the federal exchanges. This new challenge is the issuance of tax forms, and it is gearing up for a fight in the second enrollment period. After the troubled federal exchange launch last year, all eyes are glued to the performance of the exchange in this year’s enrollment period. Alongside the enrollment, tax forms are an addendum that the administration cannot ignore.
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At outset of Obamacare, all eyes were on the troubled healthcare.gov launch that gripped the administration on October 1, 2013. While the Affordable Care Act was being lauded as the coveted reformer of the health insurance, it had its own demons to fight.

As time passed, exchange problems were weeded out and the system became better, with the administration launching offline enrollment measures to keep enrollments up. When the results started coming in, the administration had exceeded its expectations to finally deliver 8 million newly insured individuals on the federal exchange. The number of young adults, coveted for risk balancing in health insurance industry, signed up in decent numbers, with nearly 35 percent people signing up from this demographic. The administration thought most of the exchange problems were solved.
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Since its inception, the Affordable Care Act has attracted the ire of opposition for mainly being a Democratic idea. The GOP has tried more than once to repeal the law. When the repeal did not work, it tried for a replacement of the law. The idea of replacement didn’t work, as the alternative did not hold ground against the already established Obamacare.

After the launch debacle of healthcare.gov and other state exchanges, the GOP utilized the fiasco to fan the flames of discontent among the public and strongly pushed for a complete repeal of the law. [Side note: We haven’t seen the last of this push, the exchanges should be featured prominently during the upcoming elections in November.] The exchanges were staggering under the combined pressure of failed technology, a broken enrollment system and continuous pressure from the opposition and the public to deliver on ACA’s promise. To add to the woes of the Obama administration, the Republican side launched a well thought-out negative ad campaign that was meant to break the law’s remaining hold on the health insurance market.
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On the launch of healthcare.gov and state-based exchanges, a major fear gripped undocumented sections of the American population – could the Immigration authorities use the information submitted for getting health coverage on Obamacare marketplaces to take action? The people living undocumented in the country feared that if they disclose their family income and status while applying for the coverage, the personal information they divulge might create problems later. The fear was so strong that most of these groups did not participate in Obamacare exchange enrollment, and preferred to stay away from better health insurance coverage.
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There’s a lot in the pipeline for small businesses – SHOP exchange, collective buying power to purchase better health insurance and a chance to provide the same level of benefits as their large counterparts. However not many have weighed in on an aspect that might become a primary concern for small organizations in the near future – increasing healthcare costs. Amid the intricacies of the ACA, the increasing cost of providing better coverage has been in the crosshairs for a long time. Sadly, the same increase in costs for small employers is coming into play, and not all small firms are ready to play along.

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