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发帖数: 29846 | 1 by: Alex Nussbaum
February 12, 2014
(Bloomberg) — Health insurers told to pay $150 billion in taxes over a
decade to help fund Obamacare are now shifting at least part of that cost
back to taxpayers.
Congress passed the insurer tax four years ago to help cover the uninsured
under the Affordable Care Act. Now, the industry is pushing to include some
of the cost in contracts with Medicaid programs for the poor that are
jointly funded by state and federal governments.
The strategy may add $36 billion to $39 billion to the cost of Medicaid over
a decade, depending on how quickly the health program expands, according to
an industry-funded study released today by the actuarial firm Milliman Inc.
The tax shift is “one of the awkward little complexities of the law that
are only now coming to light,” said Dan Mendelson, chief executive officer
at Avalere Health LLC, a Washington-based consultant. “It’s unusual.”
The insurer tax was among a variety of fees included in the act to make
health care companies pay their “fair share,” as U.S. Senator Charles
Schumer of New York put it during the 2009 debate over the legislation. The
idea was that insurers who would benefit from millions of taxpayer-
subsidized customers under the law should contribute toward its costs.
With the tax kicking in this year, companies that manage Medicaid plans are
arguing that the added cost should be shifted, and states seem willing to
comply. The result is a “very circular” scenario in which the U.S.
government raises money from insurers then hands at least part of it back,
said Shawn Guertin, Aetna Inc.’s chief financial officer.
Taxpayer cost
The tax “doesn’t make any sense to be levied on the Medicaid HMOs,”
Thomas Carroll, an analyst at Baltimore-based Stifel Nicolaus & Co., said in
a telephone interview. “It’s all going to be paid by the taxpayers.”
States will pay $13.3 billion to $13.9 billion more with the federal
government picking up the rest of the cost, Seattle-based Milliman projected
in its study. As a result, annual Medicaid payments will rise about 1.6
percent a year starting in 2015, the actuary found.
The report was commissioned by Medicaid Health Plans of America, a
Washington-based industry group that has pushed for the tax to be repealed.
The 2010 law known as Obamacare imposes an estimated $150 billion in taxes
on for-profit insurers over the next decade, Milliman estimates. Employers
with self-funded plans and nonprofits that specialize in Medicaid or
Medicare policies, such as local hospitals, are exempt.
Weigh benefits
The added costs need to be weighed against the benefits of the ACA,
including rules that ensure sick Americans can’t be denied insurance, said
Mendelson, a former budget official in President Bill Clinton’s White House
, in a phone interview. The law will expand coverage to 25 million people
starting in 2016, according to congressional projections.
While the act may raise Medicaid costs, “it also means now it’s possible
for a person with diabetes in this country to get insurance,” Mendelson
said. “It’s not fair to look at any one of these effects in isolation.”
The tax is based on a company’s U.S. market share. It’s also expected to
raise premiums by as much as 2.5% for employers and individuals who buy
their own insurance, according to a 2011 estimate by Congress’ Joint
Committee on Taxation. That would add $350 to $400 a year for the average
family premium if the entire tax is passed onto consumers.
Thirty-seven states outsource at least some of their Medicaid coverage to
private insurers. The industry has leverage thanks to federal rules that
require states to pay “actuarially sound” fees to ensure companies can
provide adequate benefits to the poor. Most states interpret that to include
the cost of federal taxes.
Little choice
That has left states little choice, said Mari Cantwell, a chief deputy
director at California’s Department of Health Care Services, which runs the
state’s Medicaid program.
California expects to spend $87 million on the health insurer fee in the
next fiscal year, according to the department. While that’s a small portion
of the $34 billion it expects to pay to Medicaid insurers, it’s still “
confounding” Cantwell said in a telephone interview.
“It’s a tax on plans, but in the Medicaid world, it’s really a tax on
both the state government and the federal government,” she said.
In Florida, where Republican Governor Rick Scott has been an outspoken
critic of Obamacare, the tax is projected to cost the state as much as $1.2
billion over a decade, Milliman said.
Seeking options
“Unfortunately, if you have to pay a tax like this, it has to come out of
something else,” Michelle Dahnke, a spokeswoman for the Florida Agency for
Health Care Administration, said in a phone interview. “We may have to let
something else go.”
Insurers should “pay their fair share,” said Ryan Carey, a spokesman for
the Senate Finance Committee, whose Democratic majority helped write the ACA
’s tax provisions. He didn’t say whether states should be reimbursing the
fee.
“From the very beginning, every group that stood to gain from 25 million
newly insured Americans was going to pitch in and help make the law work,”
Carey said in an e-mail. “That’s the way the law was designed, and it
shouldn’t change now.”
WellPoint Inc., the insurer with the biggest Medicaid enrollment, defended
the request on a conference call with analysts Jan. 29.
“The states are really understanding the need for a viable program required
this fee to be passed on,” said Joseph Swedish, chief executive officer at
Indianapolis-based WellPoint. “They understand the need for a sustainable
Medicaid program, and this is part of sustainability”
2014 profit
For some insurers, shifting the fee is “critical” for 2014 profit, said
Carroll, the Stifel Nicolaus analyst. At about 2% of premiums, the tax is
equal to the entire increase Medicaid insurers get in most years, he said.
Because the levy isn’t deductible from corporate income taxes, its impact
will be magnified, he said by telephone.
“It could absolutely be a big chunk of profits” for some insurers, Carroll
said.
So far, health plans say they’re succeeding in getting the fee covered.
Minnetonka, Minnesota-based UnitedHealth Group Inc., the biggest U.S.
medical insurer, told analysts on a Jan. 16 call that it has written
agreements from a third of the 24 states where it sells Medicaid plans and
verbal commitments from others. Aetna, based in Hartford, Connecticut, also
has found support, said Guertin, the CFO.
“The good news is that nominally most states recognize that it needs to be
an element of the rate,” he said in an interview. “Medicaid has always
been a low-margin business.” | a*********a
发帖数: 3656 | 2 O8开，根本没有降低医疗费用的措施。所作的就是从中产那里多收税，补贴低收入的买
保险。原本的费用一分钱没减少，现在又有新的税收加进去，新的政府机构要建立，最
低保险限度要达到。医疗占经济的比重只可能增加，不可能减少。
结果不但O8开会破产，还会加速medicare 和 medicaid 破产。
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【在 l****z 的大作中提到】
: by: Alex Nussbaum
: February 12, 2014
: (Bloomberg) — Health insurers told to pay $150 billion in taxes over a
: decade to help fund Obamacare are now shifting at least part of that cost
: back to taxpayers.
: Congress passed the insurer tax four years ago to help cover the uninsured
: under the Affordable Care Act. Now, the industry is pushing to include some
: of the cost in contracts with Medicaid programs for the poor that are
: jointly funded by state and federal governments.
: The strategy may add $36 billion to $39 billion to the cost of Medicaid over
|
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