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Daily Archives: October 30th, 2017

The Trump administration  has shortened the enrolment period on healthcare and cut advertising dollars for it. What this means is that if you already have healthcare under the ACA (Obamacare), you can still continue your coverage or renew the coverage. The administration is pushing misinformation to reduce the number of people who are currently using the system so they can show that participation is down because the coverage is so bad and expensive. If successful they will ten present a plan that will be less affordable and cover fewer people while gathering the money saved form subsidies to finance the “tax reform” plan which not benefit the “middle class” which no one has defined. It is important that all of us pay attention to this as this administration has nothing good for us on the horizon. Everything  proposed by the administration is geared to campaign promises which promise no good for anyone who is not already wealthy ( notice the wealth of the Cabinet appointees) MA

By Walecia Konrad MoneyWatch October 30, 2017, 5:45 AM

Open enrollment for people shopping for 2018 health insurance through the Obamacare exchanges begins on Thursday, Nov. 1. For most consumers, it promises to be an even more frustrating event than usual.
Fewer choices in the exchange marketplace and recent cutbacks from the Trump administration, including ending important reimbursements and slashing consumer support, make for an uncertain market and confused customers.
People are fending for themselves at a time when they seem more perplexed than ever. Almost 76 percent of Americans don’t know when open enrollment is, according to a new survey from Policygenius. And 18 percent didn’t realize the Affordable Care Act was still the law.
This year, it’s more important than ever to be in the know. Here are six steps you can take to navigate open enrollment.
1.Watch the mail
In a normal year you would have gotten a letter from your current insurer by now informing you of any changes in your existing plan and what premiums you can expect to pay for 2018. Patients often use these letters to determine if they’ll keep their current coverage and to help them compare it with any alternatives available.
But many insurers have held off on sending renewal notices because of the uncertainty over premium prices. In fact, many insurers are only just now sending out these notices.
Here’s why. Last summer when insurers first began filing their premium rate changes for 2018, the industry and state regulators were worried that President Donald Trump would make good on his threat to cut off government cost-sharing reimbursements. And, in fact, he did eliminate those payments earlier this month.
Under the Affordable Care Act, insurers must provide subsidies to low-income patients to help pay for out-of-pocket health-care costs such as deductibles and co-pays. The federal government then reimburses insurers for those subsidies. Now that the federal government has announced it will no longer make these reimbursements, most insurers have raised premiums to offset the costs of unreimbursed cost-sharing payments. (More on premium hikes soon.)
Efforts to reinstate cost-sharing reimbursements aren’t too promising. The Alexander-Murray Bipartisan Health Care Stabilization Act of 2017 is languishing in Congress. And earlier this month a federal judge in California rejected efforts from 18 states and the District of Columbia to force the Trump administration to continue making the payments.
Legislative and legal challenges are expected to continue, but probably not in time to affect the 2018 enrollment period.
The good news: As it stands now, if you qualify for cost-sharing subsidies you’ll still receive them (even though your insurer won’t be reimbursed). But overall premium prices will rise as a result.
Get off to a fast start
No matter what news you receive from your current insurer, you want to start researching your options as soon as open enrollment begins. That’s because the Trump administration has significantly decreased  the number of days in the open-enrollment period, so you have less time to make your decision.
In the 39 states in which the federal government runs the exchange, open enrollment runs from Nov. 1 until Dec. 15 for coverage starting January 2018. Some states that run their own exchanges will have longer open-enrollment periods. And some people whose current plan won’t be offered next year may qualify for more time to get coverage if they miss the Dec. 15 deadline.
In the shorter time frame you’ll also likely have fewer places to turn for help. Government spending on outreach and advertising for the exchanges has been drastically cut, and funding for “navigators,” people who are trained to help consumers choose an exchange plan, has also been reduced dramatically. “The absence of navigators makes things harder,” said Tom Bulliet, a partner in the health care practice group at Ropes and Gray.  He suggested that people with tough questions see if the legal aid society in their area can help.
2. Don’t confuse cost-sharing subsidies with premium subsidies
We’ve discussed how cost-sharing subsidies work. Premium subsidies are different. These are the tax credits under the Affordable Care Act designed to help low- and mid-income consumers afford their monthly health insurance premium. The majority of exchange customers qualify for premium tax credits.
These tax credits aren’t going away, and because they’re calculated based on income and the cost of a silver level plan, in most cases premium relief increases as premium rates rise. So consumers who qualify for premium tax credits will likely see little change in how much they pay out-of-pocket for their monthly premium bill, even with the big increases insurers have put through.
However, exchange consumers who don’t qualify for premium tax credits will carry the heaviest burden for the current premium hikes.
Compare premiums for all metal levels
 3. Exchange insurance programs come in four levels: bronze, silver, gold and platinum. The higher the level, the more comprehensive the coverage, the less out-of-pocket costs and, normally, the higher the premiums.
But because cost-sharing subsidies are available only in silver plans, they’ve undergone the highest premium increases to make up for the lack of government funds. “Surcharges on silver plans attributed to the end of the cost-sharing payments range from 7.1 percent to 38 percent,” according to a recent analysis from the Kaiser Family Foundation.
“That means we’re in a situation where gold plans, with more comprehensive coverage, may actually be cheaper than silver,” explained Kathleen Hempstead, senior adviser at the Robert Wood Johnson Foundation. This year, it’s really worthwhile to compare all metal level plans,” she advised.
This works on a case-by-case basis. Some insurers have applied premium increases to all metal level plans to help pay for the lack of cost-sharing reimbursements. So depending on your exchange, you may see increases across the board. According to the Kaiser analysis, premium increases ranged from 0.1 percent to 27.2 percent across all metal level plans due to the end of cost-sharing reimbursements.
 4. Every exchange market will have at least one insurer for 2018 coverage, and many of those are expected to offer various metal level plans. Bottom line: Even if it looks as if you have only one insurer choice, be sure to look at all the plans that one insurer is offering. And keep in mind that premium tax credits can be applied to any level plan.
 5. Beware auto enrollment
This is when your current exchange insurer automatically renews your coverage. But you may not be getting the same coverage. Premium prices, provider networks and out-of-pocket costs may change. For all the reasons we’ve discussed above, you need to compare the plan you’ve been automatically renewed into with any alternatives you may have.
 6. Don’t go naked
Earlier in the year, there was speculation that the Trump administration would look the other way if the IRS didn’t enforce penalties for people who don’t get health insurance coverage. This individual mandate is one of the most debated aspects of the ACA. But the IRS announced earlier this month that it will require taxpayers to disclose whether they have purchased health insurance.
So be warned. If you go without, you will face the penalty.

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Eliza Newlin Carney

The debate over the Russian election interference and American election security is a case study in the utter dysfunctionality of Beltway politics. By contrast, a number of states have already embarked on practical, problem-solving innovations in securing the ballot in future elections.

On the national stage, President Trump’s “election integrity” commission has careened from one controversy to another, taking steps that actually threaten to undermine ballot security. Outside the spotlight, state election officials are quietly taking steps to respond to the Russian threat and upgrade American election systems with better machines, more accurate voter rolls, and firewalls against hacking.

The state-level picture is not all rosy, of course, and plenty of Republican statehouses have moved in the wrong direction with ill-advised voting restrictions that threaten to keep voters from the polls. But when it comes to the Russia threat, many state administrators have managed to tune out the political bickering and pursue public-private collaborations that involve federal officials, academics, cybersecurity experts, and even tech giants like Google and Facebook. Consider:

  • Colorado will soon become the first state to roll out a statewide election security measure known as a “risk limiting” audit, a type of post-election audit that cross checks a sampling of paper records against electronic vote tallies, and that is considered the gold standard among cybersecurity experts.
  • Rhode Island has increased its information technology staff by 40 percent, recently convened a cybersecurity summit for more than 100 municipal election officials, and has started implementing automatic voter registration to improve the accuracy of its voter rolls. The Rhode Island legislature has also approved a new requirement for risk-limiting election audits in that state.
  • West Virginia’s secretary of state has brought on board a cybersecurity expert from the state’s Air National Guard to help protect its election systems from outside intrusion.
  • New York Governor Andrew Cuomo has ordered a top-to-bottom review of election-related cybersecurity efforts in the state.
  • Virginia has decertified all its paper voting machines, and is replacing them with new systems that facilitate audits by creating a voter-verifiable paper trail. The state has also created a new position for a digital security expert and has upgraded its software system.

Helping facilitate such efforts is the Election Assistance Commission, the federal agency created by the 2002 Help America Vote Act. The EAC, which marks its 15th year in existence this month, and which Republicans have repeatedly tried to defund and shutter, is coming into its own after a bumpy history that included a stretch without a single commissioner on board.

EAC officials are working closely with the National Conference of State Legislatures, and with a “Defending Digital Democracy” project launched in July at Harvard University’s Belfer Center for Science and International Affairs, to bring election officials together with tech experts, business leaders and other election stakeholders. Facebook and Google, under fire and possibly facing new regulations for their role facilitating Russian disinformation campaigns, are among those advising state election officials on how to guard against the types of threats they daily face.

“We can’t just ask local election officials to protect their systems on their own, or state officials to protect their systems on their own,” says EAC chairman Matthew Masterson. “It has to come from local, state, federal, the private sector as well as academia. It’s all part of a coordinated response.”

One outcome of the Belfer project will be a playbook for how to improve cybersecurity, using simulations not unlike those conducted by national security officials. The EAC has also been working with the Department of Homeland Security, which in January declared the nation’s election systems part of the nation’s critical infrastructure, to facilitate communication with the states. Many state election administrators were irate to learn only after the fact the details of Russian hacking efforts that had been known to intelligence officials for months.

The EAC and the National Institute of Standards and Technology also recently announced the first new technical standards in more than a decade to guide voting machine manufacturers. These voluntary standards have already been embraced by all but three states, and are expected to be finalized by early next year. States are in desperate need of new technologies as their voting machines, many purchased with HAVA money 15 years ago, near obsolescence.

The challenge for state and local election officials, as always, is how to pay for it all.

The challenge for state and local election officials, as always, is how to pay for it all. HAVA came with a $4 billion federal assist. The Trump administration not only has no plans to boost state funding, but is actively undermining the states. The Trump “voter integrity” commission continues to demand vast amounts of voter data from the states, despite lawsuits that contend the demand violates privacy laws in many states, and puts voter information at risk.

Under fire from its inception, the Trump commission has now been roiled by the arrest of a staff member on charges of possessing child pornography, and increasingly loud complaints from two of its Democratic members that the commission has failed to inform them of what it’s doing, when it will release its report, and even when it will next meet. There’s also new evidence that a voter database masterminded by the commission’s vice chairman, Kansas Secretary of State Kris Kobach, is riddled with errors and subject to security risks.

The states have no silver bullet to secure American elections. But at least state and local officials are making a good-faith effort to ensure the sanctity of the vote. The same can’t be said of their federal counterparts.

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