Medicare donut hole

Whoops, anyone here ever get to their donut hole in their Part D or Med Advantage plan? This executive order may just effect you.

The order offers few specifics, but in a few paragraphs, it does give agencies affected by the ACA the authority to waive or delay implementation of any part of the law that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, insurers, drug companies, etc.

Drug company's may be able to stop immediately paying their percentage of brand name drugs if you reach the donut hole.

My shots have dropped down to about 16k a month. We have top notch supplemental through my wife's retirement plan but we are in a free fall now to see what and how much Medicare will pay as they were paid 100% before medicare with about 5 thousand out of pocket on medications and deductibles per year. The thing is that we are saving almost 800 a month since going on Medicare so we have up to 10k to call it a wash if we are impacted by the doughnut hole, but if they fail to pay 8k a month I am screwed. I have not felt this good in three years since the lung surgery in October, and this hard work outside where I am sweating, bending, and working my old sick asz off. Even the mets in my spine have not been bothering me as much as a month ago, and I have not had bad pain for three weeks now. I am convinced that hard physical work and short term projects which keep my attention on positive things is a life saver, but sick people faced with uncertainty on insurance issues is a nightmare, and it is so sad to see people with serious problems at the financial assistance desks trying to get coverage for needed procedures. I have been blessed with extra time and coverage so far, but so many people are suffering, and I was oblivious to the same when I was young and healthy. I do have one complaint. Why can't folks with retirement income and investments not pay a double the current medicare contribution, and still allow folks who only have SS keep the low payments. The last eight years being sick I have only reached the income limit on SS once and I never understood why people having good years stop contributing. A person should keep contributing until their income exceeds 250k, yet one of my business partners makes over 500k a year and all he does is complain about taxes. He is a self made man, and I have a great deal of respect for him, but he is constantly arguing on facebook how taxes should be cut because socialist are stealing his money.......he has one son who inherited over five million from a grandfather and grandmother, and he lives in a gated community in Arizona in a couple million dollar home, and his whole focus in this 68 year old man is being Silas putting his gold under the floor boards.......it is quite sad. I wish he had grandchildren and understood that we are only as strong as the weakest link in the chain.

Mcare and adv will likely do better than strapped to obamacaid.

Office of the Press Secretary

For Immediate Release January 20, 2017
EXECUTIVE ORDER
- - - - - - -
MINIMIZING THE ECONOMIC BURDEN OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT PENDING REPEAL
By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows:
Section 1. It is the policy of my Administration to seek the prompt repeal of the Patient Protection and Affordable Care Act (Public Law 111-148), as amended (the "Act"). In the meantime, pending such repeal, it is imperative for the executive branch to ensure that the law is being efficiently implemented, take all actions consistent with law to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market.
Sec. 2. To the maximum extent permitted by law, the Secretary of Health and Human Services (Secretary) and the heads of all other executive departments and agencies (agencies) with authorities and responsibilities under the Act shall exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications.
Sec. 3. To the maximum extent permitted by law, the Secretary and the heads of all other executive departments and agencies with authorities and responsibilities under the Act, shall exercise all authority and discretion available to them to provide greater flexibility to States and cooperate with them in implementing healthcare programs.

Sec. 4. To the maximum extent permitted by law, the head of each department or agency with responsibilities relating to healthcare or health insurance shall encourage the development of a free and open market in interstate commerce for the offering of healthcare services and health insurance, with the goal of achieving and preserving maximum options for patients and consumers.
Sec. 5. To the extent that carrying out the directives in this order would require revision of regulations issued through notice-and-comment rulemaking, the heads of agencies shall comply with the Administrative Procedure Act and other
2
applicable statutes in considering or promulgating such regulatory revisions.
Sec. 6. (a) Nothing in this order shall be construed to impair or otherwise affect:
(i) the authority granted by law to an executive department or agency, or the head thereof; or
(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.
(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.
(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.
DONALD J. TRUMP
THE WHITE HOUSE,

The EO changes nothing pursuant to Article 3 of the ACA that has to go through congress but the EO could take off the individual mandate or open the way for more than the already 50 some exemptions.

https://www.balloon-juice.com/2017/01/20/trumps-eo-on-the-aca/

Section 2 is the critical component for the individual market. Section 3 has significant impact for both Exchanges and Medicaid.

Analysis below the fold:

Section 2 instructs ever element of the government to use all legal discretion in the direction of minimizing costs to any state or individual. If there is a way to rationally argue that a decision could lead to a cost or not to a cost, the federal government will come down on the side of not imposing a cost. This is critical as the Secretary of Health and Human Services (HHS) has broad discretionary power to grant hardship exemptions to the individual mandate penalty. If the Secretary of HHS determines that paying a dollar is an undue hardship, an exemption can be granted. Under this executive order, the hardship exemptions will be freely and frequently issued.

Now what does that mean? If we assume that very few people will need to pay the mandate penalty we should expect quite a few healthy people to leave the 2018 risk pool. Fewer healthy people in the risk pool means the proportion of people who have strong reason to believe that they will be expensive in 2018 will increase. That means the average premium will increase much faster as the risk pool will be proportionally sicker and more expensive with fewer healthy people to insure the sicker and more expensive individuals.

This will not have significant impact on the subsidized, on-Exchange enrollment as long as the premium tax credits are still tied to the cost of the second lowest Silver. The federal government absorbs the vast majority of the premium increase risk for the subsidized population. The issue will become apparent for the people who are buying off-Exchange where they do not get any subsidies. They bear the entire risk of increased premiums. As premiums increase, the healthy non-subsidized buyers will quickly make a decision to go uncovered as the expense does not justify the gain. Carriers will need to model a much sicker and more expensive single, unified risk pool as the non-subsidized portion of the risk pool will death spiral.

Section 3 deals with state based waivers. There are three major ACA waivers. 1115 is the Medicaid waiver program. 1331 is the Basic Health Plan waiver program. 1332 is the State innovation waiver. Section 3 makes as official policy maximum flexibility. 1331/1332 are mostly areas that Blue states would be interested in. 1115 is where the action is.

Louise Norris picked out the implication very quickly and clearly for Medicaid

Anything will go for non-expansion state 1115 waiver applications. The Kentucky waiver will get approved with work/job training requirements. If this is the impetus to have Texas or Alabama expand Medicaid as it provides local political cover, then this could be a good thing even if it is not close to ideal.

ppaca wrote:Whoops, anyone here ever get to their donut hole in their Part D or Med Advantage plan?  This executive order may just effect you.

The order offers few specifics, but in a few paragraphs, it does give agencies affected by the ACA the authority to waive or delay implementation of any part of the law that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, insurers, drug companies, etc.

Drug company's may be able to stop immediately paying their percentage of brand name drugs if you reach the donut hole.

Please explain to us how this, specifically, is a BAD thing, and I quote: "it does give agencies affected by the ACA the authority to waive or delay implementation of any part of the law that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, insurers, drug companies,"

Why so desperate to spread unfounded rumors?

If you look up two posts you will see that is from the office of the President. If you don't understand why the drug manufacturer's not paying their percentage in the donut hole then you are hopeless man. Just shaking my head. Go to the post on the speech you'll really like that one.

Not much changed though with the EO most all of it has be undone by congress.


Yes Pkr it might effect the individual mandate right now.