Great article from Health Affairs about the effects of ACA repeal on employer healthcare by JoAnn Volk
Much of the recent attention on the future of the Affordable Care Act (ACA) has focused on the fate of the 22.5 million people likely to lose insurance through a repeal of Medicaid expansion and the loss of protections and subsidies in the individual insurance market. Overlooked in the declarations of who stands to lose under plans to “repeal and replace” the ACA are those enrolled in employer-sponsored health plans — the primary source of coverage for people under 65.
Job-based plans offered to employees and their families cover 150 million people in the United States. If the ACA is repealed, they stand to lose critical consumer protections that many have come to expect of their employer plan.
It’s easy to understand the focus on the individuals who gained access to coverage thanks to the health reform law. ACA drafters targeted most of the law’s insurance reforms at the individual and small-group markets, where consumers and employers had the greatest difficulty finding affordable, adequate coverage prior to health reform. The ACA’s market reforms made coverage available to those individuals with pre-existing conditions who couldn’t obtain coverage in the pre-ACA world, and more affordable for those low- and moderate-income families who couldn’t afford coverage on their own.
Less noticed, but no less important, the ACA also brought critical new protections to people in large employer plans. Although most large employer plans were relatively comprehensive and affordable before the ACA, some plans offered only skimpy coverage or had other barriers to accessing care, leaving individuals—particularly those with costly, chronic health conditions—with big bills and uncovered medical care. For that reason, the ACA extended several meaningful protections to employees of large businesses.
The ACA requires all new health plans, including those sponsored by employers, to cover recommended preventive services without cost-sharing, bringing new benefits to 71 million Americans. That means individuals can get the screenings, immunizations, and annual check-ups that can catch illness early or prevent it altogether without worrying about meeting a costly deductible or co-payment. With that peace of mind, it’s no wonder it’s one of the most popular provisions of the ACA. Women employees can also access affordable contraception, making available a wider variety of contraceptive choices and increasing use of long-term contraceptive methods.
Under the ACA, employers cannot impose a waiting period for coverage of a pre-existing condition. Prior to the ACA, individuals who became eligible for an employer plan—for example, once hired for a new job—might have to wait up to 12 months for the plan to cover pre-existing health conditions. You could “buy down” that waiting period with months of coverage under another plan, so long as it was the right kind of plan and you didn’t go without coverage for 63 days or more. But if you lost your job, couldn’t afford COBRA, went a few months without coverage and then were lucky enough to get another job with benefits, you might find the care you needed wasn’t covered under your plan for an entire year.
The ACA requires all health plans, including those sponsored by large employers, to cover dependents up to age 26. Prior to the ACA, one of the fastest growing groups of uninsured was young adults — not because they turned down coverage offered to them, but because they were less likely to have access to employer-based plans or other coverage. The result has been a dramatic increase in the number of insured young adults, particularly among those with employer-sponsored coverage. This ACA requirement is one provision President-elect Trump and many anti-ACA legislators have pledged to retain.
The ACA requires all new health plans, including those sponsored by employers, to cap the amount individuals can be expected to pay out-of-pocket each year. Prior to the ACA, even those with the security of coverage on the job couldn’t count on protection from crippling out-of-pocket costs.
The ACA prohibits employer plans from having an annual or lifetime dollar limit on benefits. Prior to the ACA, employer plans often included a cap on benefits; when employees hit the cap, the coverage cut off. For individuals who needed costly care, like a baby born prematurely or those with hemophilia or multiple sclerosis, that often meant a desperate scramble to find new coverage options as one after another benefit limit was reached.
The ACA guarantees individuals the right to an independent review of a health plan’s decision to deny benefits or payment for services, regardless of whether the employer plan is insured or self-funded. Prior to the ACA, only workers in insured plans had the right to an independent review of a denied claim. But more than 60 percent of workers are in self-funded plans, and the only option for those workers to hold their plan accountable was to sue, an expensive and lengthy process.
If you’re one of the 150 million people who get their coverage through an employer plan, you may want to pay attention to the prognostications of what’s to become of the ACA. Your access to high-quality, affordable health care will depend on the outcome.
See the original article Here.
Volk J. (20174 January 11). Get health insurance through your employer? ACA repeal will affect you, too [Web blog post]. Retrieved from address http://healthaffairs.org/blog/2017/01/11/get-health-insurance-through-your-employer-aca-repeal-will-affect-you-too/
Does ACA repeal have you worried? Look into this great article from Kaiser Health News about some of things that could disappear with ACA repeal by Julie Appleby and Mary Agnes Carey
The Affordable Care Act of course affected premiums and insurance purchasing. It guaranteed people with pre-existing conditions could buy health coverage and allowed children to stay on parents’ plans until age 26. But the roughly 2,000-page bill also included a host of other provisions that affect the health-related choices of nearly every American.
Some of these measures are evident every day. Some enjoy broad support, even though people often don’t always realize they spring from the statute.
In other words, the outcome of the repeal-and-replace debate could affect more than you might think, depending on exactly how the GOP congressional majority pursues its goal to do away with Obamacare.
No one knows how far the effort will reach, but here’s a sampling of sleeper provisions that could land on the cutting-room floor:
CALORIE COUNTS AT RESTAURANTS AND FAST FOOD CHAINS
Feeling hungry? The law tries to give you more information about what that burger or muffin will cost you in terms of calories, part of an effort to combat the ongoing obesity epidemic. Under the ACA, most restaurants and fast food chains with at least 20 stores must post calorie counts of their menu items. Several states, including New York, already had similar rules before the law. Although there was some pushback, the rule had industry support, possibly because posting calories was seen as less onerous than such things as taxes on sugary foods or beverages. The final rule went into effect in December after a one-year delay. One thing that is still unclear: Does simply seeing that a particular muffin has more than 400 calories cause consumers to choose carrot sticks instead? Results are mixed. One large meta-analysis done before the law went into effect didn’t show a significant reduction in calorie consumption, although the authors concluded that menu labeling is “a relatively low-cost education strategy that may lead consumers to purchase slightly fewer calories.”
PRIVACY PLEASE: WORKPLACE REQUIREMENTS FOR BREAST-FEEDING ROOMS
Breast feeding, but going back to work? The law requires employers to provide women break time to express milk for up to a year after giving birth and provide someplace — other than a bathroom — to do so in private. In addition, most health plans must offerbreastfeeding support and equipment, such as pumps, without a patient co-payment.
LIMITS ON SURPRISE MEDICAL COSTS FROM HOSPITAL EMERGENCY ROOM VISITS
If you find yourself in an emergency room, short on cash, uninsured or not sure if your insurance covers costs at that hospital, the law provides some limited assistance. If you are in a hospital that is not part of your insurer’s network, the Affordable Care Act requires all health plans to charge consumers the same co-payments or co-insurance for out-of-network emergency care as they do for hospitals within their networks. Still, the hospital could “balance bill” you for its costs — including ER care — that exceed what your insurer reimburses it.
If it’s a non-profit hospital — and about 78 percent of all hospitals are — the law requires it to post online a written financial assistance policy, spelling out whether it offers free or discounted care and the eligibility requirements for such programs. While not prescribing any particular set of eligibility requirements, the law requires hospitals to charge lower rates to patients who are eligible for their financial assistance programs. That’s compared with their gross charges, also known as chargemaster rates.
NONPROFIT HOSPITALS’ COMMUNITY HEALTH ASSESSMENTS
The health law also requires non-profit hospitals to justify the billions of dollars in tax exemptions they receive by demonstrating how they go about trying to improve the health of the community around them.
Every three years, these hospitals have to perform a community needs assessment for the area the hospital serves. They also have to develop — and update annually — strategies to meet these needs. The hospitals then must provide documentation as part of their annual reporting to the Internal Revenue Service. Failure to comply could leave them liable for a $50,000 penalty.
A WOMAN’S RIGHT TO CHOOSE … HER OB/GYN
Most insurance plans must allow women to seek care from an obstetrician/gynecologist without having to get a referral from a primary care physician. While the majority of states already had such protections in place, those laws did not apply to self-insured plans, which are often offered by large employers. The health law extended the rules to all new plans. Proponents say direct access makes it easier for women to seek not only reproductive health care, but also related screenings for such things as high blood pressure or cholesterol.
AND WHAT ABOUT THOSE THERAPY COVERAGE ASSURANCES FOR FAMILIES WHO HAVE KIDS WITH AUTISM?
Advocates for children with autism and people with degenerative diseases argued that many insurance plans did not provide care their families needed. That’s because insurers would cover rehabilitation to help people regain functions they had lost, such as walking again after a stroke, but not care needed to either gain functions patients never had, such speech therapy for a child who never learned how to talk, or to maintain a patient’s current level of function. The law requires plans to offer coverage for such treatments, dubbed habilitative care, as part of the essential health benefits in plans sold to individuals and small groups.
Appleby J., Carey M. (2017 January 12). Health law sleepers: six surprising health items that could disappear with ACA repeal [Web blog post]. Retrieved from address http://khn.org/news/health-law-sleepers-six-surprising-health-items-that-could-disappear-with-aca-repeal/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=40532225&_hsenc=p2ANqtz-8vl0H_K8CNgaURbqgYS5m3isu1NUGrj0FRIdsUX8JCwcifTDRV-UvKdu6lZGvB06FTyhENvPFLaOMOsIrr2IBVBTNWQg&_hsmi=40532225
Did you know that ACA repeal could have and effect on health savings plans (HRA)? Read this interesting article from Benefits Pro about how the repeal of the ACA might affect your HRAs by Marlene Y. Satter
With the repeal of the Affordable Care Act looming, one surprising factor in paying for health care could see its star rise higher on the horizon—the retirement planning horizon, that is. That’s the Health Savings Account—and it’s likely to become more prominent depending on what replaces the ACA.
HSAs occupy a larger role in some of the proposed replacements to the ACA put forth by Republican legislators, and with that greater exposure comes a greater likelihood that more people will rely on them more heavily to get them through other changes.
For one thing, they’ll need to boost their savings in HSAs just to pay the higher deductibles and uncovered expenses that are likely to accompany the ACA repeal.
But for another—and here’s where it gets interesting—they’ll probably become a larger part of retirement planning, since they provide a number of benefits already that could help boost retirement savings.
Contributions are already deductible from gross income, but under at least one of the proposals to replace the ACA, contributions could come with refundable tax credits—a nice perk.
Another proposal would allow HSA funds to pay for premiums on proposed new state health exchanges without a tax penalty for doing so—also beneficial. And a third would expand eligibility to have HSAs, which would be helpful.
But whether these and other possible enhancements to HSAs come to pass, there are already plenty of reasons to consider bolstering HSA savings for retirement. As workers try to navigate their way through the uncertainty that lies ahead, they’ll probably rely even more on the features these plans already offer—such as the ability to leave funds in the account (if not needed for higher medical expenses) to roll over from year to year and to grow for the future, and the fact that interest on HSA money is tax free.
But possibly the biggest benefit to an HSA for retirement is the fact that funds invested in one grow tax free as well. If you can leave the money there long enough, you can grow a sizeable nest egg against potential future health expenses or even the purchase of a long-term care policy. And, at age 65, you’re no longer penalized if you withdraw funds for nonapproved medical expenses.
And if you don’t use the money for medical expenses in retirement, but are past 65, you can use it for living expenses to supplement your 401(k). In that case, you’ll have to pay taxes on it, but there’s no penalty—it just works much like a tax-deferred situation from a regular retirement account.
Satter M. (2017 January 16). HSAs could play bigger role in retirement planning [Web blog post]. Retrieved from address http://www.benefitspro.com/2017/01/16/hsas-could-play-bigger-role-in-retirement-planning?ref=hp-news
Do you which medical conditions are driving your healthcare cost? Check out this great article from Employee Benefits Advisor about the cost associated with your employer healthcare by Phil Albinus
Healthcare costs surrounding diabetes reached $101 billion in diagnoses and treatments over the past 18 years — and the cost grew 36 times faster than the cost of ischemic heart disease, the leading cause of death in the U.S. Further, out of 155 medical conditions, only 20 accounted for half of all medical spending, according to a JAMA analysis of 2013 healthcare costs.
The third-most expensive medical condition, low back and neck pain, primarily strikes adults of working age while diabetes and heart disease is primarily found in people 65 and older.
The JAMA study found total health spending for these conditions totaled $437 billion in 2013. Diabetes, heart disease, low back and neck pain, along with hypertension and injuries from falls, comprise 18% of all personal health spending. All in all, 20 conditions make up more than half of all spending on healthcare in the U.S.
These stark figures shed light on the rising healthcare costs that employers pay when addressing their workforce’s ailments.
According to Francois Millard, senior vice president and chief actuarial officer for Vitality Group, one of the study’s sponsors, this is the first study to dig into the details of the leading ailments of the U.S. and its costs to employers and families as they deal with the conditions.
“In absolute terms, most money for care is in the working age population,” he says. “It impacts households and employers and contributes to the financial burden of families.”
“What we see is the financial burden increases as the disease increases, and while the paper doesn’t go into detail, we already have a significant knowledge of diabetes and heart condition. It is related to modifiable behavior.”
The JAMA study noted the differences between public health program spending from personal health spending, including individual out-of-pocket costs and spending by private and government insurance programs.
“While it is well known that the U.S. spends more than any other nation on healthcare, very little is known about what diseases drive that spending,” said Dr. Joseph Dieleman, lead author of the paper and assistant professor at the Institute for Health Metrics and Evaluation at the University of Washington, in a press statement. “IHME is trying to fill the information gap so that decision-makers in the public and private sectors can understand the spending landscape, and plan and allocate health resources more effectively.”
Despite using figures from 2013, the information can help employers as they identify where their healthcare dollars are going.
“Given the biggest increases in healthcare spending on impact working age populations, it requires employers to improve their work environments and facilitate good health. And [this study can] help increase the transparency of health within their populations,” says Millard.
“Employers need to think what they do that impacts beyond the four walls of the employers and create a symbiotic relationship with health within their societies,” he adds.
The study can also boost transparency into the healthcare data. “This study is also an accountability and outcome of the money they are spending on health treatment,” Millard says. “Is it sufficient to still pay for services or can we push for more accountability for health outcomes? The other thing this facilities is that employers get the adequate level of data. They can ask the right questions and determine accountability for the huge amounts of healthcare.”
He adds, “With all the uncertainty around 2017, perhaps this transparency will give employers a voice to all of the money that they are spending.”
The top 10 most costly health expenses in 2013:
1. Diabetes – $101.4 billion
2. Ischemic heart disease – $88.1 billion
3. Low back and neck pain – $87.6 billion
4. Hypertension – $83.9 billion
5. Injuries from falls – $76.3 billion
6. Depressive disorders – $71.1 billion
7. Oral-related problems – $66.4 billion
8. Vision and hearing problems – $59 billion
9. Skin-related problems, such as cellulitis and acne – $55.7 billion
10. Pregnancy and postpartum care – $55.6 billion
Albinus P. (2017 January 12). What medical conditions are driving employer healthcare costs?[Web blog post]. Retrieved from address http://www.employeebenefitadviser.com/news/what-medical-conditions-are-driving-employer-healthcare-costs?brief=00000152-1443-d1cc-a5fa-7cfba3c60000
Great article from our partner, United Benefit Advisors (UBA) by Nancy Bourque
The Occupational Safety and Health Administration (OSHA) recently released a final rule on the procedures for the handling of whistleblower complaints under Section 1558 of the Patient Protection and Affordable Care Act (ACA). The regulations protect employees (which includes former employees and applicants for employment) who may have been subject to retaliation for seeking assistance under certain affordability assistance provisions, or for reporting potential violations of the ACA’s consumer protections.
Employers are prohibited from discharging or retaliating against an employee who:
A covered employee, or a person acting on their behalf, may file a complaint within 180 days of an alleged violation. Section 18C’s whistleblower protections do not replace any protections that a whistleblower may have under the Employee Retirement Income Security Act (ERISA) Section 510. Whistleblowers may bring claims under either, or both statutes if their whistleblowing is protected under both.
The complaining employee must demonstrate:
If OSHA finds there is reasonable cause to believe a violation has occurred, the employer’s obligations include reinstatement of the complaining employee to his or her original position, back pay with interest, compensatory damages and legal expenses.
Practically speaking, this means that both large and small employers should ensure that employees who apply for, or receive, an APTC or tax credit are not singled out, retaliated against, or treated differently from employees who do not receive a tax credit. Employers should consider ensuring that individuals, who have access to that information, properly protect and firewall information relating to Marketplace coverage, enrollment, subsidies, or tax credits.
Bourque N. (2017 January 10). Handling of retaliation complaints under section 1558 of the affordable care act[Web blog post]. Retrieved from address http://blog.ubabenefits.com/handling-of-retaliation-complaints-under-section-1558-of-the-affordable-care-act
Great article from the Kaiser Family Foundation about Americans thoughts on ACA repeal by Ashley Kirzinger, Bryan Wu, and Mollyann Brodie
The latest Kaiser Health Tracking Poll finds health care among the top issues Americans want President-elect Donald Trump and the next Congress to address in 2017. When asked which issue they would most like the next administration to act on in 2017, one-fourth of the public mention the economy and jobs (24 percent), followed by immigration (20 percent), and health care (19 percent). Among Democrats and independents, the economy and jobs is the top issue (23 percent and 24 percent, respectively) while the top issues for Republicans are immigration (30 percent) and economy and jobs (29 percent). Among all partisans, health care ranks among the top three issues that the public wants the next administration to act on in 2017.
The top issue for voters who supported President-elect Donald Trump are similar to those among Republicans: economy and jobs (31 percent) and immigration (31 percent), followed closely by health care (27 percent).
When asked to mention which health care issue they would most like President-elect Trump and the next Congress to act on in 2017, about one-third of the public mention the Affordable Care Act (ACA) but attitudes are mixed between wanting the next administration to act on repealing the 2010 health care law (14 percent), improving/fixing the law (11 percent), or keeping/expanding the law (8 percent).
When asked about a series of health care priorities for President-elect Trump and the next Congress to act on, repealing the ACA falls behind other health care priorities. Two-thirds of the public (67 percent) say lowering the amount individuals pay for health care should be a “top priority” for President-elect Trump and the next Congress. This is followed by six in ten (61 percent) who say lowering the cost of prescription drugs should be a “top priority,” and nearly half (45 percent) who say dealing with the prescription pain killer addiction epidemic should be a “top priority.”
Smaller shares say repealing the 2010 health care law (37 percent), decreasing how much the federal government spends on health care over time (35 percent), and decreasing the role of the federal government in health care (35 percent) should be top priorities.
While about two-thirds of Democrats, Republicans, and independents say lowering the amount individuals pay for health care should be a “top priority,” partisans differ in how they prioritize other health care issues. Most notably, while 63 percent of Republicans say repealing the 2010 health care law should be a top priority – this view is shared by much smaller shares of independents (32 percent) and Democrats (21 percent). Similarly, Republicans (50 percent) are more likely than independents (34 percent) or Democrats (26 percent) to place a top priority on decreasing the role of the federal government in health care. By contrast, Democrats and independents are somewhat more likely than Republicans to place a top priority on lowering the cost of prescription drugs (67 percent, 61 percent, and 55 percent, respectively) and on dealing with the epidemic of prescription painkiller addiction (51 percent, 46 percent, and 39 percent, respectively).
Lowering out-of-pocket health care costs is a top priority for Americans, and this was also a campaign promise from Donald Trump during his 2016 presidential campaign. When asked how confident they are in President-elect Trump’s ability to deliver on this campaign promise that Americans will get better health care at a lower cost than they pay now, Americans are split with similar shares saying they are either “not too confident” or “not at all confident” (51 percent) as saying they are “very confident” or “somewhat confident” (47 percent).
Confidence in President-elect Trump’s promise that Americans will get better health care at a lower cost is largely divided by party identification and 2016 vote choice with nearly nine in ten Republicans (85 percent) and Trump voters (86 percent) saying they are either “very” or “somewhat” confident in the next administration’s ability to deliver on this campaign promise. This is compared to 81 percent of Democrats and 86 percent of Clinton voters who say they are either “not too confident” or “not at all confident” that the next president will deliver on this promise.
Throughout the 2016 presidential election, it became clear that the two major political parties in the U.S. have competing views on the future of health care. When given two competing approaches to the future of health care, six in ten Americans (62 percent) prefer “guaranteeing a certain level of health coverage and financial help for seniors and lower-income Americans, even if it means more federal health spending and a larger role for the federal government” while about one-third (31 percent) prefer “limiting federal health spending, decreasing the federal government’s role, and giving state governments and individuals more control over health insurance, even if this means some seniors and lower-income Americans would get less financial help than they do today.”
There are also partisan differences, with about half of Republicans (53 percent) preferring the approach that Republican leaders have coalesced around – limiting federal health spending, decreasing the federal government’s role, and giving states and individuals more control; this approach is preferred by much smaller shares of independents (27 percent) and Democrats (15 percent). The majority of Democrats (79 percent) and independents (65 percent) prefer guaranteeing a certain level of coverage for seniors and lower-income Americans – even if it means a larger role for the federal government and increased federal spending.
The future of the Affordable Care Act has been at the forefront of the political agenda since the 2016 election with President-elect Trump and Republican lawmakers in Congress saying they will quickly move to repeal the health care law in 2017. The latest survey finds public opinion towards the law is divided with similar shares of the public saying they have an unfavorable opinion (46 percent) as say they have a favorable opinion (43 percent) of the law, which is largely stable from previous months.
As Congressional lawmakers make plans for the future of the ACA, the latest Kaiser Health Tracking survey finds that – similar to overall attitudes towards the law – the public is also divided on what they would like lawmakers to do when it comes to the 2010 health care law.
Overall, 49 percent of the public think the next Congress should vote to repeal the law and 47 percent say they should not vote to repeal it. Of those who want to see Congress vote to repeal the law, a larger share say they want lawmakers to wait to vote on repeal until the details of a replacement plan have been announced (28 percent) than say Congress should vote to repeal the law immediately and work out the details of a replacement plan later (20 percent).
The survey examines the malleability of attitudes towards Congress repealing the health care law and finds that both supporters and opponents of Congress voting to repeal the law can be persuaded after hearing counter-messages. After hearing pro-repeal arguments, the share of the public supporting repeal can grow to as large as 60 percent, while counter-messages against repeal can decrease support to 27 percent.
Among those who originally said Congress should not vote to repeal the 2010 health care law, about one-fifth (22 percent) change their opinion after hearing that some consumers around the country have seen large increases in the cost of their health insurance – which is similar to the share who shifted their opinion after hearing that the country cannot afford the cost of providing financial help to individuals to purchase health insurance.
On the other side of the debate, some of those who originally said they support Congress voting to repeal the health care law are also persuaded by hearing arguments often made by opponents of the repeal efforts. The survey finds that a share shifts their opinion after hearing that some people with pre-existing conditions would no longer be able to get health coverage and after hearing that some of the roughly 20 million Americans who got health insurance as a result of the law would lose their coverage.
Overall, large shares of Americans say their own health care will “stay about the same” if lawmakers vote to repeal the 2010 health care law. More than half of Americans say the quality of their own health care (57 percent) and their own ability to get and keep health insurance (55 percent) will stay about the same if the law is repealed. Fewer (43 percent) say the cost of health care for them and their family will stay about the same if the law is repealed. In each of these cases, about equal shares believe their own situation will get better as say it will get worse.
After being read a definition of “pre-existing condition,” just over half (56 percent) of U.S. adults say that they or someone in their household would be considered to have such a condition. Overall, these individuals are more likely than those without a pre-existing condition to say their access, quality, and cost of health care will get “worse” if the ACA is repealed. However, about one in five of these individuals say their access, quality, and cost of health care will get “better” if the ACA is repealed.
One-third of individuals who have someone in their household with a pre-existing condition say the cost of health care for them and their family will get worse if the ACA is repealed, compared to about one in five of those living in a household without someone with a pre-existing condition. Larger shares of those with a pre-existing condition also say their ability to get and keep health insurance will get worse than those without a pre-existing condition (24 percent vs. 17 percent), and the quality of their own health care will get worse (21 percent vs. 15 percent).
In addition, individuals with a pre-existing condition in their household also report being more worried about health-care related issues than those without a pre-existing condition. Slightly more than half (54 percent) of those with a pre-existing condition say they are either “very worried” or “somewhat worried” about not being able to afford the health care services they need, compared to 43 percent of those without a pre-existing condition. Similarly, 43 percent of those with a pre-existing condition are worried (either “very” or “somewhat”) about losing their health insurance compared to 30 percent of those without a pre-existing condition.
The latest Kaiser Health Tracking Poll finds President-elect Donald Trump’s transition and cabinet appointments was the most closely followed news story during the past month with seven in ten (68 percent) Americans closely following news about his transition. Other stories that captured the attention of Americans include the conflict involving ISIS in Mosul, Iraq (64 percent), the CIA’s report of Russia interfering in the 2016 presidential election (64 percent), and the top health policy story this month – Republican plans to repeal the ACA (63 percent). Other health policy stories followed by Americans this month include the ongoing heroin and prescription painkiller addiction epidemic in the U.S. (57 percent), Republican plans for the future of Medicare (51 percent), and the passing of the 21st Century Cures Act (37 percent).
See the original article and charts Here.
Krizinger A., Wu B., Brodie M. (2017 January 06). Kaiser health tracking poll: health care priorities [Web blog post]. Retrieved from address http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-health-care-priorities-for-2017/
Stay up-to-date with the most recent compliance alerts from our partners at United Benefits Advisors (UBA).
On January 20, 2017, the IRS released a Memorandum on the tax treatment of benefits paid by fixed indemnity health plans that addresses two questions:
The IRS concluded that an employer may not exclude payments under an employer-provided fixed indemnity health plan from an employee’s gross income if the coverage’s value was excluded from the employee’s gross income and wages. Further, an employer may not exclude payments under an employer-provided fixed indemnity health plan if the plan’s premiums were made by salary reduction through a §125 cafeteria plan.
A fixed indemnity health plan pays a specific amount of cash for certain health-related events (for example, $40 per office visit or $100 per hospital day). The amount paid is neither related to the medical expense incurred, nor coordinated with other health coverage. Further, a fixed indemnity health plan is considered an “excepted benefit.”
Under HIPAA, fixed dollar indemnity policies are excepted benefits if they are offered as “independent, non-coordinated benefits.” Under the Patient Protection and Affordable Care Act (ACA), excepted benefits are not subject to the ACA’s health insurance requirements or prohibitions (for example, annual and lifetime dollar limits, out-of-pocket limits, requiring individual and small-group policies to cover ten essential health benefits, etc.) This means that excepted benefit policies can exclude preexisting conditions, can have dollar limits, and do not legally have to guarantee renewal when the coverage is cancelled.
Further, under the ACA, excepted benefits are not minimum essential coverage so a large employer cannot comply with its employer shared responsibility obligations by offering only fixed indemnity coverage to its full-time employees.
Some examples of fixed indemnity health plans are AFLAC or similar coverage, or cancer insurance policies.
Generally, the Internal Revenue Code imposes taxes on wages paid with respect to employment. For federal income tax withholding, the Internal Revenue Code generally requires every employer who pays wages to deduct and withhold taxes on those wages.
In the context of an employer-provided fixed indemnity health plan, when the employer’s payment for coverage by the fixed indemnity plan is excluded from the employee’s gross income, then the payments by the plan are not excluded from the employee’s gross income.
In contrast, when the premiums are paid with after-tax dollars, the payments by the plan are excluded from the employee’s gross income.
Download the release here.
Great article from Kaiser Health News about ACA enrollment by Phil Galewitz
Despite the Affordable Care Act’s rising prices, decreased insurer participation and a vigorous political threat to its survival, consumer enrollment for 2017 is outpacing last year’s, according to new federal data and reports from state officials around the country.
Americans’ anxiety about how a new Republican-controlled Congress and President-elect Donald Trump will repeal and replace the health law is helping fuel early enrollment gains in the online marketplaces that sell individual coverage, state exchange officials and health consultants said.
Healthcare.gov, the federal marketplace which handles coverage for 39 states, enrolled6.4 million people from Nov. 1 through Monday, about 400,000 more than at the same time a year ago, the Health and Human Services Department said Wednesday. Monday was the deadline in those states to sign up for coverage starting Jan. 1, but open enrollment will continue until Jan. 31 for 2017 coverage.
“The marketplace is strong … and now we know the doomsday predictions about the marketplace are not coming true,” HHS Secretary Sylvia Burwell said in a press briefing.
The surge in sign-ups on the federal marketplace mirrors activity on several state-run Obamacare exchanges, according to figures obtained from states independently by Kaiser Health News. Minnesota, with more than 54,000 enrollees as of Monday, doubled the number of sign-ups it had at the same time last year. Colorado, Massachusetts and Washington had enrollment growth of at least 13 percent compared to a year ago.
“Because of the new administration and the high likelihood of changes coming to the ACA, it is creating a sense of urgency” for people to enroll, said Michael Marchand, director of communications for the Washington Health Benefit Exchange. Enrollment exceeded 170,000 customers on the Washington exchange as of this week, up 13 percent compared to same time a year ago.
Other state exchanges saw moderate increases: Connecticut, 3 percent; Idaho, 4 percent; Maryland, 1 percent. California’s enrollment is about same as a year ago. Rhode Island’s enrollment dropped to 27,555 from 31,900 for the same period last year. State exchange officials cited a drop in customers who were automatically renewed because UnitedHealthcare dropped out.
About 12.7 million people enrolled in the state and federal exchanges for 2016 coverage at the end of the previous enrollment season. HHS predicted in October that an additional 1.1 million people would sign up for 2017 coverage. Burwell said Wednesday that her department is sticking with that projection, even though “the headwinds have increased” since the election.
Obamacare, now in its fourth open enrollment season, took some heavy blows this year after several big insurers — including UnitedHealthcare, Humana and Aetna — withdrew from many marketplaces for 2017 because of heavy financial losses. At the same time, remaining insurers increased premiums by 25 percent on average.
All of that, plus a changed political climate in Washington, was expected to dampen enrollment. While the surprise presidential election outcome may have been the primary force for changing those expectations, other factors also have fueled enrollment growth this fall, state officials pointed out in interviews.
More people who don’t qualify for government subsidies are buying health plans on the exchanges because it’s an easier way to compare available plans in one place. Noting that trend, Premera Blue Cross in Washington recently stopped selling individual coverage off the exchange.
In Minnesota, higher government subsidies — which reduce premiums for people with lower incomes — is the main reason why more people have signed up, according to Allison O’Toole, CEO of MNsure, the state-run exchange. The subsidy amount is tied to the cost of the second-lowest silver plan on the exchange, so as premiums rise for that plan, the subsidy rises too. Premiums soared by an average 50 percent in Minnesota for second-lowest silver.
Another factor driving earlier enrollment in that state was caps set by several Minnesota insurers on the number of new enrollees they would accept. People signed up earlier to make sure they could get the plan they wanted, according to O’Toole.
Minnesota’s growth is surprising because one of its biggest carriers, Blue Cross and Blue Shield of Minnesota, stopped selling its most popular health plan on the exchange. That forced about 20,000 people to change insurers or switch from Blue Cross’ PPO, which has a broad provider network, to its HMO plan with a narrower network.
In Colorado, the 18 percent increase in enrollment so far has exceeded officials’ expectations, said Luke Clarke, the spokesman for Connect for Health Colorado, the state exchange. “We had an office pool and no one picked a number that high,” he said. “It was a healthy surprise,” particularly because premiums increased in the state by about 20 percent on average.
Conservatives warn it’s still too early for Obamacare supporters to celebrate.
“I suspect that some states saw big increases because local advocacy groups were able to tell their constituents that they should enroll before Trump is sworn in and Republicans take over Congress — thereby pretty much guaranteeing that they get a full year’s coverage regardless of what Republicans might do on repeal,” said Joe Antos, a health economist with the American Enterprise Institute, a conservative think tank.
Under that scenario, large enrollment increases this fall might be followed by a dropoff in January over the 2016 numbers and the final enrollment tally could end up similar this year’s, he said. Antos noted the true enrollment figures will be known once people pay for their coverage and stay enrolled for the full year.
“As with everything related to ACA,” Antos said, “it’s easy to find a happy story if you squint hard enough and don’t wait for the enrollment process to complete — or the plan year to end.”
Galewitz P. (2016 December 21). Obamacare enrollment is beating last year’s early pace [Web blog post]. Retrieved from address http://khn.org/news/obamacare-enrollment-is-beating-last-years-early-pace/
Does the new year have you worried? Check out this great article from Employee Benefits Advisor about employers concerns in 2017 by Phil Albinus
In the aftermath of President-elect Donald Trump’s surprise victory last month, the top employee benefit concern among employers remains their role on the Affordable Care Act. According to a survey of 800 employers conducted by brokerage solution provider Aon, nearly half — 48% — responded that the employer mandate is their biggest concern for the new administration.
According to J.D. Piro, head of the Aon’s law group, the concern stems from whether or not Trump will repeal and replace Obamacare and what plans the 115th Congress has for Medicare.
“It’s all of those [issues] and the employer mandate which has the reporting obligations, the disclosure obligations, 1094 and 1095 forms and the service tracking … all of that goes into the ACA. The concern is, is it going to be dropped, expanded or modified in some way?” Piro tells EBN.
“Employers have all sorts of questions about that,” he adds.
The employer mandate was by far the top employer concern, according to the Aon survey, which was administered after the election. “Prescription drug costs” received 17% of responses and the “excise tax” received 15% of respondents’ attention. “Tax exclusion limitations on employer-sponsored healthcare” garnered 10% of votes while “paid leave laws” and “employee wellness programs” trailed at 8% and 2%, respectively.
The results didn’t surprise Piro. The employer mandate “is something employers had to get up to speed on and learn how to administer in a very short period of time. It was so complex that it was delayed for a year. It’s not yet part of the framework, and people are still addressing how to comply with it,” he says.
While Piro declined to make any predictions about what the new administration will accomplish in terms of healthcare, he does think Congress will act quickly, if at least symbolically.
“I think something will happen in 2017. The most likely scenario is Republicans will pass some sort of repeal bill in the first 100 days of the new administration, but they will put off the effective date of the repeal until 2018 or 2019,” he says. “It will be somewhere down the road so they can decide when and what the replacement is going to be.”
The sheer complexity of ACA and Medicare will not make its repeal an easy matter for either the new Trump administration or Congress.
“This is an interconnected web of laws and rulings and the ACA affects every sector of healthcare. It’s thousands of pages of regulations,” Piro says. “Repealing it is not as easy as turning off a light switch or unplugging a computer and plugging it back in again.”
“A lot of people are affected by ACA and you have to consider what the impact is going to be.”
Albinus P. (2017 January 04). What’s employers’ no. 1 concern in 2017 [Web blog post]. Retrieved from address http://www.employeebenefitadviser.com/news/whats-employers-no-1-concern-in-2017?utm_campaign=eba%20daily-jan%204%202017&utm_medium=email&utm_source=newsletter&eid=909e5836add2a914a8604144bea27b68
Great article from our partner, United Benefit Advisors (UBA) by Danielle Capilla
Recently, the U.S. Department of the Treasury, Department of Labor (DOL), and Department of Health and Human Services (HHS) (collectively the Departments) issued final regulations regarding the definition of short-term, limited-duration insurance, standards for travel insurance and supplemental health insurance coverage to be considered excepted benefits, and an amendment relating to the prohibition on lifetime and annual dollar limits.
Effective Date and Applicability Date
These final regulations are effective on December 30, 2016. These final regulations apply beginning on the first day of the first plan or policy year beginning on or after January 1, 2017.
Short-Term, Limited-Duration Insurance
Short-term, limited-duration insurance is a type of health insurance coverage designed to fill temporary gaps in coverage when an individual is transitioning from one plan or coverage to another plan or coverage. Although short-term, limited-duration insurance is not an excepted benefit, it is exempt from Public Health Service Act (PHS Act) requirements because it is not individual health insurance coverage. The PHS Act provides that the term ‘‘individual health insurance coverage’’ means health insurance coverage offered to individuals in the individual market, but does not include short-term, limited-duration insurance.
On June 10, 2016, the Departments proposed regulations to address the issue of short-term, limited-duration insurance being sold as a type of primary coverage.
The Departments have finalized the proposed regulations without change. The final regulations define short-term, limited-duration insurance so that the coverage must be less than three months in duration, including any period for which the policy may be renewed. The permitted coverage period takes into account extensions made by the policyholder ‘‘with or without the issuer’s consent.’’ A notice must be prominently displayed in the contract and in any application materials provided in connection with enrollment in such coverage with the following language:
THIS IS NOT QUALIFYING HEALTH COVERAGE (‘‘MINIMUM ESSENTIAL COVERAGE’’) THAT SATISFIES THE HEALTH COVERAGE REQUIREMENT OF THE AFFORDABLE CARE ACT. IF YOU DON’T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE AN ADDITIONAL PAYMENT WITH YOUR TAXES.
The revised definition of short-term, limited-duration insurance applies for policy years beginning on or after January 1, 2017.
Because state regulators may have approved short-term, limited-duration insurance products for sale in 2017 that met the definition in effect prior to January 1, 2017, HHS will not take enforcement action against an issuer with respect to the issuer’s sale of a short-term, limited-duration insurance product before April 1, 2017, on the ground that the coverage period is three months or more, provided that the coverage ends on or before December 31, 2017, and otherwise complies with the definition of short-term, limited-duration insurance in effect under the regulations. States may also elect not to take enforcement actions against issuers with respect to such coverage sold before April 1, 2017.
Capilla D. (2016 December 27). Regulations regarding short-term limited-duration insurance, expected benefits, and lifetime/annual limits [Web blog post]. Retrieved from address http://blog.ubabenefits.com/regulations-regarding-short-term-limited-duration-insurance-excepted-benefits-and-lifetime/annual-limits?utm_source=hs_email&utm_medium=email&utm_content=39791464&_hsenc=p2ANqtz-93zXbLZ1IMRNJd0vnbk3Qrw4dBOsmz06ljjf7Fbt8-gf0U9T4rXwQr0zAzQjAWJ9lcagi3yTGOaLaZxUAf7zB03D0c8Q&_hsmi=39791464