Executive Order from President Trump on the ACA

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On Friday, January 20, 2017, President Trump signed his first Executive Order, titled “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal.”

The Executive Order instructs the Secretary of the Department of Health and Human Services (HHS) and the heads of all other executive departments and agencies with authority, or responsibility, under the Patient Protection and Affordable Care Act (ACA) to exercise all authority and discretion to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the ACA that would impose a fiscal burden on any state, or cost a fee, tax, penalty, or regulatory burden on individuals, families, health care providers, health insurers, patients, recipients of health care services, purchasers of health insurance, or makers of medical devices, products, or medications.

Notably, employers are not specifically enumerated in the list of those being protected from fiscal burdens, although arguments could be made that they are “purchasers of health insurance.”
The Executive Order also indicates that, as required, heads of agencies must comply with the Administrative Procedure Act and other applicable statutes in considering or promulgating such regulatory revisions. Essentially, the required notice-and-comment process of rule making still stands as required.

Risk-averse employers will wait for confirmation from various federal agencies that regulations they are in the process of complying with (notably, ACA-related reporting) are on hold for the time being. Without confirmed Cabinet members for the Secretary of HHS, the Secretary of the Treasury, and the Secretary of Labor, there will likely be a lag in information directly from any one agency. President Trump’s Chief of Staff also sent out a memo that essentially put a regulatory freeze on all agencies until presidential appointments are confirmed. We are, unfortunately, in a “wait and see” period.

Download the release here.

Obamacare Enrollment Is Beating Last Year’s Early Pace

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.”

See the original article Here.


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/

What’s employers’ No. 1 concern in 2017?

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.

Looking ahead

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.”

See the original article Here.


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

Stepping away from traditional workplace wellness programs

Interesting article from Employee Benefits Advisors about workplace wellness programs by Brendan Weafer

Many of today’s business owners are throwing a lot of money into workplace wellness programs because they understand the financial value of healthy employees. They aren’t, however, putting the same amount of thought into what type of wellness programs employees might actually use.

Employers have seen reports like the 2014 study by Virginia Tech College of Engineering that showed unhealthy workers are less productive, most likely to get injured, and need longer rest breaks than employees with a well-rounded lifestyle. They realize that unfit employees also have a higher turnover rate, which results in additional onboarding and training costs for employers. But simply offering a company wellness program doesn’t guarantee a reduction in employee healthcare costs, especially if the programs aren’t teaching healthy lifestyle training.

Many of the workplace wellness programs being offered today still rely on traditional ideas that have proven ineffective. Many programs are metrics-focused, recommending tasks like walking 10,000 steps a day or offer small — often taxable — incentives in an attempt to motivate participants to lose weight in a short amount of time. This kind of goal-oriented program does not actually teach the day-to-day wellness choices that are fundamental to building a healthy lifestyle. A number of programs incorporate wearable technology that measures walking, but walking is only one component of health, just as broccoli is a single component of a well-rounded diet. If you were only eating broccoli, that wouldn’t be a healthy lifestyle.

Moving and breathing

Workplace culture holds the key to fixing the national health crisis, and there are better ways for employers to ensure that an employee wellness program will actually work and provide employees with lasting change.

Since you can’t meditate to a smaller waistline or diet to a better night’s sleep, here are three things that employers should make sure to incorporate into the company wellness programs — things that can actually help employees learn and maintain a healthier lifestyle:

· Improve mobility with movement that can be done right at their desk, or on the fly.

· Increase strength with a bodyweight exercise program that starts small and builds throughout the year.

· Improve their diet with nutritional guidelines and tips including recipes, best times of day to eat, and how to optimize food choices — even for the holidays.

It is commonly misunderstood how small choices made on a daily basis can undermine wellness efforts. By providing achievable daily challenges to reinforce healthy choices, workplace wellness programs that take the holistic approach in teaching healthy lifestyle habits will see better results. Small changes, practiced routinely over time, become the tools of a sustainable healthy lifestyle that produces significant long-term results.

See the original article Here.


Weafer B. (2016 December 14). Stepping away from traditional workplace wellness programs [Web blog post]. Retrieved from address http://www.employeebenefitadviser.com/opinion/stepping-away-from-traditional-workplace-wellness-programs?feed=00000152-1387-d1cc-a5fa-7fffaf8f0000

4 Things Your Company Should Consider as New Overtime Rules are Put on Hold

Great article from SHRM by Sushma Tripathi

The U.S. Department of Labor (DOL) is fighting a court ruling that put new FLSA (Fair Labor Standards Act) overtime regulations on hold. Last month, a district court in Texas issued a nationwide preliminary injunction blocking the DOL’s final rule that sought to raise the required salary level to qualify for white collar exemptions.

Although the DOL now seeks to lift the injunction, the overtime changes that were scheduled to take effect December 1 remain on hold for the time being.

Several possibilities exist as to what will happen next. The DOL could file a motion to stay, or suspend, the injunction during the appeals process. If the court were to grant such a motion, this would cause the rule to take effect. If no motion to stay is filed, or if such a motion is denied, the injunction will stand during the appeals process.

To add a further layer of complication, the DOL filed a motion for an expedited appeal on December 2, which motion was granted on December 8, and the DOL’s opening brief will be due on December 16, 2016. Further, the states’ brief in support of the district court’s injunction will be due on January 17, 2017 and the DOL’s reply brief will be due on January 31, 2017. We will not have a decision on the expedited appeal until sometime in February 2017. While all this plays out, it’s natural to ask: What should businesses be doing?

Here a few things to consider:

  • Rapidly assess what actions to take and what actions are possible. Many employers spent months preparing for the FLSA changes, identifying workers affected by the final regulations, and determining whether to increase their salaries to comply or reclassify them as non-exempt employees, and communicating those changes to their employees. If an employer already notified an employee of a salary increase effective December 1 or already made the change, it may be too difficult to reverse that change and communicate that the change won’t occur. You should confer with your counsel and consider whether it’s better to go ahead with your initial plans and stay the course, especially if your payroll team already processed the change.
  • Start tracking time now. The court may side with the DOL and the proposed regulations could be reinstated retroactively to the original December 1 effective date. For that reason, employers that decide not to take action to comply with the new regulations while the litigation and appeal are pending should consider directing reclassified employees to track time. This will ensure that, in the event the final rule is later upheld and overtime becomes due retroactively, employers will have an accurate record of hours worked.
  • Continue to evaluate the FLSA status of employees. While the rule is delayed, employers should continue to evaluate the FLSA status of their employees by reviewing job duties and descriptions to ensure that employees are properly classified. Whether or not the rule is upheld, employers remain subject to FLSA requirements that dictate proper job classification and payment methods. Take this opportunity to make sure employees’ duties match their job descriptions. Following the recession in 2008, in many workplaces, tasks were redistributed after layoffs and many employees took on additional duties that were never added to into their job descriptions. These employees may need to be reclassified under existing FLSA regulations.
  • Be transparent in communicating changes. In deciding how to proceed, employers are strongly advised to consult with internal or external legal counsel and other experts to discuss options available before making and communicating decisions related to this latest development. Employee relations and financial implications should be considered. Employers should also keep in mind that applicable state laws may require advance notice of any changes in pay. State laws may also govern the overtime exempt status of employees. Remember to convey to employees that it’s the law that’s causing potential changes and not your company. Otherwise, morale can be impacted if employees feel they are being demoted by being reclassified.

While we have no crystal ball and cannot predict what a Trump administration will do, one can guess that it might direct the DOL to abandon the appeal, because President-elect Trump previously stated that he thought that small businesses should be exempt from the proposed increases in minimum salary for the white-collar exemptions. The Trump administration might prefer to take a more gradual approach to raising the minimum salary levels, instead of the almost 100 percent increase contemplated by the DOL’s rule, or may prefer no increase at all. So, our advice to employers is to take this time to make sure you’re in compliance with existing wage and hour laws and ensure you have employees classified properly. There’s no time like the present.

See the original article Here.


Tripathi S. (2016 December 14). 4 things your company should consider as new overtime rules are put on hold[Web blog post]. Retrieved from address http://blog.shrm.org/blog/4-things-your-company-should-consider-as-new-overtime-rules-are-put-on-hold

5 employee benefits trends for 2017

Interesting article about emerging trends in employee benefits for 2017 by Marlene Satter

As the old year ticks down toward a new year filled with a drastic change in Washington that will no doubt have plenty of ripple effects throughout the country, the employee benefits sector will also be in for plenty of changes.

Based on its 14th Annual U.S. Employee Benefit Trends Study and other industry indicators, MetLife has prognosticated five trends it believes will be key in 2017.

There are no silver bullets and the health system as structured today cannot pivot effectively. But there are some strategies...

Employers might be surprised by some, and are probably already wrestling with others—but here’s what to watch for in the year to come.

5. Customization.

If there’s one thing that’s clear in benefits, it’s that everybody is not happy with the same cookie-cutter benefit package.

And as the job market improves and employers have to work harder to attract and retain top talent, one way to do that is to provide benefits that satisfy needs that might be a little out of the ordinary. Employers that can satisfy their employees’ diverse needs, the study found, “will emerge clear winners in the talent war.”

What’s more, employees are becoming more focused on specific benefits.

The study revealed that 28 percent of all generations agree that critical illness insurance is a must-have, but it doesn’t stop there—different generations want different things. For instance, about 14 percent of millennial employees consider pet insurance a must-have benefit.

And don’t forget about benefits communications. No rubber-stamp information wanted here—employees want communications about their benefits customized to them.

4. Enrollment.

Here’s an area where employees are not happy—so change will have to come if the situation is to improve.

The study found that only about a third of employees say that their company’s benefit communications are easy to understand—and that leads many to assume they don’t need many of the benefits they’re offered. That’s definitely not a good situation.

The good news: 71 percent of employers say that by working with an enrollment firm they were able to improve communication, including explaining and clarifying nonmedical benefits.

For employers to stay ahead of the curve, they’ll have to join the movement to better educate their employees on enrollment.

3. Financial stress.

The biggest single source of stress for employees is financial stress, which weighs not only on employees but on employers’ bottom lines as well. And that situation screams to be addressed.

While financial wellness programs help employees to better manage their personal finance situations, cutting stress as a result, employers so far haven’t jumped on the bandwagon.

In fact, some of the few who offered them have quit doing so, with just 31 percent of employers having provided financial wellness programs this year. That’s down from 39 percent last year, according to the study.

If employers wise up and provide help with financial wellness, employees will sleep better at night and work better during the day. And so will their employers.

2. Data security.

Whether it’s hackers or phishers, more threats to data security arise every day—not just for consumers but for companies and their employees.

Losses from hacked, hijacked or ransomed data can drive a company out of business, but employers also have to be as protective of their employees’ data as they are of their customers’.

One way to do that, the study pointed out, is to shore up the digital support chain by moving to a single benefits carrier; that can help to limit the exposure of employee data.

With the average cost of a large-scale data breach sitting at approximately $4 million, according to a study conducted by the Ponemon Institute, it’s a smart investment.

1. Legal services.

If you’re looking for a new lure to attract top talent, this could be your ticket. MetLife has characterized legal services as the “best-kept secret of benefits.” SHRM adds that it has doubled in popularity over the past 10 years.

At some point, the study pointed out, just about everyone is going to have to deal with a legal issue. Major life events, such as buying a home, getting married, having a baby or caring for an aging parent, all have important legal implications.

According to MetLife insights, “For about $20 a month, a legal plan can help,” adding that the benefit is of particular importance to millennials. Of adults that are offered a legal plan through work, a Harris poll found that nearly 70 percent of those aged 21–34 are enrolled.

See the original article Here.


Satter M. (2016 December 7). 5 employee benefits trends for 2017[Web blog post]. Retrieved from address http://www.benefitspro.com/2016/12/07/5-employee-benefits-trends-for-2017?page_all=1

ACA ‘repeal and replace’ plans in motion for 2017: What should HR do?

ACA's replacement may soon by on the way according to this article by Lauren Stead

Republican House and Senate leaders have been energized by the election of a president likely to accept a proposal to repeal Obamacare. As a result, they’re preparing to dismantle the Affordable Care Act (ACA) within the first 100 days of Donald Trump’s first term. 

Reports coming out of Capitol Hill indicate that the repeal measures GOP congressional leaders are planning to introduce would most likely be modeled after a 2015 repeal bill that was vetoed by President Obama. In addition, Senate leaders are thinking of using a process called reconciliation, which would allow budget bills to pass with a simple majority vote and bypass any filibuster attempts from Democrats.

Republicans are looking to pass repeal measures as Trump transitions into office, but delay the effective date of the repeal for two to three years.

GOP leaders are hoping the delay of the full rollback of Obamacare would sway enough Democrats to vote for the repeal and avoid a protracted legislative process.

The delay would also buy Republican lawmakers time to come up with a plan to replace the ACA so some 20 million Americans who purchased insurance on Obamacare’s exchanges don’t lose their health insurance seemingly overnight — while still fulfilling the promises of the Trump campaign to take down the existing law.

Republicans have released few details on what exactly their replacement plan may look like, but Trump said he wants it to save some of the more popular parts of the ACA — like guaranteed coverage for individuals with pre-existing conditions and the ability for children to stay on their parents’ insurance policies until they are 26 years of age.

What does this mean for employers?

Employers, meanwhile, are left wondering: What do — and what can — we do with our company sponsored plans now?

The answer: Stay the course. Even if a repeal bill is passed the second Trump takes office, it’s unlikely to change anything in the near future.

For at least a little while, it looks like larger companies (those with 50+ employees) will still be subject to the employer mandate/shared-responsibility non-compliance penalties if they drop coverage — or even drop benefits limits significantly — for full-time equivalent employees (those working 30+ hours per week on average). The GOP hasn’t released any specific timelines.

That means large employers still have to work on complying with the ACA’s reporting requirements, for at least the 2016 plan year (for which reporting will be due in 2017).

Obamacare compliance should still be at the forefront of every employers’ actions, as it’s unlikely the feds will waive non-compliance penalties just because companies are banking on a future repeal.

See the original article Here.


Stead L.(2016 December 7). ACA 'repeal and replace' plans in motion for 2017: what should HR do?[Web blog post]. Retrieved from address http://www.hrmorning.com/aca-repeal-and-replace-plans-in-motion-for-2017-what-should-hr-do/

2016 Election Results: The Potential Impact on Health and Welfare Benefits

If you missed our partner,United Benefit Advisors (UBA) checkout this article by Les McPhearson

Following the November 2016 election, Donald Trump (R) will be sworn in as the next President of the United States on January 20, 2017. The Republicans will also have the majority in the Senate (51 Republican, 47 Democrat) and in the House of Representatives (238 Republicans, 191 Democrat). As a result, the political atmosphere is favorable for the Trump Administration to begin implementing its healthcare policy objectives. Representative Paul Ryan (R-Wis.) will likely remain the Speaker of the House. Known as an individual who is experienced in policy, it is expected that the Republican House will work to pass legislation that follows the health care policies in Speaker Ryan's "A Better Way" proposals. The success of any of these proposals remains to be seen.

Employers should be aware of the main tenets of President-elect Trump's proposals, as well as the policies outlined in Speaker Ryan's white paper. These proposals are likely to have an impact on employer sponsored health and welfare benefits. Repeal of the Patient Protection and Affordable Care Act (ACA) and capping the employer-sponsored insurance (ESI) exclusion for individuals would have a significant effect on employer sponsored group health plans.

Trump Policy Proposals

President-elect Trump's policy initiatives have seven main components:

  • Repeal the ACA. President-elect Trump has vowed to completely repeal the ACA as his first order of Presidential business.
  • Allow health insurance to be purchased across state lines.
  • Allow individuals to fully deduct health insurance premium payments from their tax returns.
  • Allow individuals to use health savings accounts (HSAs) in a more robust way than regulation currently allows. President-elect Trump's proposal specifically mentions allowing HSAs to be part of an individual's estate and allowing HSA funds to be spent by any member of the account owner's family.
  • Require price transparency from all healthcare providers.
  • Block-grant Medicaid to the states. This would remove federal provisions on how Medicaid dollars can and should be spent by the states.
  • Remove barriers to entry into the free market for the pharmaceutical industry. This includes allowing American consumers access to imported drugs.

President-elect Trump's proposal also notes that his immigration reform proposals would assist in lowering healthcare costs, due to the current amount of spending on healthcare for illegal immigrants. His proposal also states that the mental health programs and institutions in the United States are in need of reform, and that by providing more jobs to Americans we will reduce the reliance of Medicaid and the Children's Health Insurance Program (CHIP).

Speaker Ryan's "A Better Way" Proposal

In June 2016, Speaker Ryan released a series of white papers on national issues under the banner "A Better Way." With Republican control of the House and Senate, it would be plausible that elected officials will begin working to implement some, if not all, of the ideas proposed. The core tenants of Speaker Ryan's proposal are:

  • Repeal the ACA in full.
  • Expand consumer choice through consumer-directed health care. Speaker Ryan's proposal includes specific means for this expansion, namely by allowing spouses to make catch-up contributions to HSA accounts, allow qualified medical expenses incurred up to 60 days prior to the HSA-qualified coverage began to be reimbursed, set the maximum contribution of HSA accounts at the maximum combined and allowed annual high deductible health plan (HDHP) deductible and out-of-pocket expenses limits, and expand HSA access for groups such as those with TRICARE coverage. The proposal also recommends allowing individuals to use employer provided health reimbursement account (HRA) funds to purchase individual coverage.
  • Support portable coverage. Speaker Ryan supports access to financial support for an insurance plan chosen by an individual through an advanceable, refundable tax credit for individuals and families, available at the beginning of every month and adjusted for age. The credit would be available to those without job-based coverage, Medicare, or Medicaid. It would be large enough to purchase a pre-ACA insurance policy. If the individual selected a plan that cost less than the financial support, the difference would be deposited into an "HSA-like" account and used toward other health care expenses.
  • Cap the employer-sponsored insurance (ESI) exclusion for individuals. Speaker Ryan's proposal argues that the ESI exclusion raises premiums for employer-based coverage by 10 to 15 percent and holds down wages as workers substitute tax-free benefits for taxable income. Employee contributions to HSAs would not count toward the cost of coverage on the ESI cap.
  • Allow health insurance to be purchased across state lines.
  • Allow small businesses to band together an offer "association health plans" or AHPs. This would allow alumni organizations, trade associations, and other groups to pool together and improve bargaining power.
  • Preserve employer wellness programs. Speaker Ryan's proposal would limit the Equal Employment Opportunity Commission (EEOC) oversight over wellness programs by finding that voluntary wellness programs do not violate the Americans with Disabilities Act of 1990 (ADA) and the collection of information would not violate the Genetic Information Nondiscrimination Act of 2008 (GINA).
  • Ensure self-insured employer sponsored group health coverage has robust access to stop-loss coverage by ensuring stop-loss coverage is not classified as group health insurance. This provision would also remove the ACA's Cadillac tax.
  • Enact medical liability reform by implementing caps on non-economic damages in medical malpractice lawsuits and limiting contingency fees charged by plaintiff's attorneys.
  • Address competition in insurance markets by charging the Government Accountability Office (GAO) to study the advantages and disadvantages of removing the limited McCarran-Ferguson antitrust exemption for health insurance carriers to increase competition and lower prices. The exemption allows insurers to pool historic loss information so they can project future losses and jointly develop policy.
  • Provide for patient protections by continuing pre-existing condition protections, allow dependents to stay on their parents' plans until age 26, continue the prohibitions on rescissions of coverage, allow cost limitations on older Americans' plans to be based on a five to one ratio (currently the ratio is three to one under the ACA), provide for state innovation grants, and dedicate funding to high risk pools.

Speaker Ryan's white paper also addresses more robust protection of life by enforcing the Hyde Amendment (which prohibits federal taxpayer dollars from being used to pay for abortion or abortion coverage) and improved conscience protections for health care providers by enacting and expanding theWeldon Amendment.

Speaker Ryan also proposes other initiatives including robust Medicaid reforms, strengthening Medicare Advantage, repealing the Independent Payment Advisory Board (IPAB) that was once referred to as "death panels," combine Medicare Part A and Part B, repealing the ban on physician-owned hospitals, and repealing the "Bay State Boondoggle."

Process of Repeal

Generally speaking, the process of repealing a law is the same as creating a law. A repeal can be a simple repeal, or legislators can try to pass legislation to repeal and replace. Bills can begin in the House of Representatives, and if passed by the House, they are referred to the Senate. If it passes the Senate, it is sent to the President for signature or veto. Bills that begin in the Senate and pass the Senate are sent to the House of Representatives, which can pass (and if they wish, amend) the bill. If the Senate agrees with the bill as it is received from the House, or after conference with the House regarding amendments, they enroll the bill and it is sent to the White House for signature or veto.

Although Republicans hold the majority in the Senate, they do not have enough party votes to allow them to overcome a potential filibuster. A filibuster is when debate over a proposed piece of legislation is extended, allowing a delay or completely preventing the legislation from coming to a vote. Filibusters can continue until "three-fifths of the Senators duly chosen and sworn" close the debate by invoking cloture, or a parliamentary procedure that brings a debate to an end. Three-fifths of the Senate is 60 votes.

There is potential to dismantle the ACA by using a budget tool known as reconciliation, which cannot be filibustered. If Congress can draft a reconciliation bill that meets the complex requirements of our budget rules, it would only need a simple majority of the Senate (51 votes) to pass.

Neither President-elect Trump nor Speaker Ryan has given any indication as to whether a full repeal, or a repeal and replace, would be their preferred method of action.

The viability of any of these initiatives remains to be seen, but with a Republican President and a Republican-controlled House and Senate, if lawmakers are able to reach agreeable terms across the executive and legislative branches, some level of change is to be expected.

See the original article Here.


McPhearson L.(2016 November 14). 2016 election results: the potential impact on health and welfare benefits [Web blog post]. Retrieved from address http://blog.ubabenefits.com/2016-election-results-the-potential-impact-on-health-and-welfare-benefits

Health insurers willing to give up a key ACA provision

Great article about new changes to the ACA from BenefitsPro by Zachary Tracer

U.S. health insurers signaled Tuesday that they’re willing to give up a cornerstone provision of Obamacare that requires all Americans to have insurance, replacing it with a different set of incentives less loathed by Republicans who have promised to repeal the law.


Known as the “individual mandate,” the rule was a major priority for the insurance industry when the Affordable Care Act was legislated, and also became a focal point of opposition for Republicans.

In a position paper released Tuesday -- the first since President-elect Donald Trump’s victory -- health insurers laid out changes they’d be willing to accept.

“Replacing the individual mandate with strong, effective incentives, such as late enrollment penalties and waiting periods, can help expand coverage and lower costs for everyone,” AHIP said.

That also includes openness to Republican ideas such as an expanded role for health-savings accounts and using so-called high-risk pools to cover sick people.

In return, insurers are asking Republicans to create strong incentives to buy insurance, and to ensure the government continues to make good on payments it owes insurers under the ACA. The paper was released by America’s Health Insurance Plans, or AHIP, the main lobby for the industry.

“Millions of Americans depend on their current care and coverage,” AHIP said in the document outlining its positions. The group called on lawmakers to “ensure that people’s coverage -- and lives -- are not disrupted.”

Republican replacement

Now that they’re set to gain control of the White House, Republican lawmakers are working to define their vision for replacing the law after years of attempts to repeal it. Obamacare brought insurance coverage to about 20 million people via an expansion of Medicaid and new insurance markets, and repealing the law without a replacement would leave those individuals without coverage.

Trump has said that repealing and then replacing the law will be one of his first priorities. Republicans in Congress, however, have signaled that they’ll need time to write a replacement -- potentially via a years-long delay between passing a repeal and implementing it -- to craft a replacement.

And AHIP on Thursday said insurers will need at least 18 months to create new products and get them approved by state regulators, if Republicans change the market. It could take even more time to educate consumers and change state laws, AHIP said.

“It’s taken six years to get where we are now and to demonstrate the failure of Obamacare, so it’s going to take us a little while to fix it,” said Senator John Cornyn of Texas, a member of the Republican leadership in the chamber.

Medicaid changes

Republicans may also make substantial changes to Medicaid, by turning the joint state-federal program into one where the U.S. sends “block grants” to the states, which exert more control. Vice President-elect Mike Pence said on CNN Tuesday that the Trump administration will “develop a plan to block-grant Medicaid back to the states” so they can reform the program. Some Medicaid programs are administered in part by private insurers.

AHIP said any such plans should ensure that payments are adequate to meet the health needs of individuals in Medicaid coverage. And they should ensure that when enrollment increases in an economic downturn, funds are available to help states deal with the increased demand, AHIP said.

AHIP is open to working with Congress on replacement plans for the ACA, said Kristine Grow, a spokeswoman for the lobby group. The document is the first detailed look at AHIP’s priorities.

Big insurers like UnitedHealth Group Inc. and Aetna Inc. are already scaling back from the ACA’s markets, because they’re losing money. At the same time, remaining insurers are boosting premiums by more than 20 percent on average for next year.

Trump’s election increased the level of uncertainty in the market, and a repeal bill without something to replace the law could destabilize it further. To shore up insurance markets, AHIP says lawmakers should fund a program, known as reinsurance, designed to help insurers with high costs, through the end of 2018, and avoid cutting off cost-sharing subsidies for low-income individuals.

See the original article Here.


Tracer Z.(2016 December 7). Health insurers willing to give up a key ACA provision[Web blog post]. Retrieved from address http://www.benefitspro.com/2016/12/07/health-insurers-willing-to-give-up-a-key-aca-provi?ref=mostpopular&page_all=1

The year in employer-based healthcare: ACA uncertainty and cost-stemming efforts

Great recap from Employee Benefits Advisors about the ACA over the past year by Phil Albinus

With President-elect Donald Trump now filling his cabinet with men focused on elimination and possible replacement of the Affordable Care Act, it’s no surprise the top EBA story of the year in healthcare was the ACA and its future in a new political landscape. Almost immediately following his win, the fate of the insurance law that gave coverage to an extra 20 million uninsured Americans became uncertain.

On the campaign, candidate Trump called Obamacare a failed plan and a disaster, and many benefit advisers shared that view. Immediately following his victory, President-elect Trump revealed that his health plan would likely continue hallmarks of the ACA, such as the pre-existing condition rule as well as the provision allowing parents to keep their 26 year-old children on their health plans, but details have yet to be released.

Still, industry experts agreed that one of the first elements of the ACA to go would be the Cadillac tax. The employer mandate was a top concern for employers in a survey that was taken immediately after the election. According to Aon, which conducted the survey one week after the election, the reason was uncertainty. “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?” said an Aon representative.

When it comes to the new administration’s healthcare team, Trump has chosen U.S. Representative Tom Price (R-Ga.) to head the Department of Health and Human Services. A physician and outspoken critic of the ACA, Price has previously introduced legislation to replace President Obama’s health insurance law.

Critics of the ACA seemed to be hearted by Price’s nomination. “I think [it] shows a seriousness [about] at least repealing key parts of the ACA. No. 1 on the list to go first I think is the Cadillac tax,” says Brian Marcotte, president and CEO of The National Business Group on Health.

Marcotte adds, “I also think the employer and individual mandates would also be on the docket, as well as the federal subsidies. There’s a lot that’s unclear [about] how that would be done, but there is a seriousness here with [Trump] appointing Price.”

According to Craig Hasday, president of Frenkel Benefits, the politically divisive ACA would have to be replaced by a plan that pleased both sides of the political aisle. “I would give the Democrats an ‘A’ for effort, but a failing grade in executing President Obama’s signature legislation. And to a large part, I attribute this to partisanship arrogance. The party of ‘hope and change’ didn’t stay focused on what has worked to make our country great: the democratic process,” he says.

Cost concerns on the ballot
In other 2016 healthcare news that could have an impact on the coming year, the rising cost of prescription drugs remains a top concern. This year, it even reached the ballot box. A proposition to regulate drug costs failed on the California ballot in November, but a similar plan could pass or fail in Ohio next year.

Voters in California decided that drug prices should not be regulated so that state agencies would pay the same prescription costs that the U.S. Department of Veterans Affairs pays for its prescriptions. Despite this defeat, Ohio voters will decide a similar piece of legislation on the ballot next year, which is virtually identical to California’s prop 61.

Consumer-driven healthcare: Exchanges and telemedicine
The emerging private health insurance exchange market continued to emerge this year as large-scale employers took a wait-and-see approach to this healthcare delivery option. This was not the case with small to mid-size companies that saw the benefits of technology platforms that aim to simplify shopping for coverage, administering plans, costs controls and achieving improved results. Since the private exchange market now numbers at least 150 players, “employers are taking a longer time to assess which exchange is right for them,” says Barbara Gniewek, a principal PwC’s healthcare practice.

The caution over private benefit exchanges for workers approaching retirement thawed a bit in 2016 as well. A Willis Towers Watson survey found that 56% of U.S. employers said they were confident that public exchanges will be a viable option for their pre-age 65 retirees who are not yet eligible for Medicare. Employers consider public exchanges to be “relatively stable after a rocky start,” too. “About 25% of large U.S. employers offer pre- and post-age 65 retiree health benefits,” says Willis Towers Watson senior director of policy affairs John Barkett. “This is down from the late 1980s when upwards of two-thirds of employers provided this kind of coverage.”

When it came to new technology, American employers enthusiastically jumped on the telemedicine bandwagon even if their employees did not. Telemedicine services — such as workplace kiosks connected to nurse practitioners — among large employers surged to 59% in 2016 from 30% in 2015, according to Mercer’s National Survey of Employer-Sponsored Health Plans. The survey of 2,544 participants also noted the potential for significant savings when health plan members have a telephonic or video visit to assess non-acute issues. A telemedicine visit averages $40 compared with a traditional office visit that usually costs $125. “Now we have to get people to use the service in order for members and plan sponsors to benefit from the offering,” says a Mercer healthcare reform leader.

When it comes to curbing costs and providing healthcare to workers, onsite clinics delivered in 2016. According to the Employer Measure of Productivity, Absence and Quality Survey from the National Business Group on Health and Truven Health Analytics, 60% of the employers surveyed offered an onsite clinic to some portion of their workforce. Employers offering onsite clinic access to their entire workforce saw an average of less than five workdays missed per employee in 2014 compared to employers without clinics. They reported an employee absence rate in 2014 at more than 20 days per employee.

See the original article Here.


Albinus P. (2016 December 15). The year in employer-based healthcare: ACA uncertainty and cost-stemming efforts[Web blog post]. Retrieved from address http://www.employeebenefitadviser.com/news/the-year-in-employer-based-healthcare-aca-uncertainty-and-cost-stemming-efforts?brief=00000152-1443-d1cc-a5fa-7cfba3c60000