Feds pump out even more Obamacare instructions

Have you heard about the recent changes coming to the ACA? If not take a look at this great article from HR Morning about the recent changes that will be going into effect for the ACA by Jared Bilski

If you believe Republicans on Capitol Hill, the Affordable Care Act (ACA) isn’t long for this world. Still, the Obama administration continues to clarify how businesses are supposed to comply with the law’s many provisions. 

The Department of Labor (DOL), Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS) just put their heads together for the 35th time to address questions surrounding Obamacare reforms.

Here’s some of the most useful info to come out of this latest FAQ:

Qualified small employer HRA

As HR Morning reported previously, the 21st Century Cures Act, among other things, allows certain small employers to offer a general purpose stand-alone health reimbursement arrangement (HRA) without violating the ACA. It is also referred to as a “qualified small employer health reimbursement arrangement” — or QSEHRA.

The FAQ touches on how this new law jibes with the ACA and clarified that in order to be a QSEHRA, the structure of the plan must:

  • be funded entirely by an eligible employer — one with fewer than 50 full-time equivalent employees in the prior year and that doesn’t offer a group health plan to any of its employees
  • provide payment to, or reimbursement of, an eligible employee for medical care under Code section 213(d)
  • not reimburse more than $4,950 for eligible expenses for individuals or $10,000 for families, and
  • be provided to all eligible employees of the employer offering the HRA.

One thing the 21st Century Cures Act (and the feds’ FAQ) doesn’t address: Whether the Employee Retirement Income Security Act (ERISA) applies to a QSEHRA.

Special Enrollment & HIPAA

The FAQ also addressed special enrollment for group health plans under the Health Insurance Portability and Accountability Act (HIPAA). Because HIPAA generally allows current employees and dependents to enroll in a company’s group health plan if the employees/dependents lose their previous coverage, they must be offered the same special enrollment option if they lose individual market coverage (i.e., health coverage they obtained through the individual Obamacare marketplace — or “exchanges”).

This could happen to individual market participants if an insurer that was covering an employee/dependent decides to stop offering that individual market coverage. As we saw last year, several major insurers have taken that step.

One exception to this special enrollment: If the loss of coverage is due to a failure to pay premiums in a timely manner — or “for cause.”

Updated women’s preventive services

As you know, under the ACA, non-grandfathered health plans are required to provide recommended preventives services for women without any cost-sharing.

Those services are listed in the Health Resources and Services Administration’s (HRSA) guidelines, and the guidelines were just updated on December 20, 2016. The updated guidelines bolster many of the existing covered preventive care services for women in the areas of:

  • breast cancer
  • cervical cancer
  • gestational diabetes
  • HIV, and
  • domestic violence.

The services in the updated guidelines must be covered — without cost-sharing — for plan years beginning on or after December 20, 2017 (Jan. 1, 2018 for calendar year plans). Until then, plans can keep using the previous HRSA guidelines.

See the original article Here.

Source:

Bilski J. (2017 January 6). Feds pump out even more Obamacare instructions [Web blog post]. Retrieved from address http://www.hrmorning.com/feds-pump-out-even-more-obamacare-instructions/


Get Health Insurance Through Your Employer? ACA Repeal Will Affect You, Too

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.

Preventive Services Without Cost-Sharing

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.

Pre-Existing Condition Exclusions

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.

Dependent Coverage To Age 26

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.

Annual Out-Of-Pocket Limit

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.

Prohibition On Annual And Lifetime Limits

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.

External Review

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.

Source:

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/


Health Law Sleepers: Six Surprising Health Items That Could Disappear With ACA Repeal

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.

See the original article Here.

Source:

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


HSAs could play bigger role in retirement planning

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.

See the original article Here.

Source:

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


Kaiser Health Tracking Poll: Health Care Priorities for 2017

Great article from the Kaiser Family Foundation about Americans thoughts on ACA repeal by Ashley Kirzinger, Bryan Wu, and Mollyann Brodie

KEY FINDINGS:
  • The latest Kaiser Health Tracking Poll finds that health care is among the top issues, with the economy and jobs and immigration, Americans want President-elect Donald Trump and the next Congress to address in 2017. 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 including lowering the amount individuals pay for health care, lowering the cost of prescription drugs, and dealing with the prescription painkiller addiction epidemic.
  • When presented with two general approaches to the future of health care in the U.S., six in ten (62 percent) Americans 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 three in ten (31 percent) prefer the approach of “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.”
  • As Congressional lawmakers make plans for the future of the ACA, the latest survey finds the public is divided on what they would like lawmakers to do when it comes to the 2010 health care law. Forty-nine percent of the public think the next Congress should vote to repeal the law compared to 47 percent who 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 to repeal the law 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). However, the survey also finds malleability of attitudes towards Congress repealing the health care law with both supporters and opponents being persuaded after hearing counter-messages.

Top Issues for President-elect Trump and Congress

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).

LOWERING OUT-OF-POCKET COSTS IS A TOP PRIORITY FOR AMERICANS

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.

LOWERING OUT-OF-POCKET COSTS TOPS PRIORITIES REGARDLESS OF PARTISANSHIP

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).

CONFIDENCE IN PRESIDENT-ELECT TRUMP’S ABILITY TO REDUCE HEALTH CARE COSTS

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.

Americans’ Attitudes on the Future of Health Care in the U.S.

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.

ATTITUDES TOWARDS THE FUTURE OF THE AFFORDABLE CARE ACT

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.

REPEALING AND REPLACING THE AFFORDABLE CARE ACT

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).

HOW FLEXIBLE ARE AMERICANS’ OPINIONS OF REPEALING THE ACA?

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.

PERCEIVED EFFECTS OF CHANGES TO HEALTH CARE SYSTEM

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.

INDIVIDUALS WITH A PRE-EXISTING CONDITION

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.

Kaiser Health Policy News Index

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.

Source:

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/


Executive Order from President Trump on the ACA

Stay up-to-date with the most recent compliance alerts from our partners at United Benefits Advisors (UBA).

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.

Source:

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.

Source:

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.

Source:

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.

Source:

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