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Health plans - design

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[Opinion] Politics and the Exchanges
"If this cannot be worked out by all of the stakeholders, states will aggressively look to implement public plans or single-payer initiatives (Colorado has one on the ballot this fall). In exchange for insurers continuing to operate profitable group policies in the states they are licensed, insurers should be required to have a presence on the exchanges. In return, the government needs to make sure these individual plans are underwritten soundly, that eligibility requirements tighten up in a manner that the industry has advocated for." (Frenkel Benefits)
One in Five New York Manufacturers Have Cut Jobs Because of Obamacare
"One-fifth (21%) of manufacturers and 17% of service firms said they reduced the number of employees because of the ACA's effects.... Twenty-four percent of manufacturers and eighteen percent of service firms said they cut wages and benefits because of the ACA.... [T]he median [health care cost] increase for New York businesses in 2016 was 8.5%, and the median expected cost increase for 2017 was 10%." (U.S. Chamber of Commerce)
Marketplace Plan Payment Options for Dealing with High-Cost Enrollees
"This paper considers potential modifications of the HHS risk adjustment methodology to maintain plan protection against risk from high-cost cases within the current regulatory framework.... [M]odifications of the transfer formula and of the risk adjustment model itself are mathematically equivalent to a conventional actuarially fair reinsurance policy. Furthermore, closely related modifications of the transfer formula or the risk adjustment model can improve on conventional reinsurance by figuring transfers or estimating risk adjustment model weights recognizing the presence of a reinsurance function." (National Bureau of Economic Research [NBER])
[Opinion] How to Rescue Obamacare as Insurers Drop Out
"[If] the federal exchange and all of the other state exchanges were to adopt the 'one big marketplace' rule, the risk that insurers such as Aetna and UnitedHealth would selectively abandon customers in Obamacare exchanges would evaporate. Merging the relatively healthy individuals who now buy coverage outside the exchanges with those using Obamacare would help stabilize insurance for the whole group." (The Washington Post; subscription may be required)
Employees Have Positive Attitudes Toward Workplace Wellness Programs, But Participation Is Low
"Most (81%) participants saw a positive impact on their physical wellbeing and more than 60% agreed or strongly agreed that including family in such programs would be likely to increase their participation. For those who did not participate, 37% did not find them personally relevant and 20% did not know they were available.... A great majority (91%) said they would engage in healthier behaviors if they were rewarded. Almost all employees under age 35 agreed (98%), but those over 55 (85%) were somewhat less motivated by rewards." (American Journal of Managed Care)
Blue Cross Plans May Be Obamacare's Fire Wall
"The nation's Blue Cross and Blue Shield plans could be the biggest benefactor of insurers leaving public exchanges under the [ACA]. So far, most Blue Cross plans have said they remain supporters of public exchanges and will maintain offerings for 2017. This includes the nation's biggest Blue Cross plan, Anthem, which operates in 14 states and will expand to more markets should it win regulatory approval of its Cigna acquisition." (Forbes)
Some Small Businesses Restore Group Health Coverage
"Some small companies that dropped group health insurance for their employees are reversing course, driven by a tightening labor market and rising costs and fewer choices for individual coverage.... Questions about the merits of individual versus group coverage are intensifying as changes continue to roil the insurance market." (The Wall Street Journal; subscription may be required)
[Guidance Overview] Opt-Out Payments Under the ACA
"[U]nconditional opt-out payments increase the employee's cost of coverage (and, accordingly, impact whether the coverage is affordable under the ACA), [but] conditional opt-out payments made pursuant to an 'eligible opt-out arrangement' do not. So, what is a conditional payment under an eligible opt-out arrangement?" (Jackson Lewis P.C.)
Does Digital Health Need Reimbursement?
"[T]he reimbursement environment is changing for the better for telemedicine reimbursement ... But do digital health tools need direct reimbursement under third-party payment programs to thrive?.... With the push by the federal government and private payers for value-based purchasing, population health management and bundled and capitated payments (collectively, APMs), digital health tools can be valuable simply for the efficiencies improved quality they can bring to the delivery of health care services." (McDermott Will & Emery)
CMS Focuses on Provider Steering of Medicare- and Medicaid-Eligible People to Marketplaces
"On August 18, CMS [addressed] a concern expressed by insurers that providers and provider-affiliated organizations are steering people eligible for Medicare and/or Medicaid coverage to individual marketplace plans to obtain higher provider payment rates.... [CMS asked] for comments on the extent and nature of this practice and on what can or should be done about it. CMS also sent letters to all Medicare-enrolled dialysis facilities expressing the concerns found in the information request." (Health Affairs)
Making HSAs Relevant to Millennials (PDF)
"[M]any Millennials are in the financial wellness game, but they're not accessing the HSA's full value.... [S]ome tips for tailoring the HSA message.... [1] Paint a picture.... [2] Highlight the unique now- or-later nature of HSAs.... [3] Illustrate the long-term impact.... [4] Tell the story differently ... [5] Encourage them to take action." (HSA Coach)
Think Your Obamacare Plan Will Be Like Employer Coverage? Think Again
"[S]ix years into the health law, the reality is that a typical Obamacare plan looks more like Medicaid, only with a high deductible. The typical marketplace plan covers a small number of low-cost doctors and hospitals, and offers fewer frills than employer plans. The recent high-profile exits of many of the national insurers from markets around the country will only heighten the shift." (The New York Times; subscription may be required)
Insights for Optimizing Your Employee Benefits Program (PDF)
12 pages. "Benefits optimization is an approach to designing a portfolio of employee benefits that maximizes desired workforce outcomes against a given benefits budget.... Further enabling employers to refine their approach to benefits optimization is the increased availability of data and analytics, which represents a powerful tool that employers can use to learn more about the employee base, gain a better understanding of the types of benefits employees need at various life stages, and predict financial behaviors. These capabilities can be harnessed to design benefit plans, educational programs, and communications materials to drive desired employee behaviors and outcomes." (Prudential)
[Official Guidance] Text of IRS Rev. Proc. 2016-28: Inflation Adjusted Amounts for Health Savings Accounts (HSAs) (PDF)
"For calendar year 2017, the annual limitation on deductions ... for an individual with self-only coverage under a high deductible health plan is $3,400. For calendar year 2017, the annual limitation on deductions ... for an individual with family coverage under a high deductible health plan is $6,750.... For calendar year 2017, a 'high deductible health plan' is ... a health plan with an annual deductible that is not less than $1,300 for self-only coverage or $2,600 for family coverage, and the annual out-of-pocket expenses ... do not exceed $6,550 for self-only coverage or $13,100 for family coverage." (Internal Revenue Service [IRS])
Where Insurers' Exits Are Hurting Obamacare Exchanges, and Where They Aren't
"Many major metropolitan areas, such as those in California, New York and Texas, will still have several insurers for individual health insurance consumers to choose from. In Texas, all major metro areas ... including Austin, Dallas, Houston and San Antonio -- will have at least three insurers after Aetna and UnitedHealthcare exit. That's true also for most urban exchange customers living in the Northwest, the Midwest and New England. Most hurt will be marketplace consumers in Arizona, North and South Carolina, Georgia and parts of Florida, where only one or two insurers will be left when open enrollment season begins Nov. 1." (National Public Radio)
Health Care Provider/Payor Integration: 2016 Is Not the 1990s
"While many of the factors that drove hospitals and health systems to establish [Provider-Sponsored Health Plans (PSHPs)] are again present in today's health care market, the drive to move away from fee-for-service payment systems has heightened the desire of many hospitals and health systems move back into the PSHP business in order to gain control of the full premium dollar." (McDermott Will & Emery, via National Law Review)
[Guidance Overview] Government Proposes Rules for Employer Opt-Out Payments Under ACA
"An unconditional opt-out arrangement increases the employee's required contribution for purposes of determining the affordability of health coverage under the ACA. The proposed regulations provide an exception for opt-out payments made under an 'eligible opt-out arrangement.' In an eligible opt-out arrangement, employees must offer 'reasonable evidence' of alternative coverage at least every plan year." (Willis Towers Watson)
[Opinion] Employers, Unions Look to Direct Contracting for Health System Contracts
"Employers and unions are quietly beginning to go around their brokers and health plans, which have often become the complicit contracting agents for the industry's excesses. Seen from this perspective, direct contracting's potential is virtually limitless." (Employee Benefit News)
[Opinion] Another Obamacare Architect Recognizes Its Unintended Consequences
"Dr. Bob Kocher, an Obamacare architect turned venture capitalist, has admitted the law has had a significantly negative unintended consequence ... Back in 2009 and 2010, Dr. Kocher believed that the consolidation of physicians and hospitals into large health systems would lead to higher quality care at lower cost. As Dr. Kocher notes, the systems are consolidating, but they are not hitting cost and quality targets. Instead, smaller, physician-led practices do better at such improvements." (National Center for Policy Analysis Health Policy Blog)
Insurer Exits from ACA Exchanges Turn Few Choices Into None
"Later this year, residents of Pinal County, Arizona, who go shopping for health insurance under Obamacare will face a peculiar dilemma -- they'll have to buy a product that may not exist. The 400,000-population county southeast of Phoenix currently doesn't have a single health insurer offering coverage next year on the [ACA]'s exchanges, where Americans can shop for the insurance they're required to have under the law.... Pinal County is just one place around the country where Americans will be left with few, if any, choices for coverage." (Bloomberg)
Aetna Had Warned It Might Leave ACA Exchanges If Humana Merger Was Blocked
"Aetna warned the Obama administration in July that it would withdraw from some [ACA] exchanges if officials moved to block its proposed merger with rival Humana ... 'Unfortunately, a challenge by the DOJ to that acquisition and/or the DOJ successfully blocking the transaction would have a negative financial impact on Aetna and would impair Aetna's ability to continue its support, leaving Aetna with no choice but to take actions to steward its financial health,' the letter read." (Morning Consult)
Medical Providers Try Uber, Lyft for Patients with Few Transportation Options
"For people without access to private transportation, getting to medical appointments can be a challenge ... Some hospitals and medical providers think that ... ride-hailing services such as Uber and Lyft -- can address this problem by making the trips easier and, in some cases, it is even covered by Medicaid and other insurance plans. Partnerships between ride-hailing companies and hospitals are emerging around the country. While the efforts are still small, some hospitals and medical transportation providers think the potential for growth is large." (Kaiser Health News)
[Guidance Overview] Proposed Rule Affects Opt-Out Payments to Employees Who Decline Health Coverage
"To avoid having to increase the required contribution by the amount of the opt-out payment, the arrangement must meet specific requirements. Employers with calendar-year plans will need to act quickly to implement necessary changes. Employers also need to review their flex credit programs[.]" (Segal Consulting)
[Opinion] The ACA Six Years Later: Success or Failure?
"There are a few aspects of the ACA that make sense, including the electronic delivery of prescriptions and the ability for people with pre-existing conditions to obtain coverage. But there are also unintended consequences. The healthcare cooperatives have largely been a failure and the rapid consolidation of healthcare providers is concerning to both regulators and consumers.... While plans may be available to all, they are rapidly becoming unaffordable to those that most need coverage. Six years later, some 30 million Americans are still uninsured." (BDO Center for Healthcare Excellence and Innovation)
Hidden Plan Exclusions May Leave Gaps In Women's Care
"Buried in the fine print of many marketplace health plan documents is language that allows them to refuse to cover a range of services ... [S]ome women with hereditary breast and ovarian cancer, advocates say, may have gaps in care because of the exclusions." (Kaiser Health News)
[Opinion] Aetna to Withdraw from Nearly 70 Percent of Its Obamacare Exchanges
"Aetna's forthcoming withdrawal is the latest blow for the ACA, whose insurers argue that they have been overwhelmed by pools that don't include enough healthy members to balance out heavier users. 'Back when UnitedHealth was the only insurance company bailing out, it was easy to dismiss as just one company trying to boost its bottom line,' wrote Bloomberg's Max Nisen ... 'But when all five big insurers are bleeding money, it's clear you've got bigger problems.' " (The Atlantic)
[Opinion] Is Medical Mutual of Ohio Losing or Winning?
"Limiting network choice and limiting where to do business is bound to reduce the unhealthy risk while also eliminating providers who are unwilling to lower their reimbursement rates. Instead of Medical Mutual rolling out 45% increases to members they will send them cancellation notices.... Obamacare supporters will point to the rate reductions as a product of the law working. Never mind the fact that it is only 'working' by limiting the providers of care that are essential to the health of those Obamacare was supposed to protect the most." (InsureBlog)
Strategies to Stabilize the ACA Marketplaces: Lessons from Medicare
16 pages. "In implementing and managing the Medicare Advantage and Part D programs, policymakers have used a range of approaches intended to guarantee the markets' viability and long-term success. These include policies and strategies to encourage participation by insurance companies, keep premiums stable, and enhance enrollment. In this paper, the authors consider whether any of these policies or strategies could also be used to help stabilize the ACA marketplaces, and if so, what the pros and cons of doing so would be." (Robert Wood Johnson Foundation)
Private Health Exchanges: Coming to Your Employer?
"Although the number of employers adopting private exchanges jumped 35 percent in the 2016 plan year (on top of a 100 percent jump in 2015) only 3 percent of all U.S. employers use an exchange. Employers may be slow to jump on the bandwagon because they don't know about this new structure, or they may not be convinced it will lower costs." (CBS MoneyWatch)
Aetna Cuts ACA Exchange Participation to 4 States in 2017
"Aetna Inc. will withdraw from 11 of the 15 states where it currently offers plans through the [ACA] exchanges ... Aetna will reduce the number of counties where it sells exchange plans next year to 242 from 778 ... Aetna has been a major player in ACA business, with about 1.1 million individual enrollees, roughly 838,000 of whom purchased their coverage on the exchanges.... Aetna's move comes after UnitedHealth Group Inc. and Humana Inc. already unveiled major reductions in their ACA-plan offerings, and as more nonprofit cooperative insurers have said they will fold." (The Wall Street Journal; subscription may be required)
Telehealth Parity Laws: Lack of Uniformity Creates Obstacles for Expected Cost Savings
"[T]elehealth implementation varies from state to state in terms of what services providers will be reimbursed for delivering, as well as what sort of 'parity' ... is expected between in-person health services reimbursements and telehealth reimbursements. This variation affects providers' ability to implement telehealth options ... Consequently, telehealth faces significant obstacles in becoming an accepted and used health care option for individuals, and states and the nation as a whole cannot fully realize the cost savings of telehealth." (Health Affairs)
Federal District Judge Denies Preliminary Injunction in ACA Premium Stabilization Program Case
"Judge Ebinger did not resolve the question of which party was most likely to prevail in the lawsuit ... Rather, in rejecting the motion for a preliminary injunction, she relied heavily on the lack of irreparable injury. She noted that the liquidators were merely seeking money from the federal government and that they had an adequate remedy in a lawsuit in the federal Court of Claims for what they were owed." [Gerhart v. HHS, No. 16-151 (S.D. Ia. Aug. 12, 2016)] (Health Affairs)
[Opinion] Tri-Agency Proposed Regs Change Excepted Benefit Conditions for Hospital Indemnity, Fixed Indemnity, and Specified Disease Insurance (PDF)
"[T]he proposed new federal regulatory restrictions add new 'conditions' for several types of 'excepted benefits' coverage that are not expressly included in the statutory language that was adopted in HIPAA and that remained unchanged by the ACA.... [T]he proposals in the NPRM exceed the text of the statutory standards and as a result exceed the authority of these Departments." (Council for Affordable Health Coverage [CAHC])
[Guidance Overview] Group Health Plan Sponsors Should Review Gender Transition Benefits
"While each set of rules clearly prohibits 'categorical exclusions' based on gender identity or transgender status, it might be permissible to exclude coverage for a service that applies broadly to all participants but may impact transgender employees and those undergoing a gender transition, as long as the exclusion has a legitimate, nondiscriminatory basis." (Willis Towers Watson)
Will Your Prescription Meds Be Covered Next Year? Better Check!
"CVS Caremark and Express Scripts, the biggest prescription insurers, released their 2017 lists of approved drugs this month, and each also has long lists of excluded medications. Some of the drugs newly excluded are prescribed to treat diabetes and hepatitis. The CVS list also excludes some cancer drugs, along with Proventil and Ventolin, commonly prescribed brands of asthma inhalers, while Express Scripts has dropped Orencia, a drug for rheumatoid arthritis. Such exclusions can take customers by surprise[.]" (National Public Radio)
More Small, Midsized Firms Choose Health Plan Self-Funding
"Between 2013 and 2015, the proportion of midsized companies with 100 to 499 employees that were self-insured increased 19 percent, to 30.1 percent ... The percentage of small firms with fewer than 100 employees that self-funded their health plans grew 7 percent, to 14.2 percent ... Meanwhile, self-funding by large companies declined slightly, to 80.4 percent." (Healthcare Finance News)
[Opinion] An Obamacare Offer Small Businesses Can't, and Shouldn't, Refuse
"Whatever you may think about the health exchanges for individuals or the Medicaid expansions, they have unquestionably expanded coverage.... In the case of coverage for small businesses, the ACA's SHOP exchanges have fizzled. To be more precise, fewer than 1/3 of 1 percent of employees in businesses with 50 of fewer employees are insured through SHOP exchanges. And that is a pity, because the ACA SHOP eases the purchase of insurance for employers and broadens choice for their employees." (RealClearMarkets)
Insights for Optimizing Your Employee Benefit Programs (PDF)
12 pages. "Nearly two-thirds (65%) of surveyed finance executives said that employee benefits are critical to attracting and retaining employees, and 63% indicated employee satisfaction with benefits is important for their company's success.... [S]everal trends are challenging employers to think more holistically about their benefit offerings and the outcomes they wish to achieve through these offerings." (Prudential)
CMS Report Cites Flat Per-Enrollee Costs In ACA Marketplaces
"The fact that claims cost growth was essentially flat from 2014 to 2015 strongly suggests that the health of the risk pool is improving as enrollment grows. This hypothesis is supported by the fact that cost growth was lower in states that saw greater growth in individual market enrollment." (Timothy Jost, in Health Affairs)
[Guidance Overview] Exposure Draft for Update of NAIC ERISA Handbook: Multiple Employer Welfare Arrangements (PDF)
"[Most multiple employer welfare arrangements (MEWAs)] are not ERISA-covered plans since they are usually not established or maintained by an employer or employee organization. Significantly, states may regulate MEWAs whether or not they are employee welfare benefit plans or covered by ERISA." (ERISA (B) Working Group, National Association of Insurance Commissioners [NAIC])
Why Marilyn Tavenner Is Worried About Obamacare This Fall
"[Marilyn Tavenner, head of America's Health Insurance Plans,] rattled off her wish list for the Obamacare exchanges, including the need to market to more young, healthy Americans. She also noted that two of the '3Rs' -- risk corridors and reinsurance, meant to help health plans through the first difficult stages of the ACA -- are scheduled to be phased out. That places more of a burden on the last 'R' -- the risk-adjustment program, which has been frustrating for insurers." (Politico)
[Guidance Overview] Building on Premium Stabilization for the Future
"[CMS is] are exploring options to modify the ACA's permanent risk adjustment program to better adjust for the highest-cost enrollees and their actuarial risk, which would achieve some of the same risk-sharing benefits as the reinsurance program.... In future rulemaking, [CMS plans] to propose modifying the risk adjustment program to absorb some of the cost for claims above a certain threshold (e.g. $2 million), funded by a small payment from all issuers. This type of risk sharing would reduce uncertainty for issuers who are not yet able to reliably predict the prevalence and nature of high-cost cases in their Marketplace business, while also protecting access to robust coverage options for people with very high-cost conditions." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Changes in ACA Individual Market Costs 2014-2015: Near- Zero Growth Suggests an Improving Risk Pool (PDF)
"[A]fter making comparability adjustments described [in this memo], per-member-per-month paid claims in the ACA individual market fell by 0.1 percent from 2014 to 2015. For comparison, per-enrollee costs in the broader health insurance market grew by at least 3 percent.... Available evidence indicates that the slow ACA individual market cost growth resulted at least in part from a broader, healthier risk pool.... Nearly all states saw continued growth in Marketplace enrollment in 2016, suggesting continued risk pool improvement." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Court Examines Plan's Residential Treatment Restriction Under Mental Health Parity Rules
"This case would likely have turned out differently under the final mental health parity regulations applicable to group health plans for plan years beginning on or after July 1, 2014 ... Unlike the 2010 interim final regulations, the preamble to the final regulations clarifies that the mental health parity requirements apply to restrictions and exclusions on the 'scope of services' or 'continuum of care' that is provided for mental health conditions and substance use disorders. The term 'scope of services' refers to the 'types of treatments and treatment settings' that are covered by a group health plan. At its simplest, this could include coverage for outpatient visits and inpatient hospital stays." [Danny P. v. Catholic Health Initiatives, No. 15-5024 (W.D. Wash. Jun. 30, 2016)] (Thomson Reuters / EBIA)
Initial Insights from Year 2 of the ACA Risk Adjustment Program
"Total risk adjustment transfer payments at the national level remained at about 10% of premium in the individual market and 6% of premium in the small group market. Roughly one in four issuers offering plans in a given state or market in both 2014 and 2015 switched between payer and receiver status. Statewide risk scores rose more year-over-year than the movements in market demographics and average plan benefit richness would have suggested. Where available, the interim risk adjustment report did not provide a reliable indication of the ultimate value of the 2015 risk score." (Milliman)
Active Life Expectancy in the Older U.S. Population, 1982-2011: Racial Differences Persisted
"[The authors] examine changes in active life expectancy in the United States from 1982 to 2011 for white and black adults ages sixty-five and older. For whites, longevity increased, disability was postponed to older ages, the locus of care shifted from nursing facilities to community settings, and the proportion of life at older ages spent without disability increased. In contrast, for blacks, longevity increases were accompanied by smaller postponements in disability, and the percentage of remaining life spent active remained stable and well below that of whites. Older black women were especially disadvantaged in 2011 in terms of the proportion of years expected to be lived without disability." (Health Affairs)
Most Major U.S. Companies Will Offer Telehealth Benefits
"In 2017, 90 percent of large employers will offer their employees access to telehealth services -- broadly defined as a remote connection with a health-care provider... By 2020 ... 97 percent of large employers will offer their employees access to telehealth services.... In 2012, just 7 percent of employers offered access to telehealth services." (Bloomberg BNA)
Suicide Prevention: Access to Behavioral Health Services Lacking
"There are a number of barriers that could be keeping individuals from receiving services that would reduce their likelihood of engaging in self-harm behavior. The differences in the use of services by individuals with commercial and Medicaid insurance indicates that access to care is one of those barriers. The commercially insured were more likely to have a primary care visit, specialty care visit, and prescription drug filled for a behavioral health medication prior to an intent-to-harm-self emergency department encounter. People with Medicaid were more likely to have an emergency department encounter." (Health Affairs)
[Guidance Overview] CMS Announces 2018 Changes to Medicare Advantage Value-Based Insurance Design Model
"In the second year of the model, beginning January 1, 2018, CMS will: [1] open the model test to new applicants; [2] conduct the model test in three new states -- Alabama, Michigan, and Texas; [3] add rheumatoid arthritis and dementia to the clinical categories for which participants may offer benefits; [4] make adjustments to existing clinical categories; and [5] change the minimum enrollment size for some MA and MA-PD plan participants." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Technological Innovation in Healthcare and Benefits
"Americans are uncomfortable navigating healthcare. Employees don't want paper materials or a one-time enrollment meeting. They want information when they want it. Healthcare is exploding with technology tools to guide in making healthcare decisions with an emphasis on cost transparency." (Frenkel Benefits)
[Opinion] It's Time for the Government to Play Hardball with Those Whining Obamacare Insurers
"What if [the government] conditioned participation in Medicaid and Medicare managed care on a certain minimum participation in the private exchanges? Alternatively, it could reinvent and restore the public option, whether by offering Medicare to all Americans under 65 or sponsoring its own public plans. These mechanisms might work because, given their lower premium rates, they might attract more low-use enrollees -- the elusive young and healthy cadres needed to help subsidize costlier and older members." (Michael Hiltzik, via Los Angeles Times)
[Opinion] U.S. Chamber of Commerce Comment Letter to IRS on Expatriate Health Plans, Expected Benefits, and Limited Duration Insurance
"If finalized, these regulatory proposals would render an overly narrow and restrictive application of the flexibility that the EHCCA was designed to provide: the compliance deadline or effective date; the new regulatory definition of 'substantially all;' the new notice requirement for electronic furnishing of statements; the truncated term for short-term, limited duration insurance; and travel requirements for expatriates. The Chamber has discrete concerns regarding each of these sections and recommends substantive changes for these provisions in the Final Rule." (U.S. Chamber of Commerce)
Employers' Health Plan Cost Increases Will Be Far Lower Than ACA Premiums
"A majority of large employers expect the cost growth for their health care benefit to remain stable at 6 percent in 2017, but specialty drugs are the most-cited driver of cost increases ... Many employers expect to be able to hold cost growth at 5 percent by making changes to plan benefit designs. There's also a growing focus on streamlining delivery systems and tactics aimed at controlling drug costs." (Morning Consult)
[Guidance Overview] Health Care Reform -- The Gift That Keeps on Giving: Section 1557 Nondiscrimination Rules
"Covered plan sponsors must ensure that their group health plans do not discriminate based on any section 1557 protected status in terms of health coverage, claim denials, or cost sharing limits.... [If] a plan contains a blanket exclusion of coverage for transgender services, that exclusion must be removed. These changes should be made in time to be communicated during 2017 open enrollment meetings." (Wilkins Finston Friedman Law Group LLP)
Obamacare Appears to Be Making People Healthier
"A few recent studies suggest that people have become less likely to have medical debt or to postpone care because of cost. They are also more likely to have a regular doctor and to be getting preventive health services like vaccines and cancer screenings. A new study ... offers another way of looking at the issue. Low-income people in Arkansas and Kentucky, which expanded Medicaid insurance to everyone below a certain income threshold, appear to be healthier than their peers in Texas, which did not expand." (The New York Times; subscription may be required)
GAO Report: Medicaid 'Innovation' Waivers Should Expand, Not Restrict Health Coverage
"Under the ACA, states can use 1332 Medicaid waivers starting in 2017 to tinker with some of the law's core provisions, including the individual mandate, employer penalties, rules governing exchanges and covered benefits, as well as premium tax credits. However, the GAO report states that as a practical matter, proposals cannot upend the need for the IRS and the federal exchange,, to administer a consistent program across states, one that does not unduly burden the government to make state-specific IT changes, for example." (American Journal of Managed Care)
[Opinion] Risk Adjustment Gone Wrong
"Risk adjustment requires an insurer to report on the health risk of its members, and to do that it needs good data. Plans that played the game better from the start set a high priority on collecting and reporting on that information.... The dominant pre-ACA players had more years of member data, and mature analytics capabilities, to help them maximize their risk scoring. This has created a serious penalty for new entrants in the first few years which CMS has not addressed." (The Health Care Blog)
Employers Expect Health Care Costs to Increase 5.0%
"[N]early nine in 10 (88%) employers identified managing pharmacy spending generally for high-cost specialty drugs specifically as their top priority over the next three years. Planned actions include: [1] Ensuring appropriate utilization.... [2] Addressing specialty pharmacy spending that occurs through the medical benefit plan.... [3] Differentiating benefit coverage to influence site of care." (Willis Towers Watson)
Aetna Judge Hands Off Anthem Merger Case to Speed Trials
"U.S. District Judge John Bates ... [said] he would keep the case against Aetna Inc.'s deal for Humana Inc., leaving the challenge to Anthem Inc.'s takeover of Cigna Corp. to another judge. Bates kept the Aetna case because it's on a tighter deadline with its merger agreement expiring at the end of the year. 'Given the complexity and importance of these cases, the court cannot feasibly try and decide both in that time frame,' the judge wrote ... 'Ultimately, it will be fairer to the parties and better for the public if one of the cases is randomly reassigned to another judge in this district, who can give it prompt and full attention while this judge does the same with the other.' " (Bloomberg)
[Opinion] ERIC Comment Letter to IRS on Proposed Regs for Expatriate Health Plans and Other Issues (PDF)
"Flexibility is needed to ensure expat plans can continue to be a viable option for employees.... Indemnity and disease-specific benefits improve the lives of employees, and flexibility must be maintained.... Short-term, limited duration plans serve an important niche, and the Departments must take a balanced approach in regulating them.... Effective date should be delayed as planning is already underway for the 2017 plan year." (The ERISA Industry Committee [ERIC])

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