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Health plans - design

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ACA's 10 Essential Benefits: A Look At What's At Risk In GOP Overhaul
"Since the 10 required benefits are spelled out in the [ACA], it would require a change in the law to eliminate entire categories or to water them down to such an extent that they're less generous than typical employer coverage.... [P]olicy experts say there's room to 'skinny up' the requirements in some areas by changing the regulations that federal officials wrote to implement the law." (Kaiser Health News)
Facing Pressure, Insurance Plans Loosen Rules For Covering Addiction Treatment
"Aetna will stop requiring doctors seek approval before prescribing particular medications -- such as Suboxone -- that are used to mitigate withdrawal symptoms, and typically given along with steady counseling.... The change comes as addiction to opioids, which include heavy-duty painkillers and heroin, still sweeps the country.... And it puts Aetna in the company of Anthem and Cigna, which both recently dropped the prior authorization requirement for privately insured patients across the country." (Kaiser Health News)
Ex-CEO of Aetna: Here's What Health Care Should Look Like After Reform
"Obamacare has a 'structural imbalance' that resulted in higher costs for healthier, younger people, [former Aetna CEO Ronald Williams] said, but lower costs for those who are 'older and more likely to need care'.... Williams said what is needed is 'much more competition' and lower cost, more flexible plans so that consumers have 'a range of options as opposed to a "one-size-fits-all" approach.' " (CNBC)
[Opinion] Lifetime HSAs: The 'Antisocial' Health Reform that's Good for You!
"Under an individualized lifecycle theory of saving for future health care needs, most young peoples' premium dollars would accrue in their HSAs. Only a small portion of their premiums would go for catastrophic insurance. Over time HSA balances would grow and the ratio of HSA deposits to insurance premiums would decline as one's health risk increases with age." (National Center for Policy Analysis Health Policy Blog)
Healthcare Benefits in 2017: What Employers Have to Say
"2016 marked a milestone for healthcare consumerism, with the amount of organizations offering HDHPs jumping from 28% four years ago to 39% in last year's survey to 53% in this year's survey.... With this rise in HDHPs came an increase in the number of employees being enrolled in a Health Savings Account [HSA], Healthcare Reimbursement Arrangement [HRA], or Flexible Spending Account [FSA] ... 51.5% of respondents' employees are enrolled in one or more of these plans/arrangements." (Healthcare Trends Institute)
[Opinion] The Future of the ACA: Actuaries Focus on the Individual Health Insurance Market
"A recent report from the nation's top actuaries ... offers an unvarnished explanation of the impact of the relevant actuarial principles that informed the ACA and that must be negotiated in the process of its replacement.... The actuarial principles expounded in the paper appear to transcend law and politics and any ACA replacement plan that fails to take them in account may face significant, if not insurmountable, hurdles in achieving its objective." (Mintz Levin)
Health Savings Accounts: A Growing Tool for Consumers (PDF)
"As of January 2016, 59 plans offering HSA/HDHPs reported approximately 20.2 million HSA/HDHP enrollees, up from 19.7 million in 2015, or an annual increase of 2.5 percent.... The [largest group] of HSA/HDHP enrollees (35 percent) were ages 45-64, with 30 percent ages 25-44 ... Large group plans (firms with more than 50 employees) accounted for over 75 percent of all HSA/HDHP enrollment." (America's Health Insurance Plans [AHIP])
Interactive Tool Compares Proposals to Replace the ACA
Plans available for comparison: [1] The ACA, 2010; [2] Rep. Tom Price's Empowering Patients First Act, 2015; [3] House Speaker Paul Ryan's A Better Way: Our Vision for a More Confident America, 2016; [4] Sen. Bill Cassidy's Patient Freedom Act, 2017; and [5] Sen. Rand Paul's Obamacare Replacement Act, 2017. (Henry J. Kaiser Family Foundation)
[Opinion] Insurers, Not Government, Will Lead the Way to Lower Healthcare Costs
"In seeking solutions to the healthcare crisis, politicians have a different focus than insurers. Access is the politician's biggest concern -- how to address the needs of the greatest number of their constituency with the least friction possible.... Health insurance carriers, in contrast, concern themselves most with cost considerations in order to remain competitive in the marketplace.... [A] government-led solution will not work." (Frenkel Benefits)
Small Business Health Fairness Act Fact Sheet
"Introduced by Rep. Sam Johnson (R-TX), chairman of the Subcommittee on Social Security, and Rep. Tim Walberg (R-MI), chairman of the Subcommittee on Health, Employment, Labor, and Pensions, the Small Business Health Fairness Act (H.R. 1101) would empower small businesses to band together and offer coverage through AHPs to purchase quality health care coverage at a lower cost for their employees." (Committee on Education and the Workforce, U.S. House of Representatives)
[Guidance Overview] Unpacking the Trump Administration's Market Stabilization Proposed Rule
"The proposal states that HHS intends to issue guidance delaying 2018 filing deadlines, which likely will give insurers additional time to adjust to the new rules, but deadlines cannot be delayed long.... The first issue addressed by the NPRM is guaranteed availability.... The NPRM proposes reducing the open enrollment period for 2018.... The NPRM preface asks for comments on establishing continuous coverage requirements to discourage adverse selection and encourage continuous coverage.... The NPRM states that it is the intention of HHS to, beginning with the 2018 plan year, rely on state regulators to ensure network adequacy[.]" (Timothy Jost, in Health Affairs)
Investing HSA Funds Is Key to Substantial Growth
"The ability to invest HSA funds is a significant factor in helping drive account growth. In June 2016, HSA investment assets grew 23 percent from the previous year ... However, it is estimated that only 3 percent of all HSA account holders invest, which means the overwhelming majority of account owners are missing out." (DataPath)
CMS Proposes New Rules to Encourage Insurers to Stay in ACA Marketplace
"The proposed rule gives states greater authority, CMS said. States with the means to do so will review qualified health plans to assess issuer network adequacy ... CMS is also releasing a revised proposed timeline for the qualified health plan certification and rate review process for plan year 2018." (Healthcare Finance News)
Trump Administration Proposes Rule to Stabilize Obamacare Markets
"CMS said that the rule, which modifies the actuarial value used to determine the levels of Obamacare health plans, may lead to higher out-of-pocket costs for consumers.... The rule also addresses insurers' complaints about potential abuse of special enrollment periods in the individual market, requiring people to submit documents proving they qualify for changes to their coverage. Notably, the rule doesn't address age-rating bands that set how much more insurers can charge older people compared to younger participants." (Morning Consult)
Aetna Chief Executive Says Obamacare Is in 'Death Spiral'
"Aetna chief executive Mark Bertolini said ... his company has not decided whether to continue selling insurance in the exchanges in 2018, but it already has exited most of the markets where it previously sold plans, remaining in only four states this year.... He said that Aetna's heaviest utilizers of health care -- the top 1 percent to 5 percent -- are driving half of the costs in the exchanges." (The Washington Post; subscription may be required)
Anthem Sues Cigna Over Action to Terminate Merger Agreement, Seeks Enforcement of Merger Plus Recovery of Damages
"Anthem believes that there is still sufficient time and a viable path forward potentially to complete the transaction that will save millions of Americans more than $2 billion in annual medical costs and deliver significant value to shareholders. In addition to filing this lawsuit, Anthem is pursuing an expedited appeal of the District Court's decision and is committed to completing this value-creating merger either through a successful appeal or through settlement with the new leadership at the Department of Justice." (Anthem, Inc.)
Humana to Pull Out of Obamacare Exchanges in 2018
"Humana cut back its [ACA] exchange participation to 11 states last July, when the Department of Justice sued to block its deal with Aetna. The insurer said that despite efforts to mitigate losses on its exchange plans in 2017 through narrower networks and selective market participation, it is seeing early signs of high pharmacy utilization among its new members." (CNBC)
[Guidance Overview] In Brief: Health Insurance Premium Tax Credits and Cost-Sharing Subsidies (PDF)
15 pages. "Certain individuals without access to subsidized health insurance coverage may be eligible for premium tax credits ... Individuals who receive premium credits also may be eligible for subsidies that reduce cost-sharing expenses. The ACA established two types of cost-sharing subsidies. One type of subsidy reduces annual cost-sharing limits; the other directly reduces cost-sharing requirements (e.g., lowers a deductible). Individuals who are eligible for cost-sharing subsidies may receive both types." [Report R44425, Feb. 10, 2017] (Congressional Research Service)
[Official Guidance] Text of CMS Proposed Regs: ACA Market Stabilization
71 pages. "[W]e propose changing the dates for open enrollment in the individual market for the benefit year starting January 1, 2018, from a range of November 1, 2017, to January 31, 2018 (the previously established open enrollment period for 2018), to a range of November 1, to December 15.... [W]e propose increasing pre-enrollment verification of eligibility for all categories of individual market special enrollment periods for all States served by the platform from 50 to 100 percent of new consumers who seek to enroll in Exchange coverage.... [W]e propose revising our interpretation of the guaranteed availability requirement to allow issuers to apply a premium payment to an individual's past debt owed for coverage from the same issuer enrolled in within the prior 12 months.... [W]e propose to increase the de minimis variation in the actuarial values (AVs) used to determine metal levels of coverage for the 2018 plan year.... We are not proposing a modification for the de minimis range for the silver plan variations." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
The Future of Essential Health Benefits
"[C]ritics of the EHB cite them as a cause of high health insurance costs and as an example of federal overreach. They say the EHB are too expansive and too prescriptive.... Because the principal changes to private insurance mandated by the EHB were to increase availability of coverage for maternity, mental health and substance use disorders, and habilitative care, one possible goal of modifying the EHB rule would be to restrict these benefits." (Health Affairs)
Employee Loses Wellness Plan Challenge
"An employee who temporarily stopped receiving health insurance coverage due to a refusal to submit to a wellness plan assessment test but who then received retroactive coverage did not have a valid claim to challenge the legality of the plan ... The court also found that the company voluntarily ceased its program at issue and therefore was not likely to resume it in the same way as before." [EEOC v. Flambeau, Inc., No. 16-1402 (7th Cir. Jan. 25, 2017)] (Society for Human Resource Management [SHRM])
Cigna Sues Anthem Over Merger Agreement, Seeks Termination and $15 Billion
"Cigna Corporation [on Feb. 14] announced it has exercised its right to terminate the proposed merger agreement with Anthem, Inc. ... To effect this termination, Cigna has filed suit against Anthem in the Delaware Court of Chancery.... The complaint seeks payment by Anthem of the $1.85 billion reverse termination fee contemplated in the merger agreement, as well as additional damages in an amount exceeding $13 billion." (Cigna)
Aetna-Humana Merger Agreement Ends by Mutual Agreement
" 'While we continue to believe that a combined company would create greater value for health care consumers through improved affordability and quality, the current environment makes it too challenging to continue pursuing the transaction,' said Aetna Chairman and CEO Mark T. Bertolini. 'We are disappointed to take this course of action after 19 months of planning, but both companies need to move forward with their respective strategies in order to continue to meet member expectations.... [We] remain committed to a shared goal of helping drive the shift to a consumer-centric health care system.' " (Aetna)
[Opinion] How High-Deductible Health Plans Hurt Consumers
"Health plan deductibles accounted for 10 percent of the annual wages for the lowest-wage workers in [a recent] study ... Low-wage workers didn't get as much care.... Low-wage workers received less primary and preventive care and much more hospital care.... Despite receiving the least amount of care, low-wage workers had just as high of health care costs as the highest-wage workers who received the greatest amount of care." (Families USA)
Aetna, Humana Walk Away from $34 Billion Deal After Court Ruling
"Health insurers Aetna Inc and Humana Inc walked away from their $34 billion merger deal on Tuesday, after a U.S. judge ruled in January the combination would stifle competition in the private Medicare Advantage program for retirees.... Aetna will pay Humana a $1 billion breakup fee, or $630 million after taxes, and terminated its plan to sell some Medicare Advantage assets to Molina Healthcare Inc[.]" (Reuters)
[Guidance Overview] DOL Gives a Peek at Non-quantitative Treatment Limitations
"[A recent DOL Fact Sheet] provides some examples of violations of the [mental health parity] rule: [1] A categorical exclusion for 'chronic' behavior disorders ... when there was no similar exclusion for medical/surgical 'chronic' conditions. [2] No coverage resulting from failure to obtain prior authorization for mental health benefits ... [3] A categorical exclusion for all residential treatment services for mental health benefits. [4] Requiring prior authorization for all mental health benefits when that requirement does not apply to medical/surgical benefits. [5] Requiring a written treatment plan and follow-up for mental health benefits when no similar requirements were imposed on medical/surgical benefits." (Benefits Bryan Cave)
Republicans Keep Changing When Obamacare Will Be Repealed, Yet Health Insurers Have a Deadline Coming Up
"The political clarity [health insurers] are seeking will affect how they design and price 2018 individual market plans, and even whether they participate in the ACA's exchanges at all. As much clarity as possible by March 'would be helpful,' said Kristine Grow, [spokesperson for] America's Health Insurance Plans. But key Republican figures have offered varying deadlines: March or April, or sometime this year, or maybe even next year." (MarketWatch)
[Opinion] American Benefits Council Warns Against Legislation That Would Tax Employees' Health Insurance
"In a series of letters to the White House today on behalf of the employer community and the employer -- sponsored system generally, the Council offered clear and compelling arguments that a so-called 'cap' on the tax exclusion for employee health insurance would be a big mistake." (American Benefits Council)
[Guidance Overview] Congress Allows Small Employers to Pay for Individual Policies of Insurance (PDF)
"The Act allows small employers to pay or reimburse employees for the cost of coverage under an individual policy of health insurance, but only if certain conditions are met ... Because the Act was enacted so late in the year, it may be difficult for small employers to take advantage of it during 2017, particularly if they are already offering coverage under a group policy issued in the small group market." (Hinkle Law Firm LLC)
Potential Effects of Expansion of Association Health Plans (PDF)
"[Association health plans (AHPs)] could create adverse selection concerns if they operate under different rules.... AHPs face increased insolvency risk without clearly defined regulatory authority.... AHPs would need to be subject to state-level consumer protection laws.... AHPs would be unlikely to obtain lower provider payment rates than larger insurance companies." (American Academy of Actuaries)
Potential Impact of Selling Health Insurance Across State Lines (PDF)
"Allowing insurers to sell coverage across state lines has limited potential for premium savings, as premiums would continue to reflect local health care costs. Out-of-state insurers could have difficulty developing provider networks and negotiating provider payment discounts. Unintended consequences could result if states are given more flexibility regarding benefit requirements or issue and rating rules. Adverse selection would occur, threatening the viability of insurers licensed in states with more restrictive requirements." (American Academy of Actuaries)
Do Employees Truly Understand the Advantages of an HDHP/HSA?
"While high deductibles can initially scare your employees away, once they compare the overall savings of a lower HDHP premium and the tax advantages of an HSA, they might become a more tempting choice. Make a few subtle changes when you communicate the HDHP/HSA plan and your participation might just go up[.]" (Frenkel Benefits)
Employers Balk at Curbs on Generous Health Plans
"Several Republican plans for replacing the ACA include their own curb on generous health plans: a cap on how much of employer-provided health benefits could be shielded from taxes. Such a cap could force certain workers to start paying income tax on a portion of the cost of their coverage." (The Wall Street Journal; subscription may be required)
Long-term Individual and Population Consequences of Early-life Access to Health Insurance
"This paper analyzes the impact of gaining health insurance in childhood on health and economic outcomes during adulthood using dynamic microsimulation.... [I]ncreased access to health insurance in childhood results in 11 additional months of life expectancy and 16 additional months lived free of disability. There is no change in total lifetime medical spending, although both Medicaid and Medicare expenditures fall. Lifetime earnings increase by about 8% for individuals who gain the benefits of childhood health insurance." (Michigan Retirement Research Center [MRRC])
[Opinion] A Plan to Repeal and Replace Obamacare
"The new Administration and Congress have the opportunity not only to free America from the failure of Obamacare but also to improve on the prior system. Congress should act immediately to initiate repeal while the Administration takes aggressive administrative actions to stabilize the private market. Congress must replace Obamacare through a careful transition process that establishes everyone on more solid ground." (The Heritage Foundation)
Legislative Actions in the 112th, 113th, and 114th Congresses to Repeal, Defund, or Delay the Affordable Care Act (PDF)
26 pages. "This report summarizes legislative actions taken during the 112th, 113th, and 114th Congresses to repeal, defund, delay, or otherwise amend the ACA.... Most of the House-passed ACA legislation was not considered in the Senate during that period. A few bills to amend specific elements of the ACA that attracted sufficiently broad and bipartisan support were approved by both the House and the Senate and signed into law." [Report R43289, Feb. 7,2017] (Congressional Research Service [CRS])
Using High-Risk Pools to Cover High-Risk Enrollees (PDF)
"The impact of adopting a high-risk pool approach on access to coverage, premiums, and government spending depends on the specific approach and how its details are structured, including those related to eligibility criteria, benefit coverage requirements, and funding sources. It is also important to consider how high-risk pool approaches would interact with other insurance market rules pertaining to insurance issue, benefit coverage requirements, and premium rating." (American Academy of Actuaries)
[Guidance Overview] Qualified Small Employer HRAs Face Steep Compliance Path
"The compliance path for QSE HRAs is steep enough that they may not be adopted by a significant number of eligible employers.... [C]ompliance hurdles that small employers will face: [1] Requirement that no group health plan be maintained.... [2] Confusion over impact on premium tax credits.... [3] Annual notice requirement.... [4] Annual tax reporting duties.... [5] Lack of financial incentive for benefit advisers." (E is for ERISA)
[Guidance Overview] New HRAs for Small Employers: Some Questions and Answers
"What employers can offer a Small Employer HRA? ... What expenses can be reimbursed by a Small Employer HRA? ... Are there limits on reimbursement? ... Do employees have to have health insurance coverage? ... Are Small Employer HRAs subject to [ERISA]? ... Are Small Employer HRAs subject to COBRA continuation coverage? ... Do employers have to provide any special notices to employees?" (Greensfelder)
Return-to-Work Strategies for Employees with Mental Health Conditions (PDF)
"Compassion and support for employees aside, it is simply good business to protect the mental health and productivity of employees. This article describes existing challenges surrounding employees with mental disorders: the link between mental disorders, disability and an employee's ability to return to work; best practices for employers, employees and health care providers; and the role of the insurance company. Together, using proven strategies, everyone contributes to the optimal solution of helping employees with mental disorders return to work." (Benefits Quarterly, published by the International Society of Certified Employee Benefit Specialists [ISCEBS])
[Guidance Overview] Payments Under Fixed Indemnity Health Plans May Be Taxable Under New IRS Memorandum
"[If] the premium for the employer-provided fixed indemnity health plan is paid for by the employer or is paid by the employee on a pre-tax basis, then any benefit payments are taxable. The question then becomes how to withhold and report when the benefits are paid by the insurance carrier rather than the employer. While there are rules on how to handle withholding and tax reporting in the case of insured disability benefits, no such rules yet exist for fixed indemnity benefits." (Miller Johnson)
[Guidance Overview] Supplemental and Wellness Benefits Received May be Taxable
"Many employers offer their employees various 'supplemental benefits,' such as accident insurance, cancer insurance, or critical disease insurance. [In CCM 201703013, the IRS] ruled that, to the extent the employer pays the cost of these benefits (or the employee contribution is made 'pre-tax' through a cafeteria plan), the benefits received are taxable income to the employee." (Barrett McNagny LLP)
Older Workers and Retirees: Avoiding HSA Pitfalls
"Employers sponsoring HDHP/HSA programs for older workers need to be aware of the potential complications caused by Medicare Part A entitlement while those offering HDHP/HSA programs for retirees need to be concerned about the HSA comparability rules. Failure to address these issues can result in participant aggravation and potential excise taxes." (Conduent)
'Massive Confusion' Abounds for Insurers as GOP Wavers on Obamacare Redo
"Insurers have a hard enough time making the normal predictions of who will get sick and how much it will cost. Now the usual fog of rate setting is compounded by the possibility that basic rules of coverage could get overhauled or even disappear before anything takes their place. Consumers and patients could ultimately pay the price." (Kaiser Health News)
Trump's 2-for-1 Regulatory Reduction Challenged in Court
"President Donald Trump's Executive Order requiring two regulations be repealed for every new one adopted and related OMB guidance have been challenged in a law suit ... by Public Citizen, the Natural Resources Defense Council and the Communications Workers of America.... The complaint alleges that the agencies cannot lawfully comply with the president's order because doing so would violate the statutes under which the agencies operate and the Administrative Procedure Act." [Public Citizen v. Trump, No. 17-253 (complaint filed Feb. 8, 2017)] (, a blog by Stinson Leonard Street)
[Opinion] Cigna Comments on Injunction Blocking Transaction with Anthem
"Cigna intends to carefully review the opinion and evaluate its options in accordance with the merger agreement. Cigna remains focused on helping to improve health care by delivering value to our customers and clients and expanding our business around the world." (Cigna)
[Opinion] Anthem Responds to Court's Adverse Decision on Acquisition of Cigna
"The company promptly intends to file a notice of appeal and request an expedited hearing of its appeal to reverse the Court's decision so that Anthem may move forward with the merger, which was approved by over 99% of the votes cast by the shareholders of both companies." (Anthem, Inc.)
Opioid Addiction: Implications for Employers (PDF)
"Employers can contribute toward curbing the opioid addiction epidemic in a number of ways and should play an instrumental role in facilitating increased awareness of and access to needed programming.... This article will explore the size and prevalence of the opioid epidemic, reflect on its implications for employers -- including public policy initiatives -- and suggest specific strategies for employer interventions." (Benefits Quarterly, published by the International Society of Certified Employee Benefit Specialists [ISCEBS])
Best Practices for Workplace Financial Wellness Programs (PDF)
12 pages. "A highly effective financial wellness program can save an organization well into the millions of dollars for large companies -- and that's focusing on the easiest costs to measure: wage garnishments, absenteeism and utilization of FSAs and HSAs. With additional analysis, companies can also measure healthcare costs savings, reduction in costs associated with delayed retirement, employee engagement, productivity, retention, and morale." (Financial Finesse)
Administration Considers ACA Market Stabilization
"On February 1, 2017, the administration sent to the Office of Management and Budget a proposed 'market stabilization' rule. The proposed rule is rumored to contain a provision that would raise the age rating ratio in the individual market from the statutory 3-to-1 ratio to 3.49-to-1, increasing premiums for older people and decreasing them for younger enrollees." (Timothy Jost, in Health Affairs)
Federal Judge Blocks Anthem's Planned Acquisition of Cigna
"The ruling echoed a decision last month by a different judge who blocked Aetna Inc.'s plans to take over Humana Inc.... Judges found that merging top industry rivals threatened to harm consumers on price and service, with the benefits of those deals failing to outweigh the threats. While Aetna is considering a possible appeal in its case, [the Feb. 8 ruling] almost certainly kills the Anthem-Cigna transaction, as discord between the companies has grown considerably since they announced their deal in July 2015." (The Wall Street Journal; subscription may be required)
Text of District Court Order Enjoining Merger of Anthem and Cigna (PDF)
"[T]he merger will be enjoined due to its likely impact on the market for the sale of health insurance to 'national accounts' ... within the fourteen states where Anthem operates as the Blue Cross Blue Shield licensee.... [P]laintiffs have established that the high level of concentration in this market that would result from the merger is presumptively unlawful under the U.S. Department of Justice and Federal Trade Commission Horizontal Merger Guidelines ... The evidence has also shown that the merger is likely to result in higher prices, and that it will have other anticompetitive effects: it will eliminate the two firms' vigorous competition against each other for national accounts, reduce the number of national carriers available to respond to solicitations in the future, and diminish the prospects for innovation in the market." [U.S. v. Anthem, No. 16-1493 (D. D.C. Feb. 8, 2017)] (U.S. District Court for the District of Columbia)
[Opinion] Obamacare Exchanges Were in Big Trouble Before Trump
"[A]ny of these theories of the decline suggests that Obamacare was already incredibly fragile. The program was either: [1] primed to decline anyway, [2] primed to decline as soon as a Republican took the White House and voters began worrying about the future of the program, or [3] so vulnerable that a small amount of advertising could make the difference between enrollment growth and a significant decline. All three of these theories suggest that this program badly needs to be replaced with something that doesn't begin to topple as soon as anyone looks at it funny." (Megan McArdle, on Bloomberg)
Reports of the Demise of Obamacare Repeal and Replace Are Greatly Exaggerated
"[T]he repeal part is still on track to occur this spring ... likely in March.... The Republicans are now looking to see how much of the replace elements they can include under the Senate budget reconciliation rules.... [T]hey are looking to include the expansion of health savings accounts ... a provision that would encourage states to create high risk pools and provide federal funds for them ... reforming Medicaid by creating a form of state block grants via per capita limits, and including a new tax credit scheme to subsidize consumer purchases of individual health insurance." (Bob Laszewski's Health Care Policy and Marketplace Review)
Workplace Wellness Programs Focused on Cardiovascular Health May Reduce Prevalence of Disease
"Using a scoring index called the Worksite Health Achievement Index (WHAI) ... [researchers] assessed the comprehensiveness of 20 different employers' heart health programs, policies and environmental support structures to their employees' cardiovascular health.... Among large employers ... higher scores were associated with lower rates of four modifiable risk factors: high blood pressure, high cholesterol, tobacco use and physical inactivity. With those high scores, however, comes higher costs." (mobihealthnews)
Employees Turn Away From High-Deductible Health Plans
"High-deductible plans were once a bargain relative to traditional plans so long as you didn't have a big or catastrophic claim, but that relative advantage appears to have ebbed.... Even with PPOs, deductibles are going up substantially, which help keep premiums in check but may be turning PPOs and other traditional benefit plans into something that looks and feels of a high-deductible plan[.]" (
The Changing Dynamics of U.S. Health Insurance and Implications for the Future of the ACA
"[T]he ACA's unprecedented coverage changes increased transitions to Medicaid and nongroup coverage among the uninsured, while strengthening the existing employer-sponsored insurance system and improving retention of public coverage.... [The authors] identified key opportunities for policy makers and insurers to improve underlying Marketplace risk pools by focusing on people transitioning from employer-sponsored coverage; these people are disproportionately younger and saw almost no change in their likelihood of becoming uninsured in 2014 compared to earlier years." (Health Affairs)
[Opinion] 12 Fundamentals of Highly Effective Healthcare (PDF)
"[1] Reform Obamacare to better serve Americans ... [2] Make an advanceable and refundable tax credit available to all Americans ... [3] Reform hospital care to better serve patients ... [4] Encourage price transparency to boost competition in medical services ... [5] Increase Americans' access to primary care ... [6] Reform Medicare Accountable Care Organizations ... [7] Encourage private Medicare Advantage plans ... [8] Help seniors better plan for end-of- life with home-based palliative care ... [9] Empower consumers through Personal Health Accounts ... [10] Improve patients' care coordination through medical homes ... [11] Reform Medicaid to boost flexibility ... [12] Reform prescription drug pricing." (National Center for Policy Analysis [NCPA])
Congressman Paul Ryan Says Congress Will Replace Obamacare This Year
" 'We are going to be done legislating with respect to health care and Obamacare this year,' Ryan said, though he added that it could take time for the Trump administration to implement the changes. 'The question about how long it takes to effectuate the change, how long it takes to put these things in place, that's a question that the HHS can answer,' he said." (Morning Consult)
Issues Facing Republicans in Replacing the ACA
"Many of the choices facing Republicans are variations of a fundamental question: how much of the [ACA] to keep, and how much to discard? ... Future of Medicaid ... Pre-existing Conditions ... Taxes and Fees ... Transition and Timing" (The New York Times; subscription may be required)

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