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Benefits in the News > By Subject >

Health plans - design

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Non-Partisan Panel Urges Overhauling Health Care at End of Life
"The country's system for handling end-of-life care is largely broken and should be overhauled at almost every level, a national panel [appointed by the Institute of Medicine, the independent research arm of the National Academy of Sciences,] concluded ... Many of the report's recommendations could be accomplished without legislation. For example, the panel urged insurers to reimburse health care providers for conversations with patients on advance care planning.... But some recommendations -- like changing the reimbursement structure so that Medicare would pay for home health services instead of emphasizing hospital care, and so that Medicaid would provide better coverage of long-term care for the frail elderly -- would require congressional action." (The New York Times; subscription may be required)
Health Care Survey of Employers: Changes Ahead in 2015
"Employers estimate that 2015 health care costs will increase by 4% after changes to medical and pharmacy plan designs, vendors, provider networks or other features. Eight in 10 companies (81%) plan to make moderate to significant changes to health benefit programs for full-time active workers. Two-thirds of CEOs and CFOs will be more directly involved in health care strategy decisions than they were three to five years ago to help control costs and reduce exposure to the 2018 excise tax." (Towers Watson)
ERISA at 40: ERISA, Nixon, and the Could-Have-Been ACA (PDF)
"This article looks at the Nixon administration's proposal to reform the US health care system, presented to Congress in 1974 -- the same year ERISA was enacted. Although it wasn't adopted, the proposal included a number of provisions that are surprisingly similar to those appearing in the Affordable Care Act." (Buck Consultants at Xerox)
Plan Selections by Zip Code in the Health Insurance Marketplace
"The dataset provides the total number of Qualified Health Plan selections by ZIP Code for the 36 states that are participating in the Federally-facilitated Marketplace, or have State Partnership Marketplaces or supported State-based Marketplaces, for the initial Marketplace open enrollment period from October 1, 2013 through March 31, 2014, including additional special enrollment period activity reported through April 19, 2014. The data represent the number of unique individuals who have been determined eligible to enroll in a Marketplace plan and had selected a plan by April 19." (Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS])
ACA Is Erasing the Difference Between Hospitals and Insurers
"Most hospitals currently make more money performing a surgery than providing preventive care to avoid one, but under the Affordable Care Act they're being encouraged to change that: Instead of compensating doctors and hospitals for each service provided, the law encourages arrangements that reward hospitals for better outcomes. Some health-care providers have responded by consolidating." (Bloomberg Businessweek)
Employee Choice in the SHOP Marketplace
"To date, the majority of state-based SHOP Marketplaces have chosen to implement employee choice, but federal regulations have made implementation of employee choice voluntary until 2016.... While a majority of small businesses say they are interested in giving employees more plan choices, detractors have raised concerns that employee choice may overwhelm employees with too many choices or result in higher premiums in the SHOP if higher-risk employees can select more comprehensive plans than lower-risk employees." (Health Affairs)
An Update on the Small Business Health Options Program: Is It Working for Small Businesses?
"On Thursday, September 18, 2014, ... the Committee on Small Business Subcommittee on Health and Technology held a hearing titled, An Update on the Small Business Health Options Program: Is It Working for Small Businesses?' ... The purpose of the hearing was to examine the current state of the SHOPs and whether they are working for small businesses." [Page includes links to testimony by [1] Mayra Alvarez, Director State Exchange Group, Center for Consumer Information and Insurance Oversight, CMS; [2] Dr. Roger Stark, Health Care Policy Analyst, Washington Policy Center; [3] Adam Beck, Assistant Professor of Health Insurance, The American College of Financial Services; and [4] Jon Gabel, Senior Fellow, NORC, University of Chicago.] (Committee on Small Business, U.S. House of Representatives)
[Opinion] Reference Pricing and Network Adequacy Standards: Conflict or Concord?
"[R]ecent federal guidance ... blurs the distinction between in-network and out-of-network providers and may make it more difficult for regulators and consumers to understand the effective 'size' of a particular network. This confusion could undermine the goal of improving transparency in consumers' health care choices and make it difficult for consumers to use prices in choosing providers. More troubling, expanded use of 'reference pricing' under the guidance could leave patients paying unexpectedly large out-of-pocket amounts for services provided by ostensibly in-network providers." (Health Affairs)
[Opinion] Number of Uninsured Americans Aged 18-64 Drops by Two Percentage Points
"The number of uninsured Americans aged 18-64 has dropped by two percentage points from the first quarter of 2013 to the first quarter of this year ... [T]hat brings the proportion of uninsured down to where it was about ten years ago.... Obamacare has not managed to overcome the results of the recession that began in December 2007." (National Center for Policy Analysis Health Policy Blog)
2014 Health and Voluntary Workplace Benefits Survey: Most Workers Continue to be Satisfied With Their Own Health Plan, but Growing Number Give Low Ratings to Health Care System
"Confidence about various aspects of today' s health care system has also remained fairly level before and after the passage of PPACA.... Confidence about the health care system decreases as workers look to the future. While 47 percent of workers indicate they are extremely or very confident about their ability to get the treatments they need today, only 30 percent are confident about their ability to get needed treatments during the next 10 years, and just 19 percent are confident about this once they are eligible for Medicare[.]" (Employee Benefit Research Institute [EBRI])
Health Care Costs Follow Health Risks and Can Be Mitigated Over Time Through Incentivized Workplace Wellness Programs
"The study was designed to evaluate the impact of UPMC's health management and wellness program, MyHealth, on the health and health care costs of its own employees ... [T]here were significant improvements in health-risk status as well as increases in the use of preventive and chronic disease management services ... The findings are particularly meaningful since healthcare workers are a prime target for improving population health and mitigating rising healthcare costs." (UPMC Health Plan)
Employer Wellness Programs: Mind, Body, Spirit -- and Wallet
"All health-contingent wellness programs, whether activity-only or outcome-based, must satisfy the following criteria: Frequency of Opportunity to Qualify ... Size of Reward ... Reasonable Design ... Uniform Availability and Reasonable Alternative ... Notice of Availability of Reasonable Alternative." (von Briesen & Roper, s.c.)
[Guidance Overview] How the ACA Affects U.S. Territorial Employees (PDF)
"Employers should be pleased by the greater flexibility they have in designing benefit programs for their territorial employees. Although their plans may have to meet ACA benefit mandates, employers generally will not be adversely impacted if they fail to offer affordable, minimum value health coverage to these employees. In addition, because it is unlikely that a territorial employee would ever be considered full-time for purposes of the shared responsibility provisions, the tracking and reporting obligations of these employees should be minimal." (Buck Consultants at Xerox)
[Guidance Overview] Can a Plan That Fails to Cover Inpatient Hospitalization Services Provide Minimum Value?
"Whether these plans were 'intended,' or whether they are consistent with Obamacare, is irrelevant. Under currently applicable laws and regulations, these plans appear to work as advertised. Moreover, no employer is required to do anything more than the law requires; and any employer that does risks putting itself at a competitive disadvantage relative to those that do not. The regulators are free to change the rules. Despite a high likelihood that they are aware of these plans, however, they have not yet seen fit to act." (Mintz Levin via Lexology)
What Can Employers Do to Reduce the Cost of Obamacare?
"Surprisingly, firms that are large enough to self-insure can satisfy the mandate without covering hospitalization! They can also avoid paying for mental health care and even emergency rooms visits. Yet insurance for small firms and individuals does have to cover these things." (John Goodman, in Forbes)
Measuring Wellness: From Data to Insights
"[A recent survey explored] the extent to which employers use health-related employee data to guide the operation and outcomes measurement of US wellness programmes.... Key findings: [1] More matters than cost effectiveness: Wellness programmes can be part of a progressive HR strategy to make the organisation an employer of choice. [2] Better data collection is needed, but what to do with it? Employers struggle to interpret the data they have and they lack sufficient insights to assess key programme objectives. [3] Leading obstacles to participation in wellness programmes are insufficient time and privacy concerns, employees say." (The Economist)
[Guidance Overview] Five ACA Issues Employers Should Be Following (PDF)
"Employers have about three months to finalize their employer mandate compliance plans under the [ACA].... While most employers are in the final stages of planning, ... [other] issues that employers should be aware of as they move forward into 2015 and beyond [include]: [1] ACA-related litigation [2] Employer mandate reporting [3] Section 510 liability [4] Alternatives to traditional plan offerings [5] The looming Cadillac tax." (Epstein Becker Green)
Are Wearables a Good Fit for Your Wellness Program?
"Wearables are more expensive than the typical pedometer by $10 to $15 per participant. As a result, while some companies distribute a device to every employee, others require employees to complete an activity to earn one. For example, a large financial services firm rewarded employees with a Fitbit for completing a health assessment. And for those employees who wanted to upgrade to a more expensive version, the company subsidized the cost." (HealthFitness)
Optimizing Enrollment in Employer Health Plans: A Comparison of Enrollment Strategies in the Diabetes Health Plan
"The subjects were 5014 eligible employees from 11 self-insured employers who had purchased the Diabetes Health Plan, which offers free or discounted copayments for diabetes related medications, testing supplies, and physician visits.... Overall, the proportion of eligible members who were enrolled within the automatic enrollment strategy was 91%, compared with 35% for voluntary enrollment. Income was a significant predictor for voluntary enrollment but not for automatic enrollment. Within automatic enrollment, covered dependents, Hispanics, and persons with nondiabetes comorbidity were more likely to enroll than other subgroups." (American Journal of Managed Care)
What's Causing Healthcare Premiums to Rise?
"[1] New premiums may be an attempt to correct for errors in the previous year. If insurers set premiums higher than necessary in 2014, they may not have needed to raise them as much for 2015. [2] [HHS] has warned insurers against raising premiums by more than 10 percent, threatening to analyze any such increases. As a result, insurers have an incentive to raise premiums by smaller amounts from year to year, to avoid attracting attention from HHS. [3] Some Americans are still allowed to be in noncompliant (and therefore cheaper) plans. In 25 states, non-ACA-compliant plans are allowed to run through at least 2015." (National Center for Policy Analysis)
New Data Show Early Progress in Expanding Health Care Coverage, with More Gains to Come
"[T]he share of Americans without health insurance averaged 13.1 percent over the first quarter of 2014, down from an average of 14.4 percent during 2013, a reduction corresponding to approximately 4 million people. The 13.1 percent uninsurance rate recorded for the first quarter of 2014 is lower than any annual uninsurance rate recorded by the NHIS since it began using its current design in 1997." (The White House Blog)
Quality of Health Care After Adopting a Full-Replacement, High-Deductible Health Plan with a Health Savings Account: A Five-Year Study (PDF)
"This study reports use of health care services related to health care quality over five years ... [at] a single large employer ... that adopted an HSA-eligible health plan for all employees. It represents one of the longest observation periods reported with a full-replacement CDHP, and it is one of the few studies with a matched control group. The introduction of the HSA-eligible health plan had a negative impact on office visits for annual physicals, well-child visits, and preventive visits in the year that the plan was adopted. In the second year, office visits increased for HSA-eligible health plan enrollees, but were mostly unchanged for the comparison group. By the fourth year in the HSA-eligible health plan, office visits for annual physicals, well-child visits, and preventive visits were down slightly relative to the comparison group." (Employee Benefit Research Institute [EBRI])
Income, Poverty and Health Insurance Coverage in the United States: 2013
"The percentage of people without health insurance coverage for the entire 2013 calendar year was 13.4 percent; this amounted to 42.0 million people." (U.S. Census Bureau)
ACA Tempers New State Coverage Mandates
"To discourage states from passing mandates that go beyond essential health benefits requirements, the law requires states, not insurers, to cover the cost of mandates passed after 2011 that apply to individual and small group plans sold on or off the state health insurance marketplaces. If a mandate increases a plan's premium, states will be on the hook for the additional premium cost that's attributable to the mandate." (Kaiser Health News)
Text of GAO Report: Coverage of Non-excepted Abortion Services by Qualified Health Plans
"GAO was asked to provide a list of QHPs that do and that do not cover abortion services and for additional information on issues related to that coverage. This report describes whether non-excepted abortion services are covered by QHPs within the 28 states with no laws restricting such coverage for the 2014 benefit year and provides additional information -- such as the scope and the cost of non-excepted abortion services coverage -- for selected QHPs that cover such services." (U.S. Government Accountability Office [GAO])
Why Any Plan Sponsor Fiduciary Needs to Give HSAs Another Look
"Banks, insurance companies, and investment firms with active IRA programs may be interested in making their programs friendly for employers that want to make the HSAs widely available to employees with education as to the advantages of keeping the HSA accounts invested.... It will be critical for anyone marketing or offering these programs to be very sensitive to the conditions for exemption from ERISA. Some employers may be willing to offer HSAs as a fully ERISA-covered benefit, but most will want to stay ERISA-exempt, and for the latter category it will be necessary to keep the program simple and be very careful with the handling of investment options." (Fiduciary News)
Looking Ahead to the ACA's 'Cadillac Tax' on High-Cost Health Coverage (PDF)
"Given the potentially dramatic financial effect of the Section 4980I excise tax, some employers have determined that radical modifications to benefits may be required to avoid liability. Employers are developing strategies for limiting its negative impact, including plotting out a 'glide path,' whereby the value of employer-sponsored coverage will be reduced gradually between 2014 and 2018 to bring the cost of coverage under the Section 4980I thresholds (and employees will not see their benefits dramatically reduced between 2017 and 2018). Complicating the development of any long-term strategy, however, is the paucity of guidance related to Code Section 4980I." (Groom Law Group)
Race to the Middle? Middle and Skinny Plans Under Healthcare Reform
"A number of innovative strategies for avoiding or minimizing the impact of tax penalties under Code 4980H(a) and Code 4980H(b) exist in the marketplace. However, these strategies are not one size fits all. Even when the strategy seems to fit, the questionable compliance of these strategies with the many requirements for health plans under PPACA make for numerous cracks in the elusive glass slipper that is the cost-effective, compliant, and penalty-eliminating group health plan. [The authors review] compliance concerns with so-called 'Middle Plans' currently emerging, and highlight employer risks in implementing a Skinny Plan." (Hill, Chesson & Woody)
Early Observations Show Safety-Net ACOs Hold Promise to Achieve the Triple Aim and Promote Health Equity
"This post will outline five key observations regarding emerging safety-net ACOs and suggest broad policy implications. We are defining safety-net ACOs as collaborative entities of providers and sometimes payers that are [1] accountable for managing the health of their population, [2] assuming upside and/or downside financial risk, and [3] serving predominantly Medicaid (including dual eligibles) and uninsured patients." (Health Affairs)
[Opinion] No Shift to Part-Time Work Seen (Yet) Under ACA
"It is still possible that businesses will initiate a shift to more under-30 hour work weeks as the mandate nears. (And the mandate requirement and penalties include a 'look back' -- what the workforce looks like before the start date of the mandate.) But the mandate has been delayed twice, and it' s being phased in much more slowly. And it's not at all certain it will ever happen at all[.]" (Association of Health Care Journalists)
The Federal Courts' Role in Implementing the ACA
"All of this litigation has altered, or has the potential to alter, the way in which the ACA is implemented and consequently could affect the achievement of the law's policy goals, such as the number of people who obtain affordable health insurance, and what is required to be included in a health plan. This issue brief examines the federal courts' role to date in interpreting and affecting implementation of the ACA, with a focus on the provisions that seek to expand access to affordable coverage." (Henry J. Kaiser Family Foundation)
[Opinion] Why Do Large Employers Want to Control Their Employees' Health Benefits?
"Large companies believe it is the best bulwark against government-monopoly, single-payer health care. They simply do not see a third option, individually owned health insurance, because it is not widely discussed in the public space.... Larger firms have human resource (HR) bureaucracies within them to manage health benefits. ... Forcing workers to get health benefits through their employers gives large businesses a competitive advantage over smaller rivals, which do not have the same HR capacity." (National Center for Policy Analysis Health Policy Blog)
[Opinion] Limiting Choice to Control Health Spending: A Caution
"Seeking to end the rapid rise in health care costs, in the 1990s employers embraced managed care plans -- plans, like health maintenance organizations, that restricted consumers' choices with narrow networks, as well as requirements for preapproval for some forms of treatment.... These cost-saving measures became increasingly unpopular. The backlash was swift and severe. Today's new narrow network plans also restrict choices, so will they suffer the same fate as 1990s managed care?" (Austin Frakt, in The New York Times; subscription may be required)
Closely Related Plans Cannot Be Unbundled for ERISA Safe Harbor Exception Analysis
"The bundling of the basic and supplemental benefits was not necessarily the sole deciding factor here -- there were other indications that the two types of coverage were closely related. And there was no suggestion that the employer intended that the supplemental coverage fall within the safe harbor. But the court's decision underscores the importance of not bundling (either intentionally or inadvertently) a voluntary program with employer-sponsored coverage if the voluntary coverage is not intended to be part of the ERISA plan." [Menkes v. Prudential Ins. Co. of America, No. 13-1408 (3d Cir. Aug. 6, 2014)] (Thomson Reuters / EBIA)
Companies Cut Back on Dependent Coverage
"Amid growing public concern that an unintended result of the [ACA] might be a broad elimination of corporate-sponsored health benefits, it appears that ... the value of coverage for spouses and dependents is beginning a slow fade. In a recent survey ... 22% of 1,234 responding employers have already reduced their subsidies for covered dependents. The kicker is that an additional 50% expects to cut back over the next five years." (CFO)
In Employer Health Insurance Costs, Stability Is the New Normal
"Premiums for family policies in the group market grew 72% between 1999 and 2004; 34% between 2004 and 2009; and 26% between 2009 and 2014. Even as premium growth moderated, health insurance costs still outpaced inflation and wage growth. But this year premiums grew 3%, about the same rate as wages and inflation. Despite fears that premiums would rise in the group market because of the [ACA], they have remained stable." (The Wall Street Journal; subscription may be required)
Flaw in Federal Software May Allow Employers to Offer Plans Without Hospital Benefits
"The [online minimum-value calculator provided by HHS] appears to allow companies enrolling workers for 2015 to offer inexpensive, substandard medical insurance while avoiding the [ACA's] penalties ... Employer insurance without hospital coverage 'flies in the face of Obamacare,' said Liz Smith, president of employee benefits for Assurance, an Illinois-based insurance brokerage. At the same time, a kind of catch-22 bars workers at these companies from subsidies to buy more comprehensive coverage on their own through online marketplaces." (Kaiser Health News)
The Early Impact of the ACA: Individual Premiums Up Substantially
"[N]ational enrollment trends obscure significant variation across states, as a result of the types of people who opted in and how insurers set premiums. Across all states, from before the fourth quarter of 2013 to the first half of 2014, enrollment-weighted average per-person premiums in the individual health insurance market rose by 24.4% beyond what they would have had they simply followed state-level seasonally-adjusted trends. This large increase stands in contrast to the experience in Massachusetts, which saw premium decreases after its 2006 reform." (The Brookings Institution)
[Opinion] Support Builds for Employee Health Care Protection Act Ahead of House Vote
"The House of Representatives will vote [on Sept. 11] on H.R. 3522, the Employee Health Care Protection Act, authored by Rep. Bill Cassidy (R-LA). The bill helps to protect American workers from the president's #BrokenPromises by allowing health insurance plans currently available on the group market to continue to be offered through 2019. Ahead of the vote, a wide range of stakeholders voiced support for the bill and praised the committee for working to prevent the administration from doing any more damage to our nation's health care." (Energy & Commerce Committee, U.S. House of Representatives)
'Observation Care' vs. 'Inpatient Care' at the Hospital: Why it Matters to Seniors on Medicare
"Seniors must have three consecutive days as admitted patients to qualify for Medicare coverage for follow-up nursing home care, and no amount of observation time counts for that three-day tally. That leaves some observation patients with a tough choice: Pay the nursing home bill themselves -- often tens of thousands of dollars -- or go home without the care their doctor prescribed and recover as best they can.... Although Medicare officials recently began experimenting with limited exemptions, they have been unable to resolve the problem. But most observation patients with private health insurance don't face such tough choices. Private insurance policies generally pay for nursing home coverage whether a patient had been admitted or not." (Kaiser Health News)
Governor Brown Signs California's Mandatory Paid Sick Leave Law
"[E]very employer with a paid sick leave policy will now have to review their policies to ensure they meet the minimum requirements of the law. Many paid sick leave policies, for example, exclude part-time, temporary, and seasonal employees from paid sick leave benefits. The new law provides no such limitation and will place employers with such limited policies squarely in violation of the law." (Ogletree Deakins)
Health Plans, TPAs and PBMs Are Still on the Hook to Provide Contraceptive Coverage
"The new rules establish a second mechanism for eligible organizations to take advantage of the religious exemption from providing coverage for contraceptive services. Now, eligible organizations can use the process set out in the 2013 rules, or, simply notify HHS in writing of its religious objection. In turn, HHS or DOL will notify the health plan, third party administrator, or PBM responsible for providing enrollees in the health plan with contraceptive services at no cost for as long as they remain enrolled in the health plan." (Mintz Levin)
CFOs Waging All-Out Attack on Healthcare Costs
"Plan design is one big area of attack, with more companies adopting high-deductible health plans. Another recent survey of large employers that was conducted by the National Business Group on Health found that 81% expect to offer at least one consumer-directed health plan next year, up from 72% this year. And 32% will offer a consumer-directed plan as the only option next year, up from 22% this year." (Treasury & Risk)
Premiums and Employee Contributions for Employer-Sponsored Coverage, 1999-2014
"Since 1999 the Employer Health Benefits Survey has documented trends in the employer-sponsored health insurance market. Every year about two thousand private and non-federal public employers with three or more employees have completed the full survey. Among other topics, the survey asks firms for the premium or full per person cost of their health coverage as well as the share that workers are responsible for. [This graphing tool] allows users to look at changes in premiums and worker contributions for covered workers at different types of firms, over time." (Henry J. Kaiser Family Foundation)
Does Apple's HealthKit Signal the End of Employer-Based Health Insurance?
"Apple is launching ... a mobile heath tracking system that will enable people to gather information on their health via their iPhone or soon-to-be released Apple Watch and, in time, automatically route that information to an online health record that can be accessed by their primary care physician immediately. While it may take some time to create this portable, web, and mobile health information environment, ... what Apple is doing is one of three main drivers that will move health insurance from being employer based to consumer based. This may forever change the way health care is financed and delivered." (Employee Benefit News)
Premiums for Family Health Coverage Rise 3% in 2014
"This year's increase continues a recent trend of moderate premium growth. Premiums increased more slowly over the past five years than the preceding five years (26 percent vs. 34 percent) and well below the annual double-digit increases recorded in the late 1990s and early 2000s. This year's increase also is similar to the year-to-year rise in worker's wages (2.3 percent) and general inflation (2 percent)." (Health Affairs)
[Guidance Overview] Departments Provide Guidance on Contraceptive Coverage Mandate for Employers with Religious Objections (PDF)
"Notably, a religious nonprofit entity could self-administer its self-insured plan directly rather than contracting with a TPA, or engage a religious TPA that, in turn, objects to providing contraceptive coverage. In those situations, the entity's employees would appear not be able to obtain contraceptive coverage services." (Buck Consultants at Xerox)
Nonprofit Religious Employers to Move Forward with Lawsuits Despite Revised Contraceptive Coverage Regs
"The government says its revised system accommodates religious employers' beliefs while ensuring their employees have access to the same range of contraception methods through their insurance as other workers. It plans to offer the new arrangement to nonprofit employers and some for-profit companies with religious objections to contraception. Religious groups say the compromise remains inadequate, and the administration should allow affiliated employers to omit contraception coverage entirely from health plans, as houses of worship are allowed to do." (The Wall Street Journal; subscription may be required)
California Repeals 60-Day Limit on Health Insurance Waiting Periods
"The new law, effective January 1, 2015, prohibits California insurance companies from applying any 'waiting or affiliation period' under a group or individual health benefit plan. So where does that leave California employers, who are permitted under federal law (the ACA) to have a one-month orientation period and up to a 90-day waiting period? They'll be able to continue applying ACA-compliant orientation periods and waiting periods, as the law prohibits carriers -- but not employers -- from imposing a waiting period." (Proskauer's ERISA Practice Center)
[Opinion] House Bill Would Raise Small Business Premiums and Undercut Health Reform's Consumer Protections
"[H.R. 3522] would allow insurance companies, through 2018, to continue to offer to any small employer the health insurance plans in the small group market that the insurers were selling in 2013.... [S]uch plans would not have to comply with the [ACA's] market reforms and consumer protections that otherwise apply to all health insurance plans offered in the small group market, starting in 2014.... [The] bill would likely have serious adverse effects both on premiums in the small group market -- causing them to rise substantially for many small firms -- and on health reform's consumer protections, such as the reform that prevents insurance companies from charging higher premiums to firms with older, less healthy workforces." (Center on Budget and Policy Priorities)
2014-2015 Benefits Open Enrollment Guide for Employers (PDF)
14 pages. "The savvy employer's guide to benefits enrollment includes: [1] Answers to tough benefits enrollment questions.... [2] Employees spend more time on vacation planning than on choosing benefits. [3] What is voluntary insurance -- and why do employees need it? [4] Out-of-pocket costs 101. [5] Key changes to tax-free savings accounts for employers. [6] Tools to help put your companies' benefits to work." (Aflac)
[Guidance Overview] So What, Exactly, Is an 'Offer of Coverage'?
"In at least one instance, the Treasury Department and IRS let us know what an offer of coverage is not, when they clarified that an employer cannot foreclose the possibility of all penalties by providing coverage to all its full-time employees at no cost.... [For] employers with high turnover and large cohorts of contingent and temporary workers, these rules are game-changing. And offers of coverage, at least to sometimes significant portions of their workforce, are new." (Mintz Levin)
Stop Loss Insurance, Self Funding and the ACA (PDF)
A white paper in draft form; 23 pages. "Many articles have been written discussing the potential for and consequences of small employer self-insurance in the post-ACA environment, however, at this point, the increase in small employer self-funding is not known.... One of the areas states are seeing evidence of this interest is in the stop loss insurance policies being developed for and specifically marketed to small employers. This paper explores trends in stop loss insurance seen by state departments of insurance and the regulatory issues they raise. This paper also identifies issues about which state insurance departments need to be aware when regulating stop loss insurance policies." (National Association of Insurance Commissioners [NAIC])
[Opinion] Zeke Emanuel, Center for American Progress Give Up on Obamacare
"The examples given in [a recent paper by the Center for American Progress] are too government-heavy: All-payer databases, price fixing, and mandatory 'transparency.' Another weakness is that only governments will be able to share in the savings. How about a model where patients share in the savings, through a credit to a Health Savings Account (or Medicare MSA), for example?" (National Center for Policy Analysis Health Policy Blog)
Waiting Period Limits for California Small Group Early Renewals
"California law governing insurers and HMOs restricted the waiting period to 60 days under legislation that very recently has been repealed effective January 1, 2015. The repeal left open the issue of whether carriers would hold employers renewing late in 2014 to the 60-day waiting period limit. At least with regard to small group coverage (2 to 50 employees), the answer to that question appears to be 'yes' for two major carriers in the state whose approach may be a bellwether for other carriers. They will not permit a 90-day eligibility waiting period on small group policies or HMO contracts that are renewed or first issued during the remainder of 2014." (E is for ERISA)
[Opinion] The Brave New World of Rationing in PPACA
"Insurers are not sitting back with open arms and welcoming all of the poorest, sickest and most costly patients. Instead, we are now in a brave new world of rationing, restriction, and manipulation in order to nudge the worst risk among us to choose the other insurer's plan. [This article provides] an overview of the allowable ways insurers can restrict sick folks from flocking to their plans under PPACA.... Doctor Rationing ... Treatment Rationing ... Patient Rationing ... Drug Rationing ... Fraud and Abuse Protection Rationing." (Benefit Revolution)
Accountable Care States: The Future of Health Care Cost Control (PDF)
26 pages. "[The authors] propose that the federal government should implement a model that gives states the option to become 'Accountable Care States' -- meaning that they are accountable for health care costs, the quality of care, and access to care -- with sizable financial rewards for keeping overall costs low. This model would control costs across the system rather than shift costs from public programs to the private sector or to consumers. The Accountable Care States model offers the potential for substantial savings in health care spending." (Ezekiel Emanuel, Topher Spiro, Maura Calsyn, Carter Price, Stuart Altman, Scott Armstrong, John Colmers, David Cutler, Francois de Brantes, Paul Egerman, Bob Kocher, Peter Orszag, Meredith Rosenthal, John Selig, Joshua Sharfstein, Andrew Stern, and Neera Tanden)
Full D.C. Circuit Will Rule on ACA Subsidies
"It is unclear at this point whether the D.C. Circuit's grant of en banc review of the subsidies question will have any effect on the Supreme Court's consideration. The Justices might opt to wait to see if a conflict in lower court exists, but they also could go ahead and grant review of the pending case. That would proceed more slowly than will the new review in the D.C. Circuit, however." (SCOTUSblog)
Driving Innovation in the Health Care Marketplace: A CEO Report (PDF)
108 pages. "This report highlights the innovations we have made and the public policy changes we believe would permit the private and public markets to better leverage their collective purchasing power to create a more consumer-centric health care system focused on driving value by promoting health and improving outcomes. The report also provides information on current efforts by leading BRT companies to make health care costs more transparent and improve data on quality of care, which together will lead to a more value-driven health care system.... Our report presents a vision for what the public and private sectors can do over the next decade to remove existing barriers to innovation and create a framework for public policy that supports innovations to get better care for less money." (Business Roundtable [BRT])

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