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Health plans - design


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[Guidance Overview] Proposed Amendments to the Cafeteria Plan Provisions of the Puerto Rico Internal Revenue Code
"These proposed amendments are intended to reactivate in Puerto Rico cafeteria plans and make the adoption of these plans more attractive to Puerto Rico employers by expanding the list of 'qualified benefits' that they may be provided to Puerto Rico employees. However, as more fully explained [in this article], unless HR 453 is further amended to correct or eliminate certain deficiencies existing in Section 1032.06 of the 2011 PR Code, it will be very difficult to accomplish its intended goal." (McConnell Valdes)
[Opinion] One Thing Small Businesses Don't Need: ACA Repeal
"The reality is the ACA has been instrumental in helping small employers and their employees who struggled previously to afford health insurance coverage. Prior to the enactment of the health care law, small businesses and their employees comprised a disproportionate share of the working uninsured.... By 2016, however, the insurance landscape for small employers had undergone a dramatic shift.... And thanks to the health care law's cost-containment provisions, premiums are stabilizing for many small firms. We've seen much smaller increases in the small group market compared to pre-ACA, where double-digit increases were often the norm." (John Arensmeyer in Morning Consult)
Large Employer Health Plans Could See Impacts from ACA Overhaul
"If you think that because you get health insurance through your job at a big company, you won't be affected if Republicans overhaul Obamacare, think again. Several of the law's provisions apply to plans offered by large employers too.... No copays for preventive services ... No annual or lifetime limits on coverage ... Annual cap on out-of-pocket payments for covered services ... Adult kids' coverage expanded ... Guaranteed external appeal rights ... No waiting periods to join a plan ... No waiting periods for coverage of pre-existing conditions ... Standardized plan descriptions ... Basic coverage standards for large-group plans." (Kaiser Health News)
Health Care in 2017: What to Expect
"Trends from 2016: Rising costs as a catalyst for change ... Continued interest in HDHPs ... Decision support & transparency tools ... Alternative care options ... Communication on the rise.... What to expect in 2017: Personalized enrollment software ... Centralized information ... [ACA]." (Hodges-Mace)
[Opinion] Does Achieving Lower Health Care Premiums Necessarily Mean Lowering Insurance Coverage?
"What would happen if the plans were more attractive -- if people saw value in them? And, if we had 75% of the eligible group signing up as a result, what impact would that have on current premiums? ... [P]rices could come down at least 30% to 40% from 2018 prices. Said another way, the anti-selection load the current Obamacare exchange plans are carrying is worth at least 30% to 40%." (Bob Laszewski's Health Care Policy and Marketplace Review)
[Guidance Overview] The Ball Dropped on New Year's Eve for Some ACA Section 1557 Nondiscrimination Rules
"Because the injunction was issued at the final hour, many of those entities subject to the regulations had already made necessary changes to their group health plans in order to comply by the January 1, 2017 deadline. Those entities will need to decide whether it makes business sense to suspend, alter, or reverse those changes pending any subsequent legal developments." (Ogletree Deakins)
[Guidance Overview] The Mental Health Parity and Addiction Equity Act: Does Your Plan Comply? (PDF)
"Why should health plan sponsors be concerned? ... What plans are subject to MHPAEA? ... What does MHPAEA require? ... What are DOL and HHS looking for? ... What are the courts saying? ... Compliance steps." (benefits Magazine, published by the International Foundation of Employee Benefit Plans [IFEBP])
[Opinion] Deals Will Be Cut for ACA Replacement -- Who Wants What?
"While [AHIP] has put forward a long list of concerns ... there are two key assurances health insurers want in order to support an ACA replacement plan. The top priority of health insurers is predictability.... The second priority of health insurers is some requirement for consumers to make consistent payment of premiums." (Morning Consult)
Nearly Three-Quarters of U.S. Employees Would Like a Customized Benefits Package
"[O]nly half of workers are satisfied with their current employer benefits. Married workers are more satisfied than non-married workers (55 percent vs. 45 percent) and workers who use a financial advisor are more likely to be satisfied with their benefits (62 percent vs. 46 percent).... Employees ranked health care coverage, retirement savings accounts and vacation as the three most popular workplace benefits." (Wolters Kluwer Law & Business)
CVS, Cigna Decisions Encourage Use of Cheaper EpiPen Alternatives
"Shortly after Cigna announced it would stop covering the name-brand EpiPen, CVS declared it would begin selling a cheaper generic version of the costly epinephrine injector.... Cigna issued a statement explaining its decision to revise its covered drug list in hopes that it would 'encourage use of the generic version as it will deliver more overall value to customers and clients.' " (American Journal of Managed Care)
[Official Guidance] Text of ACA Implementation FAQs, Part 37: Health Reimbursement Arrangements and Application of Code Section 162(m)(6) to Certain Clinical Risk-Bearing Entities (PDF)
"Q1: May a family HRA be integrated with a non-HRA group health plan sponsored by the employer of the employee's spouse that covers all of the individuals covered by the family HRA if that non-HRA group health plan otherwise meets the applicable integration requirements ? Yes.... Q2: May a family HRA be integrated with a combination of [1] self-only coverage of the employee by a qualifying non-HRA group health plan sponsored by the employer and [2] qualifying non-HRA group health plan coverage sponsored by the employer of the employee's spouse that covers all members of the family covered by the family HRA (other than the employee)? Yes." (U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL] and U.S. Treasury Department)
Six Ways to Promote Wellness Program Participation
"Organize a Wellness Team ... Recognize team sports.... Offer gym membership discounts ... Start a 'Biggest Loser' contest ... Offer healthy snack choices ... [Offer programs on financial] wellness." (DataPath)
Court Dismisses Participant Action for ACA Violations by Non-Compliant Group Health Plan
"An action against a group health plan whose terms violated both ERISA and ACA was properly dismissed under Article III of the Constitution due to lack of constitutional standing by the participants, a federal Appeals Court has ruled. The mere fact that the participants paid money into a non-compliant plan did not satisfy the injury-in-fact requirement of constitutional harm necessary to establish standing." [Soehnlen v. Fleet Owners Insurance Fund, No. 16-3124 (6th Cir. Dec. 21, 2016)] (Wolters Kluwer)
Senate Takes First Step Toward ACA Repeal
"The Senate has passed a measure to take the first step forward on dismantling President Barack Obama's health care law... The nearly party-line 51-48 vote early Thursday came on a nonbinding Republican-backed budget measure that eases the way for action on subsequent repeal legislation as soon as next month.... The House is slated to vote on the measure on Friday, though some Republicans there have misgivings about setting the repeal effort in motion without a better idea of the replacement plan." (InsuranceNewsNet.com)
States Mull Contraception Coverage as Obamacare Repeal Looms
"Growing numbers of U.S. states are seeking to ensure that women have continued access to free birth control in case the insurance benefit is dropped as part of President-elect Donald Trump's vow to repeal and replace the [ACA].... California, Maryland, Vermont and Illinois since 2014 have enacted statutes codifying the [ACA]'s contraception mandate in state law and expanding on the federal law's requirements. Democratic lawmakers in New York, Minnesota, Colorado and Massachusetts said they are pursuing similar measures this year[.]" (Reuters)
Legislative Actions to Repeal, Defund, or Delay the ACA (PDF)
26 pages. "This report summarizes legislative actions taken through the end of the 114th Congress to repeal, defund, delay, or otherwise amend the ACA. The information is presented in three tables. Table 1 summarizes the ACA changes that have been signed into law. Table 2 lists all the House-passed ACA bills. Table 3 summarizes the ACA provisions in the vetoed reconciliation bill." [Report R43289, Jan. 9, 2017.] (Congressional Research Service [CRS])
ACA Repeal Puts Health Benefit Income Tax Exclusion at Risk
"[A]ll the Republican proposals that are likely to have a significant role in shaping repeal-and-replace legislation seek to collect more taxes by modifying the tax exclusion on employer-sponsored health benefits in some way.... Options under consideration include: [1] Keeping the 'Cadillac tax' but modifying the tax amount and creating a 'safe harbor' based on a plan's actuarial value.... [2] Imposing a cap on the existing employee exclusion for employer-sponsored coverage.... [3] Limiting the amount of the employee exclusion based on actuarial levels." (The Alliance)
The Employer Stop-Loss Insurance Marketplace Since the Affordable Care Act
"ACA has considerably increased the need for and expanded employer interest in stop-loss coverage due to several factors: [1] Removal of annual and lifetime maximums ... [2] Removal of pre-existing condition exclusions ... [3] The individual mandate and extending dependent coverage to age 26 have all increased membership in employer-sponsored plans; [4] Expanded taxes on fully insured health plans." (Milliman)
[Opinion] Get Health Insurance Through Your Employer? ACA Repeal Would Affect You, Too
"Although most large employer plans were relatively comprehensive and affordable before the ACA, some plans offered only skimpy coverage or had other barriers to accessing care, leaving individuals -- particularly those with costly, chronic health conditions -- with big bills and uncovered medical care. For that reason, the ACA extended several meaningful protections to employees of large businesses." (Health Affairs)
[Opinion] ACA 'Repeal and Delay' Would Leave a Narrow Window to Stabilize Exchanges
"Even if policymakers believe interim measures would in fact bring stability to the Exchange market for the transition period following 'repeal and delay,' legislators and the executive branch will have a narrow window to influence the 2018 coverage decisions facing health plans. Given the extended time it takes health plans to price coverage options and complete the regulatory review and approval process, actions intended to stabilize the market for 2018 would need to occur as early as the first calendar quarter of 2017 or shortly thereafter if they are to have their intended effect." (Health Affairs)
The Future of the ACA, Part 5: The Rep. Tom Price Plan(s)
"This [article] focuses principally on Price's replacement bill, the Empowering Patients First Act. [The authors] examine the bill's underlying policy prescriptions in an effort to discern how the legislation would deal with six key features of the ACA ... [1] the individual mandate; [2] premium subsidies; [3] access to coverage (exchanges/marketplaces); [4] the employer mandate; [5] insurance reforms and underwriting rules; and [6] coverage for low-income individuals, children, and the aged (Medicaid)." (Mintz Levin)
UnitedHealth Group to Buy Outpatient Surgery Chain for $2.3 Billion
"While the acquisition is a relatively small one for UnitedHealth, whose annual revenues last year were around $180 billion, it marks the latest step in the company's evolution from a traditional insurer to a diversified health services company." (The New York Times; subscription may be required)
The Future of the ACA Under the Trump Presidency and GOP-Controlled Congress (PDF)
62 presentation slides. "Even with GOP control of the Presidency and Congressional majorities, a complete repeal of the ACA is unlikely. Many ACA changes require a filibuster-proof majority vote in the Senate (60). A small number of changes (albeit significant ones) do not require overcoming the filibuster -- largely those related to taxes and spending (reconciliation). However, the Executive Branch can make at least some ACA changes unilaterally." (Trucker Huss)
[Guidance Overview] EEOC Issues Guidance on New Wellness Notice Mandated for 2017
"The [EEOC Q&As] clarify that an employer is not required to provide the [new model notice] if the employer currently provides a notice that informs an employee what information will be collected via the wellness program, who will receive it, how it will be used, and how it will be kept confidential. However, if all of this information is not included in the existing notice or if the existing notice is not easily understood, the employer must provide the new wellness program notice. The Q&As also note that, while a third party provider may provide the notice on behalf of any employer, it is the employer who is ultimately responsible for making sure that employees receive the new notice." (Thompson Coburn)
Health Plans Shift Toward Paying Doctors for Value Provided
"The use of high-performance networks is up from 11 percent in 2015, with another 39 percent potentially adding them over the next three years.... Other plan design features expected to be adopted more widely ... include: Reducing point-of-care costs for the use of high-value services.... Increasing point-of-care costs for the use of commonly overused services.... Requiring employees who undergo certain types of medical procedures to pay a higher cost share if they do not get a second opinion." (Society for Human Resource Management [SHRM])
[Guidance Overview] Administration Sticks with Current Accommodation for Employers Objecting to Contraceptive Coverage
"The Supreme Court had suggested a procedure under which the objecting employers would contract with insurers to cover their employees but inform their insurers that they did not want to include contraceptive coverage to which they objected. The insurers would then separately provide contraceptive coverage to the employees without any involvement or payment from the objecting entity employers. The administration concluded based on comments it received that this compromise was not feasible for insurers." (Timothy Jost, in Health Affairs)
Court Enjoins Part of Final ACA Nondiscrimination Rule (PDF)
"The injunction would prohibit OCR from enforcing, for example, the transgender services requirements in the regulation, but would not prevent an individual from bringing a private lawsuit to enforce those requirements. As such, at least for the time being, issuers and plan sponsors should exercise caution in changing plan designs based on the decision." [Franciscan Alliance v. Burwell, No. 16-108 (N.D. Tex. Dec. 31, 2016)] (Groom Law Group)
The Scoop on Wellness Regulations: Vendor Edition
"[E]mployers must obtain 'prior, knowing, voluntary, written authorization' from spouses of employees if your wellness program asks the spouse about current or past 'manifestations of disease and disorder.' ... What does 'prior, knowing, voluntary, written authorization' actually mean? The guidance is a bit unclear, but employers should be careful to make sure that any wellness vendors you work with have an eye on these regulations as well." (Frenkel Benefits)
More Employers Adopt 'Narrow Networks' of Health Care Providers
"Despite employers' slow adoption of narrow networks, more are considering limiting their plans' in-network health providers and selecting those that make the cut based on whether they offer pricing discounts for their services ... So-called high-performance networks limit providers to those that have high-quality ratings for their services, although the two approaches to selecting covered providers -- price and quality -- are not mutually exclusive." (Society for Human Resource Management [SHRM])
No More Out-of-Network Coverage for California Anthem Blue Cross Members
"As of January 1, Anthem converted its 2016 PPO (Preferred Provider Organization) health plans, which provide coverage for out-of-network doctors and hospitals, to EPO (Exclusive Provider Organization) health plans with no out-of-network coverage. Many members are still likely unaware that their PPO plan is now an EPO because Anthem sent out misleading notices in September 2016." (Consumer Watchdog)
[Official Guidance] Text of Agency ACA FAQs, Part 36: Religious Accommodation in Response to Zubik v. Burwell (PDF)
11 pages. "On July 22, 2016, the [DOL, HHS and Treasury Department] published a request for information (RFI) seeking input from interested parties to determine, as contemplated by the Supreme Court's opinion in Zubik, whether modifications to the existing accommodation procedure could resolve the objections asserted by the plaintiffs in the pending RFRA cases, while still ensuring that the affected women receive full and equal health coverage, including contraceptive coverage.... [T]he Departments received over 54,000 public comments ...

[Question:] Are the Departments making changes to the accommodation at this time? [Answer:] No. As described in more detail [in this document], the comments ... indicate that no feasible approach has been identified at this time that would resolve the concerns of religious objectors, while still ensuring that the affected women receive full and equal health coverage, including contraceptive coverage.... As the government explained in its briefs in Zubik, the Departments continue to believe that the existing accommodation regulations are consistent with RFRA[.]" (U.S. Department of Labor [DOL]; U.S. Department of the Treasury; U.S. Department of Health and Human Services [HHS])

How to Measure Your Wellness Success: It's Different Than You Think
"[I]ncreasing engagement and participation in a program, for the most part, doesn't drive positive health outcomes at all.... For successful lifestyle modification, these are actions that build mindfulness and awareness, and focus on changing the underlying behaviors that predict health outcomes over time. Engagement in meaningful actions with that help individuals improve their diet and increase their physical activity level will be predictive of success." (Grooms Benefit Solutions)
New Broker Rules Might Help Employers
"In recent years, many employers sought to control costs by turning to companies that promote individual medical plans to certain employees, like... Those eligible for COBRA [or] Part-time workers not eligible for the employer's group plan.... Now, new regulations bar insurers from discouraging sicker people from enrolling through the practice of altering broker commissions for mid-year enrollments." (bswift)
House Committee Releases Charts Detailing Effects of Obamacare
"[T]he Energy and Commerce Committee released eight infographics as part of a chart pack giving an Obamacare reality check. Together, the materials tell the truth about Obamacare, one where fewer plan options exist in counties across the country, and costs continue to rise each year, leaving vulnerable patients looking for help with nowhere to turn." (Energy and Commerce Committee, U.S. House of Representatives)
Banking on Paid Time Off
"A growing number of employers are switching to PTO banks, making it an increasingly popular approach to administering paid leave.... [A poll] found strong growth in PTO banks -- from 38 percent of employers in 2010 to 63 percent in 2015. At the same time, there are emerging trends that could put a cap on the growth of PTO banks, including state and local laws governing sick leave." (Society for Human Resource Management [SHRM])
Text of Comment Letters Submitted to DOL on ACA FAQs Part 34
These letters were submitted in response to DOL's request for comments on coverage and cost-sharing for specific medical management techniques in connection with tobacco cessation interventions, and disclosures with respect to mental health and substance abuse benefits. Deadline for submission of comment letters was Jan. 3, 2017. (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
Federal Court Issues Nationwide Injunction Against Enforcement of ACA Rules on Gender Identity and Termination of Pregnancy
"The government failed to submit much briefing on the issue, presumably expecting RFRA to be inconsequential given the Final Rule's express carve-out for RFRA-protected activities. The court, however, viewed the government's failure to identify a compelling interest as a serious deficit. The court further observed that the government's own health insurance programs -- Medicare and Medicaid -- do not mandate coverage for gender transition surgeries and that the military's TRICARE health insurance program specifically excludes transition coverage." [Franciscan Alliance v. Burwell, No. 16-108 (N.D. Tex. Dec. 31, 2016)] (Stradley Ronon)
District Court Halts Implementation of Section 1557 Regs on Gender Identity and Termination of Pregnancy (PDF)
"[On] December 31, 2016, the U.S. District Court for the Northern District of Texas issued an opinion preliminarily prohibiting HHS from enforcing, on a nationwide basis, the provisions of the regulation implementing Section 1557 concerning gender identity or termination of pregnancy. The regulations concerning certain required notices and taglines and translation aids aimed at individuals with limited English proficiency are not affected and are still in effect." [Franciscan Alliance v. Burwell, No. 16-108 (N.D. Tex. Dec. 31, 2016)] (United Actuarial Services, Inc.)
Federal Judge Denies Request to Delay EEOC Rules on Wellness Programs
"Some groups have raised concerns that workers could face discrimination if employers have access to their private medical information or that the data could be leaked or sold. But a group representing large employers said the lawsuit was a nonissue because the value of the wellness incentives most offer is nowhere near the 30 percent limit allowed under the regulations." (Kaiser Health News)
Understanding Product Offerings and Choices on a Private Exchange (PDF)
19 pages. "Employers, on average, offer 14 different product categories to their employees through a private exchange. The median number of Medical plan choices being offered to employees is six, and employers are even offering significant choice among Dental and Vision plans.... Larger companies (200+ employees) offer the same median number of Medical, Dental, and Vision plan choices as smaller companies." (Private Exchange Research Council [PERC])
Rate of Uninsured Americans Has Dropped in Every State
"By 2015, one year after the ACA went into effect, the percentage of uninsured working age Americans fell in every state and the District of Columbia, particularly among those with low incomes who need health insurance the most ... Adults in Arkansas, California, Kentucky, Nevada, Oregon, Rhode Island, New Mexico, Washington and West Virginia gained the most ... Kentucky led the nation with a 25-percentage-point drop in its rate of those who lacked health insurance." (Association of Health Care Journalists)
The Republican Study Committee's ACA Replacement Proposal
"On January 4, 2017, the House Republican Study Committee, a caucus of conservative Republican House members, introduced the American Health Care Reform Act (AHCRA), their replacement proposal.... It is similar to proposals made by the Study Committee in 2013 and 2015.... The proposal would: [1] Repeal the ACA entirely, effective January 1, 2018 ... [2] Replace the ACA's means-tested premium tax credits and the current tax exclusion for employer-sponsored coverage ... [3] Expand access to and tax-subsidized contributions and expenditures for health savings accounts." (Timothy Jost, in Health Affairs)
Why Obamacare's Insurance Marketplaces Won't Necessarily Collapse with a Repeal
"Even with a transition period, some exchanges may lose insurers or see big premium hikes, particularly if Republicans abruptly end elements key to the financial stability of the insurance marketplace, like the cost-sharing reductions that help low-income people afford coverage. But many experts say it's unlikely that lawmakers would end such a critical aspect of the law." (The Washington Post; subscription may be required)
Health Insurance Coverage for Americans with Pre-Existing Conditions: The Impact of the ACA
"This analysis also offers a first look at how health insurance coverage for people with pre-existing conditions actually changed when the ACA's major insurance market reforms took effect in 2014. It finds that, between 2010 and 2014, the share of Americans with pre-existing conditions who went without health insurance all year fell by 22 percent, a drop of 3.6 million people. The ACA's individual market reforms appear to have played a key role in these gains." (Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS])
Answers to Some Questions about QSEHRAs
"Which employers can offer QSEHRAs? ... What benefits does a QSEHRA cover? ... What are the health plan requirements for employees? ... Can employees be excluded? ... Is a QSEHRA subject to COBRA or ERISA rules? ... Are there administrative requirements for QSEHRA?" (DataPath)
2016 Best Practices in Sponsorship of Healthcare Plans
"[E]mployers' confidence that they will offer benefits 10 years from now rose to 54% in 2016 from 44% last year, more than double the lowest confidence levels in 2012 (23%).... [E]mployers continue to focus on controlling costs and adopting solutions to improve the effectiveness of their health care programs.... creating and leveraging best practices, especially superior network and provider contracting strategies, to control costs and improve workforce health.... [This downloadable 36-page report identifies] specific tactics that best-performing companies are doing[.]" (Willis Towers Watson)
Can a Continuous Coverage Requirement Produce a Healthy Insurance Market?
"[S]everal Republican proposals preserve the ACA's protections for people with pre-existing conditions -- but only for policyholders who maintain continuous coverage.... Compared to the limited penalties imposed by the individual mandate, the financial penalties and loss of consumer protections for pre-existing conditions may provide a much stronger incentive to purchase insurance." (RAND Corporation)
[Opinion] Building a Better 'Cadillac'
"[T]his paper addresses and proposes improvements for [several] criticisms leveled against the Cadillac tax: ... [Make] adjustments based on employer size, geographic differences, and health status variability across employers.... [R]eplace the current indexing plan with an index based on GDP either before the Cadillac tax is implemented or after a limited number of years.... [Use] some of the revenue raised by the Cadillac tax ... to help cover out-of-pocket medical expenses for those with low or middle incomes.... [An] exclusion cap is somewhat preferable to the Cadillac tax (or any other excise tax on high-cost plans). (Urban Institute)
Seven Tips for Adding Prescription Drug Coverage Limits
"Plan sponsors can ask participants to pay attention to drug prices and to ask their doctors to prescribe lower cost generics or over-the-counter drugs when possible. Participants can be asked to fill prescriptions at lower cost pharmacies or specific pharmacies. Sponsors may need to explain why they're excluding certain high-cost drugs from coverage or making them more expensive when a less-expensive alternative is available." (International Foundation of Employee Benefit Plans [IFEBP])
EEOC's ADA and GINA Wellness Regs Survive AARP's Challenge
"AARP raised two principal arguments as to both rules: first, that EEOC's interpretation of the term 'voluntary' to permit the use of 30 percent incentives is contrary to both the ADA and GINA; second, that EEOC did not adequately explain its reversal from its previous position that incentives were not permitted under either statute. Peeved because of AARP's delay in bringing suit and its request for expedited review, which meant the administrative record could not be prepared in time for the court to review it for the preliminary injunction, the court gave deference to the EEOC and concluded that AARP was not likely to succeed on the merits." [AARP v. EEOC, No. 16-2113 (D.D.C. Dec. 29, 2016)] (Wolters Kluwer)
Obamacare a Losing Bet for Health Insurers, Three Years in a Row
"Health insurers lost money on Obamacare plans in 2016 for the third straight year. But they lost less than the $4.5 billion lost in 2015, and for 2017 they will get closer to break-even results ... Still, even though 2016 premiums rose an average of 25 percent for benchmark plans on which federal subsidies are based, most insurers will remain below their target profitability levels, and more premium increases can be expected for 2018[.]" (Bloomberg BNA)
Predictions for ACA Repeal-and-Replace Prospects
"Facing a filibuster, Republicans are likely to turn to the budget reconciliation process, in which a simple Senate majority is needed to pass measures related to federal revenues and spending, as long as those measures are budget-neutral ... [H]ealth benefit specialists shared possible scenarios to repeal and replace ACA at a December policy forum[.]" (Society for Human Resource Management [SHRM])
ACA Replacement: What to Expect
"Republicans have not reached a consensus on a detailed replacement law since ACA was enacted in 2010 and the difficulties are many. Some Republicans ... say that they would retain popular portions of ACA, such as a ban on preexisting condition exclusions, while eliminating the mandate for individuals to maintain health coverage.... The table [in this article] is based on plans offered by Republican leaders that may provide clues to future legislation." (Bloomberg BNA)
ACA Repeal Process Begins in Congress
"On January 3, 2017, Senator Mike Enzi, Chair of the Senate Budget Committee, introduced a concurrent budget resolution in the Senate ... This provision does not specifically refer to repeal of the [ACA], but that is clearly its goal. The concurrent resolution also establishes a 'reserve fund for health care legislation,' which is intended to pocket any savings from repeal for subsequent replacement legislation ... A budget resolution cannot be filibustered in the Senate and need only pass each house by a simple majority." (Health Affairs)
Separate vs. Combined Leave Policies
"To further evaluate whether to have a single PTO policy or separate policies for vacation, personal days and sick leave, [this article describes] some of the pros and cons of each.... Payout of Leave upon Termination ... Carryover of Accrued Leave ... Tracking of Leave ... How and When Leave is Earned ... Waiting Periods for Accruing and Using Leave ... Flexibility and Morale ... Privacy Issues ... Employers' Bottom Line." (Ford & Harrison LLP)
The 2017 Watch list for Healthcare
"Watch for [1] refreshed approaches to privatizing Medicare ... [2] changes in how anti-trust issues and competition is regulated by the U.S. Department of Justice and the Federal Trade Commission ... [3] privatization to be injected into the Veterans Health and Indian Health programs ... [4] healthcare officials to relax reporting requirements for physicians and hospitals ... [5] pressures to be exerted toward drug manufacturers to reduce prices ... [6] private insurers to recover.... [7] consumer responsibility to become a key theme in health reform ... [8] employers to stay in the employee health benefits game." (Paul Keckley)
ACA Pregnancy Termination, Gender Identity Protections Blocked; Wellness Program Incentives Survive
"Yesterday, January 1, 2017, several [ACA] rules were scheduled to go into effect. On December 31, however, a [Texas federal District Court] judge granted a preliminary injunction blocking parts of a nondiscrimination rule issued under ACA section 1557. On December 30, [a D.C. District Court] judge refused to block a rule allowing employers to offer significant incentives for employees to disclose medical information in connection with workplace wellness programs." (Health Affairs)
District Court Rejects Retirees' Claim for Lifetime Healthcare Benefits
"[T]he court first observed that the agreements were for three-year terms and did not expressly state that the healthcare benefits vested, whereas the pension plan documents stated that Plaintiffs' pension benefits were lifetime benefits. Next, the court observed that several of the agreements restated and sometimes redefined the healthcare benefits available going forward, which would be unnecessary if the benefits had vested." [Sloan v. BorgWarner, Inc., No. 9-10918 (E.D. Mich. Dec. 5, 2016)] (Proskauer's ERISA Practice Center)
[Opinion] Stop Small Businesses from Getting Hit with Obamacare Tax Increases
"Making changes to the nearly seven-year-old, 2,000 page [ACA] -- Obamacare -- involves a lot of moving parts. One item that can't fall through the cracks is eliminating Obamacare taxes ... [The Health Insurance Tax] is a tax on health plans sold in the fully-insured market, 86% of these plans are purchased by small businesses. Since they bear much of the brunt of the tax, many small business owners feel they're being punishing for offering health insurance to their employees.... Repealing the Health Insurance Tax, the Medical Device Tax and the Cadillac Tax must be the first order of Congressional business to help our country's businesses, as well as individuals and families." (U.S. Chamber of Commerce)
[Opinion] Uncertainty Around Obamacare Will Cause Insurers to Bolt Exchanges
"If the uncertainty of this market was large before with the ACA, it is almost unknowable under whatever comes next. Thus the initial exit of some latecomers, including United Healthcare, and undercapitalized minor entrants, such as nonprofit co-ops, is almost certain to become a flood of firms leaving the exchanges. They have little choice since the risks are too large and the actuarially appropriate rates are still not obvious given the political turmoil and changing rules." (Newsweek)

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