Headlines about "Health plan costs - healthcare delivery"
Gathered from the web by the editors at BenefitsLink.com.
[Official Guidance] Form W-2 Reporting of Employer-Sponsored Health Coverage: IRS Informational Page Updated May 2, 2012
"The chart ... illustrates the types of coverage that employers must report on the Form W-2. Certain items are listed as 'optional' based on transition relief provided by Notice 2012-9 (restating and clarifying Notice 2011-28)." (Internal Revenue Service)
[Official Guidance] Text of CCIIO Announcement on Medical Loss Ratio Annual Reporting Form Reminding Health Insurers of June 1 Deadline (PDF)
"[The final regs require] an issuer to submit an annual report to the Secretary by June 1 of the year following the end of an MLR reporting year. The first annual report must be submitted to the Secretary by June 1, 2012.... Please refer to the Medical Loss Ratio (MLR) Annual Reporting Form Instructions at: http://www.cciio.cms.gov/resources/other/index.html#mlr for the complete set of instructions." (Centers for Medicare & Medicaid Services, Center for Consumer Information and Insurance Oversight)
[Official Guidance] Text of CCIIO Announcement on Medical Loss Ratio Rebate Notices, Reminding Health Insurers of August 1 Deadline (PDF)
"[The final regs require] an issuer to provide information in the form of a rebate notice to enrollees who are owed rebates, regardless of the form in which the rebate payment is made (e.g., check or future premium credit).... CMS has developed a standard form for the rebate notice that each issuer must send by August 1 of the following year to enrollees entitled to a rebate based upon the prior MLR reporting year. For example, notice of rebates based on the 2011 MLR reporting year must be provided by August 1, 2012.... Please refer to the Medical Loss Ratio (MLR) Rebate Notice Instructions at http://www.cciio.cms.gov/resources/other/index.html#mlr for the complete set of instructions." (Centers for Medicare & Medicaid Services, Center for Consumer Information and Insurance Oversight)
Colorado Creating Online Price List of Health Care Procedures
"[14] states have or are setting up searchable databases designed to help people shop and compare health care options based on price and quality. Colorado is launching its All Payer Claims Database this fall. [The project] is the result of 2010 legislation and is expected to have data from most of the claims in the state in 2013." (Kaiser Health News)
[Opinion] Looking at Single-Payor Health Care Efforts in Vermont, Montana and California
"In May 2011, [the Vermont governor] signed the single-payor bill into law, which laid the groundwork for creating a publicly funded health system in which the state would act as the main insurer by 2017. [Montana's Governor] also asked the federal government for a waiver this past September so Montana could set up its own single-payor health system based on what is used by its northern neighbor, Saskatchewan, although no waiver has been granted. Even California lawmakers proposed a bill in January that would have established a single-payor healthcare system, although it was ultimately defeated." (Becker's Hospital Review)
[Guidance Overview] HHS Notice Addresses Rules for Insurers That Meet or Exceed Medical Loss Ratio Standards
"The extended notice requirement will hopefully reduce confusion that may have otherwise occurred when some individuals received rebates and others, in different insurance plans, did not. Importantly, the electronic disclosure rules for providing SBCs, which are referenced in the extended notice requirements for MLRs, were recently addressed in DOL frequently-asked-questions[.]" (Practical Law Company)
[Guidance Overview] FAQs on Summaries of Benefits and Coverage Address Electronic Distribution and Coverage Example Calculator
"Although the latest FAQs do not delay the fast-approaching compliance date for providing [Summaries of Benefits and Coverage, or "SBCs"], plans, plan sponsors and insurers may nonetheless welcome the first-year policies provided in the new guidance. In particular, the rule permitting partial SBCs for plans with multiple insurers may be helpful in preparing initial SBCs, though the FAQ also underscores challenges for later years when information from separate insurers must be combined in the same SBC. In addition, plans and insurers may want to document their SBC compliance efforts in case they wish to use the Departments' one-year good faith compliance policy." (Practical Law Company)
[Guidance Overview] DOL, HHS and Treasury Guidance on SBC Requirements Provides Compliance Exceptions During First Year
"[T]he agencies acknowledged the administrative difficulties for issuers and plans in some circumstances to provide such summaries. [For example, in] discussing a question about health plans that use two or more issuers to provide various types of coverage, the departments said issuers have no obligation to provide coverage information for benefits that it does not insure, but that group health plans �are responsible for providing complete SBCs with respect to a plan.�" (Bloomberg BNA)
Health Care Costs for American Families in 2012 Exceed $20,000 for the First Time
"The annual Milliman Medical Index (MMI) measures the total cost of healthcare for a typical family of four covered by a preferred provider plan.... The 2012 MMI cost is $20,728, an increase of $1,335, or 6.9% over 2011. The rate of increase is not as high as in the past, but the total dollar increase was still a record." (Milliman)
[Guidance Overview] IRS Notice 2012-31 Addresses 'Minimum Value' Determination for Employer-Sponsored Health Plans (PDF)
"Basing minimum value on benefits generally offered in the large-employer market, which entails recognizing that those plans do not have to offer essential health benefits, is an important distinction that will help large-employer plans meet the minimum value threshold.... The guidance asks for comments on any other benefits (such as wellness benefits) that should be reflected in the calculation of minimum value.... The IRS guidance does not provide any further clarification on how the employer contributions to an HSA or HRA would be adjusted. If the full value is not reflected, a plan could fail to meet the minimum value threshold." (Buck Consultants)
Resource Page on Implementation of Health Insurance Medical Loss Ratios by the States, Updated May 11, 2012
"The N.H. insurance department released its first health insurance premium rate report in April 2012, a study mandated by legislation enacted two years ago. According to the report, premiums grew 14 percent between 2009 and 2010, driven primarily by claims costs, as well as new medical technologies and the growth in outpatient facility costs." (National Conference of State Legislatures)
[Official Guidance] Text of Official Corrections to Interim Final CMS Regs for Health Insurance Issuers Implementing Medical Loss Ratio Requirements (PDF)
8 pages; the clarifications are more than typographical errors. "This document corrects technical errors that appeared in the interim final rule published in the Federal Register on December 1, 2010, entitled 'Health Insurance Issuers Implementing Medical Loss Ratio ... Requirements under the [PPACA]' and in the correction notice published in the Federal Register on December 30, 2010, entitled 'Health Insurance Issuers Implementing Medical Loss Ratio ... Requirements Under the [PPACA]; Corrections to the Medical Loss Ratio Interim Final Rule With Request for Comments.' ... We believe that it is unnecessary to provide for a public comment period or to delay implementing these corrections, as they clarify provisions of a final rule that has been subjected to notice and comment procedures and do not make any substantive changes to it." (Centers for Medicare & Medicaid Services)
Innovation in the Health Care Sector Continues
"The Galen Institute held a conference ... in which speakers from more than a dozen companies described the investments they are making in better health, better health care services, and more efficient care delivery. They demonstrated that the best solutions to the problems in our health sector come not from remote Washington bureaucrats trying futilely to re-engineer our health sector through costly, cumbersome, and confusing rules and regulations, but from innovators who are listening to doctors, patients, and consumers." (Galen Institute)
Some States Mandating Better Coverage of Oral Medications Used for Cancer Treatment
"In contrast to conventional IV chemotherapy, which often kills both cancer and healthy cells alike, many of the new oral oncology drugs target specific biologic processes in cancer cells and block their growth. In addition to being highly effective, they're convenient, especially for patients who live far from a treatment facility.... Health plans, however, have been slow to adjust to the change. People who get traditional IV chemotherapy on an outpatient basis often pay a flat co-payment that covers the drug as well as the cost of administering it. Annual out-of-pocket costs are also typically capped. Oral anti-cancer medications, on the other hand, are generally considered a pharmacy benefit. Instead of a co-payment, plan members often pay a percentage of the drugs' cost -- up to 50 percent in some cases -- with no annual out-of-pocket limit." (Kaiser Health News)
Massachusetts May Impose 'Luxury Tax' on the State's Most Pricey Hospitals
"The penalty is not included in the Senate's version of health-care reform, which instead calls for a special commission to determine acceptable and unacceptable factors contributing to price variation. [One state senator] has said the House's fee could 'force those folks that are higher cost to make decisions that aren't well-thought-out.' But [a state representative] said steps must be taken to address the differences in how hospitals are paid." (lowellsun.com)
[Opinion] Why Employer-Paid Health Insurance Drives Up Health Care Costs
"Stanford Nobelist Kenneth Arrow famously described third-party insurance as one of the principal flaws in America's health-care market. That is to say, because patients don't pay for their health care directly, they're insensitive to the cost and value of that care. But the 155 million Americans with employer-sponsored insurance in fact have fourth-party insurance. Not only do they not directly pay for their care, but they don't directly pay for their third-party insurance." (Forbes)
[Guidance Overview] Preauthorization of Surgical Procedure Not Covered by the Plan Was Not a Fiduciary Breach
"This case is another example of how participants may be left without a remedy for harm caused by the actions of a plan fiduciary. The U.S. Supreme Court's decision last year in Cigna v. Amara ... suggested that courts may be more inventive in using equitable principles to fashion remedies for fiduciary breaches. However, this court found no breach of fiduciary duty and therefore did not address the issue of remedies." (Thomson Reuters/EBIA)
[Official Guidance] Agencies Revise Summary of Benefits and Coverage Template and , Sample Completed SBC, and Coverage Example Calculations
Q&A 14 in Part IX of "FAQs About ACA Implementation" explains the changes: "In the diabetes treatment scenario, the version originally posted contained a typographical error, listing the allowed amount for insulin as $11.92, rather than $119.20 -- a difference that impacts the total cost of care for diabetes in the coverage example calculations. To correct this error, the Departments have posted updated versions of the SBC template, the sample completed SBC, and the guide for coverage examples calculations - diabetes scenario. The updated SBC template and sample completed SBC also include sample taglines for obtaining translated documents ... as well as updated Sample Care Costs amounts for the diabetes coverage example, due to more accurate rounding in making these calculations. Finally, the updated versions include some appearance modifications (such as changes in bolding, underlining, shading, capitalization, margin justification, use of hyphens, and row and column sizing) to ensure the document is accessible to individuals with disabilities, consistent with section 508 of the Rehabilitation Act. Plans and issuers may use either version, or may make similar modifications to their own SBCs, without violating the appearance requirements for an SBC. The updated versions of these documents are labeled �corrected on May 11, 2012� in the lower right corner of the first page and are available at www.dol.gov/ebsa/healthreform and cciio.cms.gov. These three documents replace the prior versions issued contemporaneously with the final regulations in February 2012." (Employee Benefits Security Administration)
[Official Guidance] Text of Final CMS Regs for Medical Loss Ratio Requirements (PDF)
"[T]his final rule establishes a simple, straightforward notice requirement for health insurance issuers that meet or exceed the [Medical Loss Ratio, or 'MLR'] standards established by the Affordable Care Act, but only requires the notice for the 2011 MLR reporting year, the first year that the MLR rules are in effect, and does not require issuers to include information about the current or prior year MLR. The notice will direct enrollees to the HHS Web site for specific information about issuers' MLRs." (Centers for Medicare & Medicaid Services)
[Official Guidance] Affordable Care Act Implementation FAQs -- Set 9 -- The Summary of Benefits and Coverage
"[Question]: A previous FAQ provided a link where written translations for the SBC template and the uniform glossary would be available in the future. Are these translations available? [Answer]: Written translations in Spanish, Chinese, and Tagalog are now available. Navajo translations will be available shortly." (U.S. Centers for Medicare & Medicaid Services, The Center for Consumer Information and Insurance Oversight)
Trend in Massachusetts Experience: Small Employers Moving to Less Generous Health Insurance Plans
"A new analysis ... found that 27 percent of people in Massachusetts who got their insurance through the small group market at the end of 2010 were in a plan with a lower 'actuarial value,' meaning the deductibles and copayments were the highest among plans on the market. That's up from just 2 percent in the first quarter of 2008." (The Boston Globe)
Massachusetts Politicians Taking Different Tacks Pursuing Containment of Health Care Costs
Provides an interesting list of proposed programs, technologies, expenditures and tax relief. "The current legislative session's policy focus has been health care payment reform, and the Massachusetts Senate, House of Representatives and governor have each proposed their own unique approach to transition the market away from fee-for-service and to contain cost growth." (ML Strategies)
Growing Power of Some Providers to Win Steep Payment Increases from Insurers Suggests Policy Remedies May Be Needed
"Interviews in 12 U.S. communities indicated that so-called must-have hospital systems and large physician groups -- providers that health plans must include in their networks so that they are attractive to employers and consumers -- can exert considerable market power to obtain steep payment rates from insurers. Other factors, such as offering an important, unique service or access in a particular geographic area, can contribute to provider leverage as well." (Health Affairs)
Proposed Meaningful Use Stage 2 Regs Draw Strong Reaction
"[A few paragraphs in the 68-page comment letter from the American Hospital Association have] drawn the attention and ire of patient and consumer advocate groups. Citing HIPAA concerns, the AHA disagrees with the Centers for Medicare & Medicaid Services proposal 'to provide patients with the ability to view, download, and transmit large volumes of protected health information via the Internet.'" (HealthLeaders Media)
More Than Half of Patients Consider Budget Before Making Medical Visits
"[One survey] found that 57% considered their budget before making health-related decisions. Nearly 31% attempted to be frugal by skipping or reducing annual visits to their primary care physician, and 32% passed up or cut back on follow-up appointments. Almost 27% went without or decreased visits to specialists. When it came to blood work and lab tests, almost 21% refrained from them because of cost concerns. Nineteen percent went without an imaging test." (amednews.com)
[Opinion] Innoculate the Budget Deficit from Health Care Reform
"As we work to restrain health care cost growth, we must, at the same time, inoculate the future deficit from the inevitable failures of health reform. We can do this by choosing a federal health care spending level and stipulating that any spending above that amount must be financed on a current basis with a tax. For example, if federal health care spending were allowed to grow at the rate of GDP plus 0.5 percent (a rate proposed by both President Obama and Rep. Ryan), any health spending in excess of that growth rate would be financed with tax revenues in the next year." (Brookings)
In Japan, All-Payer Rate Setting Under Tight Government Control Proving to Be Effective at Containing Costs
"Japan's single payment system contains spending while retaining the advantages of multiple health insurance plans. Combining hospital and physician fees -- not typically done in the U.S. -- also helps achieve these objectives. Applying a single rate to U.S. providers, a growing number of whom are employed by hospitals, would simplify billing, provide incentives for physicians to practice more efficiently, and possibly encourage more physicians to locate in medically underserved areas." (The Commonwealth Fund)
[Opinion] Fee-for-Service Model: Culprit Behind Exponential Health Care Cost Growth?
"Moving away from fee-for-service requires realigning the care delivery and payment incentives in the health care system. [Reimbursement should be] based on the quality and utility of care provided, not just the sheer volume of services. This idea -- paying for 'value over volume' or 'paying for performance' -- is now a common refrain in the world of health policy. Some experts even go so far as to say that too much care can be detrimental to health, such as unnecessary or redundant medical imaging scans[.]" (The Atlantic)
[Opinion] How to Fix Our Enormous, Inefficient Health Care System
"[C]hange will require new structures and institutions, not tweaks to the current system. That's the only way to disrupt the wasteful habits of the status quo. [The author offers] two specific proposals for new frameworks. The first ["Create Special Heath Care Courts"] is now broadly accepted by health care thought and political leaders of both sides ... but has been stymied so far by a powerful special interest. The second [" Replace Public Health Care with Comprehensive Providers"] is radical, and would be considered politically suicidal. It would also solve much of the problem of misaligned incentives." (The Atlantic)
[Opinion] Text of Comments by Consumer-Purchaser Disclosure Project to CMS on Health IT Meaningful Use Program (PDF)
"Stage 2 of Meaningful Use marks a significant step toward national commitment to effective management of health information to improve health outcomes. [The Project urges] CMS to finalize the progressive strides it makes in the proposed rule, especially those that enhance patient and family engagement. However, the proposed rule does not do enough to: (1) drive providers to share information with each other and (2) build the capability to report on quality measures that indicate whether providers are improving their ability to deliver high-value, coordinated care. [This letter elaborates and offers] recommendations on these points[.]" (Consumer-Purchaser Disclosure Project)
$57 Billion in Annual Health Care Savings Possible If Consumer-Directed Health Plans Were 50% of All Employer-Sponsored Insurance
"Enrollment is increasing in consumer-directed health insurance plans, which feature high deductibles and a personal health care savings account. [The authors] project that an increase in market share of these plans -- from the current level of 13 percent of employer-sponsored insurance to 50 percent -- could reduce annual health care spending.... That decrease would be the equivalent of a 4 percent decline in total health care spending for the nonelderly." (Health Affairs)
How Supreme Court Vote Could Affect Health Industry's Cash Flow
"[T]he net effect of a thumbs-up decision is likely to be a brighter free-cash profile (FCP) for the industry and many of its individual companies, according to [the] professor of accounting at Georgia Tech who invented the metric. The FCP is designed to forecast the ability of a company or an industry to produce cash as it grows.... 'If national health care goes through, I view it as a positive for the health-care industry, because we'll have more people covered by insurance,' .... 'If they were to get more care, better care, I would think that somebody's got to provide that care -- and it's the health care industry.'" (cfo)
Critics Say Health Insurance Industry Should Be Replaced by Single-Payer System
Dr. Arnold Relman, a former editor of the New England Journal of Medicine, spoke at an event sponsored by two advocacy groups: Mad As Hell Doctors, and Physicians for a National Health Programs. 'We run our healthcare system as if it's a business in the free market... and not like the social service it ought to be.... [and we] believe in the myth that the private market -- private capitalism -- can work as well in healthcare as it is reputed to work in other areas [of the economy].'" (The Lund Report)
Health Care Access Already in Steady Decline for Past Decade, Could Get Worse If Health Care Reform Repealed
"This paper's analysis of national survey estimates found that access to health care and use of health services for adults ages 19-64 -- the primary targets of the ACA -- deteriorated between 2000 and 2010, particularly among those who were uninsured. More than half of uninsured US adults did not see a doctor in 2010, and only slightly more than a quarter of these adults were seen by a dentist." (Health Affairs)
Nearly Half of Soon-to-Be-Retired, High-Net-Worth Americans 'Terrified' of Health Care Costs in Retirement
"While 45 percent expect health care to be their biggest expense throughout retirement, when asked to estimate how much they anticipate spending each year on health care, they said, on average, $5,621. This represents a drastic underestimation based on a 2010 study that estimates out-of-pocket health care expenses for a 65-year-old couple retiring today and living for 20 years to range from $250,000 to $430,000. That could mean as much as $10,750 a year per person in out-of-pocket health care expenses." (Nationwide Financial)
[Guidance Overview] IRS Notice Requests Comments on Minimum Value and Reporting Requirements for Group Health Plans
"The [IRS is requesting comments on] three potential approaches to determining minimum value under consideration: 1. Use of an actuarial value calculator (for insured small group plans) or minimum value calculator (for self-insured and insured large group plans) created by [HHS] and the Treasury ... 2. Creation of various design-based safe harbor checklists describing deductibles, co-pays, coinsurance, out-of-pocket maximums and other cost-sharing attributes for the four core categories of benefits and services [and] 3. For non-standard plan designs, determination by a certified actuary that the plan provides minimum value." (McDermott Will & Emery)
Massachusetts Lawmakers Unveil Ambitious Plan to Cut Health Care Costs
"[State lawmakers announced a new proposal to control rising medical costs], including new ways to pay doctors and hospitals, a specific cap on health-care spending tethered to economic growth and a tax on the state's most expensive hospitals if they can't justify their prices." (Kaiser Health News)
[Guidance Overview] Guidance Addresses Minimum Value for Employer Plans, Information Returns, and Exchange Eligibility Determinations
"Most of the minimum value details remain to be worked out (through development of the calculator and checklists), but one interesting point is highlighted with respect to the four categories of benefits.... According to Notice 2012-31, although employer plans are not required to cover all these benefit categories, ... a plan will not satisfy any design-based safe harbor if it fails to do so." (Thomson Reuters/EBIA)
[Opinion] Text of Comments by American Academy of Actuaries to CMS on Revised MLR Annual Reporting Form (PDF)
"The Medical Loss Ratio Work Group sent a letter to CMS offering comments on the revised annual reporting form, specifically on the definition of premiums, contract reserves, and the definition of pre-tax underwriting gain/(loss)." (American Academy of Actuaries)
'Accountable Care Organizations' Could Have Medicare Muscle to Transform the Health System
"The drawbacks of fee-for-service reimbursement are hardly secret. In 1909, the playwright George Bernard Shaw wondered why 'any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg.' A century later, McKinsey Global Institute identified 'payment for more care rather than more value' as one reason U.S. medical spending is more than 25 percent higher per person than even in other industrialized nations." (Kaiser Health News)
How to Explain High U.S. Health Care Spending? A Look at Supply, Utilization, Prices and Quality in Other Countries
"[The] high spending cannot be attributed to higher income, an older population, or greater supply or utilization of hospitals and doctors. Instead, the findings suggest the higher spending is more likely due to higher prices and perhaps more readily accessible technology and greater obesity. Health care quality in the U.S. varies and is not notably superior to the far less expensive systems in the other study countries." (The Commonwealth Fund)
[Guidance Overview] CMS Guidance Addresses Medical Loss Ratio Requirement
"In response to [a] question about whether 'premium holidays' are permissible in lieu of providing rebates if an issuer finds that its MLR is lower than the standard required, the guidance explains that this is a state regulatory issue not addressed by the MLR regulations." (Littler)
California State Officials Launch 'Health Happens in the Workplace' Program
"The health and wellness program evolved from a study ... of health care expenditures for state employees by the Urban Institute, in partnership with CalPERS, the largest purchaser of public employee health benefits in California. The study found that 22.4 percent of CalPERS' medical expenditures in 2008 were spent treating chronic diseases that could be prevented through changes in diet and increased physical activity." (The California Endowment)
Obesity Adds $190 Billion in Health Costs
"The nation's rising rate of obesity has been well-chronicled. But businesses, governments and individuals are only now coming to grips with the costs of those extra pounds, many of which are even greater than believed only a few years ago: The additional medical spending due to obesity is double previous estimates and exceeds even those of smoking, a new study shows." (msnbc.com)
[Guidance Overview] HHS Issues Additional Questions and Answers Guidance on Medical Loss Ratio Requirements
"Insurers are required to make the first round of rebates by August 2012 based on their 2011 MLR. While many details in the guidance relate to the actual calculation and reporting of MLRs by insurers, these rules also affect employers (e.g., in terms of handling any rebates provided)." (Thomson Reuters/EBIA)
[Opinion] Saving for Future Health Care Expenses
"Newly announced regulations under the [PPACA] threaten the very existence of consumer directed health plans in the individual market (including the anticipated health insurance exchanges) ... Yet according to a RAND study, these plans have the potential to reduce health care spending by 30% without causing any harm, even to vulnerable populations. [This article reviews] some of the advantages and disadvantages of the various health savings options." (National Center for Policy Analysis)
'Choosing Wisely' Campaign Aims to Curb Wasteful Medical Spending by Consumers
"The American Board of Internal Medicine, in collaboration with Consumer Reports, has recently launched an initiative called Choosing Wisely, which aims to reduce unnecessary medical treatments. Some organizations have estimated that up to one-third of all medical spending in the United States is unnecessary; this spending includes unnecessary hospitalizations, money spent on unproven treatments and ineffective new drugs, and futile end of life care." (The American Journal of Managed Care)
[Opinion] The Medical Loss Report: Fiddling While Rome Burns
"The Wall Street Journal, citing a Goldman analysis, is reporting that Aetna will be paying out $177 million in rebates. But Aetna has $11 billion in premium so that's only a 1.6% rebate. UnitedHealth will be paying out $307 [m]illion but that is only 1% of its $28.8 billion in premium. Wellpoint will pay out $94 million in rebates but that is only .28% of its premium for the year. The average cost of employer-provided family health insurance is now about $13,000 per year. A family rebate of perhaps $200 will amount to only about 1.5% of premium for the relatively few people who will even get one." (The Health Care Blog)
Health Care Spending Flattening Out
"Much of the slowdown is because of the recession, and thus not unexpected, health experts say. But some of it seems to be attributable to changing behavior by consumers and providers of health care -- meaning that the lower rates of growth might persist even as the economy picks up." (The New York Times; free registration required)
What's It Take to Be a 'Bronze' Health Plan Under the Affordable Care Act?
"The study projects what deductibles and coinsurance would meet the requirements of a Bronze plan, presenting two alternatives: One with a deductible per individual of $4,375, with consumers paying 20% of their health care expenses once meeting the deductible. The other with a deductible of $3,475 and patient coinsurance of 40%. Under both plans, total patient out-of-pocket costs would be capped at $6,350, as required by the health reform law. Deductibles for families would be double these amounts." (The Henry J. Kaiser Family Foundation)
Estimating the 2012 Health Insurance Rebates Under the Medical Loss Ratio Rules
"This analysis looks at the latest estimates provided by insurers to state insurance commissioners. The analysis finds that consumers and businesses are expected to receive an estimated $1.3 billion by this August in rebates from health insurers who spent more on administrative expenses and profits than allowed by the ACA. The rebates include $541 million in the large employer market, $377 million in the small business market, and $426 million for those buying insurance on their own." (The Henry J. Kaiser Family Foundation)
Performance Improvement in Health Care
"[The author] suggests that the federal government should first aim, by 2016, to hold the rate of increase in national health spending per capita to the annual projected growth in gross domestic product per capita plus 0.5 percentage points, and to maintain this rate through 2021. Achieving this target, [he] says, would reduce spending by $893 billion over 10 years." (The Commonwealth Fund)
Think Tank Proposes Plan to Improve Care for the Chronically Ill, Reduce Health Spending
"Noting the 'unprecedented opportunity' provided under the Affordable Care Act, the Health Information Technology for Economic and Clinical Health ... Act, and other recently enacted federal laws, the Commonwealth Fund Commission on a High Performance Health System today unveiled a community-based plan to enhance health and reduce spending by improving care for chronically ill patients and targeting quality improvement efforts to conditions that can yield the greatest benefit in a relatively short time. The 'Health Improvement Community' initiative proposed by the Commission has the potential to help those who most need more coordinated care and save $184 billion in health spending over the next 10 years." (The Commonwealth Fund)
[Guidance Overview] CCIIO Issues Guidance on Medical Loss Ratio Rules
"The [Center for Consumer Information and Insurance Oversight (CCIIO)] bulletin provides MLR guidance on the following topics: applicability of the MLR to certain types of plans, employer groups of one, counting employees for determining market size, individual association policies, offering policyholders a 'premium holiday,' reinsurance and reporting, Exchange user fees, states with a higher MLR standard, 'mini-med' experience and application of the adjustment, and form of rebate." (Wolters Kluwer Law & Business / CCH)
[Guidance Overview] New Michigan Motorcycle Helmet Law Could Impact Self-Funded Group Health Plans
"[T]he Michigan no-fault law, which requires fully-insured employer group health plans to pay primary to no-fault, doesn't apply to ERISA self-funded plans. However, since the no fault law doesn't extend to motorcycles, the typical Michigan employer's self-funded health plan doesn't exclude or pay secondary where a participant is injured in a motorcycle crash." (Miller Johnson)
Employers Try Health Gaming and the Power of Social Responses
"Many companies, both new and established, have recently entered the market with health-related games that incorporate a social component, whereby people collaborate, compete and support one another in reaching a specific goal. In addition to startups, employers and health insurers have worked to capitalize on this popular trend." (iHealthBeat)
Medicare Finances: Findings of the 2012 Trustees Report (PDF)
"According to the 2012 Trustees Report, expenditures from Medicare's HI Trust Fund exceeded revenues by $27.7 billion in 2011. Without a policy change that would increase revenues or reduce expenditures, the accumulated surplus in the HI Trust Fund will be depleted by 2024, the same as last year's projection; after that, the HI Trust Fund would rely on the annual revenues from Medicare payroll taxes, which are projected to cover 87 percent of annual expenditures." (National Academy of Social Insurance)
Official Summary of the 2012 Annual Reports of the Social Security and Medicare Boards of Trustees
"The long-run actuarial deficits of the Social Security and Medicare programs worsened in 2012, though in each case for different reasons. The actuarial deficit in the Medicare Hospital Insurance program increased primarily because the Trustees incorporated recommendations of the 2010-11 Medicare Technical Panel that long-run health cost growth rate assumptions be somewhat increased. The actuarial deficit in Social Security increased largely because of the incorporation of updated economic data and assumptions. Both Medicare and Social Security cannot sustain projected long-run program costs under currently scheduled financing, and legislative modifications are necessary to avoid disruptive consequences for beneficiaries and taxpayers." (Social Security Administration)
Smaller Employers Increasingly Explore Partial Self-Funding of Health Benefits
"Many large, Fortune 1000 companies already self-insure their employee benefits, and the concept is far from new. But the option for smaller groups has received more attention lately, and brokers ... said they've seen an uptick in inquiries about partial self-funding models as means of creating a bit more flexibility in an otherwise inflexible, tightening marketplace." (North Bay Business Journal)
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