Headlines about "Health plans - mandated benefits"
Gathered from the web by the editors at BenefitsLink.com.
[Guidance Overview] Chart of State Domestic Partner and Same-Sex Marriage Laws as of May 10, 2012
Jurisdictions covered are CA, CO, CT, DC, DE, HI, IA, IL, MD, ME, MA, NH, NJ, NV, NY, OR, RI, VT and WA. Issues described in this nicely done 3-page chart include: type of relationship addressed, whether or not health insurance coverage is mandated; whether a leave law applies; scope of state tax exclusion for health coverage; scope of rights (same as opposite sex vs. limited); and recognition of out-of-state relationships. (Mercer)
Health Tax Credit Could Mean Big Savings for Small Firms
"Of firms with fewer than 50 workers and that offer health benefits, 65 percent last year said they had not explored their eligibility for the tax credit, according to a national survey by ... Henry J. Kaiser Family Foundation. Of similarly sized firms that don't offer health insurance, 48 percent said they were not aware of the tax credit, the survey said. The tax break will expand to cover 50 percent of health premium costs in 2014[.]" (Crain's Chicago Business)
[Opinion] Text of Memo to Republicans on Status of Congressional Investigation on Obamacare Negotiations with Drug Makers (PDF)
"This investigation has confirmed the existence of a deal between the White House and [the Pharmaceutical Manufacturers of America, or 'PhRMA'] that explicitly bound both parties to certain commitments.... [The deal] was so clearly understood to be binding that White House Deputy Chief of Staff Jim Messina made direct contact with PhRMA's chief lobbyist for the negotiations regarding the deal to express his displeasure with an apparent violation of the agreement more than two months before the legislation was given final approval by Congress." (Majority Staff of Subcommittee on Oversight and Investigations, Committee on Energy and Commerce, U.S. House of Representatives)
Probe Continues Into Reform Law Dealings Between White House and Pharmaceutical Manufacturers
"The inquiry [by the House Energy and Commerce Subcommittee on Oversight and Investigations] aims to answer the following: Did the Obama administration and outside stakeholders make deals that exchanged policy outcomes for public support of the law; if so, who made such deals; was Congress left out of the discussions; what issues were negotiated; and what, if anything, did the White House gain in the arrangement." (Modern Healthcare)
MLR Killing Off Business, Hurting Consumers
"[According to a recent NAIFA study,] agent commissions have declined dramatically since the medical loss ratio (MLR) provision of the health care reform law went into effect, forcing many agents to reduce their services to clients, consider charging fees for services they had been providing at no additional charge and in some cases, laying off employees and leaving the health insurance market." (John Goodman's Health Policy Blog)
Individual Insurance Benefits Becoming Available Under Health Care Reform Would Have Cut Out-Of-Pocket Spending In 2001-08
"This study compared out-of-pocket spending on health care between individual and employment-related insurance, controlling for numerous characteristics such as health status. Then it simulated the impact of full implementation of provisions of the Affordable Care Act on adults who currently have individual insurance ... [Among other findings, the study determined that the] likelihood of having out-of-pocket expenditures on care exceeding $6,000 would have been reduced for all adults with individual insurance, and the likelihood of having expenditures exceeding $4,000 would have been reduced for many." (Health Affairs)
HHS Finalizes Requirement to Notify Consumers When MLR Spending Targets Met
"The final rule said that requiring the notices to be sent when MLRs are met 'will ensure that all consumers, not just those owed a rebate, are informed whether their issuer meets the minimum MLR standards established by the Affordable Care Act,' and it will 'reduce confusion as to why certain individuals receive rebates, while others, such as coworkers or family members with different plans, do not.'" (Bloomberg BNA)
[Opinion] USCCB Submits Comments on Proposed HHS Rulemaking, Urges Re-Opening of Final Rule Defining Mandate, Exemption
"'We believe that this mandate is unjust and unlawful - it is bad health policy, and because it entails an element of government coercion against conscience, it creates a religious freedom problem,' wrote Anthony Picarello, USCCB associate general secretary and general counsel, and Michael Moses, associate general counsel. 'These moral and legal problems are compounded by an extremely narrow exemption that intrusively and unlawfully carves up the religious community into those that are deemed 'religious enough' for an exemption, and those that are not.'" (The Sacramento Bee)
RAND Study of Effect of ACA on Enrollment and Premiums, Either With or Without the Individual Mandate (PDF)
The authors predict the effects of a possible Supreme Court decision invalidating the individual mandate while keeping the other parts of the law intact. They predict the effects of such a decision on health insurance coverage overall and for subgroups based on income. They also estimate where people will obtain insurance in scenarios with and without the mandate. Finally, they estimate how the elimination of the individual mandate will affect insurance premiums. (RAND)
Arizona Now Allowing Some Religious Employers' Health Plans to Opt Out of Contraceptive Drug Coverage Mandate
"[The new law] applies only to 'religiously affiliated' employers, which are defined as non-profit groups that primarily employ and serve individuals of the same religion or religiously motivated organizations with articles of incorporation clearly stating that religious beliefs are central to the organization's operating principles." (The Arizona Republic)
[Opinion] Slippery-Slope Logic, As Applied to Health Care Reform
"The idea is that while Policy X may be acceptable, it will inevitably lead to the terrible Outcome Y, so it is vital that we prevent Policy X from ever being enacted. The problem is that such arguments are often made without any evidence that doing X makes Y more likely, much less inevitable.... Justice Scalia is arguing that if the court lets Congress create a mandate to buy health insurance, nothing could stop Congress from passing laws requiring everyone to buy broccoli and to join a gym." (The New York Times; free registration required)
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)
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)
[Opinion] The Health Care Mandate Is Clearly a Tax and Therefore Constitutional
"The mandate is an amendment to the Internal Revenue Code, and it is calculated based on a percentage of adjusted gross income or a fixed amount, whichever is larger. Starting in 2014, it will be collected on your form 1040 just like your other taxes.... [Justice] Roberts and [Justice] Kennedy are no doubt aware of the political meaning of a 5-4 vote along party lines that gives Republicans what they could not get through the democratic political process. That concern, and the long history of deference to Congress on economic legislation, give the justices strong reasons to uphold the act. The tax argument offers them a way out. " (The Atlantic)
Obamacare Collapse Would Put Employers Back in Charge of Controlling Health Costs
"First, employers would push harder to control their own costs by shifting more financial responsibility to workers. Data from Mercer's employer survey suggests that a typical large employer can save nearly $1,800 per worker by replacing traditional preferred provider plans with a high-deductible policy combined with a health care account.... It won't stop there. Many employers are convinced they have to go beyond haggling over money, and also pay attention to the health of their workers." (Bloomberg BusinessWeek)
Is Acupuncture an 'Essential Health Benefit'?
"HHS has decided that health insurers will have flexibility to adjust specific covered services in all ten statutory EHB categories.... It's possible, then, that even if the HHS doesn't grant the [American Association of Acupuncture and Oriental Medicine]'s request, various health insurers could determine that acupuncture fits at least one of the above categories, or states could choose a benchmark such as the [Federal Employee Health Benefits Program] plan that would cover it." (Wolters Kluwer Law & Business / CCH)
California Moves Closer to Setting Health Insurance Standards
"State lawmakers this week moved toward establishing a minimum standard of coverage that all individual and small-group health insurance policies will have to provide after federal health-care reform takes effect in 2014." (Ventura County Star)
[Opinion] Waiting for Final Mental Health Parity Regs
"The final rule that would provide clarity to the millions who have a mental illness or substance-use disorder, and to their employers, has not been issued. This has created uncertainty and confusion for employers over what they must cover and when parity applies." (The Washington Post; free registration required)
[Opinion] Health Care Reform Implementation: The Colorado Example
"With less than two years to go before the Affordable Care Act is fully implemented, the State of Colorado is reasonably well positioned.... Adopting a 'Colorado-specific' version of health reform has been critical for state policymakers in responding to the ACA, and was a key factor in the successful passage of exchange legislation. Strong leadership, bipartisan political support, and continued aggressive action will be needed for Colorado to succeed in implementing reform on time." (Urban Institute)
New ACA Streamlining Requirement Will Cost Insurance Plans, But Benefit Medical Providers
"HHS on April 9 [issued] a proposed regulation that conforms to the ACA's requirement that a series of regulations designed to streamline health care administrative transactions be issued over a five-year period. The regulations are meant to encourage greater use of standards by health care providers and make existing standards work more efficiently." (Wolters Kluwer Law & Business / CCH)
[Guidance Overview] Proposed HHS Regs Address Health Plan Identifiers and Delay Compliance Date for Use of Standardized Billing Codes
"In general, all health plans that transmit health information electronically in connection with HIPAA covered transactions must comply with transaction standards adopted under HIPAA. The transaction standards are intended to standardize the exchange of electronic data by reducing the use of multiple formats." (Practical Law Company)
[Opinion] Report Claming Higher Cost for Health Care Reform is Bogus Attack
"Nobody, and I mean nobody, tries to assess legislation against a baseline that assumes that Medicare will just cut off millions of seniors when the current trust fund is exhausted. And in general, you almost always want to assess legislation against 'current policy', not 'current law'; there are lots of things that legally are supposed to happen, but that everyone knows won't[.]" (Paul Krugman in the New York Times; free registration required)
Misconceptions Seen in Responses of Supreme Court Justices at Oral Arguments
A Deloitte consultant and an expert working for the Kaiser Family Foundation express their concerns that the attorneys and Supreme Court justices have assumed mistakenly that the health care reform law requires individuals to purchase "Cadillac' coverage rather than a lower-cost stripped-down version. (Chicago Tribune)
White House Blasts Obama-Appointed Republican Health Care Economist
"The White House has unleashed a torrent of criticism on a leading conservative economist -- approved by President Obama in 2010 as a Republican trustee overseeing Medicare and Social Security finances -- for concluding in a new study that the Affordable Care Act will add to the deficit instead of reduce it." (ABCNews)
[Opinion] Official Federal Government Sources Agree: The Affordable Care Act Reduces the Deficit
"Today, we are reading about another brand of "new math" in describing how the Affordable Care Act will affect our nation's Federal budget deficit. In another attempt to refight the battles of the past, one former Bush Administration official is wrongly claiming that some of the savings in the Affordable Care Act are "double-counted" and that the law actually increases the deficit. This claim is false." (The White House)
2011 State Laws Implementing Immediate Market Health Reforms
State legislation adopted or implemented in response to requirements of the Affordable Care Act. Updated April 10, 2012. (National Conference of State Legislatures)
[Opinion] The Individual Mandate and the Math-less Health Reform Debate
"The Affordable Care Act attempted to cover new costs without adding significantly to tax burdens. The individual mandate was one way it tried to force us to pay, at least for ourselves. The law also included an employer mandate designed to prevent employers from dropping employee health insurance ... Congress also tried to box in states to contribute as much or more than they already do to Medicaid, another part of the constitutional debate. None of those efforts, however, tackle the original sin driving health costs." (Urban Institute)
[Guidance Overview] 2012 List of Counties Requiring Culturally and Linguistically Appropriate Services Issued by HHS
"Employers with employees in the counties listed first need to arrange for translation services for the statement to be placed on the English version of the various notices and for the notices themselves, if requested. In addition, arrangements will need to be made to provide the oral, non-English language service to assist with questions and the filing of claims." (Troutman Sanders)
[Guidance Overview] HHS Releases Final Rules Regarding Transitional Reinsurance Program (PDF)
"Of particular interest to plan sponsors is the transitional reinsurance program ..., which will require health insurance issuers, as well as certain plan administrators on behalf of self-insured group health plans, to make contributions to a transitional reinsurance program for the three-year period beginning January 1, 2014. ...[S]ection 1341 is likely to result in additional costs for employer plan sponsors and, depending on whether the plan at issue is self-administered, certain additional reporting obligations." (Crowell & Moring LLP)
[Guidance Overview] ML Strategies Health Care Reform Update, April 9, 2012 (PDF)
Weekly update on federal and state health care reform legislation, regulations and initiatives. (ML Strategies, LLC)
Obama Health Care Law Could Worsen U.S. Debt, Says Republican Study
"A study by Charles Blahous, a George Mason University research fellow and the Republican trustee for the Medicare and Social Security entitlement programs for the elderly, challenged the administration's contention that the 2010 law would reduce healthcare costs." (The New York Times; free registration required)
Health Care Reform Law Will Add $340 Billion to Deficit, Study Says
"The 2010 law does generate both savings and revenue. But much of that money will flow into the Medicare hospitalization trust fund -- and, under law, the money must be used to pay years of additional benefits to those who are already insured. That means those savings would not be available to pay for expanding coverage for the uninsured." (The Washington Post)
[Opinion] How to Replace Obamacare
"Proponents of Obamacare like to create the impression that there are tens of millions of Americans trapped by their pre-existing conditions, sick and stuck with lousy insurance and no options. In truth, the vast majority of working Americans have good and secure coverage today, including many millions of people with expensive health conditions." (Physicians for a National Health Program)
Employers Should Not Delay Preparing for 2014 Health Care Reform Requirements Despite Pending Supreme Court Case (PDF)
"Absent a ruling that deems the Individual Mandate unconstitutional and not 'severable' from the remainder of the law, the employer-specific provisions of the ACA will likely remain as enacted.... [I]t is unlikely that Congress has the political will to reopen the law and make additional changes such as removing the Employer Mandate.... As a result, the Supreme Court decision itself should provide the impetus for employers who have not yet begun planning for 2014 to start such preparations." (Epstein Becker & Green, P.C.)
Deloitte's Health Care Reform Memo: April 9, 2012
This weekly publication summarizes recent developments including legislative developments and state and implementatation updates. The current issue includes discussions of a pending Texas Circuit Court case that addresses the physician ownership constraint in ACA; of the 2013 payment rule for Medicare Advantage and Prescription drug plans recently released by CMS; and Legislative updates, at both federal and state levels. (Deloitte Center for Health Solutions)
[Opinion] Much Ado About Broccoli
"The need to legislate behavior in an effort to help reduce costs is simply a lap too far. A government dedicated to reducing costs while preserving quality and competition would need to adopt practices currently employed and bearing fruit in the private sector to moderate medical trend and improve affordability. The reality is many of these efforts - biometric testing, health risk assessments, population based plan designs, value based reimbursements - require a more prescriptive level of engagement by employees." (The Health Care Blog)
[Opinion] What Private Markets Could Do on the Day After Obamacare, If Regulatory Burdens Were Lifted
"Most pathologies in the current system are creatures of previous laws and regulations. Solicitor General Donald Verrilli explained as much in his opening statement to the Supreme Court: 'The individual market does not provide affordable health insurance,' he noted, 'because the multibillion dollar subsidies that are available' for the 'employer market are not available in the individual market.' ... If we had a deregulated, competitive market in individual catastrophic insurance, that market would be so much cheaper than what's offered today that we would likely not even need the mandate." (The Health Care Blog)
The Fact Checker: President Obama's Selective Memory of Supreme Court History
"[W]e don't know whether the president's factual error was a mere slip-up or a purposeful attempt to mislead, and we generally don't beat people over the head for off-the-cuff remarks. Let's take a look at the president's message in light of his clarifying remarks to see whether it holds up any better under scrutiny." (The Washington Post; free registration required)
Supreme Court Hears Oral Arguments on Health Care Reform: Will the Affordable Care Act Survive?
"What, if any, provisions of the sweeping health care reform law will survive remains very much in question after the historic arguments. The questioning revealed deep divisions within the Court about the constitutionality of the law's so-called 'individual mandate' and whether the rest of the Act should stand if the mandate is struck down. Even after the Supreme Court renders its decision, which is expected in June, the debate over the landmark legislation likely will continue for years to come." (Littler Mendelssohn LLC)
Milliman's Monthly Benefit News and Developments, April 2012 (PDF)
Very good summary of recent important legislation, plus a list of regulations and other activity by federal agencies affecting employee benefit plans. (Milliman)
[Guidance Overview] Regulations Clarify Summary of Benefits and Coverage
"One rule concerning the SBC that may surprise plan sponsors is the sponsor's obligation to coordinate vendors of carve-out arrangements, such as prescription drug coverage. To avoid unnecessary duplication and to provide a "complete" SBC, if a plan has medical coverage and prescription drug coverage through different vendors, the plan sponsor must combine each vendor's model SBC into one SBC to provide to participants and to beneficiaries." (Faegre Baker Daniels)
Chasing the Carrot, Not Running from the Whip: Obamacare Can Live Even If the Mandate Dies
"[W]ork being done by economists, health policy experts, and lobbyists suggests there may be alternatives to the individual mandate that would rope healthy people into buying insurance in ways that don't attract legal challenges." (Bloomberg Businessweek)
Estimating the Impact of the Medical Loss Ratio Rule: A State-by-State Analysis
"Using insurers' MLR data from 2010, this issue brief estimates the rebates expected in each state if the new rules had been in effect a year earlier. Nationally, consumers would have received almost $2 billion of rebates ... Almost $1 billion would be in the individual market, where rebates would go to 5.3 million people nationally. Another $1 billion would go to policies covering about 10 million people in the small- and large-group markets." (The Commonwealth Fund)
Catholic University in Ohio to End Contraceptive Coverage
"The controversy [over federally mandated coverage for contraceptives, sterilizations and abortifacient drugs] prompted Xavier President Michael Graham, a Jesuit priest, to review the health insurance plan offered to the university's 935 employees. Graham announced this week in a letter to the faculty that the plan will cease to cover contraception on July 1." (Reuters)
Text of Comments by American Academy of Actuaries on HHS-Proposed 'Actuarial Value Calculator' (PDF)
"The Health Practice Council submitted a comment letter to the Center for Consumer Information and Insurance Oversight (CCIIO) providing responses to questions ... on the structure of a proposed actuarial value calculator (for purposes of the ACA). The letter addresses cost-sharing inputs for the calculator, incorporation of induced demand, number of geographic pricing tiers, and incorporation of multiple network tiers." (American Academy of Actuaries)
Can Health Care Reform Survive Without the Individual Mandate?
"Some experts estimate that removing the individual mandate will raise premiums an estimated 30% and diminish the number of newly insured by two-thirds (from 27 million additional people insured to just over 16 million). [Here are] a few examples of why[.]" (William Gallagher Associates)
In a Nutshell: Supreme Court Oral Arguments About the Affordable Care Act
Scroll down target page to item entitled "Special report: Supreme Court argument about the Affordable Care Act." (Deloitte Center for Health Solutions)
Beyond the Affordable Care Act: An Economic Analysis of a Unified System of Health Care for Minnesota
"[This study] modeled a comprehensive plan covering medical, mental health and dental benefits, eliminating deductibles and coinsurance, while using only minimal copays on specialists, hospitalizations, procedures, and diagnostic tests, with coverage for all Minnesota residents.... Total state health spending [could] be reduced by nearly 9% under a unified single-payer plan ... while eliminating uninsurance in the state.... [and] despite covering the remaining 262,000 Minnesotans who would still be uninsured under the ACA." (Growth & Justice)
Transforming Our Health Care System Is Not Going to Be Easy, But It Is Necessary
"[In a recent op-ed piece, America's Health Insurance Plan's] President and CEO Karen Ignagni ... explains the challenges facing the health care system including ever-increasing costs, and how health plan tools are helping change the system for the better. Here are some highlights from her essay[.]" (AHIP)
Federal Judge Takes U.S. Attorney to Task Over Obama's Comments on Supreme Court's Jurisdiction to Review Health Care Law
"During oral arguments in Houston in a separate challenge to another aspect of the federal health care law, U.S. 5th Circuit Court of Appeals Judge Jerry Smith said Obama's comments troubled a number of people who have read them as a challenge to the authority of federal courts.... Judge Smith ordered [Justice Department attorney Dana] Kaersvang to submit a letter to the appeals court by Thursday stating the position of U.S. Attorney General Eric Holder and the Justice Department on the concept of judicial review." (The Washington Post; free registration required)
Supplemental Group Health Insurance Benefit Strategies for Retirees
"As employers consider alternatives to offering retirees traditional group Medicare insurance, they may evaluate more than one supplemental insurance solution. Employers often compare an Employer Group Waiver Plan (EGWP) solution with a private Medicare exchange ... Both solutions offer some clear benefits[.]" (Extend Health)
Wrap-Up on Constitutional Challenges to the ACA
"As volatile as the oral argument was at times, and as plainly as a few of the Justices displayed their apparent support of, or skepticism about, the ACA's constitutionality, the deliberations and drafting process may temper some of the more polarized views displayed in open court." (E for ERISA)
Public Support for Individual Mandate Is Low, But Study Says It Would Affect Few, Stabilize Insurance Market
"A recent study by the Urban Institute found that 'if the ACA were in effect today, 94 percent of the total population (93 percent of the nonelderly population) or 250.3 million people out of 268.8 million nonelderly people -- would not face a requirement to newly purchase insurance or pay a fine.'" (Wolters Kluwer Law & Business / CCH)
Why Health Care Isn't Broccoli: Some Basic Economics
"It isn't often that the course of history turns on principles taught in freshman economics. But the fate of the health reform legislation is now in jeopardy in part because some Supreme Court justices have so far failed to grasp such principles.... When someone consumes broccoli, one is not normally imposing costs on other consumers that make broccoli more costly or unaffordable. Furthermore, broccoli is not vital to preserving life or reducing pain." (Brookings)
A Summary of the Oral Arguments in the Supreme Court Review of the Affordable Care Act (PDF)
"[The Groom Law Group summarizes each day of oral argument and offers] some thoughts as to its implications for the federal health care reform law. It is important to note that it is not possible to predict the outcome of a Supreme Court case based on the questions asked during oral argument, although oral argument does allow some insight as to issues that are of particular concern to the Court." (Groom Law Group)
Public Employers and Health Insurance Exchanges: A Shift in the Landscape (PDF)
"This article presents a brief review of some of the changes coming to the health care marketplace, some possible decision scenarios for public employers, and a wrap-up of steps that public employers can take to prepare." (Gabriel Roeder Smith & Company / Donlon & Associates, Inc.)
[Opinion] Individual Mandate vs. 'Do Not Treat'
"The mandate, vilified as a violation of personal freedom, is designed to deal with uninsured people who can't cover their costs when they get seriously ill or injured. Medical ethics and federal law require that those people be treated, so hospitals, doctors and insurers make up the loss by raising prices for everyone else.... If these people can't be made to buy insurance, even with subsidies, what else might make them act responsibly? The cold-blooded answer would be to let them die." (USA TODAY)
Michigan Law Will Require Michigan Health Insurers to Provide Autism Disorder Benefits
"Single or multiple-employer self-insured plans, either private or public, are not required to provide coverage for [Autism Spectrum Disorders, or 'ASDs'] under the legislation. However, related legislation establishes ... creates an Autism Coverage Fund ... to provide incentives for [Blue Cross Blue Shield of Michigan], insurers, and self-insured plans to cover ASDs. The Fund will be financed by appropriations from the State Treasury." (Miller Johnson)
Remedies for 'Sick Insurance' -- How Prior Legislative Regulation of Health Insurance Might Predict Chances of Insurance Exchanges Succeeding
"This expository paper describes the factors that contribute to failure of health insurance markets, and the regulatory mechanisms that have been and can be used to combat these failures. Standardized contracts and creditable coverage mandates are discussed, along with premium support, enrollment mandates, guaranteed issue, and risk adjustment, as remedies for selection-related market damage." (The National Bureau of Economic Research; paid subscription or individual purchase required to retrieve full text)
Sense of Peril for Health Law Gives Insurers Pause
"Abandoning the efforts and billions of dollars invested since the law was passed in 2010 would result in turmoil for hospitals, doctors, patients and insurers. Many insurers would have difficulty changing course. 'The risk of repeal and starting from zero frightens them infinitely more' than having to comply with the law as written[.]" (The New York Times; free registration required)
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