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Healthcare Reform: Does Finger Point at You?

"Even though it's apparent the increased cost for insurance has been shifted on the shoulders of working Americans, CEOs and the benefits managers charged with designing coverage plans outside of the health insurance exchanges are beginning to question and identify future strategies that reconcile healthcare offerings with financial goals of the business.... [I]nstead of looking for a scapegoat and pointing blame, insurance entities and the companies they provide for are learning how to move from denial and deception to reshape the healthcare conversation into benefits and even expanded employee coverage they can both boast about."

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COBRA Meets Healthcare Reform

"There are no rules that require employers to explain the possible COBRA/Exchange coverage gap or differences in election periods and deadlines. Employers are left to decide whether to disseminate this information and, if so, how and when. While trying to avoid providing advice to employees, there are ways to present information and links that assist employees in accessing the needed information."

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Kentucky: Healthcare Reform's Epicenter?

"If health reform bends the cost and health curve, Kentucky could be the envy of neighboring states, most of which continue to oppose everything ACA. Years will pass before ACA impact can be quantified, but Kentucky seems uniquely suited to measure its progress."  MORE >>

Healthcare Reform Designed to Fight Obesity, First Lady Says

"One of the driving goals behind healthcare reform is curbing obesity among children in the U.S., according to First Lady Michelle Obama ... The First Lady argued that healthcare reform alone would not be enough to curb the [obesity] epidemic, but that regular checkups and healthy relationships between doctors and patients would also be integral. Increased availability of affordable healthcare coverage, which will include access to health savings accounts and flexible spending accounts, has been the driving force behind the reform."

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A Landmark Shift in Healthcare: Insights on PBM Reform

"New laws and court decisions, settlements with the Federal Trade Commission, and a proposed [DOL] rule are leading to a sweeping transformation that is already under way in the U.S. healthcare system. Pharmacy benefit managers (PBMs) are now facing the same transparency and accountability requirements that employers and health plans are subject to.... [T]hese changes could fundamentally reshape how PBMs, employers, pharmacies and insurers manage prescription drug costs."  MORE >>

Senate HELP Committee Eyes Healthcare Reform to Enhance Affordability

"[H]ospitals, insurers and pharmacy benefit managers (PBMs) all are under scrutiny by Congress in efforts to curb the growth in healthcare costs. The Senate Health, Labor Education and Pensions (HELP) Committee held a July 31 hearing to examine ways to make healthcare more affordable for consumers and other purchasers, and the discussion focused on various stakeholder groups."  MORE >>

Many Businesses Cautiously Eyeing Healthcare Reform Legislation

Excerpt: Despite the acknowledged need for change and the possibility of new business opportunities from a reformed health-care system, apprehension remains. Some finance executives fear that health reform will cost their companies more money, because they suspect that insurers will raise their rates to offset any potential new taxes or pricing restrictions. Others are concerned that reform may require complicated changes or restrictions to their plans. Still others worry that expanding coverage will increase the federal deficit and have an indirect effect on their businesses by causing inflation.

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The Economic Impact of Healthcare Reform on Small Business (PDF)

24 pages. Excerpt: Against [the] backdrop of a failing system and the prospect of true reform, Small Business Majority commissioned noted economist and Massachusetts Institute of Technology professor Jonathan Gruber to apply his trusted healthcare economics microsimulation model to the small business sector -- specifically those businesses with 100 or fewer employees. Using his model, Dr. Gruber analyzed the continued impact of no reform on small business costs, jobs, wages and profits over the next ten years and contrasted that with three different reform scenarios, all based on the shared responsibility model proposed by President Obama and now being debated on Capitol Hill.

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Employee Healthcare Cost Containment -- A Strategy that Works

"Despite countless incremental solutions such as wellness programs, consumer driven healthcare and provider payment reform there has been very little impact on both the quality and the price of healthcare for employers.... So how do employers move towards a value based healthcare delivery system within their organization? The strategy involves four interdependent and fundamental components.... [1] Population Health Management; [2] Directing Care to Maximize Value; [3] Bundled Case Rates; and [4] Measure Outcomes and Costs." [Updated Jan. 2019]

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U.S. Healthcare Braces for Tough Times as Disruptors March to Reform

"Patient-consumers are growing increasingly exasperated with healthcare delivery as we know it and are demanding better. Meanwhile, retail disruptors are capitalizing on mounting frustrations by continuing to dismantle a broken and failing fee-for-service (FFS) payment model. And, the federal government ... is now ramping up efforts to try and make good on past reforms. As the winds of disruption pick up speed, these stakeholders have signaled they have no interest in extending a lifeline."

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Federal Government Launches New Healthcare Reform Website for Employers

"The federal government has launched a new website for employers that addresses some common employer healthcare reform questions. The healthcare portion of the website allows an employer to select the location of its headquarters, the number of employees it has, and whether or not it will offer insurance to its employees in 2015. Based on these answers, a list of frequently asked questions pertaining to employers of that size are generated.... While this information is helpful for employers who have not already started preparing to meet the requirements of PPACA, employers should undertake a deeper dive and analyze exactly how PPACA will impact an employer of their size, location, and employee demographic."

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Employers Feeling Impact of Healthcare Reform

"Similar to the 2012 survey, respondents chose healthcare reform as the regulatory issue expected to have the most impact on the workplace over the next 12 months ... Respondents also expected [DOL] regulations under the [ACA] to be the most pressing priority of the current nominee for Secretary of Labor, Thomas Perez ... In reflecting on actions their companies have taken or anticipate taking in response to the ACA's implementation, only 6 percent of respondents noted discontinuing healthcare benefits for full-time employees and paying the penalty under the ACA's 'pay or play' mandate."  MORE >>

Innovation in Response to Healthcare Reform Offers Unique Opportunities That Differ by State

"The healthcare industry is used to a handful of states being at the forefront of innovation -- for example, many benefit design concepts are created in California and developments in Florida or New York often presage laws elsewhere. Perhaps surprisingly, many of the more recent big developments have come out of unexpected places -- states like Arkansas, Oklahoma, South Dakota and Utah. Much of this innovation is directly related to healthcare reform and the next step in cost control[.]"  MORE >>

Fourth Circuit Court to Hear Challenge to Healthcare Reform's Employer Mandate

"The parties will address whether the Anti-Injunction Act applies to the employer mandate (after the Supreme Court's decision that it did not apply to the dispute involving the individual mandate), whether the employer mandate exceeds Congress' powers under the Commerce, Necessary and Proper, and Taxing and Spending clauses of the Constitution, and the impact of the Equal Protection, Free Exercise of Religion, and Establishment Clauses on the employer mandate and other insurance mandates, such as the requirement to cover preventative care, including contraceptive drugs. Importantly, Liberty University's claims regarding Congress' power to enact the employer mandate under the Commerce, Necessary and Proper and/or Taxing and Spending clauses of the Constitution apply to all employers -- both secular and religious."

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Will Individuals Pay or Play? The Impact of Healthcare Reform on Employees

"For many individuals, the decision may come down to the cost of the tax vs. the cost of insurance on an annual basis, at least initially.... Employers should bear in mind the impact on employees and their families when exploring benefit strategies. However, many employers also have a golden opportunity to communicate to employees how PPACA will impact them individually, and the role the employer's group health plan (or lack thereof) will factor in to employee's individual decisions."

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New Battlefronts in the Fight Over Healthcare Reform

The healthcare reform debate has entered a new and complex phase. 'Repeal and replace' no longer fully captures the extent of Republican efforts to challenge the law as the battle moves to multiple fronts.  MORE >>

Healthcare Reform Law Cuts Medicare Advantage Payments and (Mostly) Increases Prescription Drug Program Payments (PDF)

Excerpt: While increasing overall expenditures, the Healthcare Reform Law also cuts approximately $16 billion from the Part D program, primarily byreducing Part D premium subsidies for high-income beneficiaries. Companies that offer MA and Part D plans and pharmaceutical manufacturers will be the most directly affected by these changes.  MORE >>

Employer Group Health Plans Face Immediate Issues as Healthcare Reform Becomes Law

Excerpt: The Healthcare Reform Law applies existing Internal Revenue Code section 105(h) self-insured plan nondiscrimination rules to insured health plans. This new requirement is effective for plan years beginning six months after enactment. This will make it much more difficult to offer insured health plans to a small group of executives.  MORE >>

Businesses Not Interested in Absorbing Costs for Healthcare Reform

Excerpt: Nearly nine-of-10 human resources and benefits executives at several hundred midsized and larger companies say their bottom line won't absorb any additional costs that may result from healthcare reform, according to a new survey. The poll of 433 executives, conducted by Stamford, CT-based financial and risk managers Towers Perrin, found that employers are prepared to reduce benefits, raise prices for customers, and even reduce their workforces if the healthcare reforms that emerge from Congress increase the cost of providing employee coverage.

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Small Companies Seen as Benefiting from Healthcare Reform

Excerpt: Small businesses in the United States are suffering great harm under our current healthcare system and will likely fare far better under a substantially reformed system along the lines of what is currently being debated in Washington -- as long as such a system offers appropriate levels of assistance to small businesses in meeting their healthcare obligations.

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