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Big Insurers See Big 1Q Profits, But Protesteth Too Much, Methinks

"After posting hefty profits in 2012, the publicly traded health plans have released pretty darn good first-quarter earnings and most even upped their forecasts for the year.... And, by the way, their stock prices are up.... To listen to some of the health plan executives talk, though, it's as if they expect Obamacare to swallow them whole. They warn of 20 percent-plus increases in commercial premiums as if they are inevitable. State healthcare exchanges are spoken of as more risk than opportunity."

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New NAIC Group Wades Into the Skyrocketing Cost of Health Insurance

"The Health Care Affordability and Mitigation Working Group met for the first time last week. Members discussed a 2026 work plan, outlining a fast-paced schedule to develop affordability recommendations for regulators and lawmakers. The initiative will focus on examining factors that drive health care costs and insurance premiums, including expenses within the health system that ultimately flow into insurance pricing."  MORE >>

Fifth Circuit Declines to Wade Into Circuit Split on Relationship Between Standing and Class Certification

"The Fifth Circuit noted a circuit split on how to handle a 'disjuncture' between a named plaintiff's alleged injury and the injuries of unnamed class members.... The Fifth Circuit opted not to choose a side on the split, instead concluding that the plaintiffs' allegations were adequate to support standing under either approach.... [T]he named plaintiffs and their unnamed class members suffered from essentially the same injuries and had the exact same interest: 'the return of trust funds that each plaintiff would otherwise have been entitled to if [the defendants] had not violated ERISA.' " [Chavez v. Plan Benefit Services, Inc., et al, No. 22-50368 (5th Cir. Aug. 11, 2023)]

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Wade Pfau Leaves Full-Time Role in Academia

"For most of the past decade, Pfau has served as the American College's professor of retirement income and also served as director of the school's Retirement Income Certified Professional (RICP) program."

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Effect of the Overturn of Roe v. Wade on Employer-Sponsored Group Health Plans

"[E]xpanding reproductive health services, including the addition of a travel and lodging reimbursement benefit, should be considered under the umbrella of a welfare benefit plan, which for non-governmental and non-church plan employers has the benefit, subject to limitations, of the preemption of state laws pursuant to [ERISA].... If expanded travel and lodging reimbursement provisions are desired, consideration should be given to applying these new provisions to all benefits covered under the plan[.]" [Dobbs v. Jackson Women's Health Org., No. 19-1392 (S. Ct. Jun. 24, 2022)]  MORE >>

Overturning of Roe v. Wade Creates Challenging Legal Issues for Self-Funded Health Plan Sponsors

"[If] a state has a law making it a crime for anyone to pay for or reimburse the costs of an abortion, it would be very difficult to argue that ERISA preempts said law as applied to self-funded ERISA plans ... On the other hand, laws like [Oklahoma's] -- which provide for a civil cause of action against anyone who pays for or reimburses the costs of an abortion -- are likely preempted by ERISA as it relates to ERISA self-funded group health plans.... There are numerous issues and considerations beyond the state law issues[.]' [Dobbs v. Jackson Women's Health Org., No. 19-1392 (S. Ct. Jun. 24, 2022)]  MORE >>

Businesses That Pay for Out-of-State Abortion Costs Could Be Next Target of Texas Lawmakers If Roe v. Wade Is Overturned

"Fourteen Republican members of the state House of Representatives have pledged to introduce bills in the coming legislative session that would bar corporations from doing business in Texas if they pay for abortions in states where the procedure is legal. This would explicitly prevent firms from offering employees access to abortion-related care through health insurance benefits."

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Employee Benefits Might Still Facilitate Abortions and Choice in a Post-Roe v. Wade America

"If the Supreme Court ultimately overturns Roe, all employers should review their health plans to see what, if any, impact the applicable state laws will have.... [Employers] will need to consider many factors, including [1] the types of abortion-related benefits to be offered; [2] whether the type of health plan involved (e.g., self-funded or fully-insured) offers any strategic protections; and [3] any federal guidance the DOL and IRS may issue."

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Considerations for Employers and Employer Plan Sponsors Related to Potential Changes in the Effect of Roe v. Wade

"The most pressing concern is likely whether companies can continue offering coverage of abortions through health benefit plans, including by reimbursing costs incurred when travelling outside of a state to procure an abortion.... Governors and state legislatures opposed to abortion will move quickly to pass laws regulating the practice if they do not currently have them in place. States with legislatures that support access to abortion may move with similar speed to enshrine and protect that access. Companies will face the difficult task of navigating these competing movements."

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Congress Wades Into Debate Over High-Cost Prescription Drugs; Pharma Execs Refuse to Testify

"Senators railed against pharmaceutical executives [at a Jan. 29 hearing] for declining to testify before Congress about out-of-control drug prices, as lawmakers on both sides of the U.S. Capitol kicked off investigations sure to rattle one of the nation's most powerful industries."  MORE >>

Physician Groups Wade Into Latest ACA Legal Battle

"Physicians are siding with the [ACA], and Democrats, in a lawsuit brought by GOP state leaders and supported by the Trump administration.... Groups on the amicus brief include the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry. They argued that Republican attorneys general lacked standing because they could not prove their states had suffered harm or injury from the ACA."

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Amazon Wades In: A 'Disruption' in Healthcare?

"Given its outsize influence on Americans' daily lives, [Brian Marcotte, CEO of the National Business Group on Health] said it will be intriguing to watch how Amazon can overcome the 'fragmented and complex' nature of the current healthcare-delivery system. And while the independent healthcare company proposed in the partnership will only cover employees of the three participating companies, Marcotte said it would not be a surprise if the end result -- if successful -- is someday made widely available all consumers."  MORE >>

Wading Through the Changing Tide of Paid Sick Leave Laws in Washington State

"Two months into the new year we have already seen significant changes to the Seattle sick and safe time law, a new paid leave ordinance taking effect in Tacoma, and a new ordinance enacted in Spokane. At the state level, legislators are considering a bill to mandate paid sick leave statewide. Even if this legislative effort is unsuccessful, voters may be presented with a statewide sick leave ballot initiative this November. [This article] will discuss important developments at the local and state levels in 2015 and 2016, provide an overview of ongoing enforcement efforts, and highlight compliance challenges and strategies for employers."  MORE >>

The Great 401(k)-or-Not Debate: The Perils and Rewards for RIAs Thinking of Wading Into the Fast-Moving 401(k) Stream

"[The authors] went into this webinar (sponsored by The Hartford -- thank you) with the bias that RIAs should err on the side of advising 401(k) plans and/or their participants.... It's a monster, underserved market, growing fast and there for the taking, especially by advisers accustomed to acting as fiduciaries.... But after hearing what these experts in the field had to say, [the authors] also better realize the level of knowledge and commitment involved in making a good 401(k) business work. [They] hope this transcript makes the conversation accessible to people who weren't able to attend, and makes for a good reread for those who listened in."

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Supreme Court to Wade into ERISA Subrogation Dispute

"The Supreme Court agreed Monday to determine whether an employee benefits plan is subject to equitable limitations when it demands reimbursement of benefits paid a covered employee who recovers money from third parties."

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Cash Balance Pension Plans Wade Into Murky Water

Excerpt: In the last few years, many U.S. public and private employers moved to so-called cash-balance plans. But recent judicial decisions concerning retirement funds at IBM and Xerox now have companies with these plans wondering whether they need to rethink them.

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Texas Blue Decision Could Signal Twilight of the Exchange PPO

"Lost in the noise over mega-mergers, one of the biggest carriers anywhere, Blue Cross Blue Shield of Texas, announced plans to stop selling its Blue Choice PPO on and off the exchange in 2016.... This isn't an insurer discarding a poorly performing plan design that failed to sway consumers. The Texas Blue plan has more enrollment in Blue Choice than many insurers have total members."  MORE >>

2016 Health Insurance Premiums: The Reverse Bait-and-Switch

"[It's] important to look between the lines and see which plans are not requesting double-digit hikes for 2016.... The classic 'bait-and-switch' entices consumers to the store with the lure of bargains, but when they arrive they find those items sold out, or are pressured to buy up to a more expensive product.... The insurers requesting big rate increases for 2016 may be doing just the opposite: jacking up the costs of existing products so that narrow-network products, typically featuring care integration, look more attractive."  MORE >>

Jury Still Out on Consumer-Driven Health Plans

"[C]onsumers tend to reduce their utilization of healthcare during their first one or two years in a CDHP, particularly through reductions in prescription drug spending.... [It] isn't clear whether the reductions in services tend to be necessary or unnecessary, and long-term utilization trends are not observable in most studies due to short study periods of only one or two years."  MORE >>

Broad Reach of Cadillac Tax Could Have Significant Impact on Employers

"After analyzing its plan, CalPERS found that if the tax were in place today, its Blue Shield Access+ plan offered through Blue Shield of California in the San Francisco area and the Anthem Traditional HMO plan in Sacramento would both trigger the tax because they cost more than the limit. The purchasing coalition estimated it would pay $3.9 million in excise taxes."  MORE >>