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Health plan costs - misc

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Is Enrollment in HSA-Eligible Health Plans Growing or Not? (PDF)
"Recent low health insurance premium increases combined with low unemployment may have caused employers to hold off on plans to move to HSA-eligible health plans.... Recent research has found that HSA-eligible health plans may be associated with a reduction in appropriate preventive care and medication adherence.... Growth in HSA-eligible health plans may be held back because what constitutes an HSA-eligible health plan does not provide employers their desired level of flexibility around the design of the health plan." (Employee Benefit Research Institute [EBRI])
[Guidance Overview] New 2018 Federal Poverty Guidelines Affect ACA Safe Harbor
"[If] the cost of self-only coverage under an employer's lowest-cost minimum value plan is no more than 9.56% (for 2018) of the single Federal Poverty Guideline applicable to that individual for that year, then it will be treated as affordable. For 2018, the mainland Federal Poverty Guideline is $12,140 ... [To] satisfy the safe harbor ... the monthly premium amount cannot exceed $96.71[.]" (HUB International)
Amazon 'Pouring Gasoline on the Fire': Health Plans Must Respond
"Health plans may be facing the same upheaval that Amazon brought to retailers.... Customer service will become a top priority ... as consumers gravitate toward ... whatever turns out to be the healthcare equivalent of free two-day delivery for your books and other purchases.... That could include everything from leveraging Amazon's Echo technology into the electronic medical record to using the company's delivery expertise to improve the supply chain and its purchasing power to lower the cost of drugs[.]" (HealthLeaders Media)
Despite Uncertainty, Fundamentals Are Primary Driver of Projected Spending Growth
"Projected national health spending and enrollment growth over the next decade is largely driven by fundamental economic and demographic factors: changes in projected income growth, increases in prices for medical goods and services, and enrollment shifts from private health insurance to Medicare that are related to the aging of the population. The recent enactment of tax legislation that eliminated the individual mandate is expected to result in only a small reduction to insurance coverage trends." (Health Affairs)
CMS Releases 2017-2026 Projections of National Health Expenditures
"National health expenditure growth is expected to average 5.5 percent annually over 2017-2026 ... Medicare is projected to experience the most rapid annual growth at 7.4 percent, largely driven by enrollment growth and faster growth in utilization from recent near-historically low rates.... Private health insurance spending is projected to average 4.7 percent over 2017-2026, the slowest of the major payers ... [S]pending growth is projected to be fastest for prescription drugs, averaging 6.3 percent for 2017-2026." [Full report is available on CMS website.] (Office of the Actuary, Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Treasury Inspector General Releases Report on ACA Tax Filings for Plan Year 2016
"Of the 5.1 million total tax returns during the 2017 filing season (for plan year 2016), about 2.1 million tax filers were entitled to a higher premium tax credit than they received in APTC. About 2.8 million tax filers received more APTC than they were entitled to and must repay some or all of this amount." (Health Affairs)
Administration Proposes Postal Service Cuts to Retirement, Health Benefits in $80B Savings Package
"The White House suggested USPS bring its retirement benefits in line with the same changes proposed for the rest of the federal workforce, which would save the agency $35 billion over the next decade. Under Trump's plan, the postal service also would increase employees' contributions toward their health and life insurance." (Government Executive)
Budget, White Paper Provide Insight Into Administration's Strategy on Drug Pricing
"The bulk of the proposed reforms would act on the Medicare and Medicaid programs. For Medicare, the Trump administration's proposals are largely targeted at [1] assisting beneficiaries with high out-of-pocket costs and [2] realigning incentives to alter prescribing and reimbursement practices." (Health Affairs)
[Opinion] American Academy of Actuaries Comment Letter to EBSA: Modeling the Potential Impact of Association Health Plans (PDF)
"[The Committee's] comments offer considerations that should be made when analyzing the potential impacts of these more broadly defined AHPs on individuals, employer groups, and the individual and small group health insurance markets. Different stakeholders will be affected differently, depending on allowable rating factors, plan design flexibility, and strategic considerations." (Individual and Small Group Markets Committee of the American Academy of Actuaries)
New Budget Bill Eliminates ACA's Independent Payment Advisory Board
"The bill does not include broader ACA market stabilization measures -- such as payments for cost-sharing reductions or reinsurance funds -- that have received bipartisan support.... [This article] focuses on the repeal of the [Independent Payment Advisory Board (IPAB)], cuts to the Prevention and Public Health Fund, and the delay of Medicaid cuts to disproportionate share hospitals." (Katie Keith, in Health Affairs)
Tax Bill Affects ERISA Settlements
"Any settlement of employment litigation should take account of taxes... The Tax Cuts and Jobs Act ... makes a number of changes ... The after-tax cost to defendants of a settlement has gone up. The 2018 corporate tax rate drops to 21 percent from generally 35 percent in 2017 ... If a corporate defendant settles for $100,000 in 2017, that will cost a net $65,000 after taxes. But if that settlement is made in 2018, it will cost the defendant $79,000 after taxes because the deduction saves fewer taxes." (Bob Blum Mediation)
High-Deductible Plans More Common, But So Are Choices
"For 2018, 70 percent of large employers offered at least one HDHP -- either in addition to a traditional health plan (65 percent) or exclusively as a full replacement for traditional health coverage (5 percent).... When employees at large organizations were given options, 35 percent selected an HDHP while 48 percent chose a PPO for 2018.... In 2018, the average HDHP enrollee is paying a 42 percent lower monthly premium than PPO enrollees for single-coverage plans and a 40 percent lower premium than PPO enrollees for family-coverage plans." (Society for Human Resource Management [SHRM])
Employer Enthusiasm for HDHPs Appears to be Weaker Than Once Predicted
According to [one] report, only 5 percent of large employers (those with at least 1,000 employees) currently offer HDHPs as the sole health plan option. That rate was roughly the same each of the previous two years, as well. [A second survey now] reports that less than 30 percent of employers are considering full replacement -- a significant decline in the interest expressed in 2014. Meanwhile, HDHPs have still become more common among employers, but only as an option alongside more traditional health plans like PPOs and HMOs." (Benefitfocus)
Measuring the Importance of Employer-Provided Health Coverage (PDF)
42 presentation slides. "[1] Most [employees] (63%) are satisfied with the health insurance system ...And even more (71%) are satisfied with their plans.... [2] The benefits that matter most: prescription drugs, preventive care, and emergency care.... [3] Employer-provided coverage is important for recruiting, but even more important for retention. [4] Consumers underestimate employer contributions ... [5] The top value-added services employers can provide: wellness discounts and health or flexible savings accounts." (America's Health Insurance Plans [AHIP])
Two More Health Insurers Sue Over Halted CSR Payments
"South Dakota-based Sanford Health Plan ... is seeking $1.6 million, while the Montana Health CO-OP ... seeks $5.3 million ... Those lawsuits bring the total number of CSR-related suits against the Trump administration to four. Like the Montana Health CO-OP, the other two complainants -- Maine Community Health Options and Common Ground Healthcare Cooperative -- are also consumer operated and oriented plans." (FierceHealthcare)
Workers Rank Health Care as the Most Critical Issue in the United States (PDF)
"31 percent of workers rank health care as the most critical issue in the United States.... 60 percent of workers report that health insurance is extremely important when considering whether to stay in or choose a new job, whereas only 42 percent report that a retirement savings plan is extremely important.... One-half of workers with health insurance coverage are extremely or very satisfied with their current health plan.... [J]ust 22 percent are extremely or very satisfied with the cost of their health insurance plan, and only 18 percent are satisfied with the costs of health care services not covered by insurance." (Employee Benefit Research Institute [EBRI])
Preventive Dental Benefits Save Employers Money, Studies Find
"[R]egular trips to the dentist can aid in early detection of potentially serious medical conditions.... [G]um disease has been linked to cardiovascular risks and preterm low-birth-weight babies, tooth decay with osteoporosis and oral infections with diabetes." (Society for Human Resource Management [SHRM])
The Cost of Healthcare for California Government Workers When They Retire Rises Sharply
"California taxpayers are on the hook for more than $91.5 billion to provide health and dental benefits to state government workers when they retire ... That's a substantial increase from last year's estimate, a result of changes in the way the total debt is calculated and changes in the projected cost of healthcare in the coming decades. Last year's report put the total liability at just under $77 billion." (Los Angeles Times)
ACA Cadillac Tax Delayed by Two More Years
"The Cadillac Tax was originally intended to go into effect in 2018, but President Obama delayed the effective date until 2020. The Act now delays the Cadillac Tax until 2022. The Act also affects implementation of two other ACA taxes: the medical device tax has been delayed until 2020; and while the Health Insurance Tax will be collected this year, it will be suspended during 2019 and then come back in 2020." (Morgan Lewis)
The CHIP Extension: Potential Impacts for Employers
"Increased costs and reduced eligibility in CHIP will force families utilizing this coverage to re-evaluate their options as the program adjusts to these changes.... Employers could see an increase in the number of children covered on their plans as impacted families look for alternative coverage options." (Hill, Chesson & Woody)
Amazon, Berkshire and JPMorgan Chase to Partner on Health Care
"Amazon, Berkshire Hathaway and JPMorgan announce a partnership to cut health costs and improve services for employees. The idea is to create a company that would be "free from profit-making incentives." News of the deal slammed suppliers in the industry including Express Scripts, Cigna, CVS, United Health and Aetna." (CNBC)
Massachusetts Issues Employer Assessment Regs
"These employer assessments are intended to curb the growing cost of the state's public health programs and are offset by lower state unemployment insurance rates. Both the higher assessments and lower unemployment rates are scheduled to sunset in two years. Massachusetts employers with six or more employees in the state must also submit employer health care coverage forms annually." (Willis Towers Watson)
An ER Visit, a $12,000 Bill, and a Health Insurer That Wouldn't Pay
"In recent years, Anthem has begun denying coverage for emergency room visits that it deems 'inappropriate' because they aren't, in the insurance plan's view, true emergencies. The problem: These denials are made after patients visit the ER, sometimes based on the diagnosis after seeing a doctor, not on the symptoms that sent them ... The policy has so far rolled out in four states: Georgia, Indiana, Missouri, and Kentucky." (Vox)
Workplace Wellness Programs Really Don't Work, New Study Concludes
"Over the years, hundreds of studies have examined the efficacy of wellness programs with mixed results... Much of that research has calculated savings by looking at the difference in health-care spending between employees who opt in to such programs and those who don't. But the new study, as a randomized control trial, measured differences by randomly creating a control group with no access to the wellness program at all. With that method, the researchers found that medical spending disparities pre-existed the wellness program." (Bloomberg)
New York and Minnesota Sue Over Loss of Basic Health Program Funding
"The states have sued for over $1 billion in annual funding ... They request a declaratory judgment that HHS is violating its obligation to make Basic Health Program payments and ask that HHS be required to consider and then adopt alternative funding proposals or a new payment methodology that is subject to the notice-and-comment rulemaking process." (Health Affairs)
Medicare Beneficiaries' Out-of-Pocket Health Care Spending as a Share of Income Now and Projections for the Future
"In 2013, Medicare beneficiaries' average out-of-pocket health care spending was 41 percent of average per capita Social Security income; the share increased with age and was higher for women than men, especially among people ages 85 and over. Medicare beneficiaries' average out-of-pocket health care spending is projected to rise as a share of average per capita Social Security income, from 41 percent in 2013 to 50 percent in 2030." (Henry J. Kaiser Family Foundation)
Employee Benefits Changes in 2018
"The end of the individual mandate for healthcare coverage may lead to an increase in the number of employees and their family members who will not buy health insurance.... Employees with employer-provided health coverage may not have enrolled their spouse or children in prior years because their family could have obtained coverage at a lower rate through some other program." (Butterfield Schechter LLP)
EBRI 2017 Health and Workplace Benefit Survey
"60 percent of workers report that health insurance is extremely important when considering whether to stay in or choose a new job, whereas only 42 percent report that a retirement savings plan is extremely important.... [A] majority of workers (55 percent) describe the health care system as poor (25 percent) or fair (30 percent).... [J]ust 22 percent are extremely or very satisfied with the cost of their health insurance plan[.]" (Employee Benefit Research Institute [EBRI])
Consumer Directed Health Plans Aren't Always Consumeristic
"[In] order to empower consumers to take control of their health care finances, benefit plans must be designed to do more than shift costs. They must be designed to supply real support to participants, both financially and in terms of choice architecture." (PLANSPONSOR)
Cadillac Tax Delayed to 2022 in Budget Deal
"There continues to be wide bipartisan support for repealing the Cadillac Tax. However, there is no consensus approach to replacing the lost revenue from full repeal. While it remains unlikely that the tax will ever fully take effect, the long planning process required to prepare for its effect will continue to make employers nervous each time the effective date closes in." (ABD Insurance & Financial Services)
[Guidance Overview] Good News for Employers: Continuing Resolution Provisions That Will Affect Employer-Sponsored Group Health Plans
"[1] A two-year delay of the 'Cadillac tax' (the 40% excise tax on high-cost employer-sponsored group health plans). The tax ... now will be effective in 2022.... With another delay, it's unlikely the IRS will issue regulations soon.... [2] A one-year suspension of the tax on health insurers. The tax is in effect for 2018, but suspended for 2019. The tax had previously been suspended for 2017." (Conduent)
Health Care 'Cadillac Tax' Delayed Until 2022
"With the new delay, the excise tax will be imposed beginning in 2022 on the cost of health plan coverage that is more than these pre-determined annual limits: $10,200 for individual coverage ($11,850 for qualified retirees and those in high-risk professions); $27,500 for family coverage ($30,950 for qualified retirees and those in high-risk professions).... While the tax was originally not deductible as a business expense, the December 2015 changes make it tax deductible for employers who pay it." (Society for Human Resource Management [SHRM])
2016 Health Care Cost and Utilization Report
"Total spending per person is now growing at faster rates than prior years, with 4.6% growth in 2016 compared to 4.1% growth in 2015 ... Spending growth in each year from 2012 to 2016 was almost entirely due to price increases.... Utilization of most health care services remained unchanged or declined, both year-over-year and over the 2012-2016 period. Consumer out-of-pocket (OOP) spending per person increased, but grew more slowly than total spending." (Health Care Cost Institute)
Out-of-Pocket Spending and Premium Contributions After the ACA
"[M]ean out-of-pocket spending decreased by 11.9% in the first 2 years after the insurance expansions, driven by reductions among persons eligible for the Medicaid expansion and those eligible for cost-sharing and premium subsidies on health insurance exchanges. Premium contributions increased by 12.1% ... whereas total health spending by households decreased in the Medicaid-eligible (lowest-income) group by 16.0%." (The JAMA Network)
What Do Workplace Wellness Programs Do? Evidence from the Illinois Workplace Wellness Study
"[D]uring the year prior to the intervention, program participants had lower medical expenditures and healthier behaviors than non-participants. However, we do not find significant causal effects of treatment on total medical expenditures, health behaviors, employee productivity, or self-reported health status in the first year.... [R]esults suggest these programs may act as a screening mechanism: even in the absence of any direct savings, differential recruitment or retention of lower-cost participants could result in net savings for employers." (National Bureau of Economic Research [NBER])
Removal of Actuarial Value Requirements for ACA-Compliant Pediatric Standalone Dental Plans
"ACA-compliant pediatric standalone dental plans no longer have to meet any particular [actuarial value (AV)] range. There was no change to the out-of-pocket maximum requirement. This change in policy provides new flexibility for dental issuers and closer alignment of pediatric dental benefits between standalone dental plans and pediatric coverage embedded within an ACA medical plan." (Milliman)
[Opinion] CVS-Aetna, a Few Weeks Later
"[CVS is] reserving cash for strategic acquisitions and building out their MinuteClinics.... CVS employees are required to use these clinics for their mandatory annual physicals, obviating the need for other more expensive primary care. Rumors are even circulating that following jettisoning tobacco, CVS is strongly weighing exiting the alcohol and grocery space and throwing all their resources into the health and wellness space." (Frenkel Benefits)
Employers Running Out of Time in Dealing with the Cadillac Tax
"[T]he Cadillac Tax is still alive and scheduled to take effect January 1, 2020.... Self-funded employers hoping to make material changes to their plans effective January 1, 2019 ... have already begun that process and intend to make decisions by midyear in order to have time to implement changes ... Employers with collective bargaining agreements that will not expire until later in 2018 or 2019, will face challenges in negotiating and implementing changes in their health plans by January 1, 2020 to keep their plans' gross costs from triggering the Cadillac Tax." (Findley Davies | BPS&M)
Health Insurers Rely on Group Coverage Profits to Offset Exchanges
"The individual health insurance market is still a slog for health plans, but health plans remain profitable overall because of their group coverage sales.... [I]nsurers gained ground in their medical loss ratios, which averaged 81% through the third quarter. They saw similar improvement in gross margins per member per month in the individual market segment, up to $79 per enrollee in the third quarter of 2017. That figure had been as low as $10 in 2015." (HealthLeaders Media)
Employers Received Rebates in 2016 Due to ACA's MLR Provision
"In 2016, employers in the small group market received approximately $153 million in rebates, and employers in the large group market received $191 million in rebates due to the [ACA's] medical loss ratio (MLR) provision ... Consumers in the individual market received approximately $103 million in rebates. In 2016, health insurance companies paid approximately $447 million in rebates." (Wolters Kluwer Law & Business)
Two-Year Delay for Cadillac Tax Included in Continuing Resolution Bill to Keep the Government Running
"[T]he effective date of the excise tax on high-cost health plans would be delayed for an additional two years, so that the tax will not become effective until 2022 rather than 2020. The bill also addresses other tax provisions that were part of the [ACA], such as the medical device excise tax and the excise tax on health insurers. In addition, the bill would extend the Children's Health Insurance Program (CHIP) for six additional years." (Employers Council on Flexible Compensation [ECFC])
Is the Stop-Loss Market Finally Firming?
"Of the 10 largest carriers, the loss ratio position has increased by an astounding 10 basis points over the past five years. Carriers that were once enjoying the profitability of a 71% loss are now staring at a roughly 81% figure, to their dismay. As a frame of reference, typical desired loss ratios are between 60% and 70%." (Frenkel Benefits)
Unitedhealth Raises 2018 Profit Outlook, to Take Benefit from Tax Law
"The biggest lift to its bottom line this year is a $1.7 billion benefit in earnings and cash flow from the $1.5 trillion tax bill that Trump signed into law last month. That is after a $400 million to $500 million reduction in premium revenue to comply with former President Barack Obama's healthcare law -- less than half of which is to comply with a minimum ratio for profits versus premiums collected." (Reuters)
[Guidance Overview] DOL Increases Civil Penalty Amounts for 2018 (PDF)
"The DOL's final rule implements the 2018 annual adjustments for civil penalties assessed or enforced by the DOL, including penalties under the FLSA, FMLA, OSH Act and ERISA. The increased penalty amounts became effective on Jan. 2, 2018, and may apply for any violations occurring after Nov. 2, 2015. The updated maximum penalty amounts are shown in [a table]." (Cowden Associates, Inc.)
Costs No Longer Biggest Factor in Choice of Benefits Administration Platform
"[Respondents in this year's survey who indicated that costs were their top driver when choosing a benefits administration platform] plummeted to just 23.9% of respondents this year from as many as 64.4% last year.... Leading the charge were administrative ease at 61.4%, which was up from 38% in 2016, and empowering employees to make informed benefits decisions at 51.5%, which was up from 24.4% in 2016." (Employee Benefit News)
And the HIT Just Keeps on Coming
"The [Health Insurance Tax, an ACA-imposed tax on fully insured health plans,] is non-deductible, meaning for every $1.00 in taxes the insurer will need to take in $1.54 (assumes 35% corporate tax rate). For 2018, the amount this tax must generate is $14.3 billion -- meaning insurers must generate $22 billion of additional premiums to pay for it.... To offer transparency, many insurers are breaking out these taxes on renewals for consumers to see. But, for most employer plans -- where a large amount of this revenue is generated -- this tax isn't transparent to employees." (InsureBlog)
[Opinion] The Individual Insurance Market in 2018: Business as Usual?
"Claims that the exchange market is unstable are greatly exaggerated.... A stable market does not necessarily yield optimal social or fiscal outcomes. Instead of achieving the ACA's goal of (near-) universal coverage, middle-class families who do not have access to employer coverage will continue to be squeezed out of the market. Those who have coverage will continue to see their costs rise as a result of an inefficient delivery system." (Health Affairs)
Consumers, Healthcare Organizations Unaligned on Value-Based Drug Pricing
"Most patients (74 percent) are interested in outcomes-based drug pricing, yet the majority of healthcare organizations (59 percent) are not yet working with drug manufacturers to track care outcomes -- and have no plans to do so." (BDO Center for Healthcare Excellence and Innovation)
[Guidance Overview] New Year Brings New Employer Healthcare Taxes in Massachusetts
"The increase in the EMAC tax and the new Supplement tax are both temporary and only apply for 2018 and 2019 ... The EMAC Supplement tax is a new employer assessment of 5% of wages up to the $15,000 unemployment wage base -- $750 maximum -- that applies for any non-disabled employee (including full-time and part-time) who obtains: Health coverage through MassHealth (excluding the premium assistance program), or Subsidized health insurance coverage from the Massachusetts ACA marketplace (Massachusetts ConnectorCare)." (Conduent)
Why It May Be Getting Harder to Move Employees Into CDHPs
"For employers that want to both provide choice and manage cost ... the challenge is to steer employees to most cost-efficient level of coverage that makes sense for their financial situation and healthcare needs. Decision-support tools and other resources can empower them to choose the right plan and then get the most out of it ... [A] bundled solution can make sense for some employers, to ensure their employees have access to best-in-class programs that can add value to a high-deductible medical plan." (Mercer)
Estimating the Costs of Proposals Affecting Health Insurance Coverage
"This [slide presentation] explains the process followed by CBO and the staff of the Joint Committee on Taxation (JCT) when estimating the costs of legislative proposals affecting health insurance coverage. An example is the agencies' estimate of how repealing the individual mandate to have health insurance would affect federal deficits." (Congressional Budget Office [CBO])
Overview of CBO Estimates of Federal Subsidies for Health Insurance for People Under Age 65, 2017-2027
"The federal government subsidizes health insurance for most Americans through a variety of programs and tax provisions. In 2017, net subsidies for people under age 65 will total $705 billion, CBO and the staff of the Joint Committee on Taxation (JCT) estimate. This presentation provides an overview of CBO and JCT's current baseline projections of health insurance coverage and how those projections have changed since March 2016, highlighting changes in Medicaid and CHIP enrollment and nongroup coverage." (Congressional Budget Office [CBO])
[Guidance Overview] Massachusetts Employers Should Prepare for Penalties and Other Changes to Law Regarding Health Care Contributions
"[T]he new law imposes a penalty on employers of up to $750 for each employee who is either enrolled in MassHealth or who receives subsidized coverage through the MassHealth Connector, so long as the employee is not disabled. Additionally, the new law also increases an employer's EMAC contributions (i.e., the equivalent of unemployment health insurance contributions) from 0.34% to 0.51% of the employee's wages." (Proskauer)
Maine CO-OP Sues Federal Government Seeking Cost-Sharing Reduction Payments
"[Maine Community Health Options (MCHO), a nonprofit insurer in Maine,] seeks an estimated $5.6 million in CSR payments for the 2017 plan year. The lawsuit ... reflects some of the same claims made by insurers (with mixed success) in ongoing litigation over risk corridor payments." (Health Affairs)
HHS Says New York May Have Misallocated Obamacare Exchange Funds
"The New York State Department of Health may have misallocated nearly $19.6 million in federal establishment grants to create its [ACA] exchange, the [HHS] Office of Inspector General said in a report Dec. 29. In addition, the state claimed unallowable fees of nearly $3.8 million paid to the state's exchange contractor, Maximus Inc., [the OIG report] said." (Bloomberg BNA)
[Guidance Overview] Temporary Changes to Massachusetts Employer Medical Assistance Contribution (EMAC)
"EMAC applies to employers with more than five employees in Massachusetts, and applies regardless of whether the employer offers health coverage to its employees.... For wages paid in the years 2018 and 2019, the EMAC contribution will increase to 0.51% up to the annual wage cap of $15,000, which increases the potential maximum cost per employee to $77 per employee per year." (Winston & Strawn LLP)
The Potential Premium Impact of an Essential Health Benefits Benchmark Change in Four States
"The HHS Notice of Benefit and Payment Parameters for 2019 Proposed Rule ... offered greater flexibility for states in selecting benchmarks for plan year 2019.... The greatest potential change from the current offering is the selection of a 'typical employer plan'... [This option] explicitly includes self-insured plans not subject to any state regulation, making it possible for states to select a benchmark with a narrow set of benefits in an attempt to control growth of health plan premiums." (Health Affairs)
[Guidance Overview] San Francisco Significantly Changes 2018 Minimum Healthcare Spending Requirements (PDF)
"Employers with self-insured plans will need to develop a new compliance strategy, including obtaining the needed data from the claim administrator either for just covered employees, or for all employees enrolled in a uniform health plan. Average hourly expenditures across a uniform health plan will need to be determined, adjusted for employee contributions." (Conduent)
Why the U.S. Spends So Much More Than Other Nations on Health Care
"American personal health spending grew by about $930 billion between 1996 and 2013, from $1.2 trillion to $2.1 trillion (amounts adjusted for inflation).... After accounting for those kinds of demographic factors, which we can do very little about, health spending still grew by about $574 billion from 1996 to 2013.... Did we do more for patients in each health visit or inpatient stay? Did we charge more? The JAMA study found that, together, these accounted for 63 percent of the increase in spending from 1996 to 2013." (The New York Times; subscription may be required)
[Opinion] The Frustration of Fraudulent Claims
"Despite all its quirky billing and procedure codes that add huge administrative burden ... the carrier payment system based upon thousands of CPT codes and 'modifiers' continues to be too provider-friendly. The complexity of the system has enabled unfair gamesmanship and misbehavior to the detriment of the payers (carriers and clients alike). We need a simpler and more responsive payment system." (Frenkel Benefits)

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