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Health plan costs - misc


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The Burgeoning 'Yelpification' of Health Care: Consumers Hold a Scale and a Mirror to the Health Care System
"Over the years, a slew of tools have developed to help patients with their health care decisions.... Yet, what is drawing in patients is Yelp -- the website widely known for consumer-driven restaurant reviews.... [A recent] study found that higher Yelp ratings are correlated with better-quality hospitals and can offer consumers a useful, clear, and reliable tool that can be easily accessed.... But while this research has helped to move the needle on validating Yelp as an important asset in the tool chest of health care quality tools, there are still important questions left unanswered." (Health Affairs)
CBO's AHCA Estimate: Decreases in Savings and Uninsured, Potential Market Instability for States with Major Waivers
"The most interesting and lengthy provisions of the report address the stability of nongroup insurance markets and the cost of premiums under the MacArthur Amendment EHB and community rating waivers.... Whether or not states obtained waivers and the extent of the waiver provisions would, the CBO projects, have a significant effect on the stability of the nongroup market and on nongroup market premiums. The $8 billion fund for waiver states would incentivize states to seek waivers, but it is not large enough to have a major effect on premiums." (Timothy Jost, in Health Affairs)
[Opinion] Key Takeaways from CBO's Scoring of the Republican Health Care Bill
"CBO finds that two million fewer people in 2020 and about one million fewer in 2026 would become uninsured under the AHCA. They cite that this is due to 'four million more people with employment-based coverage ... This is an interesting way to frame the effects of the AHCA, since reducing premium levels by rolling back regulations could actually have the effect of making plans more desirable for individuals looking to pay less. CBO lacks any real discussion of these positive effects." (The Heritage Foundation)
What Percentage of Health Insurance Coverage Does Your Construction Company Pay?
"[This] table may assist you in benchmarking the amount of health insurance coverage that your company provides.... [The chart] provides the 2017 averages for Preferred Provider Organization (PPO) plans." (Schneider Downs)
CBO Cost Estimate for H.R. 1628, the American Health Care Act of 2017, as passed by the House
"CBO and JCT estimate that, over the 2017-2026 period, enacting H.R. 1628 would reduce direct spending by $1,111 billion and reduce revenues by $992 billion, for a net reduction of $119 billion in the deficit over that period....

"CBO and JCT broadly define private health insurance coverage as consisting of a comprehensive major medical policy that, at a minimum, covers high-cost medical events and various services ... The definition excludes policies with limited insurance benefits (known as mini-med plans); 'dread disease' policies that cover only specific diseases; supplemental plans that pay for medical expenses that another policy does not cover; fixed-dollar indemnity plans that pay a certain amount per day for illness or hospitalization; and single-service plans, such as dental-only or vision-only policies. In this estimate, people who have only such policies are described as uninsured ...

"CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under H.R. 1628 than under current law. The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 23 million in 2026. In 2026, an estimated 51 million people under age 65 would be uninsured, compared with 28 million who would lack insurance that year under current law. Under the legislation, a few million of those people would use tax credits to purchase policies that would not cover major medical risks." (Congressional Budget Office [CBO] and Joint Committee on Taxation [JCT])

Health Savings Accounts Continue Rapid Growth
"People saving in HSAs do not do so at the expense of a defined contribution (DC) retirement plan, such as a 401(k). Fidelity found that during 2016, people who had both DC and HSA accounts saved on average 10.7 percent of their annual income in the retirement account. Those with just a DC account saved on average 8.2 percent in it.... Seventy-six percent are satisfied with the ease of using their HSA for medical expenses, 77 percent with the quality of their health care coverage, and 77 percent with how the plan helps them manage their health care costs." (Fidelity)
HHS Report: Average Health Insurance Premiums Have Doubled Since 2013
"Average individual market premiums more than doubled from $2,784 per year in 2013 to $5,712 on Healthcare.gov in 2017 -- an increase of $2,928 or 105%. All 39 states using Healthcare.gov experienced an increase in individual market premiums from 2013-2017. 62% of states using Healthcare.gov had 2017 premiums double what was measured in 2013. Three states -- Alaska, Alabama, and Oklahoma -- saw premiums triple from 2013-2017." (U.S. Department of Health and Human Services [HHS])
Employers Continue to Address Health Care Cost Increases
"[E]mployers are primarily focused on offering high-deductible health plans (HDHPs) (69 percent), targeting wellness programs (58 percent), and increasing employee cost-sharing (49 percent) ... 51 percent will offer telemedicine services, 55 percent of employers are committed to create more effective communications, 47 percent plan to focus on creating a culture of health, and 43 percent see managing specialty drugs as their highest priority." (Wolters Kluwer Law & Business)
[Opinion] Halting CSR Payments Will Devastate Individual Markets
"CSRs are an important stabilizing mechanism that must not be held hostage by political vitriol for prior legislative and administrative errors. Congress and the President must act soon to protect the individual market from collapsing. Failing to fund these CSRs will be more costly to taxpayers in the long run and is simply irresponsible[.]" (U.S. Chamber of Commerce)
Cost-Effective Healthcare Models in the Self-Insured World
"For self-insured employers, cash-based providers might be a solution to their employees' healthcare needs that result in high dollar claims. The ease of administration associated with these providers also makes them an attractive option.... Reference-based pricing follows the industry trend towards shifting healthcare costs and consumer responsibility to employees from employers. It also delivers a higher level of cost transparency from medical providers and gives the employer more control over their fixed and expected claim costs.... [C]enters of excellence have provided a seemingly win-win-win scenario for companies and their employees as well as the medical providers." (EBCG)
Policy Uncertainty Means Less Time for Oversight of Premium Hikes
"By some estimates, the lack of an individual mandate could result in up to a 20 percent bump in premiums; shutting off the CSRs would increase them by an additional 19 percent. At the same time, even those insurers committed to the marketplaces may need to revisit that commitment, change service areas, or adjust rates if they learn of competitors exiting the market or reducing their footprint." (The Commonwealth Fund)
Administration Seeks Delay of Ruling on Health Law Subsidies, Prolonging Uncertainty
"The request could further destabilize insurance markets as insurers are developing rates and deciding whether to participate in 2018. Insurers are supposed to submit their proposals to the federal government by June 21 and have already filed rate requests with several states. Loss of the cost-sharing subsidies, they say, could lead them to increase premiums by 15 percent to 20 percent or more, on top of any increases they might seek for other reasons." (The New York Times; subscription may be required)
Insurers, Marketplaces Face Uncertainty as Parties Seek Further Delay in House v. Price
"On May 22, 2017, the House of Representatives and the Department of Justice jointly asked the District of Columbia Court of Appeals to continue to hold House v. Price in abeyance, presumably for another 90 days as contemplated by the court's earlier order. The next status report would be due on August 20, 2017. The court is expected to respond to their request in the near future." (Timothy Jost, in Health Affairs)
Actuaries Examine How Changes to ACA Market Rules Would Affect Risk Adjustment
"Proposals to alter the market rules applying to the individual and small group health insurance markets would likely require changing the [ACA's] risk adjustment program, the American Academy of Actuaries said ... Loosening the issue and rating rules, incorporating high-risk pools, allowing sales across state lines, or eliminating federal essential health benefit (EHB) requirements could necessitate changes ranging from minor adjustments to major structural modifications." (Advisor Magazine)
[Opinion] Health Insurance Benefits Should Be Equitable But Not Necessarily Equal
"[We] should be designing insurance coverage in a way that provides access to care for people who need it, when they need it. That requires a subtle but important shift from equal access to equitable access. The first approach treats all people, regardless of clinical need, the same. The second recognizes that clinical need is an essential factor in determining where to direct resources and does not apologize for treating people with different needs differently." (Betsy Q. Cliff, Michael Rozier, and A. Mark Fendrick, in Health Affairs)
IRS Updates Premium Tax Credit Table, Required Contribution Percentage
"For plan years beginning in 2018, the required contribution percentage under Code Sec. 36B is 9.56 percent. For plan years beginning in 2018, the required contribution percentage under Code Sec. 5000A is 8.05 percent." (Wolters Kluwer Law & Business)
CBO to Release Estimate for House-Passed Version of the AHCA on Wednesday, May 24
"CBO and the staff of the Joint Committee on Taxation are in the process of preparing a cost estimate for the House-passed version of the American Health Care Act. CBO anticipates being able to release the estimate on Wednesday, May 24 in the afternoon.... CBO issued estimates for previous versions of the legislation on March 23 and March 13." (Congressional Budget Office [CBO])
California, New York Lead Group of States Seeking to Intervene in Litigation Over Cost-Sharing Reduction Payments
"The states' motion contends that allowing the lower court's order ending the CSR payments until Congress appropriates funding, and subjecting future CSR payments to an unpredictable appropriations process, would lead to higher insurance costs for consumers and to more insurers abandoning the individual health insurance market.... Moreover, the states assert, they have a unique sovereign interest in administering their insurance markets and protecting their residents that no other party to the litigation can represent." (Timothy Jost, in Health Affairs)
And You Thought There Was Nothing New in Healthcare? Shifting from 'Volume' to 'Value'
"Recently, a new player -- Create -- has come onto the scene in New York and New Jersey and is challenging the traditional idea that employee benefits must be delivered through conventional, big-name insurance carriers. The concept is a marketplace of health systems where employees shop for and select a health system as their exclusive care provider. So rather than carrying an insurance carrier card your health insurance ID would bear the name of the hospital network of your choosing." (Frenkel Benefits)
Obamacare Insurer Oscar's New Strategy Helps to Narrow Loss
"The privately held health insurer, created to sell plans under the [ACA], lost $25.8 million across three states in the first three months of this year, compared with a loss of $48.5 million a year earlier ... Oscar says it's trying to reinvent medical insurance from the perspective of a technology company. That means using data to design insurance products and to help guide members to the right kinds of health care when they need it." (Bloomberg)
Testimony on the Costs of Federal Civilian Personnel: A Comparison With Private-Sector Employees (PDF)
"Average benefits were 52 percent higher for federal employees whose highest level of education was a bachelor's degree than for similar private-sector employees ... Average benefits were 93 percent higher for federal employees with no more than a high school education than for their private-sector counterparts. Among employees with a doctorate or professional degree, by contrast, average benefits were about the same in the two sectors. On average for workers at all levels of education, the cost of benefits was 47 percent higher for federal civilian employees than for private-sector employees with certain similar observable characteristics, CBO estimates." (Congressional Budget Office [CBO])
2017 Milliman Medical Index
"In 2017, the cost of healthcare for a typical American family of four covered by an average employer-sponsored preferred provider organization (PPO) plan is $26,944, according to the Milliman Medical Index (MMI).... The MMI's annual rate of increase is 4.3%.... Prescription drug trends are lower, but still high.... Employees pay a bigger piece of the healthcare cost pie." (Milliman)
200,000 Postal Workers Would See Pay Raises, Benefit Cuts Under New Labor Contract
"In a potential hit for employees, the Postal Service would cut its contribution toward employees' health care plans by 3 percent through 2019. Still, even by the end of the contract USPS would pay for a maximum of 76 percent of any given plan, while the top contribution for the rest of the government caps out at 75 percent." (Government Executive)
Health Insurance Price Index Report for the 2017 Open Enrollment Period (PDF)
23 pages. "[This report] provides an in-depth analysis of the cost of individual and family health insurance plans selected by unsubsidized eHealth shoppers during the [ACA's] nationwide open enrollment period for 2017 coverage [which] began on November 1, 2016 and ended January 31, 2017.... The intent of this report is to present a nationwide snapshot of consumer behavior in the individual health insurance market by looking at the cost of health plans selected by consumers shopping outside government marketplaces through eHealth." (eHealth)
New Gene Tests Pose Threat to Insurers
"The 23andMe test results will not appear in people's medical records, and the company promises not to disclose identifiable findings to third parties. It is up to the customers to reveal them -- and the fear for insurers is that many will not." (The New York Times; subscription may be required)
Rising Health Benefit Costs Still Outpace Overall Inflation
"The pace of the rising cost that insurers charge for employee health benefits in the U.S., having slowed a bit last year, looks to be leveling off at about 7.5 percent for 2017. That figure does not take into account benefit plan design changes that are helping keep down the cost increases that employers will actually pay[.]" (Society for Human Resource Management [SHRM])
No Standing for Union Health Plan Claims Against Sanofi for Free Drug Sample Scheme
"A union health plan lacked standing to bring state unfair trade practices claims against a pharmaceutical company it charged caused monetary damage through a free samples scheme involving the osteoarthritis medication Hyalgan, and a diabetes drug switching scheme, because they failed to specifically allege that the plan or any of its beneficiaries paid, let alone overpaid, for the drug in the relevant states during the relevant time period[.]" [Plumbers' Local Union No. 690 Health Plan v. Sanofi, S.A., No. 15-956 (D.N.J. May 4, 2017)] (Wolters Kluwer)
Employers Continue to Address Health Benefit Cost and Workplace Programs in Uncertain Times
"There's high priority by 73% of employers to increase engagement in their programs, 51% will offer telemedicine services, 55% of employers are committed to create more effective communications and a culture of health (47%), and 43% see managing specialty drugs as their highest priority. To reduce costs, employers are primarily focused on offering high deductible health plans (HDHP) (69%), targeting wellness programs (58%) and increasing employee cost share (49%)." (Midwest Business Group on Health)
What Characterizes Marketplaces Having One or Two Insurers?
"Median monthly benchmark premiums range from $270 in markets with six or more insurers to $451 in markets with just one insurer in 2017. Likewise, in regions with 6 or more insurers, the median 2017 benchmark premium increase was 5.0% compared to 29.8% in regions with only 1 insurer.... The median population size for rating regions with only one marketplace insurer is 148,000, compared to 1.1 million in rating regions with 6 or more insurers." (Urban Institute)
CBO to Release Estimate for House-Passed Version of AHCA in Two Weeks
"CBO and the staff of the Joint Committee on Taxation [JCT] are in the process of preparing a cost estimate for the House-passed version of the American Health Care Act [AHCA]. CBO anticipates being able to release that estimate early in the week of May 22 and will provide advance notice of the date and time of release before publishing it." (Congressional Budget Office [CBO])
How Changes to Health Insurance Market Rules Would Affect Risk Adjustment (PDF)
"Risk adjustment helps ensure that plans are adequately compensated for the risks they enroll, thereby reducing insurer incentives to avoid high-cost enrollees.... This issue brief ... examines the risk adjustment program implemented under the [ACA] and the implications for the program under different potential changes to current insurance market rules." (Risk Sharing Subcommittee of the American Academy of Actuaries)
Enrollment in Health Plan with Tiered Provider Network Decreased Medical Spending
"An analysis of tiered network plans in Massachusetts found that they were associated with a 5 percent decrease in spending -- $43.36 less per member per quarter compared with per-member spending in similar plans not offering tiered networks." (The Commonwealth Fund)
Rising Health Care Benefit Costs Show No Sign of Abating Globally
"[M]edical insurers globally are projecting the cost of health care benefits to rise 7.8% this year, an increase from 7.3% in 2016.... Latin America projects the largest increases, driven by very high rates of inflation in some countries. The Middle East and Africa region is also projecting large increases (9.8%). Europe continues to show the lowest level of increase. U.S. insurers project a 7.5% increase this year, slightly less than they experienced in 2016." (Willis Towers Watson)
[Opinion] The Health Insurance Tax: Raising Costs for Families, Seniors, Taxpayers, and States (PDF)
"The health insurance tax hits nearly everyone, increasing the cost of health coverage for individuals, small businesses, and beneficiaries in public programs. Recognizing the tax's impact on consumers' health care costs, Congress acted to suspend the tax for one year, 2017. To ensure continued access to affordable health insurance coverage, it is important for Congress to take additional action to repeal the tax in 2018 and beyond." (America's Health Insurance Plans [AHIP])
The Path to ACA Repeal -- House Resuscitates the AHCA
"As it currently stands, the House bill leaves several open-ended questions for large employer-sponsored plans. First, it is unclear how the waivers for essential health benefits in the MacArthur Amendment will impact self-insured plans and the existing [HHS] regulations allowing such plans to choose a state 'benchmark' plan in order to define essential health benefits. Further, ... the pending CBO cost estimate may cause Congress to seek alternative funding sources for the bill, meaning that self-insured plan sponsors could find themselves in the crosshairs." (Eversheds Sutherland)
Forget Taxes, Warren Buffett Says -- The Real Problem Is Health Care
"In truth, Mr. Buffett said, a specter much more sinister than corporate taxes is looming over American businesses: health care costs. And chief executives who have been maniacally focused on seeking relief from their tax bills would be smart to shift their attention to these costs, which are swelling and swallowing their profits." (The New York Times; subscription may be required)
House Budget Panel to Assume ACA Repeal Enactment
"The House Budget Committee will assume enactment of the House-passed health care bill when it marks up a budget resolution after the Memorial Day break, a stance that may make tax-writers' jobs easier as they look to revamp the tax code.... The nature of the health care bill, which uses sharp cuts in health care spending -- much of it for the poor -- to more than offset the revenue lost by repealing taxes that hit the wealthy, has another potential impact: making the later argument over who benefits from a tax overhaul easier." (Bloomberg BNA)
Text of CBO Cost Estimate for the American Health Care Act, Incorporating Manager's Amendments 4, 5, 24, and 25
"CBO and JCT estimate that enacting H.R. 1628, with the proposed amendments, would reduce federal deficits by $150 billion over the 2017-2026 period... [In] 2018, 14 million more people would be uninsured under the legislation than under current law.... [The bill] would tend to increase average premiums in the nongroup market before 2020 and lower average premiums thereafter, relative to projections under current law. In 2018 and 2019, according to CBO and JCT's estimates, average premiums for single policyholders in the nongroup market would be 15 percent to 20 percent higher under the legislation than under current law." (Congressional Budget Office [CBO])
Did Medicare Part D Reduce Mortality?
"[The authors] investigate the implementation of Medicare Part D and estimate that this prescription drug benefit program reduced elderly mortality by 2.2% annually. This was driven primarily by a reduction in cardiovascular mortality, the leading cause of death for the elderly. There was no effect on deaths due to cancer, a condition whose drug treatments are covered under Medicare Part B.... [T]he value of the mortality reduction is equal to $5 billion per year." (Journal of Health Economics; purchase required)
ACA Round-Up: Developments Outside Congress
"Although attention has been focused on efforts in Congress to repeal and replace the [ACA], there has been ACA-related activity in the courts and on the administrative front as well. [1] The Franciscan Alliance case: defining gender discrimination under the ACA ... [2] Land of Lincoln and Moda Health Plan cases: risk corridor litigation ... [3] Administrative action: risk adjustment data validation and QHP certification." (Timothy Jost, in Health Affairs)
[Opinion] This Little-Known Legal Risk Could Force Big Changes to Our Dysfunctional Health-Care System
"Increased outside scrutiny on how ERISA-regulated health plans spend their dollars could create immense potential liability for both company directors and health insurers across the country.... These legal threats could force employers to actively manage health spending the same way they manage other large operational expenses.... [A]pproaches ... focus on proven benefits-design solutions that make poor care decisions more costly and better care decisions less costly to encourage the right behavior. Most importantly, they don't focus on shifting costs to employees." (MarketWatch)
GOP Senators to Draft Their Own Obamacare Replacement Bill
"[E]ven though the House spent months on a health care bill that would repeal and replace the [ACA], the Senate will use that legislation as a starting point to draft a separate measure.... The Senate must clear the added hurdle of the chamber's parliamentarian, who decides whether the legislation complies with the Byrd rule that allows Republicans to pass a bill with a simple majority of 51 votes under budget reconciliation. The parliamentarian can rule specific provisions out of order, stripping them from consideration." (Morning Consult)
[Official Guidance] Text of IRS Rev. Proc. 2017-36: Indexing Adjustments for Calculations of Premium Tax Credit and Eligibility for Minimum Essential Coverage (PDF)
"This revenue procedure ... [1] updates the Applicable Percentage Table ... for 2018. This table is used to calculate an individual's premium tax credit....[2] updates the required contribution percentage ... for plan years beginning after calendar year 2017. The percentage is used to determine whether an individual is eligible for affordable employer-sponsored minimum essential coverage under Section 36B.... [3] cross-references the required contribution percentage ... for plan years beginning after calendar year 2017 ... The percentage is used to determine whether an individual is eligible for an exemption from the individual shared responsibility payment because of a lack of affordable minimum essential coverage." (Internal Revenue Service [IRS])
For Health Insurers, Court Decisions Continue to Complicate Risk Corridors Program Payments
"Although an insurer can still properly file a case now, the ruling in BCBS suggests another possible approach: presenting the issue after the numbers are fully tabulated for the entire three-year risk corridors program. Such an approach could help courts focus on the ultimate issue: whether a statute stipulating that an agency 'shall pay' under specified conditions imposes a legal obligation on the government to make payment when those conditions are met." [Blue Cross & Blue Shield of N.C. v. U.S., No. 16-651C (Fed. Cl. Apr. 18, 2017) ] (Faegre Baker Daniels LLP)
[Opinion] When 'Insurance' Is Not Insurance: The Preexisting Condition Debate
"[C]onsider a person who is currently uninsured but has recently been diagnosed with a serious medical problem. Given the opportunity, this person would love to purchase a health insurance policy. But make no mistake about it, this policy is no longer insurance in any traditional sense of the term. By skipping out on paying premiums until the illness strikes, this individual has consumed a lot more than everyone else when healthy, yet is able to consume almost the same as everyone else when sick (almost because there is likely to be some cost sharing). This isn't consumption smoothing, it is free riding, and this is what the prohibition on considering preexisting conditions encourages." (David Dranove and Craig Garthwaite, at Code Red)
Moderate Republican Crafts Plan to Boost Stalled Health Care Bill
"Rep. Fred Upton, R-Mich.... said the proposal would provide $8 billion over five years to help some people with pre-existing medical conditions pay costly insurance premiums.... The existing health care measure would let states get federal waivers allowing insurers to charge higher premiums to people with pre-existing illnesses who'd let their coverage lapse.... The money in Upton's plan would help people with pre-existing illnesses pay premiums in states where insurers can charge them more." (InsuranceNewsNet.com)
Texas Department of Insurance Clarifies Position on Medical Stop-Loss Coverage Through Texas Captive Insurers
"The Department has confirmed that Texas captives may write coverage for the employer deductible or self-insured retention portions of a health benefit plan for employees. The coverage may be written as deductible reimbursement coverage payable by the captive to the parent as payor of the deductible benefits. In addition, the Department has confirmed that Texas captives may directly insure stop loss coverage for an ERISA qualified employee health benefit plan." (Mitchell Williams Selig Gates & Woodyard PLLC, via Lexology)
[Opinion] Who Should Pay to Cover Pre-Existing Conditions?
"[T]reating an expensive health condition costs (someone) lots of money. There are four basic approaches that can be taken to this problem. [1] Leave sick people to face the costs of their own treatment, whether out of pocket or through high-cost insurance, no matter how ruinous those costs become. [2] Mandate that other, healthier people overpay for the value of their own health insurance, so that sick people can underpay for the value of theirs. [3] Spread the costs of paying expensive health bills throughout society, for example by having taxpayers pick up the tab. [4] Require a targeted group to shoulder the costs." (Charles Blahous, Manhattan Institute for Policy Research)
Employers in Education, Manufacturing and Retail Taking on Greater Share of Premiums for HDHPs
"Fifty-one percent of [healthcare industry] employers offered an HDHP in addition to traditional plans, up from 37 percent in 2016 ... The manufacturing industry leads in the rate of HDHP offerings (61 percent) Employee-paid premiums for individual-coverage HDHPs fell 9 percent, while employer premiums went up 11 percent ... Thirty-nine percent of [retail industry] employees elected at least one of three income protection benefits, and 11 percent elected all three--year-over-year increases of 77 and 1,000 percent, respectively." (Benefitfocus)
[Opinion] An Insurance CEO Explains the Dangerous Game Trump Is Playing with Obamacare
"Many people in the insurance industry believe that if the government doesn't fund this and doesn't pay the insurance plans, that they will have breached their contract with the insurance plans, and this could result in millions of Americans losing their insurance coverage this year.... The Kaiser Family Foundation has estimated that, without these cost-sharing reductions, premiums will rise by an average of about 20 percent." (The Huffington Post)
Insurers' Dark Secret: Shared Savings and Facility R&C
"Some questions self-funded employers should be asking about how their claims are handled: [1] What percentage of the savings is my insurer taking as its fee? [2] Is there any dollar cap on this fee or does the insurer continue to make more as the billed charges move further away from their starting point? [3] Is the member paying cost-share on the insurer's fee and if not does the employer actually save money on a net basis? [4] What incentive does the insurer have to combat fraudulent and abusive charges when they are getting paid on the savings from these bills?" (Frenkel Benefits)
Financial Performance of Health Insurers: State-Run Versus Federal-Run Exchanges
"Researchers compared health insurers' profitability in 2013 and 2014, the years before and after the introduction of the [ACA] insurance marketplaces. The median loss for insurers overall in both years was 4 percent. Insurers performed better in states that operated their own health insurance marketplaces than in states that used the federal marketplace, with the difference largely driven by medical loss ratios." (The Commonwealth Fund)
Funding Bill Prohibits Full Risk Corridor Payments, Omits Cost-Sharing Reduction Payments
"Like the 2015 and 2016 appropriations bills, the legislation prohibits [HHS] from paying out more in risk corridor payments to health insurers that have excess losses in the marketplaces than it collects from health insurers that make excess profits.... [As] it did last year, the appropriations bill removes all funding for the Independent Payment Advisory Board (IPAB).... The bill does not include a provision for payments to insurers for cost-sharing reductions for low-income marketplace enrollees." (Timothy Jost in Health Affairs)
Cost of Service Regulation in U.S. Health Care: Minimum Medical Loss Ratios
"[T]he [ACA] introduced minimum MLR provisions for all health insurance sold in fully-insured commercial markets as of 2011, thereby explicitly capping insurer profit margins, but not levels.... [The authors] model this constraint imposed upon a monopolistic insurer, and ... test the implications of the model empirically using administrative data from 2005-2013 ... [They] find that rather than resulting in reduced premiums, claims costs increased nearly one-for-one with distance below the regulatory threshold, 7% in the individual market, and 2% in the group market." (National Bureau of Economic Research [NBER])
Health Insurance Exchange (HIX) Compare: Data on Marketplace Plans from Every State & District of Columbia
"HIX Compare datasets examine every marketplace plan from 2014 to 2017. This is the only nationally comprehensive, public dataset that includes information on all plans offered in the health insurance marketplaces. HIX Compare includes information on premiums, deductibles and out-of-pocket maximums, as well as cost-sharing requirements for primary care and specialist visits, prescription drugs, emergency room services and inpatient and outpatient visits for all plans across all 50 states and the District of Columbia." (Robert Wood Johnson Foundation)
[Guidance Overview] Employer Shared Responsibility: Have Penalties Been -- Or Will Penalties Ever Be -- Assessed?
"By not expanding the matching program, information return reporting leads to mismatches and unnecessary notices ... [The authors] have been unable to determine whether any of these types of penalties have been assessed, although based on the [Taxpayer Advocate Service], it appears that none have as of yet.... This is of particular concern to ALEs because efforts that must be taken to either correct or confirm that correct information was submitted to the IRS are costly and time-consuming." (Perkins Coie LLP)
[Opinion] Where Does the Health Insurance Premium Dollar Go?
"Much more troublesome is the 18 cents per premium dollar reported to cover the insurers' 'operating costs.' These include the cost of marketing, determining eligibility, utilization controls ... claims processing, and negotiating fees with each and every physician, hospital, and other health care workers and facilities. These operating costs are about twice as high as are the overhead costs of insurers in simpler health insurance systems in other countries." (JAMA Forum)
ACA Repeal-and-Replace Continues: What Employers Need to Know About the MacArthur Amendment
"Because the MacArthur Amendment allows states to obtain waivers with respect to essential health benefits ... [it] could result in significant opportunities for employer group health plans.... Under the ACA, an employer with a self-funded health plan can choose any state as its point of reference for essential health benefit purposes. If even one state obtains a waiver and eliminates prescription drug coverage from the list of essential health benefits, any employer with a self-funded health plan -- no matter where the employer is located -- could impose annual and lifetime limits on prescription drugs and could exclude prescription drugs from the out-of-pocket maximum." (Venable LLP)
Employers Finding All-Encompassing Strategy Key to Effective Health Care Programs
"Actions employers will take to improve the employee experience of the health care program include: [1] Implement a high-tech enrollment process with decision support.... [2] Offer greater choice of health plan options and types of benefits.... [3] Improve navigation of health care providers.... Actions employers will take to improve the employee experience of the well-being program include: [1] Provide access to a portal for tracking activity and incentives.... [2] Routinely ask for employee feedback to enhance program offerings.... [3] Personalize rewards for employees who engage in the well-being program.... [4] Offer access to tools to help households meet their financial goals." (Willis Towers Watson)
Health Policy's Gordian Knot: Rethinking Cost Control
"The central, intractable obstacle to long-term cost containment ... is the near impossibility of saying 'no' to ever-more-expensive care that yields small marginal benefits.... [The authors] propose, instead, to circumvent [this barrier] through redirection of cost-control policy away from efforts to limit use of existing, low-benefit technologies and toward strategies for influencing the emergence of new technology. To this end, [the authors] urge: redesigning value-based payment to emphasize future rewards for tests and treatments that haven't yet emerged, and varying the duration of intellectual-property protection so as to tie its rewards to therapeutic effectiveness." (Health Affairs)

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