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Health plans - design


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2017 Annual Report to Congress on Self-Insured Group Health Plans (PDF)
17 pages. "Approximately 51,600 health plans filed a Form 5500 for 2014, an increase of nearly 3 percent from the health plans that filed a Form 5500 for 2013. Of health plans filing a 2014 Form 5500, about 21,200 were self-insured and approximately 3,800 mixed self-insurance with insurance ('mixed-insured'). Self-insured plans that filed a Form 5500 covered approximately 3 3 million participants in 2014 and held assets totaling about $87 billion. In 2014 there were nearly 26 million participants covered by mixed-insured group health plans; these mixed-insured group health plans held almost $137 billion in assets." [Appendices also available: Abstract of 2014 Form 5500 Annual Reports Reflecting Statistical Year Filings, and Self-Insured Health Benefit Plans 2017 Based on Filings through Statistical Year 2014.] (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
[Opinion] The Affordable Care Act: Chapter Two
"As we now pivot to Chapter Two for the [ACA], the realities are these: [1] The healthcare system needs improvement. Affordability is the issue one.... [2] The [ACA] has flaws. It successfully increased coverage for 20 million who were uninsured via Medicaid expansion and subsidized coverage for individuals via the marketplaces, but at a hefty price -- $1.1 trillion over 10 years -- and the rules whereby insurers are required to structure and price their plans are problematic.... [3] The strength of our economies--locally and nationally -- is closely tied to the effectiveness of our health system." (Paul Keckley)
Judge Open to Anthem's Consumer Benefit Claim
"Anthem argued before a panel of three judges in the U.S. Court of Appeals for the District of Columbia Circuit that a district court ruling blocking the merger was wrong because it ignored the $2.4 billion in medical cost savings the company says it can wrestle from doctors and hospitals. U.S. Circuit Judge Brett Kavanaugh appeared most convinced by the insurer's argument that the deal would lead to savings that could be passed on to consumers. He also seemed persuaded that those savings could be good for competition." [U.S.A. v. Anthem Inc., No. 17-05024, (D.C. Cir. filed Feb. 10, 2017)] (Bloomberg BNA)
More Than Obamacare Repeal, Small Businesses Want Congress to Rein in Costs
"As a bloc, small-business owners have been among the health care law's most vocal opponents.... But every business is uniquely affected by the complex law, and simply demolishing it without putting new guardrails in place is not, for most, the ideal outcome. Small-business owners overwhelmingly say they want Republican and Democratic leaders to quit their partisan bickering, acknowledge that the country's health care economics are fundamentally broken, and work together on fixing the problem." (The New York Times; subscription may be required)
Health Care Cost Challenges Require Employer Innovation
"For the first time, employers reported specialty pharmacy as a top driver of health costs.... [E]mployers may implement pharmacy management techniques, including utilizing specialty tiers within their pharmacy plan designs.... Engaging employees in all aspects of the health insurance program is paramount to controlling benefit costs.... Helping employees understand and navigate their options and costs through coaching and support tools will increase awareness around benefit offerings and deliver on value as well." (Healthcare Trends Institute)
House Pulls AHCA Minutes After Expected Vote
"There are a few possible 'next steps' ... [1] Retain the ACA.... [2] Nothing would stop Congress from further negotiations to attempt to drum up more votes.... [3] Republicans might attempt to add piecemeal repeal efforts into future legislation, or to address those components on a stand-alone basis.... [4] Even in the absence of a comprehensive repeal or reconciliation effort, the Administration retains great flexibility, through regulatory action, to water down various provisions of the ACA." (Seyfarth Shaw LLP)
[Opinion] What Comes Next for Obamacare? The Case for Medicare for All
"[T]he repeal effort's biggest hurdle may have been loss aversion, one of the most robust findings in behavioral science. As numerous studies have shown, the pain of losing something you already have is much greater than the pleasure of having gained it in the first place.... Part of the appeal of Medicare for all is that single-payer systems reduce financial incentives that generate waste and abuse." (Robert H. Frank in The New York Times; subscription may be required)
Study Connects the Dots Between Essential Health Care and Paid Sick Leave
"Researchers ... have found that regardless of sociodemographic factors, workers who lack paid sick leave were significantly less likely to have received preventive health care screenings in the last 12 months -- even among those who have been told they have a condition such as diabetes or cardiovascular disease that places them at higher medical risk. Moreover, workers without paid sick leave are 1.6 times less likely to have received a flu shot in the past 12 months[.]" (Wolters Kluwer Law & Business)
House Leaders �Came Up Short� In Effort To Kill Obamacare
"The legislation was damaged by a variety of issues raised by competing factions of the party. Many members were nervous about reports by the [CBO] showing that the bill would lead eventually to 24 million people losing insurance, while some moderate Republicans worried that ending the ACA's Medicaid expansion would hurt low-income Americans. At the same time, conservatives, especially the hard-right House Freedom Caucus ... complained that the bill kept too much of the ACA structure in place." (Kaiser Health News)
Anxiety Disorders: Why They Matter and What Employers Can Do
"Anxiety disorders lead to an average of 4.6 work days lost to disability per month and 18.1 work days lost to disability per 3 months, as well as an average of 5.5 work days of reduced productivity per month ... [F]or every $1 invested in treating depression and anxiety, there is a $4 return for the economy. While scaling up treatment for depression and anxiety would cost $147 billion over the next 15 years, it would yield a 5% improvement in workforce participation -- representing a $399 billion return on investment[.]" (Partnership for Workplace Mental Health)
Perspectives for Employers on the Proposal for Health Reform About to Be Voted on in the House
"It is important to remember that [Friday's] scheduled vote is only the House voting on this proposal, there are still a number of steps and votes and committee conferences that will need to take place before we actually have any change to the law.... The purpose of this alert is solely to look at the potential impact of the 2017 Bill as it is currently drafted and what it might mean for employers and their group health plans and retiree medical plans. We are still a long way from final legislation approved by both the House and Senate[.]" (Winstead PC)
House Republicans Tweak AHCA Again; CBO Scores Earlier Changes
"The amendment would first delay the repeal of the [ACA]'s additional Medicare tax on the wages of taxpayers exceeding $250,000 a year ($200,000 for single filers) from 2017 to 2022, and repeal a transition rule applying to the withholding of this tax by employers for 2017. This measure would raise about $50 billion in revenue. Second, the amendment would make a number of changes to the AHCA's Patient and State Stability Fund. Under the amendment, states would be able to use the fund for reducing the cost of insurance coverage in the individual and small group market for individuals who have high health insurance costs due to the low population density of states where they reside.... Finally, the amendment revises the section of the ACA defining essential health benefits (EHB)." (Health Affairs)
Essential Health Benefits: What Could Their Elimination Mean?
"This comprehensive a repeal of the ACA would have far-ranging consequences for our health care system ... The full effect of the repeal of Title I or any of its protections would depend on what would happen to prior law and on interactions with state law.... Repeal of any particular provision of Title I, moreover, would be like pulling a thread from woven fabric -- it could have implications throughout the law that are difficult to predict, as is the case with repeal of the essential health benefits requirement," (Health Affairs)
[Opinion] If Essential Health Benefits Standards Are Repealed, Health Plans Would Cover Little
"[E]liminating Essential Health Benefit standards could weaken the ACA's core protections even for people with coverage from large employers. The ACA's prohibition on annual and lifetime limits is tied to the definition of Essential Health Benefits. Thus, repeal of Essential Health Benefit standards could make this protection meaningless, putting almost all Americans with private health insurance coverage -- not just those with individual or small-group market coverage -- at risk." (Center on Budget and Policy Priorities)
[Opinion] Five Facts About the Essential Health Benefits and American Health Care Act
"The EHBs serve as a minimum coverage standard, and are a critical element of the ACA.... [1] The EHBs are basic services ... [2] EHBs are defined by states and are based on a typical employer plan ... [3] EHBs have closed health care coverage gaps ... [4] EHB services like maternity care are not high cost drivers ... [5] Preventive health services are among the EHBs." (National Health Law Program [NHeLP])
Health Plan Switching: A Case Study -- Implications for Private and Public Health Insurance Exchanges and Increased Health Plan Choice (PDF)
24 pages. "One-third of health plan participants enrolled in both 2014 and 2015 switched health plans between 2014 and 2015. Workers enrolled in the HSA-eligible plan in 2014 were more likely to switch plans than other workers.... While HSA-eligible plan enrollees were more likely to switch plans, those who did switch were most likely to switch to the same plan type with a different carrier.... Very few HSA-eligible plan enrollees who switched plans switched to a different type of health plan." (Employee Benefit Research Institute [EBRI])
Impact of Cost Sharing Reductions on Deductibles and Out-of-Pocket Limits
"This note briefly describes the cost-sharing reductions in current law and illustrates their impact by looking at how these provisions affect average deductibles and out-of-pocket maximum limits in benchmark silver plans in 2017 in states using the federally facilitated marketplace." (Henry J. Kaiser Family Foundation)
Wellness Program: 70 Percent of Medical Cost Savings Comes from Employees Using Health Coaches
"Research shows that 70 percent of medical and pharmacy cost savings comes from just 30 percent of employees who enroll in coaching. What's more, those who enrolled in coaching saved an average of $586 on medical costs per year, compared with an average savings of $261 among wellness program participants who do not participate in coaching. This translates to approximately 6 percent more cost savings reaped by those who participate in wellness coaching." (HealthFitness)
2015 Commercial Health Insurance: Overview of Financial Results
"This report provides an overview of health insurer financial results in 2015 and evaluates changes in the health insurance industry's expense structure and enrollment relative to prior years. It also explores impacts to the insurance markets from the insurance marketplaces and the [ACA] 3R programs. In addition, the report reviews marketplace enrollment and associated subsidies from 2014 through 2016 in the context of the aggregate individual health insurance market." (Milliman)
FSA Reimbursement: Nine Qualified Expenses You May Not Know About
"Guide dogs/service animals.... Braille reading material.... Auto adaptation expenses.... Television closed captioning.... Special telephone equipment.... Wigs ... Smoking cessation programs.... Lead-based paint removal.... Transportation." (DataPath)
The Consequences of Taxing Healthcare Benefits
"[M]ore than 92 percent of those responding to the survey are against any policy that would tax workers, their families and employers on a portion of health plan premiums.... Three quarters of respondents said they would definitely reduce benefits or consider it, to avoid triggering new taxes on health benefits. Nearly 90 percent indicated they would avoid increasing benefits if it meant triggering a tax.... Only 6 percent said they would increase wages to make up for a reduction in benefits." (Lockton)
House Passes Small Business Health Fairness Act
"The House of Representatives [on March 22] passed the Small Business Health Fairness Act (H.R. 1101) ... [T]he legislation empowers small businesses to band together though association health plans (AHPs) and negotiate for lower health insurance costs on behalf of their employees. The bill passed by a vote of 236 to 175." (Committee on Education and the Workforce, U.S. House of Representatives)
As Rivals Stand Silent, One Health Insurer Protests GOP Plan
"[Dr. J. Mario Molina] has become one of the few insurance executives publicly criticizing the [AHCA], which he believes could strip away coverage for millions of their clients and cause considerable turmoil for the insurance industry. The major insurers have mostly stayed silent during the debate, supporting some of the Republicans' provisions that promise near-term stability for the insurance exchanges and a repeal of a tax on health insurance." (The New York Times; subscription may be required)
Health Care Priorities from a National Academy of Medicine Initiative (PDF)
31 pages. "Health care today is marked by structural inefficiencies, unprecedented costs, and fragmented care delivery ... Locally and nationally, new models of care delivery and payment are emerging that seek to reduce waste by rewarding value over volume, are more patient-centric, and are driving better care coordination and integration.... This paper synthesizes the range of compelling opportunities ... and presents strategic priorities for the next Administration and the nation's health leaders to undertake now and in the years ahead." (National Academy of Medicine)
Why Deductibles Would Rise Under the GOP Health Care Plan
"[T]he average deductible for a typical plan in the non-group market under the GOP plan would be about $1,550 higher in 2017 than it would have been under the [ACA] ... Most of the debate has been about what would happen to premiums -- but for consumers, it's total out-of-pocket costs that matter.... The result: premiums may be lower in some cases, but deductibles will go up." (Drew Altman, Kaiser Family Foundation, via Axios)
District Court Rules That Cross-Plan Offset Constitutes 'Grave Conflict of Interest'
"In an extraordinary decision, [a U.S. district judge] has effectively barred cross-plan offsets. The judge weighed in on two very important questions: ... whether UHC acted 'reasonably' in interpreting its client's plans to permit cross-plan offsetting; and whether the practice complies with the 'fiduciary duties imposed by ERISA'. The court offered an answer to both issues while providing very clear guidance for plans, claims administrators, medical providers and patients." [Peterson v. UnitedHealth Group Inc., No. 14-2101 (D. Minn. Mar. 14, 2017)] (AVYM Healthcare Revenue Consultants)
Implementing Global Benefits Governance (PDF)
"Corporate governance of employee benefits is an increasingly important consideration for companies because the financial costs and risks of benefits have grown significantly and companies need to ensure sufficient value in sponsoring benefits programs. Auditors are also increasingly interested in corporate governance, and that includes benefits governance. Centralization of benefits governance has followed from all of this." (Groom Law Group)
[Guidance Overview] Program of Administrative Services Is Neither a Welfare Plan Subject to ERISA Nor a MEWA, Says DOL
"[DOL Advisory Opinion 2017-01A] concluded that the Program is not an employee welfare benefit plan. It said that such a plan does not include a program maintained by an employer (or group or association of employers) which ... has no employee participants and does not provide covered benefits to employees or their dependents. Rather than being established or maintained for the purpose of providing welfare benefits to participants and beneficiaries, the Program operates so as to facilitate the efficient establishment and operation of employee benefit plans by employer-members." (Cary Kane ERISA Lawyer Blog)
Require Continuous Health Insurance Coverage in 2017, Insurers Say
"The American Health Care Act ... includes a provision under which people would pay a 30 percent surcharge ... for any year they went longer than 63 days in a 12-month period without coverage. But health insurers and the [CBO] say the provision isn't punitive enough to keep people from waiting until they get sick to enroll." (Bloomberg BNA)
[Opinion] House Proposal to Promote Association Health Plans Poses Risks for Insurance Markets, Consumers
"The Small Business Health Fairness Act, H.R. 1101 [see Fact Sheet], allows small employers to band together and buy health insurance though federally certified associations. Despite its name, the bill would have a considerable and likely detrimental impact on the private health insurance market and undermine the ability of states to protect small employers and their employees." (The Commonwealth Fund)
What's in the Manager's Amendment to the American Health Care Act?
"It consists of two sets of amendments, labeled technical changes ([ with an accompanying summary]) and policy changes ([with an accompanying summary]).... The amendments add an additional year to the relief the AHCA offered from the 'Cadillac' plan excise tax ... and accelerate the repeal of all other ACA taxes from 2018 to 2017.... Another provision clarifies that the 30 percent of premium penalty imposed on consumers who seek coverage after a gap in coverage applies only in the individual and not in the small group market.... [M]uch of the $337 billion in deficit reduction that the CBO credited to the AHCA disappears under the manager's amendment." (Health Affairs)
[Opinion] House Obamacare Repeal Bill Limits HSAs for Millions of Americans
"The House Republican American Health Care Act Managers Amendment would not allow Americans to use their tax credits to fund an HSA. Instead of using their tax credit/HSA to pay for doctor visits, prescriptions and OTC drugs, Americans will only be allowed to use their credit for insurance. This is a big mistake -- and a giveaway to insurers." (National Center for Policy Analysis Health Policy Blog)
[Opinion] How Employer-Provided Healthcare Is Strangling Consumers
"Today, it's hard to imagine health insurance markets without corporate employers as the predominant purchasers. But it is not at all obvious that employers ought to provide health insurance as a benefit, or that such a system would have materialized (particularly on such a scale) were it not for the harmful wage controls of the World War II era." (David D�Amato, in The Hill)
Text of House Budget Committee Report on American Health Care Act
"Repealing Obamacare merely begins the process of establishing truly patient-centered health care in America -- and aspects of both are contained in this legislation ... [The AHCA] is just one component of a broader effort to transform the Nation's troubled health care network. It will be supplemented by other elements, described [in this report]." (Committee on the Budget, U.S. House of Representatives)
Providing a Better Way on Health Care for Small Businesses, Working Families
"Because of their size, small businesses lack the same level of bargaining power available to large businesses and labor organizations. And they are unable to band together to increase their bargaining power to help lower health care costs for their workers. The Small Business Health Fairness Act (H.R. 1101) [see Fact Sheet] ... empowers small businesses to band together through association health plans to negotiate for lower health insurance costs on behalf of their employees." (Committee on Education and the Workforce, U.S. House of Representatives)
House Republicans Announce Updates to Strengthen American Health Care Act
"To provide more immediate help, the amendment accelerates repealing the Obamacare taxes to 2017, rather than 2018.... Under current law, Americans can deduct from their taxes the cost of medical expenses that exceed 10 percent of their income. Our proposed amendment reduces this threshold to 5.8 percent of income.... This amendment would allow states to opt out of the per capita [Medicaid] allotment baseline and instead receive federal funds through a block grant.... [T]he amendment would prevent new states from opting in to Obamacare's Medicaid expansion." (Committee on Ways and Means, U.S. House of Representatives)
GOP Recycles Controversial 2003 Bill To Boost Small-Business Insurance
"The bill would allow the establishment of nationwide 'association health plans' that could be offered by professional or trade groups, chambers of commerce and the like. Small businesses could buy coverage through these associations, in theory gaining strength in numbers to enhance their bargaining leverage with insurers, leading to cheaper, better coverage and lower administrative costs. The Small Business Health Fairness Act of 2017 is slated to head to the House floor this week." (Kaiser Health News)
Would Proposed Law Require Genetic Testing for Employees?
"The House may soon vote on the Preserving Employee Wellness Programs Act, which its sponsors say would clarify conflicting rules for incentives paid to employees who participate in voluntary health screenings, some of which may be genetic health tests.... [O]pponents ... claim the measure would compel employees to undergo genetic testing, leaving them vulnerable to discrimination by their employers. A nonpartisan could be forgiven for wondering how both sides could be talking about the same legislation." (Society for Human Resource Management [SHRM])
Employer Attitudes on Private Exchanges
"With 74% of employers not interested in using an exchange as a solution for delivering benefits to their active employees, it appears this once heavily touted option lacks any real forward momentum. In fact, less than one percent of respondents were currently using an exchange for active employees." (Chelko Center for Benefits Management)
[Guidance Overview] Welfare Plan Compliance Under the Genetic Information Nondiscrimination Act (PDF)
"GINA was enacted to protect individuals against discrimination in health insurance coverage and employment based on their genetic information. This note describes key definitions and concepts under GINA, provides a detailed look at the prohibitions on the collection and use of genetic information and other rules in the context of group health plans, and reviews the application of GINA to wellness programs and health risk assessments." (Dechert LLP)
Health Plan Innovators Focus on Clinical Outcomes
"Consumer-centric innovations such as providing tools to engage members in their own care, enabling providers to better coordinate care, and collaborating with providers to improve members' clinical health outcomes, are gaining momentum. The idea of improved clinical outcomes, something long thought to have been in the purview of health systems and other providers, is now considered to a be a worthy and achievable health plan goal." (America's Health Insurance Plans [AHIP])
HHS Launches Web Page Highlighting Administrative Actions to Empower Patients
"New measures will be announced as soon as is allowable by law. In particular, future actions will: [1] Lower costs and increase choices by providing relief from the burdensome regulations and fostering competition in insurance markets; [2] Work to ensure a stable transition period; [3] Offer states greater flexibility of their Medicaid programs to meet the needs of their most vulnerable populations; and [4] Increase the opportunities for patients to get the care they need when they need it." (U.S. Department of Health and Human Services [HHS])
Happy Anniversary ACA!
"This Thursday, March 23, marks the seventh anniversary of the passage of the [ACA]. It also marks the date the House will vote on its partial replacement, the American Health Care Act [AHCA].... Amidst the clamor of the current debate ... it's useful to harken back to the circumstances under which the ACA passed and reflect on what might be learned." (Paul Keckley)
As Opioid Epidemic Rages, Worksite Policies Overlook Prescribed Drugs
"Seventy-one percent of U.S. employers say they have been affected in some way by employee misuse of legally prescribed medications, including opioids ... 19 percent of employers feel 'extremely prepared' to deal with prescription drug misuse in the workplace. 81 percent lack a comprehensive drug-free workplace policy. 41 percent of those that drug test employees are not testing for synthetic opioids." (Society for Human Resource Management [SHRM])
Prominent Health Lawyers Offer Help for Obamacare Reform
"The most recent group to weigh in calls itself Health Lawyers for Responsible Reform, and consists of 10 of the last 17 attorneys to chair the American Bar Association's Health Law Section.... Although the group advocated against a blanket repeal of the ACA, it didn't go so far as to oppose any effort to reform the health-care law. Instead the members provided 16 principles that they believe should guide any future legislative efforts beyond the current Republican plan being debated in Congress." (Bloomberg BNA)
How Will the Proposed AHCA Be Different from the ACA for Employers?
"The AHCA would eliminate penalties imposed on employers with at least 50 full-time equivalent employees when one or more of their full-time employees obtains a premium tax credit through a health insurance exchange. The elimination would be retroactive to 2016.... The AHCA would delay implementation of the ACA's so-called Cadillac Tax ... The AHCA would repeal the ACA's maximum contribution of $2,500 to a health FSA that is part of a cafeteria plan as soon as tax year 2017. The AHCA also would repeal the tax on over-the-counter-medication without a prescription, allowing cafeteria plan participants to purchase over-the-counter medication with health FSA funds." (Bloomberg BNA)
Employer-Backed Insurance Could Take a Huge Hit from GOP Healthcare Plan
"With tax credits for workers earning up to $215,000, the Republicans' health care plan would push the incentives for companies not to offer benefits further up the income spectrum ... If a wider pool of employees opts to take the tax credit and enter the individual market, companies would have a tougher time negotiating with insurers for coverage that is both affordable and comprehensive, with less-attractive offerings leading even more workers to forgo the benefit." (NBC News)
Republicans Focusing on Health Bill Changes as Leaders Seek Support
"Major changes include making tax credits to help people afford insurance [that's] more generous for low-income people or adults between ages 50 and 64, adding some sort of Medicaid work requirements and adding a block grant option for Medicaid funding." (Morning Consult)
[Opinion] High-Risk Pools Do Not Serve Consumers Well (PDF)
"Current proposals to subsidize high-risk pools fall far short.... [O]ne recent health reform bill would establish state high-risk pools and allocate $3 billion over three years to fund them. Another recent proposal offered $25 billion over 10 years to fund them.... [It] would cost at least $178 billion a year to adequately fund high-risk pools today[.]" (AARP)
Many Provisions in the American Health Care Act Affect Plan Sponsors (PDF)
Presented as a 7-page chart. Columns include a description of the provision, its background, its location in the AHCA, and its potential effect on plan sponsors. Provisions include the Cadillac Tax, over-the-counter medications, HSA tax, FSA limit, annual fee on health insurance providers, prescription drug fee, medical device tax, deduction for retiree prescription drug costs, remuneration paid by health insurance providers, and six more. (Eversheds Sutherland)
Putting Telehealth to Work
"90% of employers reported they will provide telehealth benefits in states where they can this year. Yet ... of the employees who had access to telehealth services in 2016, only 3% used the benefit.... Employers need a well-executed and consistent communication strategy promoting the benefit that will educate employees about the existence and process for using telehealth services and to address any barriers to utilization. This strategy will help employees' knowledge and trust in the benefits that telehealth services offer." (Grooms Benefit Solutions)
House Panel Calls for Medicaid Work Requirement, Tax Credit Changes in Health Bill
"Three of the motions, which passed along party lines, were aimed at establishing requirements for Medicaid enrollment, while a fourth would allow more generous tax credits to help low-income people afford insurance. The motions were nonbinding recommendations that could be proposed on the House floor as amendments or incorporated into the bill, the American Health Care Act, when it goes before the Rules Committee ... The recommendations came after the committee at the outset of the meeting narrowly voted to advance the bill, 19-17[.]" (U.S. News & World Report)
CRS Report: The American Health Care Act (PDF)
18 pages. "This report includes three tables that, together, provide an overview of the AHCA provisions. Table 1 includes provisions that apply to the private health insurance market, Table 2 includes provisions that affect the Medicaid program, and Table 3 includes provisions related to public health and taxes. Each table contains a column identifying whether the AHCA provision repeals or amends an ACA-related provision." [Report R44786, Mar. 14, 2017) (Congressional Research Service [CRS])
Q&A on Proposed Legislation for Voluntary Employee Wellness Programs
"Regulatory clarity is needed due to a number of enforcement actions and regulatory steps taken by the [EEOC] in recent years. The EEOC's actions contradict the ACA and the rules promulgated by the Obama administration implementing the ACA. As a result, employers and employees who want to participate in these programs are caught in a regulatory Catch-22: Either follow the ACA guidelines and be in violation of the EEOC rules, or vice versa. By reaffirming the policies outlined in the ACA, H.R. 1313 will provide private-sector employers the legal certainty they need to continue offering these voluntary programs." (Committee on Education and the Workforce, U.S. House of Representatives)
Employer Association's Administrative Services Arrangement Is Not an ERISA Welfare Plan or a MEWA
"The program was developed by an association of large employers that sponsor self-insured benefit plans through administrative services only (ASO) agreements with insurance companies.... Noting that a program that has no employee participants and does not offer or provide benefits to employees or their dependents is not an ERISA welfare plan, the DOL concluded that this program is not an employee welfare benefit plan under ERISA Section 3(1) because it has employers rather than employees as participants.... The DOL also determined that the program is not a MEWA under ERISA Section 3(40) because it was not an arrangement established or maintained to provide welfare benefits to employees of two or more employers[.]" (Thomson Reuters / EBIA)
[Opinion] What the CBO Gets Wrong About the House GOP's Obamacare Repeal Bill
"CBO's new estimate neglects the behavioral effects that would result from the Republican plan. By dismantling Obamacare, insurance companies would be able to offer a wider variety of plans and people would be more enthusiastic about buying them. CBO states that average premiums would decline after 2020, and this would lead to more enrollment." (Manhattan Institute for Policy Research)
Ensuring Compliance with Network Adequacy Standards: Lessons from Four States
15 pages. "Quantitative standards and related metrics help regulators evaluate network adequacy, but regulators need flexibility in applying those standards. A combination of standardized forms and narrative submissions help regulators analyze network adequacy. States vary in the extent to which regulators require insurers to change or supplement proposed networks. States vary in their transparency about insurer network submissions and regulators' review of those submissions. Challenges remain in assessing and monitoring network adequacy." (Robert Wood Johnson Foundation)
Five Reasons Why Private Exchanges Will Thrive Post-ACA
"[1] With a private exchange, ... [y]ou choose the amount you want to contribute ... [2] A multi-carrier private exchange gives employees access to multiple health plans, so they can select the option that makes the most sense to them.... [3] Private exchanges offer tools to help employees find out which health care providers and prescription drug benefits are associated with each available plan.... [4] Simple administration ... [5] Easy renewal." (Healthcare Trends Institute)
Participation Pay-For-Value High-Need Patients
"[R]esearchers identified 17,443 Blue Cross Blue Shield of Michigan members with two or more chronic diseases, including mental health problems. They compared outcomes for members assigned to a [primary care provider (PCP)] that participated in the insurer's pay-for-performance program for at least four years to outcomes for members assigned to PCPs not in the program. Results were inconsistent.... Sustained involvement by PCPs in pay-for-value programs may be important to improving specific quality and cost outcomes for high-need patients. But PCPs do not have control over overall spending and broader approaches may be needed to improve costs for complex patients." (The Commonwealth Fund)
[Opinion] America's Employers Play a Vital Role in the 'Repeal and Replace' Debate
"Employers are uniquely positioned to help control healthcare spending and promote positive health outcomes. They have long provided the tools employees need to become fiscally responsible insurance consumers, and they are a trusted source of health information and resources. That is why policymakers should view this health reform 'reboot' as an opportunity to partner with American businesses to address the underlying causes of healthcare cost growth.... [L]egislators should reject policies that merely shift costs to private payers or vulnerable consumers. They should push for new policies and regulations that encourage responsible consumer health spending, transparency in healthcare pricing, and use of value-based models." (The Hill)

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