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Benefits in the News > By Subject >

Health plans - design


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Annual Planning for Your Company's Health Benefit Programs: Best Practices Check List
"The list [in this article] contains 25 health benefit best practices from the Mercer National Survey of Employer-Sponsored Health Plans. Each year [Mercer compares] the performance of employers that use the most of these best practices with those using the fewest (the top and bottom quartiles). And each year [the comparison indicates] that those using the most best practices have lower average healthcare cost increases. (In 2016, the two groups had average increases of 3.8% and 4.8%, respectively.)" (Mercer U.S. Health News)
[Guidance Overview] The MacArthur Amendment Language, Ethnicity in the Federal Exchange, and Risk Adjustment Coefficients
"[T]he amendment would repeal the enigmatic language included in a March 23, 2017 amendment to the AHCA that would have allowed states, beginning in 2018, to define the essential health benefits for purposes of determining premium tax credits ... In its place the amendment would allow states to apply for waivers to 'encourage fair health insurance premiums.' ... On April 18, 2017, [CMS] released the Final HHS risk Adjustment Model Coefficients for 2018.... They include for the first time ... enrollment duration factors ... as well as a number of prescription drug factors[.]" (Timothy Jost, in Health Affairs)
Mortality Rates Suggest Obamacare Could Be Killing People
"[A 2009 study] found that private health care insurance was associated in 2005 with a 40 percent mortality risk reduction among the pre-Medicare U.S. adult population ... This study had a huge effect on the political debate surrounding Obamacare.... Since Obamacare provisions extended insurance coverage, the [all-cause] death rate has substantially increased, by more than 20,000 deaths per year.... [W]hen we calculate the death rate after excluding all external causes of morbidity ... this death rate should fall to 238 per 100,000. The 2014-15 data show the actual reported death rate among U.S. adults, excluding external causes, is ... 252.9." (The Federalist)
Setting Targets for State Health Care Improvement
"Interactive [tool] shows the health care gains your state could make if it improved on coverage, quality, and other measures.... Using the interactive tool ... if the insured rate among working-age adults in Georgia [for example] rose to the expansion-state average of 91 percent, an estimated 619,770 more adults in Georgia would be insured. Similarly, if the share of adults not able to get care because of cost in Georgia dropped to the expansion-state average of 11 percent, about 382,207 fewer Georgians would skip needed care." (The Commonwealth Fund)
Preventive Services Task Force Release: Preeclampsia
"[The ACA] requires group health plans and health insurance issuers that are not grandfathered health plans to provide a wide array of preventive care items and services with no cost-sharing.... [T]he U.S. Preventive Services Task Force released a final recommendation statement on screening for preeclampsia. The Task Force recommends screening for preeclampsia in pregnant women with blood pressure measurements throughout pregnancy." (Compliance Dashboard)
Correcting Misconceptions About Invisible Risk-Sharing
"The Invisible Risk-Sharing Program (IRSP) will stabilize the individual insurance market and lower premiums while concurrently providing guaranteed access to coverage and protecting those with pre-existing conditions.... Is there enough money allocated? ... Is this program too complex for insurers? ... Is Maine a good example to predict a national outcome? ... Does the past experience of some prospective programs for small business tell us about future success in the individual market? ... How is this different from the ACA's reinsurance? ... Additional policies to consider." (Health Affairs)
The PBM Story: What They Say, What They Do, and What Can Be Done About It
"Pharmacy benefit managers (PBMs) say they reduce drug prices and increase patient access, but the facts just don't bear that out.... PBMs got their start as useful claims processors but then morphed into large corporations more interested in extracting profits from the prescription drug supply chain than in ensuring medication affordability and access. And that's the real story: PBMs have done more to enrich themselves over the past 25 years than they have done to bring down drug costs." (National Community Pharmacists Association [NCPA])
American Health Care Is So Unintelligible That an Entire Industry Has Been Created to Help Navigate It
"Medical bill advocates and other such third-party businesses have sprung up in the gaps and blind spots of America's complicated, fragmented health care system. These services make sense of health bills for consumers and even fix errors in them.... [T]hey've become even more important as high-deductible health plans -- which put employees on the line for thousands of dollars in out-of-pocket expenses -- have increased in popularity. But these services face a persistent challenge: many employees don't know that they have access to them." (MarketWatch)
HSA Plans and Onsite Clinics: Can This Marriage Be Saved?
"Under rules for HSA-eligible plans, only preventive services can be provided at no cost; employees need to pay the full cost of a non-preventive visit before they satisfy the plan deductible. Some employers with onsite clinics may be unknowingly disqualifying employees, understating their own tax liability, and incorrectly filing employment tax forms." (Mercer/Signal: US Health News )
The Payment Reform Landscape: For Employers, Keep Pushing Ahead
"While employers are sure to be affected in many ways by changes to federal health care laws, much of the cost and quality conundrum that has troubled our health care system for decades can be influenced by ongoing payment reforms and benefit design efforts in the private sector.... If employers and other health care purchasers work together to demand change from health insurance companies, they can bring their purchasing power to bear on the issues that keep them awake at night." (Health Affairs)
Steps Toward a More Sustainable Individual Health Insurance Market (PDF)
"Continued uncertainty could lead to additional insurers exiting the market, leaving consumers with fewer insurance choices -- or none at all. Improving the market would entail policymakers funding cost-sharing reduction (CSR) reimbursements, enforcing the individual mandate, directing external funding to offset premiums, and avoiding destabilizing action." (American Academy of Actuaries)
[Opinion] Health Insurance: Is It Time to Reset?
"[T]he fundamentals of the private insurance market are changing. Notwithstanding the political noise about what constitutes accessible, affordable coverage, two trends stand out: [1] The core market, employers, is shrinking. [2] ... consumers are disenchanted with health insurance.... Provider-sponsored health insurance plans that are part of regional, fully integrated systems of health are likely the future for private insurance." (Paul Keckley)
[Guidance Overview] Final Market Stabilization Rules: How Stable Is Stable?
"The Final Rule ... [1] [allows] insurers to deny enrollment to any consumer who has outstanding debt for coverage under any of its products (or that of its affiliates) during the previous twelve-month period.... [2] shortens the open enrollment period for 2017 to 45 days ... [3] imposes additional restrictions on special enrollment periods ... [4] increases the allowable [actuarial value] de minimis variations effective for 2018 to -4 to +5 percent for bronze plans and -4 to +2 percentage points for all other plan levels ... [5] shifts the [network adequacy] authority to state regulators and, where a state does not have such a function under applicable state law, the insurer's accreditation body to establish network adequacy rules and monitor compliance with those rules." (Sheppard Mullin)
[Opinion] Trump's Dealmaking Model Doesn't Fit Health Care Policy
"The partisan divide in health policy is grounded in deeply felt differences on both sides over policy and principle. It's hard to see Trump's approach to deal making working very often in health. This was why Trump couldn't force a deal with the Freedom Caucus to pass the American Health Care Act in the House; the bill was not conservative enough for the caucus, and in their eyes, it violated their principles and political promises they had made. It is also why using Obamacare's marketplace cost sharing subsidies as a bargaining chip to try to force the Democrats to the table is unlikely to work." (Drew Altman, Kaiser Family Foundation, via Axios)
Insurer Financial Performance in the Early Years of the ACA
"The individual market is where just 7% of the U.S. population gets their insurance (and thus also represents a small share of most health insurers' business), but the stability of the market and willingness of insurers to continue to participate is essential to the ACA's success.... This [article] looks at trends in insurer financial performance in the individual market over the past few years, finding that the market is showing signs of stabilizing." (Henry J. Kaiser Family Foundation)
[Opinion] Chamber Letter Encourages Congressional Action on Health Care Legislation
"The reimposition of the health insurance tax is already increasing premiums for individuals, small business and seniors. Individuals, families, and employers will bear 60% of the burden of the tax ... The lack of certainty regarding cost-sharing reduction (CSR) payments is threatening to destabilize the marketplace at the very moment that insurers are trying to price plans for 2018.... The 'Cadillac Tax' ... is already affecting the decisions and offerings of employers ... [as] businesses are now evaluating ways to reduce their health care coverage offerings for their employees." (U.S. Chamber of Commerce)
Affordable Care Act: A Tale of Two Red States
"Only one health insurer in Oklahoma is left selling coverage through the federal marketplace, and the hospital in [one] city of 36,000 is not in the network. Premiums are among the highest in the country, and while most marketplace customers qualify for the [ACA's] income-based subsidies that lower the cost, many ... middle-class clients do not.... In neighboring New Mexico ... [m]arketplace customers can still choose among four insurers, and the state has one of the lowest average premium costs.... But now both states are worried that political maneuvering at the federal level may deeply destabilize the marketplaces." (The New York Times; subscription may be required)
[Official Guidance] Text of IRS Notice 2017-28: Public Comment Invited on Recommendations for 2017-2018 Priority Guidance Plan (PDF)
"The Treasury Department's Office of Tax Policy and the [IRS] use the Priority Guidance Plan each year to identify and prioritize the tax issues that should be addressed through regulations, revenue rulings, revenue procedures, notices, and other published administrative guidance. The 2017-2018 Priority Guidance Plan will identify guidance projects that the Treasury Department and the Service intend to work on as priorities during the period from July 1, 2017, through June 30, 2018.... Please submit recommendations by June 1, 2017, for possible inclusion on the original 2017-2018 Priority Guidance Plan." (Internal Revenue Service [IRS])
Employee Benefits Considerations in Mergers and Acquisitions
"Due diligence is a critical first step in a merger or acquisition transaction.... Don't rely on the seller's representation of the condition of the benefit plans.... As you consider the impact of benefit plans on the transaction, also take into account how the type of deal -- asset or stock -- can impact the buyer's or seller's perspective.... [D]on't wait until after closing to develop a game plan for integration." (Milliman Retirement Town Hall)
How Would Sales of Health Insurance Across State Lines Affect Competition and Pricing? (PDF)
"The intent of permitting insurance companies to sell across state lines is to increase competition and reduce the costs of health insurance. There is a good possibility the most likely scenario will be to decrease competition and, without affecting the cost of health care, allow premium rates to increase faster than required by the rise in health care costs." (Lawrence Mitchell, FCA, FSA-R, MAAA)
EEOC Settles Wellness Case, Requires Payment to Employee and Workforce Training
"The Orion case gives the EEOC a more favorable result on the safe harbor issue, including a favorable ruling on the EEOC's recently issued regulations ... but it then undercuts the importance of those regulations by taking an extraordinarily broad view of what it means to act voluntarily. For now, at least, it seems that the boundaries and effect of these exceptions remain elusive." (Thomson Reuters / EBIA)
White House Officials Push Revised Health Bill
"[Under] this [ACA] replacement, states could seek waivers from many of those mandates if they demonstrate that premiums would be lowered, the number of insured people would increase, or 'the public interest of the state' would be advanced. States could request an exemption from the rule intended to ensure that people with pre-existing conditions could not be charged prohibitive premiums -- but only if those states establish a high-risk insurance pool." (The New York Times; subscription may be required)
A New Attempt Emerges to Bridge GOP Divisions on AHCA
"The proposal would first 'Reinstate Essential Health Benefits as the federal standard.'.... [T]he amendment would maintain most of the ACA's market reforms ... Waivers that would allow states to permit health status underwriting could dramatically increase premiums for people with high cost conditions to unaffordable levels. High risk pools could reduce the cost of coverage, but would have to be adequately funded." (Timothy Jost, in Health Affairs)
Stop-Loss Policies: How Low Can You Go?
"[T]he Self-Insurance Protection Act, in its current form, merely gives an additional argument that stop-loss policies cannot be treated like major medical insurance, no matter how low the attachment point is. This is like the proverbial 'belt and suspenders' since treating stop-loss like major medical insurance has been found to be preempted in some cases. The only additional protection is that the federal government would also be prevented from regulating stop-loss like regular health insurance. However, in its current form, the act does not prevent states from requiring stop loss policies to have a minimum attachment point." (Benefits Bryan Cave)
EEOC Wellness Lawsuit Against Orion Ends in $100,000 Settlement
"A federal challenge to a Wisconsin energy company's employee wellness incentive was resolved April 5 with a $100,000 settlement. A federal court had thrown out the [EEOC] claim that the program violated the Americans with Disabilities Act (ADA), but allowed the EEOC's related ADA retaliation and interference claims to proceed." (HRDailyAdvisor)
[Guidance Overview] HHS Finalizes Health Insurance Market Stabilization Rules
"The final rules, issued in expedited fashion, generally follow the proposed regulations and include changes such as: [1] Advancing by one year a change that shortens the period for annual enrollment in health insurance exchange coverage ... [2] Requiring all mid-year special enrollment elections in health insurance exchanges to be verified as appropriate. [3] Allowing insurers to collect certain past-due premiums from individuals who terminate coverage and reenroll within one year. [4] Providing for greater flexibility in the rules that establish the metal levels of exchange coverage. [5] Easing certain requirements for network plans." (Ballard Spahr LLP)
The Fate of the ACA's Cost-Sharing Reduction Subsidies
"Elimination or delay of CSR payments will severely affect insurers that provide Marketplace coverage, leading, potentially, to an exodus from the individual market. If this occurs, costs could be shifted to employers and employees ... Healthy, sustainable Marketplaces provide flexibility in coverage options for part-time and former employees. Employers should expect these individuals to request coverage options in the absence of Marketplace or other individual coverage." (Perkins Coie LLP)
Risk Corridor Suit Dismissed as Premature; Supreme Court Ends Challenge to 'Administrative Fix'
"On April 18, 2017, [a] federal court of claims judge ... dismissed ... one of approximately two dozen lawsuits now pending in the federal court of claims brought by insurers who have been denied the full payment they believe is due them under the [ACA's] risk corridor program for 2014 and 2015. Also, on April 17, the Supreme Court denied certiorari [in West Virginia's challenge to HHS'] 2013 'administrative fix,' which had allowed states to permit insurers to continue to offer ACA-noncompliant 'transitional' or 'grandmothered' health plans after December 2013[.]" (Timothy Jost, in Health Affairs)
Health Reimbursement Arrangements: What You Need to Know About Qualified Expenses, Taxes, and More
"[C]ertain types of HRA plan designs can trigger a shift from non-taxable to taxable income. These include plans that: [1] Comply with the 'medical expenses only' requirement, but reimburse employees for some or all of their unused money at the end of the year; [2] Provide a death benefit to employees' dependents from unused funds, and allow the funds to be used for non-medical expenses; [3] Allow unused account dollars to be applied to other company benefits, such as a 401(k) contribution." (DataPath)
[Guidance Overview] Market Stabilization Rule: Assessing the Trump Administration's First ACA Market-Related Regulation (PDF)
Chart summarizes the draft and final regulations, with analysis of the impact of each of the final regulation's provisions. (Faegre Baker Daniels)
Price Shopping Could Cut Employer Health Costs by 20%, But There's a Catch
"Reference pricing ... caps the amount the purchaser will reimburse for an identified procedure or test, typically at the midpoint price charged by providers in the region.... [C]overed employees are motivated to price shop, and many shift to lower-priced providers. Second, high-priced providers come back to the negotiating table and lower their prices. The researchers estimated that if all employers implemented reference pricing for just eight procedures, the U.S. would save nearly $20 billion, or almost 20% of the cost of those procedures." (Forbes)
[Guidance Overview] Changes to Stabilize HealthCare.gov Have Implications for Employer Sponsored Health Plans
"[T]hese regulations are designed to stabilize the individual insurance market and limit special enrollment opportunities on the federal marketplace through HealthCare.gov and limit the annual enrollment period ... [W]hen access to other coverage is limited or more restricted, then employers may find an increase in requests for enrollment in their group health plan coverage." (Winstead PC)
Health Insurance Companies Respond to Opioid Epidemic
"According to a September 2016 study ... the total annual cost of the U.S. opioid epidemic is $78.5 billion, most of which is attributed to insurance coverage. The impact of this crisis is having a significant effect on benefit claim costs and more so on overall productivity of the private employer workplace. With this in mind, this document outlines the posture and reformative contractual changes being taken by insurers in the health insurance industry." (EBCG)
[Guidance Overview] The Final Market Stabilization Rule: What's There, What's Not, and How It Might Work
"Although the rule addresses market stability, it nowhere mentions the two greatest current threats to the stability of the individual market. The first is the ongoing confusion as to whether Congress will appropriate, or the administration will continue to pay, the $7 billion to $9 billion in cost-sharing reduction (CSR) payments it owes to insurers ... The second threat to market stability not mentioned in the rule is the administration's mixed messages about enforcement of the individual responsibility requirement." (Timothy Jost, in Health Affairs)
[Guidance Overview] HHS and CMS Move Ahead on Regs Despite ACA Uncertainty
"[HHS and CMS] have moved ahead with finalizing their proposed changes to ACA rules.... [T]he final rules make a number of discreet changes to improve the risk pool, including: [1] Open enrollment period.... [2] Special enrollment in HealthCare.gov.... [3] Premium debt.... [4] Actuarial value." (Seyfarth Shaw LLP)
[Guidance Overview] Be Wary of Wellness Plan Designs Purporting to Avoid Income and Employment Taxes
"[IRS Chief Counsel Memo (CCM) 201622031] addresses the tax treatment of three different situations in which wellness benefits result in taxable income to employees.... [CCM 201703013] addresses the tax treatment of fixed indemnity cash payments paid by a wellness plan without regard to the amount of medical expenses incurred by the employee, where the employee is paying premiums to participate in the wellness program." (Jackson Lewis P.C.)
[Opinion] Moving Toward a Fair Federal Tax Treatment of Health Insurance (PDF)
"The federal tax exclusion on [employer-provided health] insurance is the major policy-driven contributor to increased cost growth.... [It] drives over-insurance, and thus the excessive reliance on third-party payment for medical services." (The Heritage Foundation)
[Opinion] Addressing Pre-Existing Conditions and Encouraging Continuous Coverage
"Health insurance rules must be crafted in a way that encourages individuals not only to get, but also to maintain coverage. Obamacare destabilized the market by enabling (and even encouraging) individuals to pay for coverage only when they expected to incur claims. Policymakers should link the ban on exclusions for pre-existing conditions to a requirement of continuous coverage." (The Heritage Foundation)
Text of Supreme Court Opinion: Federal Employees Health Benefit Act Preempts Missouri Law Barring Subrogation and Reimbursement (PDF)
15 pages. "We hold, contrary to the decision of the Missouri Supreme Court, that contractual subrogation and reimbursement prescriptions plainly 'relate to ... payments with respect to benefits' ... therefore, by statutory instruction, they override state law barring subrogation and reimbursement. We further hold, again contrary to the Missouri Supreme Court, that the regime Congress enacted is compatible with the Supremacy Clause. Section 8902(m)(1) itself, not the contracts OPM negotiates, triggers the federal preemption. As Congress directed, where FEHBA contract terms 'relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits),' Section 8902(m)(1) ensures that those terms will be uniformly enforceable nationwide, free from state interference." [Coventry Health Care of Missouri, Inc. v. Nevils, No. 16-149 (U.S. Apr. 18, 2017)] (Supreme Court of the United States)
Findings from the 2016 Health and Voluntary Workplace Benefits Survey (PDF)
12 pages. "One-third of workers (32 percent) are only somewhat satisfied with the benefits offered by their current employer, and 20 percent are not satisfied. One-half (49 percent) are extremely or very confident that their employer will continue to offer a similar benefits package three years from now.... Eighty-seven percent of workers report that employment-based health insurance is extremely or very important, followed by a retirement savings plan (77 percent) and dental or vision (72 percent).... Workers identify lower cost, choice, and the convenience of paying pre-tax and through payroll deductions as strong advantages of voluntary employment-based benefits" (Employee Benefit Research Institute [EBRI])
Small Group Renewals: The Devil Is in the Details
"With year after year of large premium increases, it's no wonder many employers are happy to receive a health insurance renewal below 10% -- but low-percentage renewals can often gloss over key changes to the policy that are not boldly highlighted in the renewal offer." (Frenkel Benefits)
'Wellness' Expands to Embrace Financial Planning, Volunteering Opportunities
"Eighty-four percent of surveyed employers now offer their workers financial security programs, such as access to debt management tools or student loan counseling, up from 76 percent last year ... Ninety-five percent of surveyed employers are offering physical wellness programs this year, and 87 percent are providing emotional health benefits, such as mental health counseling through an employee assistance program. Employee incentives continue to be a critical part of health-promoting programs." (Society for Human Resource Management [SHRM])
Employers Should Re-Evaluate Their Wellness and Incentive Programs
"Design incentive programs that align with company goals.... Eliminate incentives for activities that are contrary to clinical guidelines.... Make incentive targets consistent with current clinical guidelines.... Offer incentives for achievable goals.... Remember the importance of nonfinancial incentives.... Consider incentives to promote group activity rather than individual achievement.... Deliver incentives to maximize their effectiveness.... Align incentive programs ... with the firm's broader strategic goals.... Measure program results.... Develop a multiyear plan to transition existing incentive programs." (Willis Towers Watson)
HHS Releases Final Rule on ACA Marketplace Stabilization
"One of the main provisions of the final rule is the authority for insurers to sell less-generous policies that will feature lower premiums, but higher deductibles. Under this new provision, insurers can now sell policies that are four percentage points below ACA standards, compared with two percentage points under current regulations. Another provision, aimed at creating a more stable pool of enrollees, will reduce the current open enrollment period in half." (Vorys, Sater, Seymour and Pease LLP)
The Surprising Employer Benefit Millennials Really Want
"With the introduction of many flashy workplace benefits geared towards millennials such as trendy decor, student loan repayment assistance, onsite cafes, dog-friendly offices, relocation and travel privileges, improved leave policies, free snacks and more, it's surprising to know that ... 34% of millennials chose health care as the most important benefit their employer can offer. More and more millennials are seeking out companies that have an onsite health clinic." (Forbes)
GAO Report: Telehealth and Remote Patient Monitoring Use in Medicare and Selected Federal Programs
72 pages. "The Medicare Access and CHIP Reauthorization Act of 2015 includes a provision for GAO to study telehealth and remote patient monitoring. Among other reporting objectives, this report reviews [1] the factors that associations identified as affecting the use of telehealth and remote patient monitoring in Medicare and [2] emerging payment and delivery models that could affect the potential use of telehealth and remote patient monitoring in Medicare." [GAO-17-365, published and released Apr. 14, 2017] (U.S. Government Accountability Office [GAO])
[Official Guidance] CMS Actuarial Value Calculator for 2018 (XLSM)
"The Actuarial Value Calculator (AV Calculator) is designed to give an estimate of the actuarial value for a given plan design. This version of the AV Calculator uses data from a large national commercial database to build continuance tables by metal tier." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Congressional Efforts to Amend the ACA Stall: What's Next?
"Many speculate that tax reform legislation could repeal (or further delay) the 40 percent excise tax and might also include a cap on the amount of employer-sponsored coverage that an individual may exclude from income and payroll taxes. This tax exclusion is the single largest tax expenditure in the federal budget ... Unlike the 40 percent excise tax on high-cost plans, which would be paid by the plan sponsor, employees themselves would pay the income taxes owed on coverage that exceeds the cap." (Segal Consulting)
[Guidance Overview] CMS Issues Final Rule to Increase Choices and Encourage Stability in Health Insurance Market for 2018
"The final rule [1] adjusts the annual open enrollment period for 2018 to more closely align with Medicare and the private market.... [2] promotes program integrity by requiring individuals to submit supporting documentation for special enrollment periods and ensures that only those who are eligible are able to enroll. It will encourage individuals to stay enrolled in coverage all year ... [3] promotes personal responsibility by allowing issuers to require individuals to pay back past due premiums before enrolling into a plan with the same issuer the following year.... [4] allows issuers additional actuarial value flexibility to develop more choices with lower premium options for consumers, and to continue offering existing plans.... [5] reduces waste of taxpayer dollars by eliminating duplicative review of network adequacy by the federal government." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Official Guidance] Text of HHS Final Regs: ACA Market Stabilization
139 pages. "This final rule amends standards relating to special enrollment periods, guaranteed availability, and the timing of the annual open enrollment period in the individual market for the 2018 plan year; standards related to network adequacy and essential community providers for qualified health plans; and the rules around actuarial value requirements." (U.S. Department of Health and Human Services [HHS])
Trump Is Playing a Risky Game of Chicken with Health Insurers
"The specific issue that insurers and the president are focused on at the moment are cost-sharing reductions, payments to health insurers that help reduce the deductibles and co-pays for 7 million Americans. The way the payments are funded has been successfully challenged in a lawsuit by House Republicans, but the administration has continued paying them while the case is on appeal. If the payments are stopped, insurers will have to decide whether to exit the market completely or raise premiums by around 15 percent -- and the mere possibility that they could go away or be used as a bargaining chip may make some queasy about offering plans at all." (The Washington Post; subscription may be required)
Repeal, Replace ... Revise: Your Guide to Market Stabilization
"The Trump administration's proposed rule aimed at stabilizing the health law's insurance marketplace could have rapid, dramatic effects on people who do not get insurance through work and buy it on the [ACA]'s exchanges.... The controversial proposal by [HHS] drew letters from nearly 4,000 organizations and individuals during an unusually short, 20-day public comment period that ended in early March. Consumer groups hate it, saying it would wreak havoc by making it harder to get coverage. But [some] experts ... say it's helpful for insurers, though more adjustments are necessary." (Kaiser Health News)
[Opinion] What Does 'Across State Lines' Really Mean?
"[A] suggestion: modify federal law to require that the coverage in any policy approved in any state, be available for purchase in every state. This would require the states abandon their monopolistic mandate regulations. It would bring the possibility of some premium relief to consumers in states that have the most mandates.... It would still allow the option of higher-coverage policies everywhere. But it would not require everyone have identical basic coverage -- as Obamacare does. It would not require any insurance company to build a new network anywhere so its policyholders could be in the service area." (InsureBlog)
More Choice in Employer Health Plan Offerings Raises Risk of Adverse Selection
"[Despite] incentives, older workers were less likely to switch health plans than younger workers, and the higher use of office visits for both primary care physicians and specialists, higher use of emergency departments, and a higher number of outpatient providers were all correlated with less plan switching." (Wolters Kluwer Law & Business)
Health Savings Accounts: Can They Work for Everyone? (PDF)
"More than half (53%) of all large employers offer an HSA-eligible plan, but under a fourth (24%) of covered employees are enrolled in one.... Despite the cost savings, for the most part large employers still offer these plans as a choice, rather than as the only medical plan. Just 6% of all large employers offer an HSA-eligible plan as a 'full replacement' of their traditional medical plan." (Mercer)
Trump Threatens to Withhold Payments to Insurers to Press Democrats on Health Bill
"Mr. Trump said he was still considering what to do about the payments approved by his Democratic predecessor, President Barack Obama, which some Republicans contend are unconstitutional. Their abrupt disappearance could trigger an insurance meltdown that causes the collapse of the 2010 health law, forcing lawmakers to return to a bruising debate over its future." (The Wall Street Journal; subscription may be required)
What is a Limited Purpose FSA, and How Can Account Holders Use It?
"A limited purpose FSA (LPFSA) is a healthcare spending account that can only be used for eligible vision and dental expenses. Unlike a healthcare FSA, however, an LPFSA can be held at the same time as [an HSA]. When coordinated with an HSA, the LPFSA can further reduce your taxes while allowing you to allocate HSA funds to other purposes -- including retirement." (DataPath)
Can New Type 2 Diabetes Treatments Reduce Benefit Plan Costs?
"A recent study by McMaster University scientists revealed that it may be possible to reverse Type 2 diabetes in some patients, and this condition, thought to be permanent, may actually be curable.... As insurers have implemented patient assistance programs for certain medical conditions for high-cost drugs, wouldn't it be natural to expand the program to include coaching for Type 2 diabetes? In theory, plan sponsors could provide a higher level of coverage for the drugs required for treatment of employees participating in the program." (Conduent)
DOL Review of Group Health Plan Filings Shows Decline in Percentage of Self-Insured
"The DOL noted that approximately 20,000 self-insured group health plans filing a 2014 Form 5500 were sponsored by a single employer, whereas some 1,100 plans were multiemployer plans. Moreover, self-insured group health plans filing Form 5500 covered approximately 33-million participants; 29 million of whom were active participants." (Wolters Kluwer Law & Business)
Total Wellness: Going Beyond Basic Wellness Programming
"[Employers] are beginning to think more broadly about wellness -- they're thinking about employee satisfaction and work/life balance more so than directly measurable ROI. Moving away from quantifying financial results to refocusing on the worker's own experience and needs opens the door to more sought-after programming. Instead of solely offering services to target healthcare claims, strategically mixing in other events can lead to higher levels of employee activation, productivity, retention, and job contentment." (Frenkel Benefits)

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