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Health plans - design


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Employers See Consumer Directed Healthcare as the Future
"For both employers and brokers, the rising cost of healthcare was still the biggest factor driving them to seek CDH adoption.... The utilization of technology to drive employee adoption of CDHs was also cited as a critical component for success.... The importance of working with the right payer in offering a CDH was also cited as key by both groups.... Finally, over half of employers reported they need support from insurers to address organizational issues vital for driving employee participation in CDHs." (HealthPayer Intelligence)
The Senate Takes a Crack at a Healthcare Reform Replacement Bill (PDF)
A summary of the provisions of the Senate's Better Care Reconciliation Act (BCRA) that would affect group health plans, along with a description of the likely effect of each provision, and how it differs from the American Health Care Act. (Trucker Huss)
Midsized Employers Worrying More About Compliance, Health Care Costs, Reform, and Less About Employee Engagement
"Of the midsized business owners surveyed, 40 percent indicate they have experienced unintended expenses related to noncompliance with government regulations. The number of larger midsized companies that cited unintended compliance penalties grew significantly in 2016, up to 51 percent from 40 percent in 2015. The number of smaller midsized businesses that cited receiving penalties for noncompliance remained relatively steady at 37 percent in 2016, a slight increase from 35 percent the previous year." (Wolters Kluwer Law & Business)
[Guidance Overview] Mental Health Parity Rules Include Eating Disorders as Mental Health Conditions
"While employers that sponsor health plans have potential liability for MHPAEA violations, it may be difficult for employers to get the information they need from claims payers to determine whether the rules' requirements for [non-quantitative treatment limitations (NQTLs)] are being met. Therefore, employers may want to obtain assurances regarding application of NQTLs under their plans from the carriers and vendors that pay claims under their plans.... The agencies' Draft Form, although not required to be used at this time, could be beneficial for plan sponsors in that it provides a standard participant request form which might provide some level of administrative ease on the part of plan sponsors when dealing with participants' requests for information." (Lockton)
[Guidance Overview] Mental Health Parity: Can You Show That Your Health Plan Complies?
"On June 16, 2017, the [DOL] published a draft of a model form that an employee (or his or her representative) could use to request documentation of compliance with the [MHPAEA]. If an employer receives this type of request (even if not on the DOL's model form), it has just 30 days to respond. If an employer doesn't respond in 30 days, penalties of up to $110 per day may apply." (Vorys, Sater, Seymour and Pease LLP)
Senate Delays Vote on Health Bill Amid Mounting GOP Opposition
"Senate Majority Leader Mitch McConnell on [Tuesday, June 27] delayed a planned vote this week on Senate Republicans' health care bill, amid mounting opposition from moderate and conservative members over central aspects of the plan to repeal and replace the [ACA]." (Morning Consult)
A Comparison of ACA Provisions with Proposed Replacements under AHCA and BCRA (PDF)
7 pages. "This chart compares the [ACA] to provisions of both the House-passed American Health Care Act and the Senate Discussion Draft, called the Better Care Reconciliation Act. This chart is current as of June 26, 2017." (Segal Consulting)
Here We Go Again: The Senate's Health Reform Bill
"The Senate bill proposes to remove the dollar limit on health flexible spending account contributions by employees effective after December 31, 2017. Currently many employers are preparing for annual enrollment for the next calendar year and may want to address this limit if it is made unlimited rather than having an unlimited amount. The Senate bill also proposes to make over the counter medical expenses reimbursable under health savings accounts (HSAs), health flexible spending accounts (HFSAs) and under health reimbursement accounts (HRAs) effective after December 31, 2016." (Winstead PC)
Health Savings Account Landscape 2017
46 pages. "Out of the 10 plans [the authors] evaluated, only one looks compelling for use as a spending vehicle and an investment vehicle, suggesting there is much room for improvement across the industry ... Account maintenance fees represent the most important consideration for accountholders intending to use their HSAs as a spending vehicle. The current low-interest-rate environment means accountholders will generate little income from the checking accounts offered by HSAs ... As compared with retail mutual funds, the all-in cost of investing in the HSA plans ... ranges from cheap to expensive." (Morningstar)
First Comprehensive Look at Multiemployer Health Plans
"The total number of plans in the study was 1,823 for the 2005 plan year, declined steadily to 1,595 in 2013, and then increased slightly to 1,602 for the 2014 plan year.... The 1,602 health plans in the study had more than five million covered participants.... The plans in the study reported more than 209,000 contributing employers.... One in seven plans (14.7%) have costs above $14,000 per participant per year (PPPY), while one in seven (15.4%) have PPPY costs below $6,000." (International Foundation of Employee Benefit Plans [IFEBP])
[Opinion] The Senate Should Offer a Range of Options to Encourage Continuous Insurance Coverage
"The most effective approach would be to apply the prohibition on pre-existing condition exclusions to only those individuals who can demonstrate continuous coverage during the prior year. This would be the same as the federal rule for employer-group plans that was in place before Obamacare. Other, somewhat less effective alternatives, have also been proposed, such as imposing on those without continuous coverage a premium surcharge, a risk-rated premium or higher deductibles for one year. The goal of all these mechanisms is the same: Return to states authority over insurance market regulation that was pre-empted by Obamacare." (The Heritage Foundation)
Comparison of Proposals to Replace the Affordable Care Act
"President Donald Trump and Republicans in Congress have committed to repealing and replacing the [ACA]. How do their replacement proposals compare to the ACA? How do they compare to each other? Plans available for comparison: [1] The Better Care Reconciliation Act of 2017 -- Updated 6.26.2017; [2] The American Health Care Act, as passed by the House of Representatives on May 4, 2017; [3] The [ACA], 2010." (Henry J. Kaiser Family Foundation)
Amended Senate Bill Includes Waiting Period for Those Who Let Coverage Lapse
"The new Senate amendment would allow an insurer in the individual market to impose a waiting period of six months on an enrollee who had had a gap in coverage of 63 days or more during the preceding 12 months.... An individual who lost employer coverage on March 31 -- who would under the ACA be able to get coverage effective April 1 under a special enrollment period for loss of employer-sponsored coverage -- would have to wait until October if he or she had experienced a 63-day gap in coverage during the preceding year prior to getting employer coverage." (Timothy Jost, in Health Affairs)
[Discussion] Handling VEBA Assets When No Employees Are Left After Multiple Acquisitions
"The company that originally set up a VEBA was sold to another company several years later and amended the VEBA's trust. In 2016, that company was acquired by another company. The VEBA has less than $100,000 (all employer- contributed), but there are no employee members and no way to find out who was a member. Can the new company transfer the assets to a charity without being subject to the tax benefit rule? Also, can the company amend the VEBA to include only the new company's medical plan and use the assets for current employee health coverage?" (BenefitsLink Message Boards)
[Opinion] Winners and Losers in the Senate Healthcare Bill, and Four Themes Not Addressed at All
"Four themes have been missed in the rhetoric on both sides: [1] Access to insurance coverage is not the same as access to care.... [2] There's plenty of money in the system, but much is wasted and it's not spent in the most productive ways.... [3] The Medicaid program needs transformation: budget cuts without program re-design does nothing to fix it long-term.... [4] Affordability has not been addressed." (Paul Keckley)
ACA Round-Up: QHP Application Deadline Passes, House v. Price, Special Enrollment Periods
"On June 22nd, the District of Columbia Court of Appeals ordered the government and the House to respond to the motion to intervene in House v. Price filed by attorneys general from 17 states and the District of Columbia. The House and administration must respond in 10 days, and the states have 7 days to reply.... On June 23, 2017, HealthCare.gov began requiring pre-enrollment verification for eligibility for loss of minimum essential coverage and permanent move special enrollment periods (SEPs)." (Timothy Jost, in Health Affairs)
Summary of Draft Provisions: The Better Care Reconciliation Act
"[The Senate bill reduces] the Section 4980H pay or play penalties to zero. This effectively repeals the mandate to offer minimum essential coverage to full-time employees that is affordable and provides minimum value. This is made effective retroactive to the beginning of 2016.... The BCRA preserves the Cadillac tax by delaying its effective date to 2026.... The BCRA modifies the ACA's 3-to-1 age ratio to 5-to-1 (based on an estimated true cost of care ratio at 4.8-to-1) for the individual and small group market, with state flexibility to apply different ratios.... The BCRA creates a new form of association health plans referred to as 'small business health plans' (SBHP)." (ABD Insurance & Financial Services)
Senate Begins Discussions of ACA Modifications
"Both the [Senate's Better Care Reconciliation Act (BCRA)] and the AHCA would expand states' ability to waive out of certain ACA requirements (including the requirement for individual insurance to provide a prescribed set of 'essential health benefits'). The BCRA approach gives states greater latitude generally, but does not include the AHCA provision that would allow states to permit insurers to charge individuals with preexisting conditions a higher premium for up to one year.... The BCRA includes provisions specifically supporting creation of fully insured health plans by certain business associations, where the associations have been established for reasons beyond the provision of health coverage to members." (Ballard Spahr LLP)
[Opinion] The Senate Healthcare Bill: Implications for Employers
"We are wary of changes that could induce states to opt out of major parts of the ACA ... The bill continues CSR payments through 2019.... [Z]eroing out the individual mandate penalty and not including a continuous coverage requirement ... may further destabilize the individual market.... Repeal of Medicaid expansion along with funding cuts still signals potential cost shifting to private payors.... HSA expansion in 2018.... Excise Tax delayed; many other ACA taxes repealed." (Mercer)
Comparing Major ACA Provisions to the House and Senate Replacement Proposals
"The Senate absolutely did not 'start over' but simply made a few tweaks to the Obamacare Lite bill passed by the House.... If you didn't think the House bill went far enough to repeal Obamacare, you will really hate the Senate bill because, on the whole, it backtracks a few steps toward Obamacare." [Includes a detailed chart comparing provisions of the ACA, the House bill, and the Senate bill.] (Benefit Revolution)
Let's Make an 'I-Deal'? When Employees Want Special Benefit Arrangements
"Employees often try to negotiate with their employers arrangements that take into account their individual needs -- such as asking for more-flexible work hours, a reduced workload, more pay or special training. These arrangements ... are sometimes in the interest of both the employee and employer, especially if such deals make employees more motivated and committed to their jobs.... [Co-workers] are more likely to understand when a company grants nonfinancial benefits because of an employee's personal needs ... Justifying financial rewards, however, is more difficult[.]" (Society for Human Resource Management [SHRM])
Exclusive Agreement Between Hospital and Insurance Plan Does Not Violate Sherman Act
"Judge Posner, writing for a unanimous panel, held that the procompetitive benefits of the exclusive deal arguably outweighed the anticompetitive effects, finding the vertical exclusivity agreement to be economically efficient. An insurance company or plan can get better rates from a hospital in exchange for exclusive contracts, benefiting the plan and its customers. The court took considerable comfort in the short duration of the agreement as well." [Methodist Health Serv. Corp. v. OSF Healthcare System d/b/a Saint Francis Medical Center, No. 16-3791 (7th Cir. June 9, 2017)] (Sheppard Mullin)
Senate Republicans Release Bill to 'Repeal and Replace' ACA
"The Senate bill would effectively eliminate the employer mandate on a retroactive basis, effective January 1, 2016, by reducing to zero the penalties for failing to offer such health coverage. The Senate draft bill, like its House counterpart, includes provisions to promote the use of health savings accounts." (Littler)
[Opinion] Senate Health Care Bill Will Reduce Costs for Employers and Employees
"Most importantly, the Senate's health care bill lays out a path to fully repeal the 40 percent 'Cadillac' excise tax on employer-sponsored health insurance. The 'Cadillac' tax ... forces employers to scale back benefits and increasingly shift rising health care costs to employees. Full and final repeal of the Cadillac tax is essential to ensuring a healthy future for the employer-sponsored health insurance system." (The ERISA Industry Committee [ERIC])
[Opinion] Senate Republicans Offer Bill to Preserve and Expand Obamacare
"The Senate bill would preserve ObamaCare's community-rating price controls.... The Senate bill, like ObamaCare, would simply throw taxpayer dollars at unaffordable care, rather than make health care more affordable.... [T]he Senate bill would forbid the 19 states that haven't implemented ObamaCare's Medicaid expansion from doing so.... The bill would also repeal the Medicaid expansion in 2024.... the forthcoming CBO score will make it look like the Senate bill increases the uninsured more than it actually does.... [T]he bill does almost nothing to address the fundamental flaws and instability in ObamaCare's architecture." (Cato Institute)
Discussion Draft: Senate Republican Health Care Bill
"The discussion draft will: [1] Help stabilize collapsing insurance markets that have left millions of Americans with no options. [2] Free the American people from the onerous Obamacare mandates that require them to purchase insurance they don't want or can't afford. [3] Improve the affordability of health insurance, which keeps getting more expensive under Obamacare. [4] Preserve access to care for Americans with pre-existing conditions, and allow children to stay on their parents' health insurance through age 26. [5] Strengthen Medicaid for those who need it most by giving states more flexibility while ensuring that those who rely on this program won't have the rug pulled out from under them." (U.S. Senate Committee On The Budget)
Senate Healthcare Draft Relies on Subsidies GOP Has Faulted
"Senate Republicans' proposal to replace Obamacare would provide an additional $50 billion over four years to stabilize insurance exchanges ... The plan, ... includes $15 billion a year in market-stabilizing funds over the next two years and $10 billion a year in 2020 and 2021. These payments would come in addition to cost-sharing subsidy payments, which would be extended through 2019.... The draft bill also would provide $62 billion allocated over eight years to a state innovation fund, which can be used for coverage for high-risk patients, reinsurance and other items. The draft bill would phase out Obamacare's expansion of Medicaid over three years, starting in 2021." (Bloomberg)
Access to Coverage and Care for People with Preexisting Conditions: How Has It Changed Under the ACA?
"Between 2013 and 2015, 16.5 million nonelderly adults gained coverage following full ACA implementation.... Coverage and access gains for people with preexisting conditions were unrelated to the size or existence of the state high-risk pools ... [P]roposals to replace current protections for people with preexisting conditions with high-risk pools are unlikely to be sufficient to maintain the ACA's gains." (The Commonwealth Fund)
New York Governor Moves to Guarantee ACA Protections
"On June 5, [New York Governor Andrew M. Cuomo] directed the New York State Department of Financial Services (DFS) to promulgate new emergency regulations mandating that health insurance providers may not discriminate against New Yorkers with preexisting conditions or based on age or gender, in addition to safeguarding the 10 categories of protections guaranteed under the ACA." (Wolters Kluwer Law & Business)
[Guidance Overview] Indiana Reverses Course on Telemedicine Prescribing and Controlled Substances Laws
"HB 1337, signed by Governor Eric Holcomb and effective July 1, 2017, will allow providers to prescribe controlled substances via telemedicine without an in-person examination, albeit with some notable limitations and restrictions. The law reverses Indiana's 2016 telehealth law that prevented providers from prescribing controlled substances via telehealth technologies." (Foley & Lardner LLP)
Cigna Stays in Obamacare for Now; Anthem Reduces Participation
"U.S. healthcare insurer Cigna Corp said on [June 21] it will continue to offer individual coverage under Obamacare for now while rival Anthem announced it was shrinking its participation, amid uncertainty over the fate of the government-subsidized program. [June 21] was the deadline for insurers to submit to the government their 2018 rates for individual plans sold on the HealthCare.gov website[.]" (Reuters)
More Than 50 Employer Groups Urge Senate to Preserve Employer-Sponsored Health Benefits
"The letter laid out several proposals for the Senate to consider when crafting their health care bill, including: [1] Ensure that an HSA-qualified health plan can offer first-dollar coverage, or waive beneficiary costs, for products and services likely to prevent catastrophic costs later; [2] Completely separate excepted benefits (like telehealth and onsite medical clinics) from HSA-contribution eligibility; and [3] Streamline rules for rollovers from other accounts to HSAs, while simplifying rules relating to which dependents' costs can be covered from the primary insured's HSA." (Wolters Kluwer Law & Business)
[Guidance Overview] IRS Clears the Air as to Tax Treatment of Benefits Under Traditional Health Fixed Indemnity Coverage
"[S]ome overly broad statements in [CCM 201703013] suggesting that an employer could not exclude indemnity payments from wages of employees where such payments were less than unreimbursed medical expenses appeared to be contrary to established law with regard to more traditional fully-insured health indemnity plans.... In a [CCM 201719025] dated April 24, 2017, the IRS has made it clear that nothing has changed with respect to the federal tax treatment of fully-insured fixed indemnity coverage." (Alston & Bird LLP and Groom Law Group, via Employers Council on Flexible Compensation [ECFC])
[Opinion] Amid Market Uncertainty, Trump Administration Retreats from Federal Oversight
"[T]he Obama administration encouraged states to take the lead in enforcement of many of the ACA's insurance reforms. But the additional actions of Trump officials suggest a broader deregulatory approach that could weaken oversight at a time when insurers face pressure -- because of broad uncertainty regarding federal policy -- to mitigate risk by designing plans attractive only to those in good health." (The Commonwealth Fund)
Employee Engagement, Soliciting Feedback Helps Humana Boost Its Wellness Program
"In five years, the insurer was able to increase participation in the program so that 72.4% of its staffers reached 'silver' status or higher. The number of employees taking a health assessment increased from 65% to 92% between 2011 and 2016, and the number undergoing a biometric health screening increased from 74% to 87%." (FierceHealthcare)
Tear Down the Silos Between HSAs and 401(k)s
"HSAs have triple tax advantages. While funds contributed to either an HSA or a traditional 401(k) are excluded from income taxes, HSA contributions, up to annual limits, are also excluded from FICA and FUTA payroll taxes.... [If] you save your health care receipts in a file today, then during retirement you can withdraw HSA funds tax-free against those years-old receipts, which can turn the HSAs into a fund to pay for more than just future health care expenses." (Society for Human Resource Management [SHRM])
[Opinion] Savings Reported by CMS Do Not Measure True ACO Savings
"While we can observe actual spending for ACO beneficiaries, ... it's very hard to know what would have been spent if ACOs did not exist. It is important to avoid using the [CMS] benchmarks to evaluate ACO savings because benchmarks are constructed with policy goals in mind.... Using the benchmark as the measure of success, analysts have concluded, for example, that CMS actually lost money (on the order of $200 million) in the ACO program and that it was a bad deal for CMS. Contrast this with a conclusion based on the use of a counterfactual designed for research purposes (and based on regional spending trends):" (Health Affairs)
2017 Employee Benefits Report (PDF)
40 pages. "Nearly one-third of organizations increased their overall benefits offerings in the last 12 months, with health (22%) and wellness (24%) benefits being the most likely ones to experience growth ... Organizations that had reduced their benefits package were most likely to have decreased health care benefits (57%). Another one-quarter (24%) decreased wellness benefits ... Most organizations offer retirement plans to help employees save and plan for their financial future. [Defined contribution] plans were the most common, with 90% offering a traditional 401(k) or similar plan and 55% offering a Roth 401(k) or similar plan. Three-quarters of organizations (76%) provided an employer match for their 401(k) plans while 40% matched Roth 401(k) contributions." (Society for Human Resource Management [SHRM])
[Opinion] The Healthcare System: 50 Years Later
"In 1967, the healthcare system was an abstract concept. We paid scant attention unless we wrecked our cars or injured ourselves playing ball. We thought every physician infallible, every procedure evidence-based and every admission necessary. But today, healthcare matters and how our system operates confronts them daily. There's confusion about Repeal and Replace and dissonance about the politics: they understand healthcare is expensive but they think there's plenty of government money to cover anyone needing care." (Paul Keckley)
State Efforts to Lower Cost-Sharing Barriers to Health Care for the Privately Insured
"Six states and DC have policies requiring insurers in the individual market to cover certain services pre-deductible, such as doctor's visits and generic prescription drugs.... [S]tates designed these plans to make high-value health care services more accessible and affordable, although data to assess the impact of pre-deductible coverage is not yet available. Although stakeholders identified challenges in the development of these plans, states' open, public processes contributed to a generally smooth implementation." (Urban Institute)
Evidence on Recent Health Care Spending Growth and the Impact of the ACA (PDF)
13 pages. "Though average marketplace premium increases were higher in 2017 than in 2015 and 2016, marketplace competition in large urban markets has generally been intense, leading to narrower networks of providers who are willing to accept lower payment rates in private insurance plans.... 20 states have average 2017 nongroup marketplace premiums that are below their average employer-sponsored insurance premiums; 11 states have average marketplace premiums that exceed employer-sponsored insurance premiums by less than 10 percent." (Urban Institute)
[Guidance Overview] Employers, Health Plans Should Brace for Tightened Mental Health Coverage Disclosure and Enforcement
"Employer and other group health plan sponsors, fiduciaries, insurers and vendors should verify the adequacy of their current health plan mental health coverage rules and administration with existing federal rules and brace for potential expanded disclosure requirements in light of the June 16, 2017 publication by the [DOL] of Mental Health Parity Implementation FAQs Part 38... The guidance and proposed model notice [indicate] a growing attention by the department to ensuring that participates in beneficiaries understand their mental health parity [rights.]" (Solutions Law Press)
[Guidance Overview] ACA Round-Up: Mental Health and Substance Use Parity, Premium Tax Credits, and a New Marketplace Reinsurance Proposal
"On June 16, 2017, Labor, Treasury, and HHS released [FAQs] requesting public comments on a proposed form that participants, enrollees, and their authorized representatives (including providers) could use to request information from their health plan or insurer regarding [non-quantitative treatment limitations (NQTLs)], or to obtain documentation after an adverse determination regarding MH/SUD benefits.... The FAQ also clarifies that eating disorders are mental health conditions and treatment for an eating disorder is a mental health benefit within the meaning of the MHPAEA." (Health Affairs)
[Official Guidance] Text of FAQs on ACA Implementation, Part 38: Mental Health and Substance Use Disorder Parity Implementation and the 21st Century Cures Act (PDF)
"[T]he Departments are again soliciting comments on the questions and issues listed above that were previously raised in [ACA] Implementation FAQs Part 34.... In addition, ... the Departments are soliciting comments on a draft model form that participants, enrollees, or their authorized representatives could -- but would not be required to -- use to request information from their health plan or issuer regarding NQTLs that may affect their MH/SUD benefits, or to obtain documentation after an adverse benefit determination involving MH/SUD benefits to support an appeal.... Q1: Does MHPAEA apply to any benefits a plan or issuer may offer for treatment of an eating disorder? " [Also available: Supporting Statement as submitted to OMB.] (U.S. Department of Health and Human Services [HHS], U.S. Department of Labor [DOL], and U.S. Department of the Treasury)
The Rise of the Group Health Insurance Captive
"Under [one] approach, the group captive consists of a series of 'fronted' captive cells that are sponsored by the commercial carrier from who the stop-loss coverage is purchased. Under the second approach, the group captive is separately maintained and subscribed to under an enabling state law. Both approaches accomplish the pooling of stop-loss coverage at the tranche of risk underwritten by the captive.... Group captives rest on a modestly reliable regulatory foundation. To be ideally positioned to withstand challenge, group captives would need to follow to the letter the steps outlined in [two DOL] advisory opinions[.]" (Mintz Levin)
One of the Most Prestigious Brands in Medicine Is Jumping Into Obamacare
"Cleveland Clinic, a nonprofit academic medical center, is partnering with Oscar Health to sell individual insurance plans in five northeast Ohio counties. The plans will be available on the exchanges, where people can use government subsidies to purchase health coverage as well as off the exchanges, where people bear the full cost of their health coverage.... [T]he health plan will only include the Cleveland Clinic's network of providers, including its well-known main hospital, 10 regional hospitals and more than 150 outpatient clinics." (The Washington Post; subscription may be required)
Taking Your Wellness Program from Good to Great
"Keep it fair for everyone.... Follow your leader.... Stretch your budget.... Pick the right wellness vendor.... Use your team's strengths.... Keep what works.... Take a broad approach.... Communication matters." (The Alliance)
NLRB: ACA-Mandated Benefit Plan Changes Still Require Bargaining
"[A] union was in the process of negotiating an initial collective bargaining agreement when the employer, without prior notice to the union, began notifying employees that they would be eligible for health insurance after 60 days of employment instead of the prior requirement of one year of employment.... The employer argued that its unilateral change was privileged because the ACA mandated coverage of the newly hired employees.... The NLRB applied the 'well-established' doctrine that, when an employer is compelled to make changes in terms and conditions of employment in order to comply with the mandates of a statute, it must provide the collective bargaining representative notice and an opportunity to bargain over the discretionary aspects of such changes." [Western Cab Company, 365 NLRB No. 78 (May 16, 2017)] (McDermott Will & Emery)
[Opinion] Emerging Senate Repeal Bill Eviscerates Protections for Millions in Employer-Sponsored Health Plans Nationwide
"Nationwide, [the authors] estimate that the essential health benefit waivers would result in annual caps on benefits for nearly 27 million Americans with employer-based coverage. About 20 million people with employer-based coverage would face lifetime limits on coverage." (Center for American Progress)
Would States Eliminate Key Benefits if AHCA Waivers are Enacted?
"The American Health Care Act (AHCA), which passed the House of Representatives on May 5, would permit states to seek waivers to amend the required benefits if doing so would achieve one of several purposes, including lowering premiums. [This article looks] at the benefits covered by non-group plans before the ACA as a possible indication of how states could respond to the waiver authority under the AHCA." (Henry J. Kaiser Family Foundation)
Employers Satisfied with Private Exchanges in Overwhelming Numbers
"Nearly 100% of employers are satisfied using a benefits marketplace (also known as a private exchange) to deliver an online shopping experience for choosing health and other benefits to employees ... 97% of employers are satisfied ... 86% think the benefits marketplace has helped them control benefits costs. 89% say moving to the benefits marketplace has impacted their company culture positively." (OneExchange from Towers Watson)
[Guidance Overview] Expensive Problems Arise for Employers Who Don't Have Clear Health Plan Eligibility Conditions
"An insurance company needs to be able to determine who is eligible for the plan so it knows who to cover with the plan's benefits. However, an insurance company has no skin in the game as it relates to the 4980H penalties. This is perhaps creating part of the problem as the insurance company does not care if the look back measurement method is accurately (or even correctly) explained and incorporated into the eligibility conditions. Consequently, there is frequently one set of eligibility standards that apply for the purposes of the look back measurement method and a separate set of standards applied to the actual health plan. Furthermore, sometimes the health plan's SPD is not providing any eligibility conditions. This lack of synchronization is a huge problem." (Accord Systems, LLC)
[Guidance Overview] Updated List of Required Preventive Services Under the ACA (PDF)
"Guidelines keep evolving for which preventive services non-grandfathered plans must provide. The most significant change is the addition of statins to the list of required preventive drugs. Sponsors of non-grandfathered plans should review plan documents and operations to ensure that the plan complies with the latest guidelines." (Segal Consulting)
Balance Billing by Health Care Providers: Assessing Consumer Protections Across States (PDF)
10 pages. "Most states do not have laws that directly protect consumers from balance billing by an out-of-network provider for care delivered in an emergency department or in-network hospital. Of the 21 states offering protections, only six have a comprehensive approach to safeguarding consumers in both settings, and gaps remain even in these states. Because a federal policy solution might prove difficult, states may be better positioned in the short term to protect consumers." (The Commonwealth Fund)
Industry Groups to Host Series of Anti-AHCA Events
"The American Medical Association, the American Hospital Association, AARP, March of Dimes, the American Diabetes Association, the American Cancer Society, the Federation of American Hospitals and the American Heart Association will team up for the initiative ... The programs will highlight four health policy areas: insurance affordability, essential care access, protections for Medicaid patients and protections for people enrolled in employer-sponsored plans." (FierceHealthcare)
The Economy, Not Washington, Is Likely to Shape Employer Health Benefits in 2018
"Employers see health benefits as a key way of attracting talent in a tight labor market. Despite potential changes to Obamacare, employers aren't likely to roll back essential health benefits. Most employers expect health-care costs to rise 6.5 percent in 2018." (CNBC)
County-by-County Analysis of Current Projected Insurer Participation in 2018 Health Insurance Exchanges
"The CMS map displays point in time data and is expected to fluctuate as issuers continue to make announcements on exiting or entering specific states and counties. It currently shows that nationwide 47 counties are projected to have no insurers, meaning that Americans in these counties could be without coverage on the Exchanges for 2018. It's also projected that as many as 1,200 counties -- nearly 40% of counties nationwide -- could have only one issuer in 2018." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
High Premiums and Disruptions in Coverage Lead to Decreased Enrollment in Health Insurance Exchanges (PDF)
"High costs and lack of affordability are the most common factors that lead consumers to cancel coverage. Consumers with higher premiums were more likely to terminate or cancel coverage. Consumers listed lack of affordability as one of the most common reasons for not paying for the first month's coverage.... Consumers without financial assistance were more likely to terminate or cancel coverage." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
CMS 2017 Effectuated Enrollment Snapshot (PDF)
15 pages. "As of March 15, 2017, 10.3 million individuals had effectuated their coverage for February 2017, meaning that they selected a plan that started in January or February, and had paid their first month's premium.... In March of 2016, 10.8 million people had effectuated coverage through the Exchanges, and by the end of the year, only 9.1 million remained.... [On] average since 2014, more than a million enrollees per year have dropped their coverage before the end of the plan year." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Iowa Submits 1332 Waiver Request, Claiming It Is Necessary to Avoid an Individual Insurance Market Collapse
"On June 12, 2017, the Iowa insurance commissioner submitted a request for a 1332 waiver that would dramatically change the nature of the marketplace in Iowa ... To grant Iowa's waiver request, CMS would have to grant, as Iowa recognizes, waivers and modifications of many of the 1332 statutory and regulatory requirements. Iowa proposes, therefore, that CMS broadly waive 1332's requirements under President Trump's [ACA] Executive Order, or alternatively simply grant its request under the Executive Order without statutory or regulatory authority." (Health Affairs)

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