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Health plans - design


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U.S. Supreme Court Takes Up Insurers' $12 Billion Obamacare Dispute
"The U.S. Supreme Court on Monday agreed to decide whether the federal government must pay insurers $12 billion under an Obamacare program aimed at encouraging them to cover previously uninsured people after the healthcare law was enacted in 2010. The justices will hear an appeal by a group of insurers of a lower court ruling that Congress had suspended the government's obligation to make the payments. The insurers have argued that the ruling would allow the government to pull a 'bait-and-switch' and withhold money they were promised." [Maine Community Health Options v. U.S., Nos. 17-2395 (Fed. Cir. Jul. 9, 2018; cert. granted Jun. 24, 2019)] (Reuters)
[Guidance Overview] The New HRA Regs: Individual Coverage HRAs
"The new Individual Coverage HRAs can integrate with: [1] individual insurance coverage purchased on the ACA marketplace; [2] individual insurance coverage purchased outside of the ACA marketplace (including on a private exchange); [3] student health insurance coverage; [4] individual insurance coverage obtained in states that have received a [Section 1332] waiver ... [5] individual catastrophic coverage; [6] 'grandmothered' coverage (i.e., non-grandfathered coverage that is not compliant with ACA but that [HHS] has announced it will not take enforcement action on); and [7] coverage under Medicare Parts A, B, C, or D and Medigap." (Proskauer)
A Brief Look at the Medicare Secondary Payer Rules
"[The Medicare Secondary Payer Rules] prevent employers (whose plans would pay before Medicare) from coercing, inducing, or incentivizing employees, their spouses, or dependents to elect Medicare over employer-sponsored coverage.... The Rules apply to active employees and their spouses regardless of how they become eligible for Medicare (age or disability).... These Rules generally apply to employers who have 20 or more employees (full-time and part-time) worldwide." (HUB International)
[Opinion] A Simple Solution to Lower Drug Prices for All Americans
"There's a simple solution for lowering prices of both old and new drugs for all Americans, not just for seniors under Medicare: a windfall profits tax that takes back surplus profits derived from excessive prices. This tax would be equal to the difference between a drug's list price -- the price that is used for patient payments -- and the drug's justified price, multiplied by the number of units sold." (Center for American Progress)
[Opinion] New Rule Could Mean Consumer Confusion, Higher Premiums in Marketplace
"The rule will almost certainly raise marketplace premiums because HRAs will be more attractive to firms with sicker-than-average employees.... The rule has guardrails designed to prevent that from occurring, but employers may still find ways to target sicker workers.... Employees will need to do considerably more work to enroll in an individual market plan than an employer's group plan.... The new rules will likely expand enrollment in short-term plans[.]" (Center on Budget and Policy Priorities)
[Guidance Overview] Health Care-Related Expiring Provisions of the 116th Congress, First Session
44 pages. "This report describes selected health care-related provisions that are scheduled to expire during the first session of the116th Congress (i.e., during calendar year 2019).... This report generally focuses on two types of health care-related provisions ... The first type of provision provides or controls mandatory spending, meaning that it provides temporary funding, temporary increases or decreases in funding ... or temporary special protections that may result in changes in funding levels ... The second type of provision defines the authority of government agencies or other entities to act, usually by authorizing a policy, project, or activity. Such provisions also may temporarily delay the implementation of a regulation, requirement, or deadline, or establish a moratorium on a particular activity." [Report R45781, June 21, 2019] (Congressional Research Service [CRS])
More Work Needed to Shift Health Care Spending from Low-Value to High-Value Care
"[S]pending growth on the five frequently-cited, low-value services remained mostly flat (slower than the growth in total health care spending). Meanwhile, spending on the high-value services increased only moderately, with spending on three of the analyzed services ... growing faster than total health care spending. Though this is moving in the right direction, there is much more work to be done." (Altarum Institute)
Awaiting the Supreme Court on Risk Corridors
"We may learn the Supreme Court's decision on June 24. If the Court accepts the appeal, the case would be considered during the next term, which begins in October and runs through summer 2020.... If the Supreme Court does not accept the appeal, the case would be over and insurers would not recoup the more than $12 billion in unpaid risk corridor payments.... [T]his would likely have implications for litigation over unpaid cost-sharing reduction payments (CSRs) and could bolster the conclusion that insurers are entitled to these payments." (Katie Keith, in Health Affairs)
With Expected 6% Rise in Health Costs, 2020 May Be Year of 'Activist' Employer
"Employers' desire to more effectively manage healthcare spend previously meant shifting more and more costs to employees. However, continuing that trend is untenable ... and both employers and employees report dissatisfaction with high-deductible health plans." (FierceHealthcare)
An Examination of Surprise Medical Bills and Proposals to Protect Consumers from Them
"[This analysis uses] claims data from large employer plans to estimate the incidence of out-of-network charges associated with hospital stays and emergency visits that could result in a surprise bill.... For people in large employer plans, 18% of all emergency visits and 16% of in-network hospital stays had at least one out-of-network charge associated with the care in 2017." (The Peterson-Kaiser Health System Tracker)
Final Regs Permit Individual Coverage HRAs in 2020
"For the first time, employers will have the realistic opportunity to marry a tax-advantaged, defined contribution approach with an individual coverage market that is available to all employees and dependents regardless of health conditions. The Departments estimate that roughly 800,000 employers will offer ICHRAs to cover roughly 11 million individuals within five years." (ABD Insurance & Financial Services)
[Guidance Overview] Final Rules Issued for Individual Coverage HRAs
"Although the final rule retains seven of the eight classes of employees permitted under the proposed regulations ... it eliminates the class of employees below age 25.... [E]mployers may contribute more for employees based on the number of their dependents or on their age, but ... the maximum differential for contributions between older and younger employees [is limited] to a 3:1 ratio.... [An] ICHRA may integrate with Medicare (either Parts A and B or Part C). It may reimburse premiums for Medicare, including Part D, and for Medicare supplemental coverage." (Ballard Spahr LLP)
Making Virtual Health a Pillar of Your Health Plan Participants' Experience
"Nearly all health plans (94 percent) offer virtual health services, and 96 percent expect their reliance on this technology will grow ... However, despite being widely available, virtual health has generally not been embraced by health plan members. One of the most formidable barriers to adoption might be the members themselves." (Deloitte)
Stop-Loss Coverage by the Numbers
"Two primary diagnoses accounted for more than 40% of all claims of $1 million or more in 2018 ... Average stop-loss premium increases have been higher at lower specific deductible policy levels in recent years. Most plans that bid or renewed their stop-loss insurance stayed with the incumbent insurer." (Segal Consulting)
Panel Discussion: Current Issues in Employee Benefits & Executive Compensation
"What EBEC issue has had the greatest impact on your clients in the past 12 months? ... What is the most interesting EBEC matter on your desk right now and what are the issues involved? ... Are there any EBEC issues that are on the horizon that could significantly impact your clients and/or your practice? Can you describe the potential impact?" (Thomson Reuters Practical Law)
Senate HELP Committee Hearing: Lower Health Care Costs Act
June 18 hearing on Draft Bill. Page includes video of hearing along with links to testimony by: [1] Sean Cavanaugh, Aledade; [2] Benedic N. Ippolito, American Enterprise Institute; [3] Elizabeth Mitchell, Pacific Business Group on Health; [4] Tom Nickels, American Hospital Association; [5] Frederick Isasi, Families USA; [6] Marilyn Bartlett, Office of the Montana State Auditor. (Committee on Health, Education, Labor and Pensions, U.S. Senate)
IRS 2018-2019 Priority Guidance Plan, Third Quarter Update (PDF)
37 pages. Updated March 31, 2019; released June 17, 2019. Employee benefits items begin on page 14. (Internal Revenue Service [IRS])
Senate HELP Committee Releases Sweeping Legislative Package Targeting Health Care Costs
"Entitled the 'Lower Health Care Costs Act,' the Draft Bill ... takes aim at so-called 'surprise' balance medical bills ... The Draft Bill also proposes a number of measures addressing prescription drug costs, price transparency, and certain public health initiatives.... [T]he efforts to address surprise balance billing have the most widespread support ... Congress could conceivably pass some form of surprise balance billing relief on a stand-alone basis." (Groom Law Group)
Senators Agree Surprise Medical Bills Must Go -- But How?
"Two years, 16 hearings and one massive bipartisan package of legislation later, a key Senate committee says it is ready to start marking up a bill next week designed to contain health care costs. But it might not be easy since lawmakers and stakeholders at a final hearing [on June 18] showed they are still far apart on one simple aspect of the proposal. That sticking point: a formula for paying for surprise medical bills[.]" (Kaiser Health News)
[Guidance Overview] Agencies Expand HRA Availability to Provide Coverage
"The final regulations, which will become effective January 1, 2020, provide for two new types of HRAs.... [1] Excepted Benefit HRAs ... There are four requirements that must be satisfied under the regulations for an HRA to qualify as an excepted benefit HRA ... There are no special notice requirements for excepted benefit HRAs, although they will be subject to ERISA's disclosure requirements.... [2] Individually Integrated HRAs ... Current regulatory guidance prohibits employers from offering HRAs that reimburse employees for the cost of individual health coverage ... The regulations ... remove that prohibition if [certain requirements] are satisfied." (The Wagner Law Group)
[Opinion] The Cadillac Tax: It's Time To Kill This Policy Zombie
"[P]olicy makers should incentivize employers to strengthen rather than cut their support for workers' and dependents' health insurance. Lawmakers increasingly realize the need to change direction, as suggested by the bipartisan majority of House members and more than a third of the country's senators who are now co-sponsoring 2019 legislation that would repeal the Cadillac tax. Abundant evidence shows the need for this change." (Stan Dorn, in Health Affairs)
Texas Is Latest State to Attack Surprise Medical Bills
"Texas is now among more than a dozen states that have cracked down on the practice of surprise medical billing.... Under the new law, insurance companies and medical providers can enter into arbitration to negotiate a payment -- and state officials would oversee that process." (Kaiser Health News)
[Official Guidance] Text of CMS Blueprint for Approval of Affordable Health Insurance Marketplaces (PDF)
44 pages. "This document includes the Blueprint application for states seeking approval to operate either [a state-based exchange (SBE) or state-based exchange on the federal platform (SBE-FP)] for coverage years beginning on, or after, January 1, 2019, and includes the following application components: [1] Declaration of Intent Letter ... [2] Blueprint Application Part A: Application Attestation, Part B: Exchange Declarations, and Parts C or D: SBE or SBE-FP Application." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Guidance Overview] CMS Releases 2020 Medicare Part D Benefit Parameters
"Increases in the standard benefit parameters range from approximately 4.8% to 5.9%, with the OOP threshold increasing by 24.5%. Plan sponsors that want to remain qualified for the employer retiree drug subsidy will have to determine if their 2020 prescription drug coverage is at least actuarially equivalent to the standard Medicare Part D coverage." (Buck)
Mental Health Parity Litigation: Utah District Court Finds Conclusory Allegations Insufficient to Overcome Motion to Dismiss
"This case demonstrates the current litigation battle lines. Plaintiffs seek to overcome motions to dismiss and get to discovery based on the allegation that the handling of a claim violates the MHPAEA, while plans and plan administrators continue to insist that the plaintiffs must plead a factual basis for their allegations." [Kerry W. v. Anthem Blue Cross and Blue Shield, No. 19-67 (D. Utah June 5, 2019)] (Ogletree Deakins)
Takeaways from Congress's Latest Single-Payer Hearing
"[1] The hearing was supposed to address various legislative proposals that would expand coverage ... [but] the debate centered almost entirely on the Medicare for All Act.... [2] The fate of the ACA remains unknown.... [3] Potential for adverse effects on provider rates draws concerns.... [4] Cost of a single-payer system remains unknown." (Healthcare Financial Management Association [HFMA])
[Opinion] U.S. Chamber Letter to Senators on the Lower Health Care Costs Act
"[T]he Chamber strongly supports efforts to protect patients from surprise bills while providing certainty for payers and employers. Equally important, any solution should preserve and encourage market-based negotiations." (U.S. Chamber of Commerce)
[Guidance Overview] Final Rules Impose Requirements on Employers Reimbursing for Individual Coverage
"The new rules take effect January 1, 2020. Until then, employers are still prohibited from reimbursing premiums for individual coverage.... The concept of ICHRA is intended to deliver a new avenue for employers to more flexibly fund employee health coverage.... [T]here are many uncertainties about meaningful marketplace coverage opportunities for workers. Moreover, the new guidance imposes key restrictions and limitations[.]" (HUB International)
[Opinion] Are You Sure You Actually 'Like' Your Private Health Insurance?
"Four in ten Americans with employer-sponsored health insurance say their family is struggling to pay premiums, medical bills, or out-of-pocket medical costs. Half of us have a family member who is avoiding necessary medical care or prescriptions because of cost.... Thousands of physicians, medical students, nurses, and our colleagues across health care ... are joining the Medicare for All movement because we want our work to be about protecting people's health, not destroying their wealth." (CommonDreams.org)
[Opinion] Trump Administration Gets Smart on Pre-Existing Conditions
"The final rule ... enhances portability by allowing employers to give their workers a (tax-free) contribution to an HRA, so employees can buy the plan that works best for them. If there's any difference between the employer's contribution and the total premium -- for instance, an employer contributes $300 per month, and the worker selects a plan with a $350 monthly premium -- the worker can pay the difference on a pre-tax basis, so long as he purchases the plan outside of the Obamacare exchanges. Best of all, because employees own the plans and not the employer, they can keep their coverage when they change jobs." (The Federalist)
Final Rules Ease Restrictions on Health Reimbursement Arrangements
"The changes aim to ease mostly small and mid-size employers' ability to subsidize health coverage and include guardrails to protect the individual market. For larger employers, the rules create interesting opportunities to subsidize on a tax-favored basis individual health insurance for certain cohorts of employees -- such as part-timers -- who may not currently be eligible for their employer's group health plan." (Mercer)
[Opinion] The Trump Administration's Newest Health Care Rule
"A broad shift to HRAs could resemble the movement in retirement benefits from defined benefit pensions to 401(k) plans, where employers make fixed contributions instead of promising a set benefit for years in the future. A similar change in health coverage would give businesses more predictable costs while shifting the risk of higher healthcare expenses onto workers. It's all about money and determining or deflecting risk." (Business Forward)
[Opinion] Trump's Expansion of Health Reimbursement Accounts Improves Health Care Choices
"The new health reimbursement accounts rule has the potential to ... expand employees' choices well beyond the limited options they have today. With this change, the Trump administration expects the individual health insurance market to grow significantly, and become more robust as an arena for health plan participation and competition. This, of course, would partially reverse the disastrous decline in health plan choice and competition that has marked the last six years." (The Heritage Foundation)
Final Rule on Health Reimbursement Arrangements Could Shake Up Markets
"The Trump administration is trying to make this an attractive option to employers, especially small businesses. They expect employers to take them up on this offer, resulting in a significant increase in the size of the individual market.... [D]espite requests for a delay, the rule will go into effect beginning on January 1, 2020.... This post offers background information on HRAs; summarizes the final rule; and briefly discusses the rule's potential implications for employers, employees, and the individual insurance market." (Katie Keith, in Health Affairs)
HHS Final HRA Rule: Similar to the Proposed But Some Notable Changes
"The final rule newly limits the extent to which employers are permitted to vary individual coverage HRA contributions by age.... Two of the changes will make it harder for employers to shift sicker workers into the individual market.... [T]he final rule retains a January 1, 2020 effective date and thus will be relevant for consumers making decisions at the beginning of open enrollment on November 1, 2019.... [T]he attestation process may be quite a bit more porous than other situations that rely on attestation." (The Brookings Institution)
Self-Funded vs. Fully-Funded: Weighing the Cost Savings for Your Business
"Employers without the time or resources to devote to a more hands-on, complex plan should probably stay with a simpler plan like a fully insured plan. Self-funding has a number of compliance requirements that are not always present for a fully-insured plan, such as non-discrimination requirements and 5500 tax filings." (OneDigital Health and Benefits)
New Final Rule Lets Employees Use HRAs to Buy Health Insurance
"Under the new HRA rule: [1] Employers may either offer an [individual coverage HRA (ICHRA)] or a traditional group health plan but may not offer employees a choice between the two. [2] Employers can create classes of employees around certain employment distinctions ... and then offer an ICHRA on a class by class basis. [3] Employers that offer an ICHRA must do so on the same terms for all employees in a class of employees, but they may increase the ICHRA amount for older workers and for workers with more dependents. [4] Employers can maintain their traditional group health plan for existing enrollees, with new hires offered only an ICHRA." (Society for Human Resource Management [SHRM]; membership may be required to view article)
[Guidance Overview] HHS Proposes to Narrow Scope of ACA Nondiscrimination Regs
"[The] new proposal encourages a return to existing civil rights laws.... [No] longer would all operations of an non-health care entity be covered, but instead only the individual activities funded by HHS. As a result, the proposed rules would be inapplicable to most self-insured plans.... HHS proposes repealing in their entirety the provisions requiring taglines and nondiscrimination notices." (Proskauer)
DOL Releases Annual Self-Insured Health Plan Report to Congress
"The DOL acknowledges incompleteness of the information due to inherent challenges in data collection, including the fact that the Form 5500 data includes only plans with 100 or more participants or assets held in trust, and does not capture data for governmental or church plans. As a result, the report's usefulness in identifying self-insurance trends is limited, especially among small plans that are not required to file Form 5500 because they are unfunded, insured, or a combination of both. Unlike last year, the report did not mention proposed changes to the Form 5500 that would result in the collection of more detailed funding and benefit information[.]" (Thomson Reuters / EBIA)
[Official Guidance] Text of Final Regs: Health Reimbursement Arrangements and Other Account-Based Group Health Plans
497 pages. "The final rules allow integrating HRAs and other account-based group health plans with individual health insurance coverage or Medicare, if certain conditions are satisfied (an individual coverage HRA). The final rules also set forth conditions under which certain HRAs and other account-based group health plans will be recognized as limited excepted benefits. Also, the Department of the Treasury and the [IRS] are finalizing rules regarding premium tax credit (PTC) eligibility for individuals offered an individual coverage HRA. In addition, the [DOL] is finalizing a clarification to provide assurance that the individual health insurance coverage for which premiums are reimbursed by an individual coverage HRA or a qualified small employer health reimbursement arrangement (QSEHRA) does not become part of an ERISA plan, provided certain safe harbor conditions are satisfied. Finally, [HHS] is finalizing provisions to provide a special enrollment period (SEP) in the individual market for individuals who newly gain access to an individual coverage HRA or who are newly provided a QSEHRA." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]; and Internal Revenue Service [IRS])
[Official Guidance] Text of Agency FAQs: Individual Coverage and Excepted Benefit Health Reimbursement Arrangements (PDF)
18 pages. "[1] What are the benefits of offering an Individual Coverage HRA to employees? ... [2] How does an Individual Coverage HRA work?... [3] Why is the HRA rule important for small businesses and their workers?... [4] What are the expectations for take-up of the Individual Coverage HRA?... [5] I am an employer. To whom can I offer an Individual Coverage HRA? ... [6] How do my employer contributions work? ... [7] Can an employer offer an Individual Coverage HRA to satisfy the employer mandate?... [8] What other responsibilities do I, the employer, have? ... [9] May an employer allow employees to pay any portion of the premium for their individual health insurance that is not covered by the Individual Coverage HRA on a tax-preferred basis by using a salary reduction arrangement under a cafeteria plan? ... [10] Can large employers offer Individual Coverage HRAs too?... [11] What are the benefits of offering an Excepted Benefit... [12] When can employers start offering Individual Coverage HRAs and Excepted Benefit HRAs?" (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]; and Internal Revenue Service [IRS])
[Guidance Overview] HHS, DOL and Treasury Expand Access to Quality, Affordable Health Coverage Through Health Reimbursement Arrangements
"[It] is estimated this expansion of HRAs will benefit approximately 800,000 employers, including small businesses, and more than 11 million employees and family members, including an estimated 800,000 Americans who were previously uninsured.... Under the rule, starting in January 2020, employers will be able to use what are referred to as individual coverage HRAs to provide their workers with tax-preferred funds to pay for the cost of health insurance coverage that workers purchase in the individual market, subject to certain conditions. These conditions strike the right balance between employer flexibility and guardrails meant to protect the individual market against adverse selection, and include a notice requirement to ensure employees understand the benefit. Individual coverage HRAs are designed to give working Americans and their families greater control over their healthcare by providing an additional way for employers to finance health insurance." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]; and Internal Revenue Service [IRS])
[Guidance Overview] HHS Proposes to Narrow Scope of ACA Nondiscrimination Regs
"Among the proposed changes are the following: [1] Re-focus on existing civil rights laws.... [2] Repeal and replace the covered entities definition.... As a result, the proposed rules would be inapplicable to most self-insured plans.... [3] Repeal the mandatory notice and tagline requirements.... HHS now estimates that the annual burden of these requirements, which was originally estimated at $7.2 million in one-time costs, is now somewhere in the range of $147 million to $1.34 billion." (Proskauer)
Providers Push Arbitration Approaches Used in Some State Surprise-Bill Laws
"As healthcare industry advocates and legislators clashed over draft federal legislation to end such billing disputes, both sides highlighted state experiences they viewed as bolstering their preferred approach. The major differentiator among state laws and competing federal proposals remains the method used to determine provider payment." (Healthcare Financial Management Association [HFMA])
Senate Package Targets Healthcare Costs, Surprise Medical Bills
"A broad array of proposed reforms aims to lower drug prices, increase transparency, foster greater electronic exchange of health information and improve public health. The provisions targeting surprise medical bills and drug prices join a growing list of similar proposals in Congress." (Mercer)
Complexity of Health Care Poses Challenges for Small Business Owners
"Sixty-nine percent of survey respondents say the process of selecting health insurance plans is time consuming, and one in every five small business owners say they do not have enough information to make informed decisions about health care options. When they begin to seek out guidance about health care options, these small business owners most commonly turn to brokers, consultants or agents (32%), with fewer depending on online search engines (9%) or seeking advice from other business owners (7%)." (U.S. Chamber of Commerce)
House Energy and Commerce Committee Hearing: No More Surprises -- Protecting Patients from Surprise Medical Bills
Page includes video of the hearing, along with Memorandum from Chairman Pallone to the Subcommittee on Health, opening statement from Chairman Pallone, and opening statement of Subcommittee Chair Eshoo, along with testimony from: [1] Sonji Wilkes, Patient Advocate; [2] Sherif Zaafran, MD, FASA, Physicians for Fair Coverage; [3] Rick Sherlock, Association of Air Medical Services; [4] James Gelfand, The ERISA Industry Committee; [5] Thomas Nickels, American Hospital Association; [6] Jeanette Thornton, America's Health Insurance Plans; [7] Claire McAndrew, Families USA; and [8] Vidor E. Friedman, MD, FACEP, American College of Emergency Physicians. (Energy & Commerce Committee, U.S. House of Representatives)
2019 Scorecard on State Health System Performance
"[M]ost states are losing ground on key measures related to life expectancy as premature deaths from suicide, alcohol, and drug overdose continue to increase. Several states that most recently expanded eligibility for their Medicaid programs saw meaningful gains in access to health care; in other states prior gains eroded between 2016 and 2017." (The Commonwealth Fund)
Adaption of Telemedicine Services in Healthcare Industry
"Telemedicine is revolutionizing the healthcare industry and is expected to grow from a $21.56 billion market in 2017 to a $93.45 billion market in 2026. This growth is highly attributable to the accessibility and convenience of telecommunication devices and the inevitability of government initiatives for reimbursement." (WithumSmith+Brown, PC)
CVS Caremark Service Aims to Help Employers Manage Nontraditional Benefit Options
"CVS' pharmacy benefit manager launched a vendor benefit management service allowing its employer clients to offer nontraditional tools aimed at improving employee health. The program ... will allow employers to contract and manage their relationship with third-party vendors that offer employee benefits, which could be both digital and non-digital tools. The first third-party vendor in the program and available for CVS Caremark members to adopt is Sleepio, a digital program aimed at improving sleep sold by Big Health." (HealthcareDIVE)
[Opinion] Gruber and Sommers Tell What We've Learned from 10 Years of ACA
"The authors tell us that we need ongoing studies of potential solutions such as 'a public option on the insurance marketplace, moving more Medicaid beneficiaries to private coverage, and -- most dramatically -- 'Medicare-for-All' in various configurations.' So just what studies do we need?" (Physicians for a National Health Program [PNHP])
Association Health Plans Work for Cannabis Companies
"[A recent article] discussed the difficulties of Cannabis, Hemp, and CBD companies in affording their employees 401(k) plan access. These companies confront the same difficulty in accessing health benefits for their employees. Unequivocally, Cannabis, Hemp, and CBD companies (and thus their employees) are entitled to participate in AHPs." (FisherBroyles LLP, via Lexology; free registration required)
District Court Orders Nationwide Injunction: Contraceptive Mandate Under ACA Cannot Be Enforced
"On June 5, 2019, Judge Reed O'Connor of the Northern District of Texas issued a permanent injunction against the [ACA's] contraceptive mandate. The court found that the contraceptive mandate and the Obama-era accommodations process for religious entities violate the Religious Freedom Restoration Act (RFRA) and can no longer be enforced by the federal government against those who object to contraceptive coverage. This means that entities and individuals covered by Judge O'Connor's decision are fully exempt from the contraceptive mandate." [Deotte v. Azar, No. 18-825 (N.D. Tex. June 5, 2019)] (Katie Keith, in Health Affairs)
The ACA's Effects on Patients, Providers and the Economy: What We've Learned So Far
"[The authors] find strong evidence that the ACA's provisions have increased insurance coverage. There is also a clearly positive effect on access to and consumption of health care, with suggestive but more limited evidence on improved health outcomes. There is no evidence of significant reductions in provider access, changes in labor supply, or increased budgetary pressures on state governments, and the law's total federal cost through 2018 has been less than predicted." (Jonathan Gruber and Benjamin D. Sommers, for National Bureau of Economic Research [NBER]; purchase required for full document)
Congress Focuses on Surprise Billing: A Summary of Three Bipartisan Proposals
"[This article] provides a high-level summary of three bipartisan proposals addressing the issue of surprise medical bills: [1] A discussion draft of the No Surprises Act, released on May 13, 2019... [2] The Stopping the Outrageous Practice (STOP) of Surprise Medical Bills Act of 2019 (S. 1531) ... [3] A discussion draft of the Lower Health Care Costs Act of 2019, released on May 23, 2019[.]" (Alston & Bird)
[Opinion] American Academy of Actuaries Comments to House Ways and Means Committee on Expanding Access to Public Insurance Plans (PDF)
33 pages. "Proposals to expand access to public health insurance plans are being put forward to provide a way to supplement efforts to strengthen insurance markets under the [ACA] or to replace the ACA marketplaces and/or other health insurance programs altogether.... This issue paper ... outlines four approaches aiming to achieve such goals and highlights the key design elements that would need to be specified for an approach to be fully evaluated and implemented." (Health Practice Council, American Academy of Actuaries)
New State Waiver Applications, Risk Adjustment Data
"On May 31, 2019, CMS issued risk adjustment data validation (RADV) results for the 2017 plan year and finalized a new change to the risk adjustment holdback policy for 2018 and beyond. On June 5, CMS informed Colorado and North Dakota that their applications for state-based reinsurance programs under Section 1332 of the [ACA] were complete. Comments on those waiver applications can be made through July 5." (Katie Keith, in Health Affairs)
Legal Promise of Equal Mental Health Treatment Often Falls Short
"Many patients ... struggle to get insurance coverage for their mental health treatment, even though two federal laws were designed to bring parity between mental and physical health care coverage. Recent studies and a legal case suggest serious disparities remain.... Insurers can no longer write policies that charge higher copays and deductibles for mental health care, nor can they set annual or lifetime limits on how much they will pay for it. But patient advocates say insurance companies still interpret mental health claims more stringently." (Kaiser Health News)
Recent Trends in Stop Loss Claims
"The largest single Sun Life claim was $7.5 million and the largest injectable drug claim was $1.8 million. Injectable drugs account for 9.2% of the total cost of large cost claims. Cancer claims continue to dominate with almost 27% of claims paid. In 2018, 85% of policies have had some reimbursement, with 51.9% of employers submitting at least one cancer claim." (Frenkel Benefits)
 
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