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Health plans - policy

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Universal Health Care Plan Hits Snag in California
"The proposal being pushed by progressive Democrats and the California Nurses Association would make California the first state with a single-payer health care system but at a striking cost: According to the Senate Appropriations Committee analysis, the plan would require the state to come up with $200 billion annually to offset the loss of employer-based expenditures and enrollee premiums and deductibles." (Courthouse News Service)
Policy Uncertainty Means Less Time for Oversight of Premium Hikes
"By some estimates, the lack of an individual mandate could result in up to a 20 percent bump in premiums; shutting off the CSRs would increase them by an additional 19 percent. At the same time, even those insurers committed to the marketplaces may need to revisit that commitment, change service areas, or adjust rates if they learn of competitors exiting the market or reducing their footprint." (The Commonwealth Fund)
Administration Seeks Delay of Ruling on Health Law Subsidies, Prolonging Uncertainty
"The request could further destabilize insurance markets as insurers are developing rates and deciding whether to participate in 2018. Insurers are supposed to submit their proposals to the federal government by June 21 and have already filed rate requests with several states. Loss of the cost-sharing subsidies, they say, could lead them to increase premiums by 15 percent to 20 percent or more, on top of any increases they might seek for other reasons." (The New York Times; subscription may be required)
Insurers, Marketplaces Face Uncertainty as Parties Seek Further Delay in House v. Price
"On May 22, 2017, the House of Representatives and the Department of Justice jointly asked the District of Columbia Court of Appeals to continue to hold House v. Price in abeyance, presumably for another 90 days as contemplated by the court's earlier order. The next status report would be due on August 20, 2017. The court is expected to respond to their request in the near future." (Timothy Jost, in Health Affairs)
[Opinion] Healthcare Industry Is Panicking That Trump Will Blow Up Obamacare on Monday
"Organizations representing most of the healthcare industry -- along with attorneys general from 15 states and the District of Columbia -- took desperate steps Friday in a last-ditch attempt to keep President Trump from blowing up the [ACA].... On [Monday, May 22,] the Trump administration has to tell a federal appeals court whether it will continue to defend the ACA against a legal attack by the House of Representatives. Alternatively, the White House could seek a 90-day stay on the proceedings. The attorneys general are asking the court to allow them to take over the defense from the White House." (Los Angeles Times)
[Opinion] Health Insurance Benefits Should Be Equitable But Not Necessarily Equal
"[We] should be designing insurance coverage in a way that provides access to care for people who need it, when they need it. That requires a subtle but important shift from equal access to equitable access. The first approach treats all people, regardless of clinical need, the same. The second recognizes that clinical need is an essential factor in determining where to direct resources and does not apologize for treating people with different needs differently." (Betsy Q. Cliff, Michael Rozier, and A. Mark Fendrick, in Health Affairs)
[Opinion] Despite What You've Read, Many Small Businesses Support Obamacare
"While most small business owners agree there are portions of the ACA that can and should be improved, polling shows that a majority of small businesses actually prefer the current law over the GOP replacement plan, and that key provisions of the ACA are helping entrepreneurs succeed." (John Arensmeyer, in Morning Consult)
California, New York Lead Group of States Seeking to Intervene in Litigation Over Cost-Sharing Reduction Payments
"The states' motion contends that allowing the lower court's order ending the CSR payments until Congress appropriates funding, and subjecting future CSR payments to an unpredictable appropriations process, would lead to higher insurance costs for consumers and to more insurers abandoning the individual health insurance market.... Moreover, the states assert, they have a unique sovereign interest in administering their insurance markets and protecting their residents that no other party to the litigation can represent." (Timothy Jost, in Health Affairs)
ACA Repeal: A Look at the Process and an Estimated Timeline
"The road to repeal and replacing the ACA is complicated and will take some time to be successful.... This estimated timeline is designed to provide a easy visual of what the next steps might look like. The complicated process combined with the gravity of its impact suggest the ultimate result may require a bi-partisan solution." (HealthCostManager)
American Health Care Act Would Affect Key Components of Medicare
"Low-income Medicare beneficiaries who also are enrolled in Medicaid -- often referred to as 'dual eligibles' -- could be disproportionately affected by congressional efforts to cut and cap federal Medicaid financing. Not only do these older adults account for one-third of all Medicaid spending, much of the Medicaid spending for low-income Medicare beneficiaries is 'optional' for states." (The Commonwealth Fund)
ERISA Advisory Council to Meet June 6-8
"[T]the 186th open meeting of the Advisory Council on Employee Welfare and Pension Benefit Plans (also known as the ERISA Advisory Council) will be held on June 6-8, 2017.... The Advisory Council will study the following topics: [1] Reducing the burden and increasing the effectiveness of mandated disclosures with respect to employment-based health benefit plans in the private sector, and [2] Mandated disclosure for retirement plans -- enhancing effectiveness for participants and sponsors." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
Senate GOP Group Mulls Action on ACA Payments to Insurers
"Sen. Rob Portman (R-Ohio) said the group discussed a number of ideas, including supporting congressional action so insurers can still receive Obamacare payments next year that subsidize coverage for low-income beneficiaries. The Trump administration has refused to commit to making the payments beyond May. Without them, many insurers say they would be forced to exit the ACA exchanges in 2018." (Morning Consult)
[Official Guidance] Checklist for Section 1332 State Innovation Waiver Applications (PDF)
"This checklist is intended to help states pursuing Section 1332 waivers as they develop and complete the required elements of the application.... We encourage states interested in applying for Section 1332 Waivers to reach out to the Departments promptly for assistance in formulating an approach that meets the requirements of Section 1332." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Opinion] Aetna CEO: 'Single-Payer, I Think We Should Have That Debate'
"The government doesn't administer anything. the first thing they've ever tried to administer in social programs was the ACA, and that didn't go so well. So the industry has always been the back room for government. If the government wants to pay all the bills, and employers want to stop offering coverage, and we can be there in a public private partnership to do the work we do today with Medicare, and with Medicaid ... then let's have that conversation. But if we want to turn it all over to the government to run, is the government really the right place to run all this stuff?" (Vox)
[Opinion] Cigna Corporation Announces Termination of Anthem Transaction
"Cigna Corporation announced that the merger agreement with Anthem has been terminated.... Anthem was required under the merger agreement to lead the regulatory approval process and to use its reasonable best efforts to obtain regulatory approval.... Cigna ... believes that Anthem willfully breached those obligations and as a result the transaction did not receive the requisite regulatory approvals. Cigna seeks prompt payment of the $1.85 billion reverse termination fee and will pursue our claims for additional damages of over $13 billion against Anthem for the harm that it caused Cigna and its shareholders." (Cigna)
The Future of Obamacare Will Be Written by Smaller Insurers
"[It] is insurers like Medica -- a nonprofit, regional health plan with 1.2 million members -- who will determine whether people can buy insurance next year. Medica's competitors in Iowa and Nebraska have announced they will drop out next year, making the company the likely last guard against a scenario that leaves exchange participants with zero options for buying their own health coverage. Last week, Medica issued a threat that without government action, it might leave Iowa's exchange." (The Washington Post; subscription may be required)
Cigna Wins Judge's Approval to Walk Away from Anthem Merger
"Delaware Chancery Judge Travis Laster said Anthem didn't deserve a 60-day extension to an earlier order barring Cigna's exit because it was 'incredibly unlikely,' the company could close the deal. However, the judge said there was significant evidence Cigna may have violated the merger agreement by dragging its feet on antitrust concerns, which could entitle Anthem to 'potentially massive damages.' " (Bloomberg)
[Opinion] The Bipartisan 'Single Payer' Solution: Medicare Advantage Premium Support for All
"[T]here are a variety of deep-seated concerns with a single-payer approach that have kept it out of mainstream political discourse so far.... It will necessitate massive tax increases; it will cut reimbursement for services to unsustainably low rates; it will be lower quality than the employer-sponsored coverage most Americans currently have; it will consolidate power into the hands of a small number of bureaucrats; etc., etc.... [A] 'unified', market-driven, federally regulated, privately delivered system need not possess any of these objectionable attributes." (Billy Wynne in Health Affairs)
[Opinion] NCPA Urges Senate to Retain Key Prescription Drug Benefit Provisions of ACA
"[P]harmacist-provided prescription drug therapy is 'incredibly cost effective' in helping improve medication adherence by patients, which in turn 'improves health outcomes and reduces much more expensive interventions, such as emergency room treatment.' ... [Up] to $290 billion in annual health care expenses result from the lack of medication adherence ... [A] leading predictor of adherence is a patient's proximity to and relationship with a pharmacist." (National Community Pharmacists Association [NCPA])
AHCA Merits Attention from Industry Stakeholders
"Despite expected Senate revisions, the American Health Care Act poses potentially vast implications across the health care industry.... The repeal or delay of certain taxes would bring relief to some life sciences manufacturers, large health insurance companies, and employers offering high-cost health insurance plans." (Latham & Watkins)
How Changes to Health Insurance Market Rules Would Affect Risk Adjustment (PDF)
"Risk adjustment helps ensure that plans are adequately compensated for the risks they enroll, thereby reducing insurer incentives to avoid high-cost enrollees.... This issue brief ... examines the risk adjustment program implemented under the [ACA] and the implications for the program under different potential changes to current insurance market rules." (Risk Sharing Subcommittee of the American Academy of Actuaries)
ACA Replacement Clears Its First Hurdle: What's Next (PDF)
"[The] Senate's bill ... likely will differ from the AHCA in at least some aspects.... Congress essentially must pass this legislation before moving on to tax reform or any other topic it intends to address with reconciliation. So employers, multiemployer [group health plan] sponsors and other stakeholders can expect to see new legislative developments soon -- potentially before the end of this month." (Trucker Huss)
The ACA Repeal Tracker
"Here is a rundown of the main elements of the [ACA], which ones would be wiped out and which could survive under the House-passed bill, and what the surviving elements could turn into if the bill becomes law." (Drew Altman, Kaiser Family Foundation, via Axios)
[Opinion] The Health Insurance Tax: Raising Costs for Families, Seniors, Taxpayers, and States (PDF)
"The health insurance tax hits nearly everyone, increasing the cost of health coverage for individuals, small businesses, and beneficiaries in public programs. Recognizing the tax's impact on consumers' health care costs, Congress acted to suspend the tax for one year, 2017. To ensure continued access to affordable health insurance coverage, it is important for Congress to take additional action to repeal the tax in 2018 and beyond." (America's Health Insurance Plans [AHIP])
AHCA Fact Sheet: The Patient and State Stability Fund (PDF)
"The $138 billion fund will help repair state markets damaged by Obamacare. States can use the funds to cut out-of-pocket costs ... or to promote access to preventive services ... States could use these resources to promote participation in private health insurance or to increase the number of options available through the market. Even more, they have the option to arrange partnerships with health care providers to support their efforts to provide care." (Energy and Commerce Committee, U.S. House of Representatives)
AHCA Fact Sheet: Pre-Existing Conditions (PDF)
"Under our plan: [1] Insurance companies are prohibited from denying or not renewing coverage due to a pre-existing condition.... [2] Insurance companies are banned from rescinding coverage based on a pre-existing condition.... [3] Insurance companies are banned from excluding benefits based on a pre-existing condition.... [4] Insurance companies are prevented from raising premiums on individuals with pre-existing conditions who maintain continuous coverage." (Energy and Commerce Committee, U.S. House of Representatives)
From Hotspot to Health Hub: How Communication and Data Can Help Solve the Growing Health Divide
"Just as law enforcement uses data to analyze and map out crime 'hotspots,' the health care community can do the same to hone in on the heaviest users of the health care system in communities across the country -- and that could help improve health outcomes and decrease spending." (Health Affairs)
The Path to ACA Repeal -- House Resuscitates the AHCA
"As it currently stands, the House bill leaves several open-ended questions for large employer-sponsored plans. First, it is unclear how the waivers for essential health benefits in the MacArthur Amendment will impact self-insured plans and the existing [HHS] regulations allowing such plans to choose a state 'benchmark' plan in order to define essential health benefits. Further, ... the pending CBO cost estimate may cause Congress to seek alternative funding sources for the bill, meaning that self-insured plan sponsors could find themselves in the crosshairs." (Eversheds Sutherland)
Forget Taxes, Warren Buffett Says -- The Real Problem Is Health Care
"In truth, Mr. Buffett said, a specter much more sinister than corporate taxes is looming over American businesses: health care costs. And chief executives who have been maniacally focused on seeking relief from their tax bills would be smart to shift their attention to these costs, which are swelling and swallowing their profits." (The New York Times; subscription may be required)
House Budget Panel to Assume ACA Repeal Enactment
"The House Budget Committee will assume enactment of the House-passed health care bill when it marks up a budget resolution after the Memorial Day break, a stance that may make tax-writers' jobs easier as they look to revamp the tax code.... The nature of the health care bill, which uses sharp cuts in health care spending -- much of it for the poor -- to more than offset the revenue lost by repealing taxes that hit the wealthy, has another potential impact: making the later argument over who benefits from a tax overhaul easier." (Bloomberg BNA)
Effect of the ACA on Health Care Access
"[G]aining insurance coverage through the expansions decreased the probability of not receiving medical care by between 20.9 percent and 25 percent. Gaining insurance coverage also increased the probability of having a usual place of care by between 47.1 percent and 86.5 percent. These findings suggest that not only has the ACA decreased the number of uninsured Americans, but has substantially improved access to care for those who gained coverage." (The Commonwealth Fund)
What the AHCA Means for Employers
"For larger employers not in the small group market, the AHCA creates an opportunity to choose a benchmark plan that offers a significantly lower level of benefits to employees.... The provisions of the GOP plan will be implemented over a 10-year period.... [T]he most important aspect of this for employers is to understand the trend in health insurance, which is undeniably moving in the direction of consumerism." (Corporate Synergies)
AHCA Passed by Narrow Vote, But Effect Still Unknown
"The precise impact on employer reporting continues to remain unclear. The requirement imposed on employers to offer coverage to full-time employees, and to measure and report part-time or full-time status, appears to remain intact." (Hodges-Mace)
Text of CBO Cost Estimate for the American Health Care Act, Incorporating Manager's Amendments 4, 5, 24, and 25
"CBO and JCT estimate that enacting H.R. 1628, with the proposed amendments, would reduce federal deficits by $150 billion over the 2017-2026 period... [In] 2018, 14 million more people would be uninsured under the legislation than under current law.... [The bill] would tend to increase average premiums in the nongroup market before 2020 and lower average premiums thereafter, relative to projections under current law. In 2018 and 2019, according to CBO and JCT's estimates, average premiums for single policyholders in the nongroup market would be 15 percent to 20 percent higher under the legislation than under current law." (Congressional Budget Office [CBO])
Final Results of the Actuarial Challenge
Provides links to the text of 14 papers submitted by collaborative teams in response to the Actuarial Challenge, which was an invitation to "move the individual insurance market further toward the goal universal access to quality health services and providers in a financially secure and stable way with consideration of the costs the solution places upon individuals, employers, health care providers, taxpayers (present and future), and other health sector stakeholders." Of the 14 papers, five were selected to be modeled and quantified through use of a simulation system (the Milliman Health Care Reform Financing Model). Modeling results are provided. (Robert Wood Johnson Foundation, American Academy of Actuaries, and Milliman)
[Opinion] Health Reform: What's Next?
"As Senator Alexander's working group goes about the task of crafting its repeal and replace plan ... it might start by clarifying three concepts muddled by industry noise and partisan bickering of late:.... [1] Affordability is about more than insurance premiums.... [2] Access is about more than carrying an insurance card.... [3] Our health system is about neither health or a system." (Paul Keckley)
ACA Round-Up: Developments Outside Congress
"Although attention has been focused on efforts in Congress to repeal and replace the [ACA], there has been ACA-related activity in the courts and on the administrative front as well. [1] The Franciscan Alliance case: defining gender discrimination under the ACA ... [2] Land of Lincoln and Moda Health Plan cases: risk corridor litigation ... [3] Administrative action: risk adjustment data validation and QHP certification." (Timothy Jost, in Health Affairs)
House Passes American Health Care Act to Repeal and Replace the ACA
"[A] heated battle in the Senate is expected, with the AHCA likely to be significantly amended ... Of particular importance will be discussions around pre-existing conditions and essential health benefits.... Even though the repeal and replacement of the ACA seems on its way, the ACA still remains the law of the land. Employers should continue to follow its requirements until the AHCA receives the signature of President Trump." [Includes a comparison chart of ACA and AHCA provisions, with proposed effective dates.] (Duane Morris LLP)
Summary of Key Provisions of the American Health Care Act (PDF)
13 pages. "The bill's key provisions include: [1] eliminating the individual shared responsibility and employer shared responsibility penalties; ... [2] funding for state-based high risk pools, a continuous coverage requirement, and a 5:1 community rating provision with state flexibility; [3] creating state waivers for age rating, essential health benefits (EHBs), and, where an individual's coverage has lapsed, community rating; [4] replacing the ACA premium subsidies with age-based tax credits of $2,000-$4,000 ... [5] delaying the implementation of the Cadillac tax[.]" (Groom Law Group)
House Passes American Health Care Act
"The AHCA would eliminate assessments under the employer mandate ... retroactively to 2016.... The Cadillac Tax on high-cost employer-sponsored health coverage would be delayed to 2026, but not eliminated by the AHCA.... The cap on health flexible spending arrangements (FSAs) would be removed; the annual contribution limit on health savings accounts (HSAs) would increase; over-the-counter drugs could again be purchased or reimbursed through FSAs or HSAs; insurance premiums could be paid or reimbursed through HSAs[.]" (Ballard Spahr LLP)
For Large Employers, House-Passed ACA Reform Bill Mostly Significant for What It Does Not Do
"[T]he underlying mandate to offer coverage would remain in the law and could be enforced by an ERISA lawsuit, and the IRS reporting requirements would remain in place along with the penalty for non-reporting.... [T]he requirements to provide dependent coverage until age 26, the prohibition on annual and lifetime limits, first-dollar coverage for preventive care, and 90-day waiting period limitation all remain in place along with their penalties for noncompliance." (HR Policy Association)
Anthem to Petition Supreme Court to Review Rulings Blocking Cigna Deal
"Anthem said its petition would focus on the stance of the third judge, Brett Kavanaugh, who sided with its defense of the deal.... If the court did take the case, it could take a year to resolve. That would be a timing challenge under the best of circumstances, but more so here because Cigna is fighting to terminate the deal." (The Wall Street Journal; subscription may be required)
GOP Senators to Draft Their Own Obamacare Replacement Bill
"[E]ven though the House spent months on a health care bill that would repeal and replace the [ACA], the Senate will use that legislation as a starting point to draft a separate measure.... The Senate must clear the added hurdle of the chamber's parliamentarian, who decides whether the legislation complies with the Byrd rule that allows Republicans to pass a bill with a simple majority of 51 votes under budget reconciliation. The parliamentarian can rule specific provisions out of order, stripping them from consideration." (Morning Consult)
[Guidance Overview] CRS Report on H.R. 1628: The American Health Care Act (AHCA) (PDF)
72 pages. "This report contains three tables that, together, provide an overview of all the AHCA provisions. Table 1 includes provisions that apply to the private health insurance market, Table 2 includes provisions that affect the Medicaid program, and Table 3 includes provisions related to public health and taxes. Each table contains a column identifying whether the AHCA provision is related to an ACA provision (e.g., whether it repeals an ACA-related provision). In addition to the three tables, the report includes more detailed summaries of each AHCA provision, and two graphics showing the effective dates of AHCA provisions." [Report R44785, May 4, 2017] (Congressional Research Service [CRS])
House Passes AHCA: How It Happened, What It Would Do, and Its Uncertain Senate Future
"The final AHCA as passed ... [1] Eliminates the taxes and tax increases imposed by the ACA; ... [2] Removes the individual and employer mandate penalties: [3] Increases age rating ratios from 1 to 3 to 1 to 5 in the individual and small group market and allows states to go higher by waiver; [4] Permits states to waive the ACA's essential health benefit requirements; [5] Imposes a penalty on individuals who do not maintain continuous coverage; ... [6] Creates funds of $138 billion to assist states in dealing with high-cost consumers and for other purposes; [7] Ends the ACA's means tested subsidies as of 2020 and substitutes for them age-adjusted fixed-dollar tax credits." (Timothy Jost, in Health Affairs)
Section-by-Section Summary of the American Health Care Act, as Passed by the House on May 4 (PDF)
15 pages. This official summary incorporates changes to an earlier version of the bill (the changes being popularly known as the MacArthur Amendment and the Upton Amendment). (Energy and Commerce Committee, and Committee on Ways and Means, U.S. House of Representatives)
American Health Care Act Passes the House
"All attention will now turn to the Senate to determine the fate of the ACA.... [T]he Upton Amendment provides an additional $8 billion in high-risk pool funding over five years (2018-2023) for waiver states for individuals with preexisting conditions who fail to maintain continuous coverage (and therefore may be subject to health status underwriting). The $8 billion supplements the AHCA's existing $130 billion in high funding over ten years." [Article includes a 13-point summary of the bill's provisions.] (ABD Insurance & Financial Services)
What's in the Republican Health Care Bill?
"[1] Ends tax penalties ... for individuals who don't buy insurance coverage and larger employers who don't offer coverage.... [2] Ends tax increases on higher-earning people and a range of industry groups ... [3] [L]ets states impose work requirements on Medicaid recipients.... [4] Overhauls insurance subsidy system from one based largely on incomes and premium costs to a system of tax credits ... [5] Lets states get federal waivers allowing insurers to charge older customers higher premiums than younger ones ... [and] exempting insurers from providing consumers with required coverage of specified health services ... [6] [Lets states that create high-risk pools get federal waivers from the] prohibition against insurers charging higher premiums to people with pre-existing health problems, but only if the person has had a gap in insurance coverage.... [7] Retains requirement that family policies cover grown children to age 26." (Fox News)
GOP Health Bill Jeopardizes Out-of-Pocket Caps in Employer Plans
"Under the House bill, large employers could choose the benefit requirements from any state -- including those that are allowed to lower their benchmarks under a waiver ... By choosing a waiver state, employers looking to lower their costs could impose lifetime limits and eliminate the out-of-pocket cost cap from their plans under the GOP legislation." (The Wall Street Journal; subscription may be required)
New $8 Billion for Those with Preexisting Conditions Appears to Boost AHCA; Critics Say Amount Is Too Low
"The amendment has been described as funding state high-risk pools. A state could certainly use its share of the $8 billion to fund risk pools as one approach to making coverage affordable to persons subject to high premiums because of their health status. But the money could also be used to directly subsidize the premiums or cost-sharing that high-cost consumers might have to pay for commercial insurance." (Health Affairs)
For Health Insurers, Court Decisions Continue to Complicate Risk Corridors Program Payments
"Although an insurer can still properly file a case now, the ruling in BCBS suggests another possible approach: presenting the issue after the numbers are fully tabulated for the entire three-year risk corridors program. Such an approach could help courts focus on the ultimate issue: whether a statute stipulating that an agency 'shall pay' under specified conditions imposes a legal obligation on the government to make payment when those conditions are met." [Blue Cross & Blue Shield of N.C. v. U.S., No. 16-651C (Fed. Cl. Apr. 18, 2017) ] (Faegre Baker Daniels LLP)
[Opinion] When 'Insurance' Is Not Insurance: The Preexisting Condition Debate
"[C]onsider a person who is currently uninsured but has recently been diagnosed with a serious medical problem. Given the opportunity, this person would love to purchase a health insurance policy. But make no mistake about it, this policy is no longer insurance in any traditional sense of the term. By skipping out on paying premiums until the illness strikes, this individual has consumed a lot more than everyone else when healthy, yet is able to consume almost the same as everyone else when sick (almost because there is likely to be some cost sharing). This isn't consumption smoothing, it is free riding, and this is what the prohibition on considering preexisting conditions encourages." (David Dranove and Craig Garthwaite, at Code Red)
Moderate Republican Crafts Plan to Boost Stalled Health Care Bill
"Rep. Fred Upton, R-Mich.... said the proposal would provide $8 billion over five years to help some people with pre-existing medical conditions pay costly insurance premiums.... The existing health care measure would let states get federal waivers allowing insurers to charge higher premiums to people with pre-existing illnesses who'd let their coverage lapse.... The money in Upton's plan would help people with pre-existing illnesses pay premiums in states where insurers can charge them more." (
Ninth Circuit Denies Health Care Providers' ERISA Claims
"Consistent with the Second, Third, Sixth, Seventh, and Eleventh Circuits, the Ninth Circuit held that medical providers were not 'beneficiaries' under Section 502(a) of ERISA and therefore could not bring suit directly under ERISA.... The Court also denied the plaintiffs' derivative claims." [DB Healthcare, LLC v. Blue Cross Blue Shield of Ariz., Inc., No. 14-16518 (9th Cir. Mar. 22, 2017)] (Robinson & Cole LLP)
ACA Didn't Reduce Care Access for Those Already Insured
"Data from the Medical Expenditure Panel Survey from 2008 through 2014 saw no effect on access to care for continuously insured individuals across eight measures, despite the increase in coverage over that period provided by the [ACA] ... The authors note that the study covered a range of scenarios, from years with relatively low increases in insurance coverage to years during which Medicaid expansion and improving job markets drove higher expansion." (FierceHealthcare)
[Opinion] Interrogating The Dream: What Does Single Payer Really Mean?
"At the time of the Clinton administration reform efforts of the 1990s, the left wanted a 'Canadian-style' single-payer system, until the reality that Canada has a provincial system finally sank in. Medicare for all is the current paradigm, but it has not been closely examined. Most crucially, the place of Medicaid in the post-repeal environment has not been imagined by single-payer advocates.... If a single-payer solution is to be argued as anything but a pipe dream, advocates must map out a clear and realistic path forward. This includes recognizing and addressing a number of factors that single-payer dreamers have long been loath to acknowledge." (Health Affairs)
[Opinion] Who Should Pay to Cover Pre-Existing Conditions?
"[T]reating an expensive health condition costs (someone) lots of money. There are four basic approaches that can be taken to this problem. [1] Leave sick people to face the costs of their own treatment, whether out of pocket or through high-cost insurance, no matter how ruinous those costs become. [2] Mandate that other, healthier people overpay for the value of their own health insurance, so that sick people can underpay for the value of theirs. [3] Spread the costs of paying expensive health bills throughout society, for example by having taxpayers pick up the tab. [4] Require a targeted group to shoulder the costs." (Charles Blahous, Manhattan Institute for Policy Research)
Health Bill Remains In Limbo, GOP Still Divided
"Hopes for a revamped Obamacare bill veered from optimistic to doubtful in a matter of hours yesterday as the Trump administration and Republicans in Congress scrambled to build support for the massive health care legislation.... CNN reported last night that 21 Republicans have now gone on record opposing the Obamacare replacement bill. If a total of 23 GOPers reject the legislation, it will fail to reach the necessary 216 votes. Some 13 Republican lawmakers were still undecided." (
Business Groups Urge Administration to Accelerate Market-Based Health Care Reforms
"A national partnership led by two business organizations representing Fortune 500 companies, the Pacific Business Group on Health and The ERISA Industry Committee, announced today the DRIVE Health Initiative, a campaign to accelerate economic growth by controlling health costs and improving quality through the rapid adoption of value-based health care.... The Initiative's policy blueprint, found on its website, urges immediate targeted deregulation and other actions to break down policy barriers that discourage value-based care innovation and prevent the health care market from delivering valuable products at affordable costs." (The ERISA Industry Committee [ERIC])
When All Is Said and Done, Will Tax Reform Spare Employee Benefits?
"While the president's plan is silent on the tax treatment of health care premiums, it does call for ... the elimination of the ACA's 3.8 percent net income investment tax, which applies to taxpayers with a modified adjusted gross income of more than $200,000 for single filers and $250,000 for married couples filing jointly.... [That] tax hits small business owners hard, since their business earnings are often treated as personal income, and is a drag on economic growth." (Society for Human Resource Management [SHRM])

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