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Benefits in the News > By Subject >

Health plans - policy


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[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)
JBEA Advisory Committee to Meet in July
"The Joint Board for the Enrollment of Actuaries gives notice of a meeting of the Advisory Committee on Actuarial Examinations (portions of which will be open to the public) ... on July 13-14, 2017.... The purpose of the meeting is to discuss topics and questions that may be recommended for inclusion on future Joint Board examinations in actuarial mathematics and methodology ... and to review the May 2017 Pension (EA-2L) and Basic (EA-1) Examinations in order to make recommendations ... Topics for inclusion on the syllabus for the Joint Board's examination program for the November 2017 Pension (EA-2F) Examination will be discussed." (Joint Board for the Enrollment of Actuaries [JBEA])
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)
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)
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)
Witness Statements to ERISA Advisory Council: 'Reducing the Burden and Increasing the Effectiveness of Mandated Disclosures with Respect to Employment-Based Health Plans in the Private Sector'
Testimony submitted for June 6, 2017 meeting: (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
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)
[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)
[Official Guidance] Text of EBSA Request for Nominations to the 2018 ERISA Advisory Council
"The terms of five members of the [Advisory Council on Employee Welfare and Pension Benefit Plans (the ERISA Advisory Council)] expire at the end of this year. The groups or fields they represent are as follows: [1] employee organizations; [2] employers; [3] corporate trust; [4] investment management; and [5] the general public.... [N]otice is hereby given that any person or organization desiring to nominate one or more individuals for appointment to the [ERISA Advisory Council] to represent any of [these] groups or fields ... may submit nominations [which] must be received on or before August 1, 2017." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
[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)
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)
Market Uncertainty Driving ACA Rate Increases
"Two market influences, in particular, are complicating 2018 rate setting: the uncertainty surrounding continued funding of cost sharing reduction (CSR) payments and the question of how the relaxation of the individual mandate will impact enrollment and risk pools.... [Up] to two-thirds of 2018 rate increases will be due to the uncertainty surrounding these two market influences." (Oliver Wyman Health)
[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)
For AHCA, CMS Actuary Finds Smaller Coverage Losses, Smaller Spending Reductions Than CBO
"The headline from the Actuary's report that is likely to receive the most attention is that the CMS Actuary sees the AHCA as increasing the uninsured by 4 million for 2018/2019 and by 13 million by 2026. By contrast, the CBO estimated that the AHCA would increase the uninsured by 14 million for 2018 and 23 million by 2026. The Actuary also, however, projects far smaller reductions in federal health care spending from the AHCA than did the CBO -- a total of $328 billion over ten years[.]" (Timothy Jost, in Health Affairs)
Estimated Financial Effect of the American Health Care Act of 2017 (PDF)
"Over fiscal years 2017-2026, selected provisions of the AHCA are anticipated to reduce Federal expenditures by over $328 billion primarily because of lower Medicaid spending. In 2018, the number of uninsured is estimated to be about 4 million higher under the AHCA than under current law ... By 2026, the number of uninsured is estimated to be roughly 13 million higher under the AHCA.... For the individual insurance market, average gross premiums are estimated to be roughly 13 percent lower in 2026 under the AHCA than under current law." (Office of the Actuary, Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
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)
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])
Patients Can't Afford Obamacare, Drop Coverage
"CMS' report shows that 3.6 million American patients selected a plan on the Obamacare exchange during 2016, but had dropped their coverage by the end of the year. Of those who dropped their plans, 46 percent attributed the decision to cost.... [R]oughly twice as many Americans have chosen to pay the penalty tax or claim a hardship exemption than those who have enrolled in Obamacare's exchanges." (Energy and Commerce Committee, U.S. House of Representatives)
[Opinion] Health Reform: The Tipping Points We Should Be Watching
"Delegating Medicaid and insurance oversight to states is great politics for federal legislators but problematic ... if accompanied by regulations that hog-tie Governors with red-ink.... In the 57% of companies that provide coverage, employee contributions are increasing (19% for single/29% for family policies) and high deductible products are fast becoming the status quo.... Physicians are unhappy.... Hospital closures [may occur because the] ... inpatient business is increasingly unprofitable, the outpatient business is being cherry-picked by opportunistic investors, and cheaper, accessible, safe and effective alternatives are proliferating." (Paul Keckley)
[Opinion] Joint Letter to Congress Regarding Health Care Reform Proposals (PDF)
"Chief among the threats to employer-sponsored coverage are proposals to tax workers' health coverage, whether by preserving the ACA's 40 percent 'Cadillac' tax, or imposing new taxes on employee health care benefits. Legislation that implements a tax on health benefits ('cap on the exclusion') will result in a system that is worse than current law for workers and for employers, and failure to eliminate the Cadillac tax will raise coverage costs for American workers, their families and employers, and work against efforts to lower health care costs." (Employers Council on Flexible Compensation [ECFC] and 52 Other Business and Trade Associations)
Two States Make Strong Statements About Their ACA Markets
"The bold actions of New York and Nevada probably do not signal a national trend in the short run. Both are in the minority of states that run their own Exchange ... so they have more control over their Exchange markets than most states.... The Trump administration is committed to empowering states, and Medicaid and Exchange markets are more alike than different. Given this -- and absent large Medicaid cuts that could trigger insurer exits from that market -- more states may be tempted to link the Medicaid and Exchange markets[.]" (Faegre Baker Daniels LLP)
'May I Borrow Your Health Reform Bill?' (PDF)
"As details about [the] Senate bill began to emerge ... lo and behold the Senate's outline looks very much like the House bill after all.... [T]he Senate has [apparently] abandoned, at least for purposes of the health reform effort, any notion to begin taxing employees on the value of the employer-provided health insurance.... Nevertheless, there are hints the House and Senate may revisit that issue as part of their tax reform effort later in the year." (Lockton)
HHS Requests Feedback on ACA Regs; Evidence on Effect of CSR Payment Uncertainty Continues to Mount
"Some of these Obama-era initiatives -- in particular, the transitional plans -- were of questionable legality under the ACA, but some of the Trump initiatives -- such as stretching the 'de minimis variation' permitted for health plan variation, push the boundaries in other directions. The request for information seems to contemplate steps that would depart even further from the legal moorings of the ACA." (Timothy Jost, in Health Affairs)
[Opinion] Why Not Try 'Medicare for All'? ... Glad You Asked
"Because costs will spiral out of control. Because hospital care will suffer. Because the stakes are too high for a mass experiment." (Megan McArdle, via Bloomberg)
HHS Secretary Dodges Specifics on Obamacare Payments to Insurers
"[HHS] Secretary Tom Price defended the need to overhaul the [ACA] but didn't offer new ways the administration would give insurance companies much-needed answers during his testimony to a Senate panel [June 8].... But Price declined to answer Sen. Debbie Stabenow (D-Mich.) on whether the administration plans to reimburse cost-sharing reduction payments to insurers -- though he later confirmed the HHS budget request for the next fiscal year includes funding for the payments." (Morning Consult)
[Official Guidance] Text of CMS Request for Comments on Reducing Regulatory Burdens Imposed by the ACA and Improving Healthcare Choices to Empower Patients (PDF)
"HHS is interested in soliciting public comments about changes to existing regulations or guidance, or other actions within HHS 's authority, that could further the following goals with respect to the individual and small group health insurance markets : [1] Empowering patients and promoting consumer choice.... [2] Stabilizing the individual, small group, and non-traditional health insurance markets.... [3] Enhancing affordability.... [4] Affirming the traditional regulatory authority of the States in regulating the business of health insurance." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Senate Sets Timeline to Take up Repeal and Replace Legislation on ACA
"Senate Republican Leader Mitch McConnell (R-KY) ... would like the chamber to vote on a bill before the July 4th recess and use the rest of July to reconcile the House and Senate versions, leading to a final vote before the August recess.... [T]he Senate parliamentarian is still in the process of reviewing the House-passed bill to make sure it does not violate Senate rules. Therefore, the legislative vehicle has still not officially been delivered to the Senate from the House. A ruling is expected this week." (Foley & Lardner LLP)
Can Congress Get to 'Yes' on Replacing the ACA?
"[T]he ACA and AHCA are 'apples and oranges' in their approaches to reforming the healthcare system.... [To] achieve the GOP's publicly stated policy objectives, and faced with the constraints imposed by the budget reconciliation rules ... Senate Republicans will be forced to address essentially the same questions as their colleagues in the House -- and their solutions likely will differ from those of the House mostly in degree." (Mintz Levin)
[Opinion] ERIC Testimony to ERISA Advisory Council on Mandated Disclosures for Employment-Based Health Benefit Plans in the Private Sector
"[It] would be in the best interests of both plan sponsors and plan beneficiaries for DOL to do a comprehensive review of all DOL's exclusive as well as multiā€agency beneficiary disclosure requirements ... and ask a number of questions, including ... [1] Is this information specifically required by statute to be furnished? Would this information be useful to most beneficiaries? ... [2] Is this the only requirement that asks for this information, or is the same information required to be furnished multiple times, in multiple ways, every year? ... [3] Can this information be combined with other information elsewhere, or be eliminated due to repetition or lack of practical use to plan beneficiaries? [4] Does this information serve to inform of the obvious, or to restate a legal requirement that is already posted on a government website? " (The ERISA Industry Committee [ERIC])
[Opinion] ERIC Testimony to ERISA Advisory Council on Mandated Disclosures for Retirement Plans (PDF)
"Prior to this position in human resources, as a lawyer and policymaker in Washington, DC, I was naļve to the impact laws and regulations can have on plan sponsors and participants.... I now firmly believe that the decades of laws, regulations, and court decisions since the enactment of ERISA in 1974, coupled with a decrease in financial education programs in schools and communities, have caused the retirement industry to be overly complex and intimidating for a large segment of plan participants.... [E]mployers can only do so much when in place are laws, regulations, and legal precedence that impede their ability to educate their employees." (Will Hansen, for The ERISA Industry Committee [ERIC])
[Opinion] Confronting the Trade-Offs in Health Reform: What We Learned from the ACA
"Regardless of the form of financing or benefits, health care coverage is expensive because health care is expensive. Ultimately, the key to affordable coverage for all remains cost containment.... The AHCA has no provisions that address the high cost of health care; instead; it converts Medicaid into a block grant to limit federal obligations, leaving the states holding the cost containment bag for Medicaid. Similarly, the AHCA allows states to request waivers from many of the ACA's benefit provisions but does not help states containing costs other than by reducing coverage. The challenge of 'bending the cost curve' remains." (Clifford Marks, Janet Weiner, and Daniel Polsky, in Health Affairs)
[Opinion] No, Trump Didn't Cause Obamacare to Fail
"If we stay with Obamacare, within a few years tens of millions will have no insurance that is even remotely affordable. Republicans have to do a much better job of explaining their plan and providing Americans better and cheaper options. By the end of the year we could have nearly half the country without insurers if this spiral continues." (The Heritage Foundation)
[Opinion] Limiting the Employer Tax Exclusion for Healthcare Is the Wrong Idea
"[A]ltering the tax-favored status of employer-provided benefits will have the same effect as the Cadillac tax -- employers are going to plan around it.... If the employer exclusion is eliminated there would be little incentive for employers to continue to provide benefits -- and if they do, the pressure to reduce costs, and thus benefits, will be intense. The impact on lower-paid workers would be far greater than the more highly-compensated group." (Craig Hasday, via Employee Benefit Adviser)
Supreme Court 'Church Plan' Decision and Pending Rule Will Affect Preventive Services Coverage by Group Health Plans
"The group health plan requirements of the [ACA] apply to church plans ... The government has consistently taken the position, however, that, because church plans are exempt from ERISA, it has no means of compelling the third party administrators of self-insured church plans to comply with the ACA, or at least its preventive services requirement.... The leaked contraceptive rule would effectively extend the exceptions that have excused self-insured church plans -- and churches -- from complying with the contraceptive [coverage] requirement ... If the rule that emerges from HHS is significantly narrower than the leaked version, more entities might rely on the Advocate Health Care ruling to claim the protection of the church plan exemption." (Timothy Jost, in Health Affairs)
How and Why to Avoid High-Risk Pools for Americans with Preexisting Conditions
"[P]eople with preexisting conditions constitute roughly 51 percent of Americans. [This article will] explore who might end up in a high-risk pool, what their experiences might be, and policymakers' alternative options for stabilizing the marketplaces." (The Commonwealth Fund)
[Opinion] The Senate Should Build Automatic Enrollment into Health Reform: Here's How
"[A]utomatically enrolling Americans eligible for tax credits into no-premium health plans should be an important component of a renewed effort at health reform. Many of the uninsured who do not make plan selections on their own can be enrolled into plans that provide true insurance against significant or catastrophic health events. Individuals who are auto-enrolled will have the opportunity to opt-out of that coverage if they prefer; they will also be given the opportunity to switch to a different plan during the next available open enrollment period.... [The authors] seek to address some of the administrative and related issues regarding how such a system might be built and implemented." (Lanhee Chen and James Capretta, in Health Affairs)
[Opinion] Obama's Overreach May Be Downfall of ACA
"Obama administration officials knew they were on shaky ground in spending billions of dollars on health insurance subsidies without clear authority. But they did not think a long-shot court challenge by House Republicans was cause for deep concern. For one thing, they would be out of office by the time a final ruling in the case, filed in 2014, was handed down. They also believed that a preliminary finding against the administration would ultimately be tossed out. Finally, they figured that President Hillary Clinton could take care of the problem, if necessary. Well, they are out of office, Mrs. Clinton is not president and the uncertain status of the cost-sharing payments now looms as the biggest threat to the stability of the insurance exchanges created under the [ACA]." (Carl Hulse, via The New York Times; subscription may be required)
Trump Administration Appears Set to Reverse Rules for Contraceptive Coverage by Objecting Employers
"On May 30, 2017, a draft of an interim final rule ... addressing conscience-based objections to the coverage of contraceptives under the preventive services requirement of the [ACA], was leaked to the media. The draft seems authentic and has been widely reported in the media. However, the draft is currently at the Office of Management and Budget for review, and the interim final rule when released may be different from the draft." (Health Affairs)
GOP Senators Mull Taxing Employer-Sponsored Health Plans
"Senate Republicans set on reworking the [ACA] are considering taxing employer-sponsored health insurance plans, a move that would meet stiff resistance from companies and potentially raise taxes on millions of people who get coverage on the job. The move could raise billions in revenue that could be used to help stabilize the fragile individual insurance market." (The Wall Street Journal; subscription may be required)
[Opinion] ERISA: A Bipartisan Problem for the ACA and the AHCA
"[T]he ACA's attempt to create greater uniformity of benefits is at odds with the way ERISA creates a special class of protected plans and blocks states efforts to regulate them. When you ask yourself why the ACA's guarantee of essential health benefits applies to some health plans but not to others, the answer is deference to ERISA. When you ask yourself why some health plans are subject to state-mandated benefit laws but some remain exempt, the answer is ERISA.... [The authors] review the recent and upcoming ERISA jurisprudence below and conclude it is time for the Court, or Congress, to cabin ERISA's reach when it comes to health care." (Abbe R. Gluck, Allison K. Hoffman, and Peter D. Jacobson, via Health Affairs)
What Is Single-Payer Health Care? A Review of Definitions and Proposals in the U.S.
"[The authors] identified 25 proposals for national or state single-payer plans ... The proposals typically call for wide-ranging reform; nearly all include changes across the financing, pooling, purchasing, and delivery of health care services.... Common provisions are related to comprehensive benefits, patient choice of providers, little or no cost sharing, the role of private insurance, provider guidelines and standards, periodic reviews of the benefits package, electronic medical records and billing, prescription drug formulary, global budgets, administrative cost thresholds, payment reform and studies, and the authority to implement cost-containment strategies." (RAND Corporation)
California's New Single-Payer Proposal Embraces Some Costly Old Ways
"[T]he $400 billion single-payer proposal that's advancing in the California legislature would restore fee-for-service to its once-dominant perch in California. A state Senate analysis released last week warned that fee-for-service and other provisions in the legislation would 'strongly limit the state's ability to control costs.' Cost containment will be key in persuading lawmakers and the public to support the increased taxes that would be necessary to finance this ambitious, universal health care system for 39 million Californians." (Kaiser Health News)
Issues for Employers as Health Care Legislation Moves to the Senate
"The repeal of the employer mandate, the replacement of the individual mandate with a continuous coverage requirement, the delay of the Cadillac tax, and changes to requirements for individual market coverage will affect the choices available to private sector employers. Now that the Senate is drafting its own bill, employers will want to understand their stake in the legislation." (Jones Day)
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 the AHCA provisions, as amended by the five manager's amendments and the amendment referenced in H.Res. 254. 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 the AHCA provision repeals an ACA-related provision).... [T]he report [also] includes more detailed summaries of each AHCA provision and two graphics showing the effective dates of AHCA provisions." [Report R44785, updated May 26, 2017] (Congressional Research Service)
[Opinion] It's Time for 'The Talk' About the Future of Our Health System
"Public opinion is trending toward a single payer or some form of universal coverage. The majority believe healthcare coverage is a fundamental right and the federal government should play a bigger role in its provision, but most do not understand how the system operates nor believe it comprehensible. The majority think health costs are too high but rarely check prices or pursue cheaper courses of treatment. The majority believe the [ACA] is flawed but prefer it be fixed rather than replaced. And while opinions are changing, the right path forward remains unclear to most." (Paul Keckley)
Democrats Introduce Bill to Test Benefits for Gig Workers
"The Portable Benefits Pilot Program Act would create a $20 million Labor Department grant program for states, local governments, and nonprofits to experiment with portable benefits for gig workers.... The federal legislation comes as lawmakers in states including Washington, New York, and New Jersey are considering measures to provide benefits for gig economy workers. It also comes amid calls for the federal government to tweak employment tax and worker classification laws." (Bloomberg BNA)
Health Plan Payment in U.S. Marketplaces: Regulated Competition with a Weak Mandate
"While the individual market represents a small slice of the U.S. population, it has historically been the market segment with the lowest rates of take-up and greatest concerns about access to robust coverage.... [This paper lays] out in detail how the Marketplaces adopt the tools of regulated competition. [It then discusses] ways in which the Marketplace model deviates from the more conventional model and how those deviations may impact the eventual success or failure of these new markets." (National Bureau of Economic Research [NBER])
[Opinion] Efforts to Shore up MassHealth Should Favor Simplicity and Avoid Potential Conflict with Federal Law
"In an effort to make up for a funding shortfall in the Commonwealth of Massachusetts' Medicaid program, state policymakers have proposed solutions that include a 'play-or-pay' option under which employers who fail to offer major medical coverage ... would be required to pay an additional 'employer contribution' to the Commonwealth based on multiple factors and complex computations.... The 'play-or-pay' option would not only be extremely complicated to comply with and enforce, ... it may be preempted by [ERISA]." (Mintz Levin)
AHCA Uncertainty Has Some Health IT Startups Drifting Away from Providers
"Smaller digital health startups are pivoting toward consumers because the uncertainty surrounding an ACA repeal has left providers hesitant to invest in new technology ... 'In the end, it will be a scalability issue,' [said] Lee Perlman, president of GNYHA Ventures Inc., the for-profit arm of the Greater New York Hospital Association ... 'If forced to choose between providing basic patient care and new investment, basic patient care will win.' " (FierceHealthcare)
[Opinion] American Benefits Council Letter to Sen. Hatch: Policy Proposals to Preserve Employer-Sponsored Group Health Plans
"[1] Address the underlying problems with high health care costs ... [2] Fully repeal the 40 percent 'Cadillac Tax' on employer plans ... [3] Reject new proposals to tax employees' health benefits ... [4] Preserve ERISA's uniform standard for plan administration ... [5] Fully repeal the employer mandate and reduce employer reporting burdens ... [6] Expand the availability and flexibility of consumer-directed plan designs ... [7] Maintain treatment of HIPAA-excepted benefits ... [8] Stabilize the individual market, including reliable funding for the cost-sharing reduction subsidies ... [9] [S]implify the rules for electronic disclosure of any benefits documents employers are required to provide employees." (American Benefits Council)
[Opinion] Four Reasons Why the CBO's AHCA Score Is Flawed
"[1] CBO is assuming 4 million more people starting out with insurance than the actual number.... [2] AHCA's CBO score includes the potential enrollment from the 19 states that 'could' expand their Medicaid rules.... [3] While CBO doesn't actually define what constitutes insurance in the score, they insinuate that some states will cut or reduce the number of essential health benefits and cause out-of-pocket limits to rise. Suffice it to say it's amazing that they can't give us this definition yet count a few million people as uninsured because of this definition.... [4] Finally, the CBO score doesn't tell us who doesn't want to buy insurance. Without a mandate any number of people might simply say no thanks. These people aren't losing insurance, they simply don't want it." (InsureBlog)

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