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November 11, 2008

Here are the Web's best new links about compliance and cost aspects of plan operation, design and policy.


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[Guidance Overview] ERISA Service Provider Litigation: Health Benefits and the War Against PBMs (PDF)
19 pages. Presentation at the 19th Annual ABA Institute on ERISA Litigation, Chicago, November 7, 2008. (Morgan, Lewis & Bockius LLP)


Employer Mandates and ERISA Preemption: A Critique of Golden Gate Restaurant Association v. San Francisco
Excerpt: "The Ninth Circuit's recent decision in Golden Gate Restaurant Association v. San Francisco saves the employer mandate of the San Francisco ordinance from ERISA preemption by slighting the language of the statute and by misapplying the U.S. Supreme Court's existing case law under ERISA Section 514(a). If (as is likely) the Supreme Court rules upon the ERISA status of employer mandates like San Francisco's by adhering to its past decisions, the Court will strike such mandates as ERISA-preempted. Under current law, the Ninth Circuit's opinion in Golden Gate II is not sustainable." (Social Science Research Network)


Will Consumer-Directed Health Plans Survive Obama/Democratic Rule?
Excerpt: "Paul Fronstin, senior research associate at the Employee Benefit Research Institute in Washington, D.C., agrees that the Obama administration 'certainly won't be friendly toward HSAs, and is highly unlikely to support anything that expands them.' However, he says that with millions of Americans already enrolled in an account-based plan, it is 'highly unlikely that the administration will do anything to prohibit or stunt their growth.'" (AISHealth.com)


Insurance Producers Worried Obama Health Plan Could Leave Them Out
Excerpt: "[A]s the health insurance community prepares for revived efforts at health care reform under president-elect Obama, it is not the insurers who write the coverage, but the producers who sell it, that seem most alarmed by changes that could be coming. . . . Though several aspects of Obama's health plan concern them, the issue that has benefits brokers most concerned is the proposed 'National Health Insurance Exchange,' a federal pooling mechanism open to all businesses and all individuals. By making the federal government the primary intermediary in the benefits market, and greatly curtailing the degree to which group plans can differ in cost or design, the NHIE, some fear, could effectively displace the agent community nationwide." (BestWire Services via NewsEdge via Human Resource Executive Online)


Advice for the 'Seemingly Healthy': Know Your Chances for Becoming Ill
Excerpt: "Know Your Chances is all about putting the numbers describing risks and benefits in context. And this is what Americans need to do when they hear the news stories about Crestor. Should everyone be tested for CRP? If it turns out your CRP levels are high should you start downing Crestor, 'just to be safe? '" (The Century Foundation)


Chronic Disease Management: Evidence of Predictable Savings (PDF)
46 pages. Excerpt: "As major health reform once again gains national attention, the drive to obtain better results in caring for those with chronic illness while slowing spending growth has grown stronger. This study shows that carefully targeted and well-designed care management programs can improve health outcomes for people with chronic illness and save money on a predictable basis. Our report identifies the key elements of care management interventions that maximize the opportunity for success." (Health Management Associates)


UAW's VEBA Board Concerned Autoworkers' Health Care Benefits in Peril
Excerpt: "A union-run health care trust known as a voluntary employee benefit association, or VEBA, was supposed to help the automakers escape bankrup.tcy by capping the amount they would pay for retiree health care expenses. For the retirees, the VEBA was described as insurance against losing retiree health care benefits should the automakers file for bankrup.tcy. The money would be available for retiree health care regardless of how the automakers fared. But in July, GM deferred paying $1.7 billion into the VEBA, angering GM retirees." (Workforce Management; free registration required)


Retiree, Business and Labor Groups Call for Comprehensive Healthcare Reform in New Administration's First 100 Days
Excerpt: "Four leading advocacy groups representing business, labor and retirees are starting a campaign today to press Barack Obama to enact comprehensive healthcare reform, upping the pressure on the president-elect to tackle the issue quickly after he takes office. In a letter to Obama, the Business Roundtable, the National Federation of Independent Businesses, AARP and the Service Employees International Union urge that a healthcare overhaul be a priority in the administration's first 100 days." (Los Angeles Times)


Employer Coalition Focuses on High-Value Health Benefits
Excerpt: "The Mid-America Coalition on Health Care (MACHC) has announced a two-year national pilot project to establish the rationale and best practices for employers to adopt high-value health benefits. According to a press release, the Kansas City Collaborative (KC2) will use Value Based Benefits concepts to develop data-driven tools and resources to help employers improve the health of employees and their families, promote employee wellness, and manage longer-term health care costs." (PLANSPONSOR.com; free registration required)


Health Care Systems Around the World (PDF)
38 pages. Excerpt: "There are many lessons to be learned from the health systems of the ten countries presented here: (1) Can.ada; (2) Denmark; (3) France; (4) Germany; (5) Israel; (6) Japan; (7) the Netherlands; (8) Sweden, (9) Switzerland; and (10) the United Kingdom. This report provides a basic overview of the core features of each system. Links to more detailed information are included at the end of each country's section." (Insure the Uninsured Project)


U.S. News & World Report Releases America's Best Heath Insurance Plans Rankings
Excerpt: "U.S. News & World Report on Friday issued its America's Best Heath Insurance Plans rankings and published several articles related to the issue. Headlines and summaries [with links to the articles are on the Kaiser site]." (Kaiser Family Foundation)


Plan Design and Active Involvement of Consumers in Their Own Health and Healthcare
Excerpt: "Objective: Underlying consumer-driven health plans (CDHPs) is the belief that the financial incentives, enhanced choices, and increased information will stimulate consumers to become active, informed managers of their own health and healthcare (ie, activated consumers). To examine this assumption, we assessed whether enrollees became more activated after enrolling in a CDHP and the degree to which those who were more activated adopted productive health behaviors. . . . Results: The hypothesis that enrollees in a CDHP become more activated over time was not supported. However, the data suggest that those who were more activated were more likely to engage in the behaviors that CDHPs seek to encourage and to newly adopt these behaviors over time. This appeared to be true regardless of plan type." (The American Journal of Managed Care)


AMA Wants Physicians to Take Action for Accurate Insurer Payments This Fall
Excerpt: "As part of its national campaign to save the health system billions of dollars by improving the accuracy and efficiency of medical claims processing, the American Medical Association (AMA) today announced it has selected November for the first national Heal that Claim Month. Many physician practices often experience an increase in claim denials from health insurers during the last quarter of the year, making November an ideal time to appeal inappropriately underpaid and denied claims." (American Medical Association via Physicians for a National Health Program)


Uwe Reinhardt Explains Family Health Care Costs and the Health Care Reform Challenge
Excerpt: "According to the Milliman Medical Index, this total health spending figure for a typical non-elderly American family of four had reached an average of $15,600 by 2008. It had grown at an average compound growth rate of about 8.6 percent from $11,192 in 2004. To return to our family with an assumed gross wage base of $60,000: If that gross wage base grew by, say, 3 percent per year over the next decade, to $80,600 by 2017, while total family health spending grew by, say, 8 percent per year over the same time frame, to $33,700 by 2017, then about 41 percent of the family's gross wage base would be taken up by health care alone, before any deductions for taxes or fringe benefits. If the wage base grew by 4 percent, health spending still would absorb about a third of the family gross wage base." (Physicians for a National Health Program)


[Opinion] An Interview with Steffie Woolhandler on Private Insurance, High Costs and the Denial of Care
Excerpt: "[Question]: If single payer faces the serious political obstacles that come from calling for wiping out the private health insurance system, are there incremental things that can be done to take us in that direction? Woolhandler: The only incremental thing that one can do that makes any sense at all would be placing all hospital care into a single payer system as a first step, and then later placing other types of care into a single payer system. That's what happened in Saskatchewan. They initially enacted a single payer system that covered all the hospitals and then a few years later enacted a single payer system that covered everything. That will work, because if you do the whole sector at a time, you can get the administrative savings. The thing that won't work is a patch here, a patch there, because you don't get any of the administrative savings." (Multinational Monitor via Physicians for a National Health Program)


[Opinion] Letter from Sen. Max Baucus to Obama on Comprehensive Health Reform (PDF)
2 pages. Excerpt: "I write to inform you that as Chairman of the Senate Finance Committee, next week I will present to you and to the country my plan to move forward on health care reform in the early days of the 111th Congress and of your administration. As you know, the Senate Finance Committee has jurisdiction over Medicare, Medicaid, the Children's Health Insurance Program, and other health entitlement programs. I intend to work with you and with my colleagues on the Finance Committee, as well as with the Chairmen and Ranking Members of the Health, Education, Labor, and Pensions Committee and relevant Committees in the House, to finalize a comprehensive health reform plan that can pass the Congress and be put on your desk in a timely fashion for signature into law." (Sen. Max Baucus via American Benefits Council)



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(Please visit our sponsors. We try to make sure their products and services will be of interest to you. Thanks! --Editor)

Links to Items on Executive Comp, Benefits in General

Know Your Severance Rights and Risks
Excerpt: "[Don't have an employment agreement specifying severance terms.] Don't assume you will get anything, employment attorneys say. That is not to say it's impossible; in some cases even if there is no preexisting agreement, the company might offer severance to restrict the employee from competing with it for a period of time, notes Kenneth Raskin, a compensation and employment partner at White & Case. But the employer, not the employee, owns that right. Merely asking the firm to provide you with a guarantee of severance in the event of termination without cause is very unlikely to work." (CFO.com)


If Current Economic Situation Continues, Most HR Officials Say They Would Consider Providing More Financial Planning Information to Help Employees Cope
Excerpt: "A news release by the Society for Human Resource Management (SHRM) said 83% of poll respondents reported that their response could well include financial educational literature and/or workshops by investment specialists. Another 21% said they might revise investment policies for 401(k) plans and other savings programs." (PLANSPONSOR.com; free registration required)




Newly Posted Events
(Post Yours!)

Health Benefits Laws Compliance in Texas - Webcast
Nationwide on November 13, 2008
presented by U.S. Department of Labor, Employee Benefits Security Administration (EBSA)

Highlights of the ASPPA Annual Conference
in Massachusetts on November 19, 2008
presented by ASPPA Benefits Council (ABC) of New England

Massachusetts Health Reform: A Giant Step Toward Universal Coverage? - Webcast
Nationwide on November 12, 2008
presented by KaiserNetwork.org

The Business of Health Reform: Measuring the Pulse of the Employer - Webcast
Nationwide on November 12, 2008
presented by KaiserNetwork.org

The Final FMLA Regulations: What They Mean and How to Prepare your Organization for the Changes
Nationwide on December 9, 2008
presented by Spencer Fane Britt & Browne LLP



Newly Posted Press Releases
(Post Yours!)

National Business Coalition on Health Honors Leaders in Health System Reform
National Business Coalition on Health

NBCH Recognizes Health Plans for Ground-breaking Programs for Improving Health and Health Care
National Business Coalition on Health

Health Reform and Quality Improvement Leader, Bruce E. Bradley, Honored with Lifetime Achievement Award from NBCH
National Business Coalition on Health

Employees Wrongly Think "You Get What You Pay For" In Health Care
Midwest Business Group on Health

MSN Money Launches Educational Webisodes to Help Protect Military Service Members From Financial Fraud
Microsoft

Kansas City Employers Launch National Effort to Promote Employee Health and Wellness and Manage Longer-Term Health Care Costs
Mid-America Coalition on Health Care

Kansas City Employers Launch National Effort to Promote Employee Health and Wellness and Manage Longer-Term Health Care Costs
Mid-America Coalition on Health Care



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Defined Contribution and Small Plans Unit Leader
for Southern California Pipe Trades Administrative Corporation
in CA

401(k) and Pension Manager
for TPA in Colorado region
in CO

Director of Congressional Affairs
for ASPPA
in VA

Director of Regulatory Affairs
for ASPPA
in DC, VA

Pension Analyst
for Long Island Employee Benefits Group, Ltd.
in NY

Chairman of Administration Services for TPA Firm
for Dana Consulting Group, Ltd.
in IL




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