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[Official Guidance]
Text of OPM Proposed Regs to Implement Multi-State Plan Program for Affordable Insurance Exchanges (PDF)
"Through contracts with OPM, health insurance issuers will offer at least two multi-State plans (MSPs) on each of the Affordable Insurance Exchanges[.] Under the law, an MSPP issuer may phase in the States in which it offers coverage over four years, but it must offer MSPs on Exchanges in all States and the District of Columbia by the fourth year in which the MSPP issuer participates in the MSPP. OPM aims to administer the MSPP in a manner that is consistent with State insurance laws and that is informed by input from a broad array of stakeholders."
(U.S. Office of Personnel Management)
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[Official Guidance]
Text of HHS Proposed Regs on Benefit and Payment Parameters for 2014 (PDF)
"This proposed rule fills in the framework established by the Premium Stabilization Rule by proposing provisions and parameters for the three premium stabilization programs -- the permanent risk adjustment program, the transitional reinsurance program, and the temporary risk corridors program. It also proposes key provisions governing advance payments of the premium tax credit, cost-sharing reductions, and user fees for Federally-facilitated Exchanges. Finally, it proposes a number of amendments relating to the SHOP and the medical loss ratio program." [373 pages]
(Centers for Medicare & Medicaid Services)
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[Guidance Overview]
Implementing Health Reform: Benefit and Payment Parameters Proposed Regs
"The notice of benefit and payment parameters proposal is one of the longest regulatory issuances yet to emerge from the ACA implementation process -- 372 pages of preamble and regulatory text.... Viewed as a whole, the proposal illuminates more clearly than anything that has so far emerged from the implementation process what a monumental task Congress has set for the nation in trying to reshape a private, market-based, health insurance system to make it accessible to all but the poorest Americans, regardless of health status."
(HealthAffairs Blog)
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[Guidance Overview]
Regs on Essential Health Benefits Provide Additional Detail, Not Many Surprises
"The proposed rule stays fairly close to the bulletins the U.S. Department of Health and Human Services (HHS) previously released, notwithstanding receipt of extensive public comments, and thus this proposed rule seems to offer some additional certainty regarding the overall direction and approach as to the scope of the Essential Health Benefits Package."
(McDermott Will & Emery)
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Want to Sell Insurance on the Obamacare Exchanges? There's a 3.5% Fee for That.
"Health and Human Services will operate a health insurance exchange in all states that decline to set up the marketplace themselves. In order to finance the exchange's operations, new draft regulations ... envision health plans paying a 'user fee' if they want to sell in that space.... The monthly fee will start at 3.5 percent of the plan member's premium in 2014. It will then move to an amount 'specified in the annual HHS notice of benefit and payment parameters for the applicable benefit year.'"
(The Washington Post; free registration required)
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Walmart's New Health Care Policy Shifts Burden To Medicaid, Obamacare
"Walmart, the nation's largest private employer, plans to begin denying health insurance to newly hired employees who work fewer than 30 hours a week ... Walmart also reserves the right to eliminate health care coverage for certain workers if their average workweek dips below 30 hours -- something that happens with regularity and at the direction of company managers. Walmart declined to disclose how many of its roughly 1.4 million U.S. workers are vulnerable to losing medical insurance under its new policy."
(The Huffington Post)
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Young Investors Worry About Future Health Care Costs
"In a [recent] online survey ... seven different worries were reported by over half the respondents. Leading the list: health care costs, cited 76% of these investors. Other reasons for future anxiety were rising taxes (67%), viability of Social Security (63%), inflation (61%), long-term care (58%), running short of money because of longevity (52%), and housing values (52%)."
(Financial Planning)
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Employers Tackling Costs of Misdiagnosis with Clinical Integration Solutions
"[D]ata showing that even many of the best-designed workplace programs don't go far enough to address the core underlying problems in our healthcare system.... [M]isdiagnosis unfortunately remains a major workplace problem -- resulting in absent workers, poor health outcomes, wasted healthcare dollars, decreased productivity, and increased health and disability premiums.... Many of the country's leading employers have shown that, by integrating and collaborating with vendors' healthcare programs, they actually improve the quality of care their employees receive -- and positively impact their healthcare costs."
(Human Resource Executive Online)
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Health Reform at the Two Year Mark -- Still Complex, Uncertain
"'Uncertainty' and 'complexity' are two main traits of the federal law ... More than 10,000 pages of rules help define the 900-page law ... with more to come.... 'I think people still don't understand what is going to happen.' said Professor Lynn Blewett of the University of Minnesota School of Public Health."
(Duluth News Tribune)
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Are Employees Ready for Consumer-Driven Health Care?
"The shift from copays and coinsurance to cost-shifting and consumerism has happened in the blink of an eye, in benefits terms. It's historically an area where changes tend to be incremental and slow over several decades, generally through rulemaking from the IRS and Department of Labor. For such a large-scale sea change in health benefits to occur in just 10 years' time is pretty remarkable by itself, even more so when you add in the 2010 passage of health care reform."
(Employee Benefit News)
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Health Benefits Are Still Richer in Public Sector
"The standard employee premium share for a family plan is 23% in the public sector and 30% in the private, which works out to a difference of $1,100 annually.... [P]rivate workers face higher deductibles, co-pays and co-insurance costs.... Governments offer health benefits to more of their employees than private firms (75% vs. 59%).... Somewhere between 60-80% of large government employers offer [retiree healthcare], whereas fewer than 20% of large private employers do."
(Public Sector Inc.)
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For States That Waited, Finding 'A-Team' Vendors for Exchanges Won't Be Easy
"'If a state has not already selected their IT/infrastructure vendor for the exchange, I don't think there's any way you could procure a business partner and be ready by October 2013,' says Joan Henneberry, a principal at Health Management Associates and former project director of Colorado's insurance exchange. She suggests some states will opt for a federally facilitated exchange for the first year with a goal of taking it over in time for open enrollment in 2014."
(AISHealth.com; free registration required)
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Are HSAs the New Retirement Savings Vehicle?
"Unlike 401(k)s, which have strict rollover limitations (only in cases of disability, change in employment or death), HSAs allow participants to roll over funds at any time. Employees can move their money to a bank or credit union HSA that earns interest to grow tax-free, if their employer plan doesn't offer one.... HSAs also can provide a stream of income in retirement to be used for non-qualified medical expenses. Potentially, some of this income can also be withdrawn on a tax-free basis."
(On Wall Street)
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Unaffordable Cost Seen for Some Under Affordable Care Act
"'People are often surprised at how expensive health insurance is once they have to pay for their own,' said Karen Pollitz, a senior fellow at Kaiser Family Foundation. 'The subsidies will make that better, but they won't make the cost disappear.'"
(Bloomberg)
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March 1 Employer Deadline for Exchange Notices Seems Likely to Slide
"With no regulatory guidance on the horizon yet regarding how employers are supposed to provide employees with notices of their options with respect to the Affordable Care Act health care exchanges by the Act,'s March 1, 2013 deadline, sources within the administration have begun indicating that the effective date will probably be delayed."
(HR Policy Association)
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Insurance Surcharges Will Fund Most Online Health Insurance Exchanges
"To encourage participation, the Obama administration has awarded over $2 billion in startup funding. But by law, the markets must be self-sustaining by 2015 -- meaning they no longer will get federal funding. State estimates of annual operating costs vary from $15 million to $20 million a year in Rhode Island to $300 million in populous California, with the costs related to the number of people in the state as well as to how much education and outreach, among other functions, are done."
(Kaiser Health News)
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Few States Choose ACA Basic Health Coverage Option
"Many states want more direction from the federal government before establishing a Basic Health Program as authorized by the statute, the report says. Such programs are designed to capture beneficiaries who are expected to migrate back and forth, a phenomenon known as churn, between Medicaid and the upcoming health insurance exchange plans as their income levels change."
(American Medical Association)
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Health Exchanges and the Litigation Landscape
"If subsidies and tax credits aren't available in states with federally run exchanges, conservative legal scholars say, then two other lynchpins of the law would also be undermined: the requirements that employers of a certain size offer insurance and that most individuals buy insurance."
(Kaiser Health News)
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CMS Report on Progress in Building Exchanges, November 30, 2012 (PDF)
"For all Exchanges, CMS is also building a tool called the Data Services Hub to help with verifying applicant information used to determine eligibility for enrollment in qualified health plans and insurance affordability programs. The hub will provide one connection to the common federal data sources (including but not limited to SSA, IRS, DHS) needed to verify consumer application information for income, citizenship, immigration status, access to minimum essential coverage, etc. CMS has completed the technical design, and reference architecture for this work, is establishing a cross-agency security framework as well as the protocols for connectivity, and has begun testing the hub."
(Centers for Medicare & Medicaid Services)
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[Opinion]
Contraception, HSAs and the Unnecessary Controversy About Religious Conscience
"This acerbic controversy is totally unnecessary. This dispute can be diffused by health savings accounts (HSAs) or similar employer-funded medical accounts under the employee's control. Such a solution should be appealing to political leaders committed to civil discourse and mutual respect for opposing views. Unfortunately, such leaders appear to be in short supply."
(Prof. Edward Zelinsky, OUPblog)
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Benefits in General; Executive Compensation
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[Official Guidance]
Text of IRS Proposed Regs on Additional Medicare Tax (PDF)
"T]hese proposed regulations provide guidance for employers and individuals relating to the implementation of Additional Medicare Tax. This document also contains proposed regulations relating to the requirement to file a return reporting Additional Medicare Tax, the employer process for making adjustments of underpayments and overpayments of Additional Medicare Tax, and the employer and employee processes for filing a claim for refund for an overpayment of Additional Medicare Tax."
(Internal Revenue Service)
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Compensation Issues Need Attention before December 31
"As the end of 2012 approaches, various compensation-related issues may need to be addressed and corrective action taken before Dec. 31. In anticipation of widely expected increases in income, FICA and long-term capital gains tax rates starting in 2013, many companies are exploring ways to accelerate into 2012 income that would otherwise be recognized in 2013 or later, particularly for executives and other highly compensated employees."
(Society for Human Resource Management)
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Press Releases
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