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[Guidance Overview]
HHS Issues Proposed Regulations on ACA Reinsurance Fee
"[T]he reinsurance fee [will not] be levied with respect to retirees enrolled in Medicare who receive supplemental coverage from their former employers, but it would be assessed on retired employees not yet eligible for Medicare and receiving health care coverage from their former employers. The exception differs from the carve-out for retirement benefits provided in the preamble to the grandfather interim final rule, which exempts retiree-only plans from the reach of the Act's insurance market reforms. Instead, HHS has chosen to draw the line based on whether Medicare is the primary payer (in which case no reinsurance fee is imposed) or the secondary payer (in which case a reinsurance fee is imposed)."
(Mintz Levin)
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[Advert.]
Nat'l Health Benefits Conf & Expo (HBCE) Jan.29-30, 2013 -- Clearwater Beach, FL

Speakers wrote the books on wellness, onsite clinics, disease management, obesity and health reform. Hear from public employers, universities, Boeing, FirstEnergy, JetBlue,
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[Guidance Overview]
New IRS Rule on Employer Play-or-Pay Mandate
"The IRS' definition of FTE appears designed to prevent companies from avoiding their responsibility through restructuring workforces into part-timers.... (For example, the IRS says, 40 full-time employees employed 30 or more hours per week on average plus 20 half-time employees employed 15 hours per week on average are equivalent to 50 full-time employees). The agency also heads off attempts by owners to split companies in subdivisions that would enable several subsidiaries with fewer than 50 FTEs to skirt the coverage requirement."
(Thompson SmartHR Manager)
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[Guidance Overview]
IRS Releases Proposed Regs on Employer 'Shared Responsibility' Under ACA
"In response to commenters' questions regarding who would qualify as a dependent for coverage under Section 4980H, the proposed regulations define 'dependents' for purposes of Section 4980H as 'an employee's child (as defined in section 152(f)(1)) who is under 26 years of age.' 'Thus, an offer of coverage to an employee's spouse is not required for purposes of section 4980H because section 4980H refers only to dependents' ... Because employers that currently do not offer dependent coverage 'will require substantial revisions to their plans and to their procedures for administration of the plans,' IRS said in the proposed rule that it will provide transitional relief with respect to dependent coverage for plan years that begin in 2014."
(Bloomberg BNA)
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Employers Potentially Affected by Security Breaches at Health Insurance Exchanges
"Why should plan sponsors be concerned about potential data security issues with public health insurance exchanges? To the extent employers are considering dropping coverage and sending employees to the exchanges (or their employees receive subsidized coverage through any exchange), they should be aware of the potential risks that create the prospect for significant employee distractions and concomitant reductions in productivity. Additionally, as employers have to share data regarding their health coverage with the IRS, employers will need to be able to articulate to employees that they have taken all reasonable measures to ensure data security compliance to avoid claims from employees that any data breaches are a result of the employer's breach of fiduciary duty."
(Benefits Bryan Cave)
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Changing the Trajectory of Health Care's High and Rising Costs (PDF)
"Controlling costs requires decreasing waste; reforming the payment system to change incentives; changing the delivery system to improve coordination and integration; managing costly patients with chronic diseases differently; engaging patients and families in shared decision making, particularly at the end of life; and many other discrete activities.... There are numerous pilots underway, multiple successful initiatives taking place, and a great deal of positive momentum. In addition to pushing for payment and delivery system reform, among the key challenges is spreading what works."
(Alliance for Health Reform)
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ACA May Be Headed Back to Supreme Court in 2013
"The nation's highest court may have upheld a central pillar of the law last summer -- the so-called 'individual mandate' that most Americans either purchase health insurance or pay a fine -- but that doesn't mean the rest of the ACA is free from debate. Questions are slowly percolating through the lower courts -- with some possibly headed toward the Supreme Court -- about contraception coverage, the Senate's ability to 'originate' a tax and the legality of the online insurance marketplaces known as exchanges."
(PBS)
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Consumers May Draw Wrong Conclusions from Medical Prices
"[A] new study ... suggests that consumers' perceptions of prices could lead them to the wrong conclusions. At a low price, something like a flu shot signals 'great communal benefit -- an item that is accessible because people need it to be healthy,' the authors said. 'Conversely, high prices signal reduced accessibility and hence less need.' That kind of thinking can lead to bad, possibly dangerous, health decisions if consumers decide there's less risk in foregoing higher-priced health products and services."
(Kaiser Health News)
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Smoking Status and Body Mass Index Relative to Average Individual Health Insurance Premiums (PDF)
"Overall, smokers pay an average monthly premium 14% higher than non-smokers. Smoking females pay an average monthly premium 22% higher than non-smoking females.... Overall, policyholders in the 'Obese' BMI category pay 22% more on average than those in the 'Normal' BMI category. Men in the 'Obese' category pay monthly premiums that are 29% higher on average than men in the 'Normal' category -- a substantially higher percentage increase than among women."
(eHealth)
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Fiscal Deal Kills New Funding for Health Law's CO-OPs
"'We were blindsided by the elimination of funds,' said John Morrison, president of the National Alliance of State Health Cooperatives. 'The health insurance industry is getting its way here by torpedoing co-ops in the 26 remaining states. This is not about budgets; it is about those health insurance giants killing competition at the expense of millions of Americans who will pay higher premiums because of it.'"
(Kaiser Health News)
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Consumer Operated and Oriented Plans (CO-OPs): An Endangered Species?
"[Consumer Operated and Oriented Plans (CO-OPs)] are subject to the same fundamentals as any insurance entity, and they also face some unique challenges. And the recipe for success today is no different than it was last week. Those CO-OPs that did receive funding, however, are likely to face more scrutiny, as the whole idea of a CO-OP has become prematurely endangered."
(Healthcare Town Hall)
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The Jenga Game of Pay-or-Play
"So what should employers be doing to prepare for 2014? In a nutshell: Determine if the requirement to offer affordable health coverage applies. If the answer is yes, then: Become knowledgeable about state exchanges. Calculate the minimum value of employer-provided coverage. Calculate the threshold for exceeding affordable employee contributions to the plan. Prepare employee communications about the existence of the exchange. Decide whether and how long to offer employer health benefits (pay or play)."
(HighRoads)
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New Year, New Deductible: 5 Ways to Help Your Employees Save on Healthcare in 2013
"Understand Your Benefits ... Shop Around ... Take Advantage of Free Preventive Services ... Be Proactive in Asking for a Lower-Cost Service or Treatment ... Stay Alert to Savings ... By becoming proactive healthcare consumers, your employees can make value-based purchasing decisions that are good for their health and their budget. This, in turn, supports your efforts to drive down healthcare costs and boost employee productivity."
(TRENDSparency)
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[Opinion]
The Calm in the Eye of the Obamacare Storm
"Confusing to read, Byzantine to implement.... With less than nine months before October 1, 2013, when 'millions of people will start applying for coverage' under the new regime, the exchanges are behind schedule, thousands of pages of rules are yet unwritten, and small businesses, the engine of our economy, are struggling to cope with the law and avoid financial harm.... 'Administrative overload' and the potential failure of critical links will only add to the turmoil already present on the ground, as Americans line up in 2014 and 2015 for disrupted coverage, exploding costs and rationed care, amid a system in chaos and confusion."
(American Thinker)
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[Opinion]
As 2013 Begins, Get Ready for an Obamacare Tax Onslaught
"The third wave of ObamaCare taxes began on January 1 ... These new and higher taxes are being levied to partially pay for ObamaCare's massive new subsidies for private health insurance and expansion of Medicaid.... Many more taxes are coming, including a 'tax penalties' for individuals and businesses who don't comply with ObamaCare's mandate that they purchase government-approved health insurance. The Congressional Budget Office expects these penalties for non-compliance to bring in $160 billion in the first decade they are in effect."
(Galen Institute)
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[Opinion]
Text of Comments by Business Roundable to HHS on PCORI Fee Regs
"[Business Roundtable (BRT)] applauds CMS for the changes made in the proposed rule that streamline the collection of the transitional reinsurance fee.... However, BRT remains concerned about the level at which the transitional reinsurance fee has been set.... BRT believes that the total amount of fees collected should be set at a level that represents the minimum amount that is necessary that can be determined at the end of the year."
(Business Roundtable)
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Benefits in General; Executive Compensation
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Fiscal Cliff Deal Affects Wide Range of Benefits and Compensation Programs
"While the legislation's most significant provisions include higher tax rates for high-income taxpayers and a payroll tax increase for working Americans, the law also includes important provisions affecting benefit and compensation programs ranging from Roth retirement plans to health care and qualified transportation benefits."
(Towers Watson)
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Fiscal Cliff Legislation Includes Changes in Employee Benefits and Payroll Tax Withholding
"The legislation: Does not include an extension of the 2 percent payroll tax cut ... Permanently extends employer-provided education assistance ... Permanently extends the increase in the monthly tax exclusion for transit and vanpool benefits. ... Permits participants in 401(k)s, 403(b)s and similar defined contribution retirement plans to elect to transfer amounts to a designated Roth 401(k) account."
(Society for Human Resource Management)
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Disability Growth Disables the Country
"Since 1991, workers on [Social Security] disability increased almost 170 percent, from 3,194,938 to 8,575,544. In the same period, the population between 18-64 increased only 26 percent, from 155,263,000 to 196,263,504. The increase is occurring despite the Americans with Disabilities Act passed in 1990 prohibiting employment discrimination and requiring businesses to make reasonable accommodations for those with disabilities."
(National Center for Policy Analysis)
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Press Releases
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