[Guidance Overview]
Additional Guidance Issued on Summary of Benefits and Coverage Disclosure Requirements
"The FAQs also clarify that plans and issuers should continue to answer questions on the SBC template regarding annual limits even though plans are prohibited from imposing annual limits on essential health benefits effective for plan or policy years beginning on or after January 1, 2014. The SBC should include detailed information on any limits on specific covered benefits that are not essential health benefits."
(McDermott Will & Emery)
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[Guidance Overview]
Employer Shared Responsibility Rules Pose Special Challenges for the Staffing Industry
"Because temporary employees have historically shown little interest in health insurance coverage, staffing firms generally ... have 'two-tier' arrangements under which the internal staff employees are provided major medical benefits, and the temporary employees are offered no plan or perhaps a limited benefit (i.e., mini-med) plan.... [M]ost staffing firms will be subject to an annual penalty of $2,000 multiplied by the number of all full-time employees, including full-time temporary employees, less the first 30."
(Mintz Levin)
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Big Insurers Wary of Entering New Obamacare Markets
"[E]xecutives at the four largest U.S. health insurers say they are likely to sell insurance plans on less than a third of the exchanges ... [R]easons for caution ... include a lack of clarity about the kind of prices they can charge and the number of plans they can sell on each exchange, the expectation that the program is only expected to reach about 7 million people nationwide in its first year and uncertainty over whether all of the exchanges will be ready in time... [S]tates whose existing insurance markets have little or no competition, like Alabama and Alaska, may not see much of a difference[.]"
(Reuters)
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Health Care Law Opponents Sue Obama Officials Over IRS Rules
"The IRS is charged with distributing health insurance tax credits through the state exchanges. But the complaint argues that the federally created exchanges cannot deliver the tax credits because the law does not say explicitly that they can. The challengers are asking for a federal court order barring administration and enforcement of the healthcare law in these 33 states."
(Reuters)
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With Same-Gender Marriage Now Available, Maryland to End Benefits for Domestic Partners of State Employees
"The O'Malley administration has notified state employees in same-gender relationships that they won't be able to include domestic partners in their health insurance anymore. If they want coverage, they'll have to get married. The policy change is the result of the new Maryland law allowing same-gender marriage, which took effect Jan. 1. The thinking is that offering health coverage to an unmarried same-gender partner doesn't make sense anymore, officials said, particularly since an unmarried heterosexual partner doesn't have the same right."
(The Baltimore Sun)
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Part-Timers to Lose Pay Amid Health Act's New Math
"Not only will these workers earn less money, but they'll also miss out on health insurance at work. Consider the city of Long Beach. It is limiting most of its 1,600 part-time employees to fewer than 27 hours a week, on average. City officials say that without cutting payroll hours, new health benefits would cost up to $2 million more next year, and that extra expense would trigger layoffs and cutbacks in city services."
(Los Angeles Times)
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Michigan Supreme Court Won't Hear Appeal on Same-Gender Health Care Benefits
"The Michigan Supreme Court has refused to hear an appeal by Attorney General Bill Schuette, letting stand the Michigan Civil Service Commission's policy providing health care benefits to same-gender partners of state employees.... The commission's policy stemmed from a union contract that extended the health benefits to the same-gender partners of state employees, plus their dependents. The contract was negotiated by Gov. Jennifer Granholm's administration shortly before Michigan voters approved a 2004 ballot initiative that defined marriage as the union of a man and a woman."
(The Detroit News)
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Securing the Enrollment of Uninsured Americans in Health Coverage
"[The] information and skepticism gap needs to be fixed to achieve optimal enrollment. Enroll America, working collaboratively with numerous and diverse national and state-based partners as well as HHS, is in the process of building a large national and grassroots campaign to bridge the information and skepticism gap designed to achieve optimal enrollment. Additionally, through its Best Practices Institute, Enroll America is promoting state-by-state adoption of systems that are consumer-friendly and enable everyone seeking coverage to get enrolled."
(Health Affairs)
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U.K. Ad Tries to Steer Patients Away from the Emergency Room
"Here in the United States, emergency room trips have steadily grown, from 67 million visits in 1996 to 119 million trips in 2008, and ER trips can be expensive. One study back in 1994 found that treating non-emergency conditions in an emergency department setting contributed $5 billion to $7 billion in excess costs over the course of a year. A campaign to reduce emergency room trips could be one way to drive down health spending, but the evidence we have on why people go to the emergency room suggests this type of approach may not succeed."
(The Washington Post)
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[Opinion]
The Benefits of Medicaid Expansion: A Reply to the Heritage Foundation
"[W]hile a Medicaid expansion would increase [Ohio's] Medicaid costs by about $2.5 billion from 2014 through 2022, it would also save [the state] $1.5 billion by reducing state spending on current programs in favor of the largely federally financed expansion.... Medicaid expansion would create more than 27,000 Ohio jobs, reduce the number of uninsured by more than 450,000, cut health costs for employers and residents by $285 million and $1.1 billion, respectively, and lessen budget shortfalls facing Ohio's counties."
(Timothy Jost in Health Affairs)
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[Opinion]
New Obamacare Application Is an Invitation to Fraud
"Those 61 pages of the old application were mostly filled with questions to make sure that people were eligible to get the subsidies. The government needs to verify their income, and make sure that they aren't eligible for health insurance at work.... The new form largely takes your word for it all."
(American Enterprise Institute)
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[Opinion]
Oregon's Medicaid Experiment: Coverage Is the First Step
"The [Oregon} study ... showed that enrollment in Medicaid, after about two years, profoundly increased patients' use of needed medical services, and vastly reduced the financial strain that previously limited their care.... [B]ut the study's findings show that coverage alone will not necessarily lead to good health.... The bottom line is that better health requires health insurance coverage, but it doesn't end there."
(Health Affairs)
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[Opinion]
You Can Lead a Horse to Water ...
"Most of the commentary [on the Oregon Medicaid study] has been shocked that there was no statistically significant improvement in health measures between people who were enrolled in Medicaid and those who were not.... Before we even get to the outcomes question is the issue of whether very many people want to have insurance coverage, even when it is totally free."
(John Goodman's Health Policy Blog)
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[Opinion]
Here's What the Oregon Medicaid Study Really Said
"We don't know if the results speak to the health care you get through all health insurance or just Medicaid or if they're just an artifact of the study's timeframe and sample size. We don't know if different ways of designing insurance programs would lead to radically different care outcomes ... And so we don't know whether we're seeing a problem in Medicaid, an inconvenient truth about medical care, or something else."
(Ezra Klein in The Washington Post)
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[Opinion]
Obamacare Application: New and Not Improved
"Only an out-of-touch Washington bureaucracy would hold a press conference touting 'simplification' for taking one form and changing it to three forms with multiple appendices."
(Rep. Dave Camp, Chairman, U.S. House Ways and Means Committee)
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[Opinion]
State of Self-funding and the TPA Industry
"[W]ill insurers decide that participating in exchanges or even the U.S. health insurance market is simply not a viable business plan and pull out, but keep administrative services only contracts, assuming no risk for claims payment?"
(The Institute for HealthCare Consumerism)
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Benefits in General; Executive Compensation
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[Official Guidance]
Text of Final IRS Regs Requiring Updating of Employer Identification Numbers (PDF)
"This document contains final regulations that require any person assigned an employer identification number (EIN) to provide updated information to the IRS in the manner and frequency prescribed by forms, instructions, or other appropriate guidance. These regulations affect persons with EINs and will enhance the IRS's ability to maintain accurate information as to persons assigned EINs."
(Internal Revenue Service)
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Making Plan Administration Mistakes: Keep Track of How You Got There
"Plan sponsors are making decisions about how to count employees, what coverage to offer and how to measure hours. Undoubtedly, mistakes will be made. There should be a record of how conclusions were reached for each of these issues so that there is both proof of diligence and a reference point for correction if necessary. Mistakes can be fixed, but it is usually easier (and less costly) to fix things if there is a record to look back on."
(Fox Rothschild LLP)
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New York Postpones Caps on Executive Compensation and Administrative Expenses for State Contractors (PDF)
"In certain circumstances, the cap on allowable administrative expenses and the reporting requirements apply to subcontractors and agents of covered providers. If the cap applies, covered providers must incorporate by reference the terms of these regulations into their agreements with a subcontractor or agent.... The caps are effective on the first day of the provider's reporting period -- July 1, 2013 for providers using a July 1st fiscal year and January 1, 2014 for providers that annually report on a calendar-year basis."
(Buck Consultants)
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Deferred Compensation Planning Opportunities for Executives of Tax-Exempt Entities
"[B]y carefully tying additional deferrals to the executive's targeted retirement date and inserting appropriate provisions in the executive's employment agreement, the executive can effectively defer significant additional compensation, subject only to a risk of forfeiture in the event that the executive elects to voluntarily terminate employment prior to the targeted retirement date."
(Buchanan Ingersoll & Rooney PC)
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Press Releases
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