Pension Risk Consultant
for OneAmerica Financial Partners in IN

Actuary Apps Systems Engineer 5
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Lead Manager, Internal Communications
for T. Rowe Price in MD

Pension Administrator
for Jack A Cross & Associates, Inc. in CA

Manager Transition Services
for OneAmerica in IN

Relius Support Supervisor
for PenServ Plan Services, Inc. in SC

Plan Administrator II
for Verisight, Inc. in MD

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Health Care Reform - Update and Developments -- eLunch
August 15, 2013 WEBCAST
(Winston & Strawn)

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[Guidance Overview]

Self-Insured Employers Gear Up to Cover Clinical Trials
"As of Jan. 1, the [ACA] is requiring employers with self-insured plans, that in the past were not affected by state insurance laws dealing with mandated benefits, to cover certain routine costs associated with certain clinical trials.... Those state insurance laws don't touch self-insured plans, but many employers will have a combination of insured benefits [and] self-insured benefits[.]" (Employee Benefit News)  

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20 'Episodes' Drive Employer Health Costs
"[D]uring the five year period, employer healthcare costs increased by an average of 4.3 percent per year, driven by spending on preventive health services; osteoarthritis (except spine); multiple sclerosis; childbirth (Cesarean section); and complications of surgical and medical care. The majority of spending growth was driven by an increase in the cost per case, primarily attributable to medical and surgical procedures." (InsuranceNewsNet.com)  

Wellness Program ROI Depends on Design and Implementation
"While results from wellness programs vary, there are common success factors that, if adopted, lead to improved results ... One-size-fits-all programs purchased from vendors are not effective.... [W]ellness programs also must be integrated, comprehensive, diversified, strongly linked to the organization's business strategy and championed by senior leadership and managers.... Looking beyond the immediate health care costs and utilization will help the organization understand the broader value of its investment." (Society for Human Resource Management)  

Kaiser's Rising Premiums Spark Employer Backlash in California
"[S]ome of Kaiser's biggest customers are complaining that the company is no longer a bargain and, even worse, standing in the way of controlling healthcare costs. Critics say the company is so entrenched in the workplace that it refuses to negotiate rates or to fully explain why its premiums keep rising. Kaiser rejects the criticism and says it remains a great value for employers and patients, offering superior care at rates that are often 10% below its rivals. It considers the mounting backlash a direct attack on the way it does business." (Los Angeles Times)  

ACA Creates Additional Complication for Flow-through Entities (PDF)
"[It] is common to have some interests in flow-through entities held by 'active' participants, i.e., equity holders who materially participate in the conduct of the business, while other interests are held by passive investors, i.e., individuals who own equity but play little or no role in the conduct of the business. The income of the flow-through entity allocated to active participants will not constitute [net investment income (NII)] and will not be subject to the Medicare surtax. Conversely, the income of the flow-through entity allocated to passive investors will be NII and may be subject to the Medicare surtax depending on the investor's other tax attributes." (Schiff Hardin LLP)  

After AMA Declares Obesity a Disease, the First Suit Is Filed Under the ADA to Declare Obesity a Disability
"A self-described 'severely obese' Missourian has just sued his former employer in federal court for allegedly firing him because of his weight. He alleges that 'severe obesity ... is a physical impairment within the meaning of the ADA,' and that his employer regarded him as being substantially limited in the major life activity of walking. He claims that at all times he was 'able to perform the essential functions of his position with Defendant, with or without accommodation.' Is obesity, now declared a disease by the AMA, also a 'disability' under the ADA?" (Fox Rothschild LLP)  

Medical Error Cost Calculator Riles American Hospital Association
"An online tool ... which determines the 'hidden surcharge' or costs of a hospital's medical errors, employs a methodology that is 'seriously flawed,' says the American Hospital Association. The Leapfrog Group's new 'Hidden Surcharge Calculator,' a web-based tool, enables employers to add up how much of their health premium dollars go to manage hospital medical errors that harm their employees. The tool determines the costs based on the safety track records of each hospital where their workers received care." (HealthLeaders Media)  

Can Three Technologists, $40 Million, and Obamacare Change Health Insurance Forever?
"The idea behind Oscar is that using your insurance should be as easy and intuitive as using your Facebook account or your Tumblr page.... Sign into your Oscar insurance account online, and you'll see a few carefully chosen options on a page that's otherwise white and clean.... It's an elegant interface, but elegance isn't its sole purpose. It's built to funnel you toward the choices Oscar wants you to make. The same big-data methods at work in every major technology business are eagerly embraced at Oscar. Over time, the insurer hopes to get much, much better at knowing what people should do for a given set of symptoms and helping them decide to do that thing." (Ezra Klein in The Washington Post; subscription may be required)  

Sebelius Recruits Women to Blog About Health Law
"[HHS] Secretary Kathleen Sebelius asked a banquet hall full of bloggers -- most of them women -- to help spread the word about new health insurance opportunities that begin this fall under the [ACA].... To the bloggers, Sebelius plugged the law's protections for women, garnering applause when she said health insurers will no longer be able to charge women more than men for a similar policy. She cited the law's guarantee of breast cancer screenings and contraception benefits for women without extra fees or copays." (Miami Herald)  

ACA Boosts Status of Alternative Medicine
"One clause of the health law in particular ... requires that insurance companies 'shall not discriminate' against any health provider with a state-recognized license. That means a licensed chiropractor treating a patient for back pain, for instance, must be reimbursed the same as medical doctors. In addition, nods to alternative medicine are threaded through other parts of the law in sections on wellness, prevention and research." (Kaiser Health News)  

Labor Market Outcomes of Health Shocks and Dependent Coverage Expansions
"[A]mong older workers in perfect health, health shocks have a larger effect on exits from self-employment than on exits from wage and salary work, implying that extending group coverage to small firm owners may reduce the number of health-related firm failures.... [S]tate-level dependent coverage expansions ... have had a more limited impact on young adults' insurance rates than indicated by previous research.... [ACA requirements] did effectively increase the reported holding of non-spousal dependent coverage, and initial results indicate a significant association with reduced labor force participation. However, further investigation reveals that the target population's relative withdrawal from the labor force began prior to the implementation of the insurance reform, and is likely driven by the economic recession." (James R. Burgdorf for RAND)  

Taking Stock of Initial Year One Results for Pioneer ACOs
"[T]he ACO concept remains attractive, with 30 of the 32 Pioneers continuing as Medicare ACOs. Second, all Pioneer ACOs delivered high quality care, outperforming industry benchmarks. Third, 13 (or 40 percent) of the Pioneers had sufficiently strong financial performance to qualify for shared savings bonus payments. Fourth, lowering costs and improving quality does not come easily, requiring both continuing hard work and significant investment. Finally, enabling ACOs to achieve ongoing success may require modifying current rules." (Brookings)  

Less May Be More for UnitedHealth in Year One of Exchanges
"UnitedHealthcare initially planned to participate in up to 25 state marketplaces. With each successive quarterly earnings call, however, the carrier's planned exchange profile seemed to fade. Now, you can count exchanges where UnitedHealth has applied with two hands. The carrier could still play in 10-12 exchanges, but it is being extremely picky." (HealthLeaders InterStudy)  

[Opinion]

ACA Tax on Insurers Should Not Be Repealed
"Repealing the tax on health insurers would cost about $116 billion over the 2014-2023 period and undercut health reform ... 'Pay-as-you-go' rules would require Congress to offset the cost of repeal by raising other taxes or reducing spending; one likely target would be provisions of the ACA that expand health coverage to 25 million more Americans. In addition, repealing the tax would encourage efforts to repeal other revenue-raising provisions of the ACA, which in turn would require still more painful offsets or increase the budget deficit if Congress failed to offset the cost." (Paul Van de Water, Senior Fellow, Center on Budget and Policy Priorities)  

[Guidance Overview]

Supreme Court DOMA Decision: Potential Wage Overstatements and Tax Refunds
"Pending guidance from the Internal Revenue Service (IRS), employers should consider making same-year income tax and FICA withholding adjustments with respect to benefits provided to same-sex spouses in 2013. Employers should also consider whether to file for a FICA tax refund or adjustments for benefits provided to same-sex spouses in 2010, 2011, and 2012, as well as whether to perfect any protective FICA tax refund claims that may have been filed for tax years before 2010.... [E]mployers are not required to apply for a refund or adjustment of FICA taxes that they paid and the employee portion of FICA taxes that they withheld.... However, employers may be required to provide affected employees with a Form W-2c showing the amount of taxable wages for income and FICA tax purposes so that the employees can obtain an income tax and FICA refund on their own behalf." (Ogletree Deakins)  

[Guidance Overview]

The DOMA Decision: Impact on Fringe Benefits and Other Tax Implications
"Employers will have to reprogram payroll systems so that they no longer withhold income tax and FICA tax for these benefits provided to same-sex spouses residing in states where same-sex marriages are recognized.... [P]ayroll systems may have to be reprogrammed again so as to not withhold taxes for benefits provided to all same-sex spouses who were married in a jurisdiction that recognizes same-sex marriage, regardless of their state of residence. This leads to the question of whether employers have adequate data to make these changes for affected employees or whether they have to request their present (and past) employees in same-sex marriages to identify themselves (and whether future guidance will require certifications or other proof of marriage from employees with same-sex spouses)." (Ogletree Deakins)  

French Court Holds U.S. Parent Liable for Employee Benefits of French Subsidiary (PDF)
"A French court recently held that a U.S. corporate parent of an insolvent French subsidiary was a joint employer with the subsidiary and therefor liable for employee benefits payable upon redundancy of the employees.... [T]he court's finding relied heavily on the involvement of the U.S. management in the closure of the French subsidiary." (Groom Law Group)  

[Opinion]

Managing HR Risk: Micro Versus Macro
"Benefits were not always as generous as they are today. But, they creep up. In good times, they are enhanced. Look, we have a surplus this year, we can afford to enhance this benefit. Each time this is done, there is a new, albeit small, risk added to the total risk pie." (Benefits and Compensation with John Lowell)  

Cedar Brook Financial Partners’ Ryan Olds, CFP, Graduates from Leadership Lake County
Cedar Brook Financial Partners

Blue Cross and Blue Shield of Minnesota Gets Its Game On to Improve Employee Understanding of Healthcare, Health Benefits
Change Healthcare Corporation

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