WASHINGTON — The Obama administration announced on Monday that it would postpone enforcement of a federal requirement for medium-size employers to provide health insurance to employees and allow larger employers more flexibility in how they provide coverage.

The delay is the latest in a series of policy changes, extensions and clarifications by the administration, and it drew a new round of criticism from congressional Republicans, whose scorching attacks on the law have become a central theme in many of this year’s midterm election campaigns.

The “employer mandate,” which was originally supposed to take effect last month, had already been delayed to Jan. 1, 2015, and now the administration says that employers with 50 to 99 employees will not have to comply until 2016 — allowing Democrats to

placate business concerns and pushing the issue well beyond this year’s midterm elections.

In addition, the administration said the requirement would be put into effect gradually for employers with 100 or more employees. Employers in this category will need to offer coverage to 70 percent of full-time employees in 2015 and 95 percent in 2016 and later years, or they will be subject to tax penalties. “Today’s final regulations phase in the standards to ensure that larger employers either offer quality affordable coverage or make an employer responsibility payment starting in 2015,” said Mark J. Mazur, the assistant Treasury secretary for tax policy. The purpose of the penalty, he said, is to help offset the cost to taxpayers of providing coverage or subsidies to people who cannot get affordable health insurance at work.

Under the law, employers with fewer than 50 full-time employees are generally viagra online order exempt from the requirement to offer coverage.

The administration described the new policy as a form of “transition relief” to help employers adjust

to requirements of the 2010 health care law. But congressional Republicans jumped on the delay as only the latest maneuver by the Obama administration to sidestep the health care law’s legal requirements for political gain. Republicans denounced the unilateral move as a violation of the law and called on the White House to throw out all of the Affordable Care Act’s coverage mandates. “The White House seems to have a new exemption from its failed law for a different group each month,” said Senator Mitch McConnell of Kentucky, the Republican leader, who is in a competitive race himself. “It’s time to extend that exemption to families and individuals — not just businesses.” But the House Democratic leader, Representative Nancy Pelosi of California, praised the White House, saying the final rules showed “the administration’s commitment to smoothly implement the Affordable Care Act.”

Coming on the heels of a government analysis of the law’s impact on the work force, the delay is likely to breathe new life into the Republican effort to make the

health care law the central issue in the coming midterm elections. Several lines of attack, which started with the disastrous rollout of the Healthcare.gov website in October and propecia online pharmacy shifted to a wave of insurance cancellation notices in November, have largely run their course as the website’s problems came under control and canceled policies were replaced. “Once again, the president is rewriting law on a whim,” said Speaker John A. Boehner. “If the administration doesn’t believe employers can manage the burden of the law, how can struggling families be expected to?” That theme was echoed by many Republicans, who say it is unfair for the White House to grant a dispensation to employers but not to individuals and families.

Democrats see the individual mandate as more important to the operation of the law. But lawmakers from both parties have raised questions about unilateral actions by the president to waive or delay various provisions of the law. J. Mark Iwry, deputy assistant Treasury secretary for health policy, said the administration had broad “authority to grant transition relief” under a section of the Internal Revenue Code that directs the Treasury secretary to “prescribe all needful rules and regulations for the enforcement” of tax obligations. This authority has often been used to postpone the application of new laws that would cause “unreasonable administrative burdens or costs” to taxpayers, Mr. Iwry said.

Under the law, larger employers may be subject to tax penalties if they do not offer “minimum essential coverage” to employees who work at least 30 hours a week, on average. Larger companies have, for many years, been more likely to offer coverage than smaller ones. The Treasury said that companies with 50 to 99 employees accounted for 7 percent of the private sector work force, while businesses with 100 or more workers accounted for 66 percent. Most companies with 100 or more employees already offer health benefits to at least some of their workers. Small businesses with fewer than 50 employees account for nearly 28 percent of private sector employees, but 96 percent of all private employers, the Treasury said. Paul M. Hamburger, a lawyer who advises employers at the Proskauer law firm, said: “The bottom line is that Obamacare is not going away. The administration is providing another one-year delay, until 2016, for some employers. But they have to take the law seriously and figure out ways to comply.

The administration did not provide the relief sought by employers in some high-turnover industries like restaurants and retail.” In response to concerns expressed by lawmakers from both parties, the administration said that local government agencies would generally not have to provide health insurance to “bona fide volunteers”

who work as firefighters or emergency medical technicians. The administration said it was still trying to viagra online cheap figure out how to count the hours worked by certain types of employees, including part-time college instructors who are paid for teaching a certain number of classes or courses. Until guidance is issued, Treasury officials said, colleges may assume that such “adjunct faculty” members spend 75 minutes a week outside the classroom, preparing lectures or grading examinations, for each hour teaching in the classroom.

Federal officials said they were also providing some relief to employers of seasonal employees. Those who normally work a half-year or less will generally not be considered full-time employees, the administration said.

The Huffington Post February 6, 2014
John Geyman

We have heard the promises as the Affordable Care Act (ACA) was being sold to the public, including — you can keep your doctor and insurance if you like it. We now know those promises to be mostly false as the ACA enters its fifth year of implementation.

Under the guise of “competition” and “efficiency,” the ACA has unleashed a new round of disruption throughout the health care system. We are seeing further fragmentation of care, with less continuity of care with patients’ physicians. The physician-patient relationship itself is at risk in a “system” increasingly headed for strangers taking care of strangers.

More than one-half of U.S. physicians are no longer self-employed and now work for organizations, mostly growing hospital systems but also some insurers that are moving into the delivery side of health care. Two examples illustrate the new landscape:

• Several hundred patients at the University of Pittsburgh Medical Center (UPMC) recently received certified letters informing them that they could no longer see their physicians. The reason: their insurance, Community Blue, sold by Highmark, is now both a rival hospital system and an insurer. Patients were cut off from their UPMC physicians even in the middle of cancer therapy. (1)

• United Health Group Inc. is the biggest player in the Medicare Advantage market with almost three million members and 350,000 physicians in its networks. In recent months it has dropped thousands of these physicians from its networks in at least 10 states. At Moffitt Cancer Center in Tampa, Florida, for example, some 2,500 current cancer patients will have to switch plans or find other physicians. (2)

A previous Health Care Disconnects post has described how patients are losing choice of physician and hospital through narrowing networks. (3) People can be in or out of a network at a moment’s notice, a dynamic that almost certainly seems to be driven by money — how can the insurer make more money by ridding its network of higher-cost physicians and patients.

Continuity of care, especially with a primary care physician, has been and should be the foundation of the physician-patient relationship. It facilitates coordination of care by other physicians and providers. But that continuity is now being split apart by market forces from all sides — mergers and consolidation of hospital systems, business decisions of insurers, instability created by evolving accountable care organizations, shortage of primary care physicians, and the lack of inter-operability of electronic medical records, for starters. The challenge of how to coordinate and integrate health care in such a chaotic system increases by the day.

As the supposed signature domestic success of the Obama administration, we have already found that keeping your own physician and insurance plan is difficult, if not impossible. We will soon also find that health care is not more affordable, less

expensive, or better with the ACA.

It

is ironic that much of this could have been fixed before this latest round of health care “reform” kicked in with the ACA in 2009. Under a single-payer financing

system, as embodied in An Improved and Expanded Medicare for All (H.R. 676), we could have a simplified, more efficient, not-for-profit public financing system coupled with a private delivery system, assuring all Americans with a comprehensive set of benefits and full choice of physician and hospital. President Obama recognized this as early as 2003 in this speech to the Illinois AFL-CIO:

‘Phantom Networks’ of Unavailable Doctors Plague Obamacare NewsMax Wednesday, February 5, 2014 11:37 AM By: Melissa Clyne The fears of patients across the country are being realized as they discover their doctors are not participating in the Obamacare health plans, The Los Angeles Times reports. In late January, retiring Oklahoma Sen. Tom Coburn, a Republican who is also a medical doctor, disclosed to MSNBC’s Joe Scarborough that his Obamacare plan did not include the oncologist who has been treating him for prostate generic viagra cheap cancer. In order to continue to receive treatment from the same specialist, Coburn has to pay out-of-pocket. The senator is just one among thousands of patients and doctors

who are experiencing the same problem, characterized as a “phantom network” by a California woman who was thrilled to finally qualify for health coverage under Obamacare after years of being denied due to preexisting conditions only to realize she can’t find doctors participating in

the network. The issue hit home for Maria Berumen when she was referred to a specialist for numbness in her arm, according to The Times. At least four doctors wouldn’t accept her health plan despite the state exchange website and

her insurer listing them as participants in her network. Berumen’s case is not unique, according to her primary care doctor, Ragaa Iskarous, who told The Times she has repeatedly encountered the same situation with other patients over the past month. “This is really driving us crazy,” Iskarous said. Fox News cialis online free trial reported in December that analysts predicted the Obamacare system might resemble Medicaid, warning that because of the low reimbursement rate, doctors might refuse to participate in the networks. “That will leave more and more patients jockeying to see fewer and fewer doctors,” said Merrill Matthews, director of the Council for Affordable Health Insurance. That’s what happened to California resident Danielle Nelson, who was promised “half a dozen times” by her provider, Anthem Blue Cross, that her oncologists would be covered under her Obamacare policy. But when she went to the doctors’ office, a bright orange sign informed her that “Covered California plans are not accepted.” According to The Times, major insurers have drastically cut the number of doctors and hospitals in California’s new health insurance market so that premiums are affordable. The state is being flooded with consumer complaints and lawmakers are working to “swiftly ease some of the problems that have arisen.” “There are

a lot of economic incentives for health insurers to narrow their networks, but if they go too far, people won’t have access to care,” California Insurance Commissioner Dave Jones said. “Network adequacy will be a big issue in 2014 Read Latest Breaking News from Newsmax.com http://www.newsmax.com/Newsfront/obamacare-phantom-networks-doctors/2014/02/05/id/551039#ixzz2saTVDRrf Urgent: Should Obamacare Be Repealed? Vote Here Now!

New York Times by Robert Pear –

January 18, 2014:

The Obama administration is delaying enforcement of another provision of the new health care law, one that prohibits employers from providing better health benefits to top executives than to other employees.

Tax officials said they would not enforce the provision this year because they had yet to issue regulations for employers to follow.

The Affordable Care Act, adopted nearly four years ago, says employer-sponsored health plans must not discriminate “in favor of highly compensated individuals” with respect to either eligibility or benefits. The government provides a substantial tax break for employer-sponsored insurance, and, as a matter of equity and fairness, lawmakers said employers should not provide more generous coverage to a select group of high-paid employees.

But translating that goal into reality has proved difficult.

Officials at the Internal Revenue Service said they were wrestling with complicated questions like how to measure the value of employee health benefits, how to define “highly compensated” and what exactly constitutes discrimination.

Bruce I. Friedland, a spokesman for the I.R.S., said employers would not have to comply until the agency issued regulations or other guidance.

President Obama signed the health care law in March 2010. The ban on discriminatory health benefits was

supposed to take effect six months later. Administration officials said then that they needed more time to develop rules and that the rules would be issued well before this month, when other major provisions of the law took effect.

A similar ban on discrimination, adopted more than 30 years ago, already applies to employers that serve as their own insurers. The new law extends that policy to employers that buy insurance from commercial carriers like Aetna, Cigna, Humana and WellPoint, or from local Blue Cross and Blue Shield plans.

This could eventually be a boon to workers, the administration says.

“Under the Affordable Care Act, for the first time, all group health plans will be

prohibited from offering coverage only to their highest-paid employees,” said Erin Donar, a Treasury spokeswoman. “The Departments of Health and Human Services, Labor and the Treasury are working on rules that will implement this requirement.”

The enforcement delay is another in a series of deadline extensions, transition rules, policy shifts and other steps by the Obama administration to minimize disruption from the new health care law, which is sure to be invoked by both Democrats and Republicans running for office this fall.

In recent months, the administration has delayed a

requirement that larger employers offer coverage to full-time employees and delayed online enrollment in the federal insurance exchange for small businesses. It waived major provisions of

the 2010 health law so consumers could renew policies that would otherwise have been canceled or terminated because they did not meet the law’s coverage requirements.

In addition, federal officials announced that people with canceled insurance policies could obtain hardship exemptions sparing them from tax penalties if they went without insurance this year.

One of the questions facing the I.R.S. is whether an employer violates the law if it offers the same health insurance to all employees but large numbers of low-paid workers turn down the offer and instead obtain coverage from other sources, like a health insurance exchange.

Some health insurance arrangements will almost surely be forbidden, officials said. For example, they said, employers will not be able to provide coverage only to management.

Likewise, the officials said, a company could not provide free coverage to “highly compensated individuals” while requiring other employees to pay, for example, 25 percent of the cost. In addition, they said, benefits available to the dependents of highly paid executives must be available on the same terms to dependents of other employees in the health plan.

Under the 2010 law, an employer that has a fully insured health plan that discriminates in favor of high-paid executives could face a steep penalty: an excise tax of $100 a day for each individual affected negatively.

Thus, if a company had 100 employees and its health plan were found to discriminate in favor of 15 executives, the employer could be subject to a tax penalty of $8,500 for each day of noncompliance, for the 85 employees discriminated against. If the discrimination continued for 10 days, the penalty could be as much as $85,000.

If a company with 60 employees failed to meet the new standards with respect to half its employees for a year, it could face a penalty of $1 million.

One reason for the delay in enforcement is that officials have decided to review the existing nondiscrimination rules for self-insured companies, even as they try to write new rules for employers that buy commercial health insurance.

The existing restrictions on self-insured health plans are “outdated, inadequate and unworkable,” said Kathryn Wilber, a lawyer at the American Benefits Council, which represents many Fortune 500 companies.

Under the earlier law, all health benefits provided to highly compensated individuals — with the possible exception of certain executive physicals — are supposed to be provided to rank-and-file employees.

But employers say they may have legitimate reasons for wanting to offer different benefits to different workers.

“Employers should be permitted to provide lower-cost coverage to employees who may not be able to afford the comprehensive coverage being provided to other employee groups,” Ms. Wilber said.

Katie W. Mahoney, the executive director of health policy at the U.S. Chamber of Commerce, said the existing nondiscrimination rules were so convoluted that employers often complied just with the spirit of the law, “rather than with the precise requirements of the regulations.”

“Employers are likely to have difficulty complying with the new nondiscrimination requirement” as well, Ms. Mahoney said.

She said the administration should scrap the existing rules and replace them with “a single set of nondiscrimination rules and a single set of penalties for all types of group health plans.”

Wall Street Journal Saturday January 18, 2014

By Christopher Weaver and Anna Wilde Mathews Updated Jan. 17, 2014 8:07 p.m. ET Early signals suggest the majority of the 2.2 million people who sought to enroll in private insurance through new marketplaces through Dec. 28 were previously covered elsewhere, raising questions about how swiftly this part of the health overhaul will be able to make a significant dent in the number of uninsured. Insurers, brokers and consultants estimate at least two-thirds of those consumers previously bought their own coverage or were enrolled in employer-backed plans. The data, based on surveys of enrollees, are preliminary. But insurers say the tally of newly insured consumers is falling short of their expectations, a worrying trend for an industry looking to the law to expand the ranks of its customers. About 48 million Americans were uninsured in 2012. The health law is expected to cut 25 million from that total by expanding state-run Medicaid programs and the pool of privately insured people who buy through state marketplaces, also called exchanges. Only 11% of consumers who bought new coverage under the law were previously uninsured, according to a McKinsey & Co. survey of consumers thought to be eligible for the health-law marketplaces. The result is based on a sampling of 4,563 consumers performed between November and January, of whom 389 had enrolled in new insurance. One reason for people declining to purchase plans was affordability. That was cited by 52% of those who had shopped for a new plan but not purchased one in McKinsey’s most recent sampling, performed in January. Another common problem was technical challenges in buying the plans, which 30% mentioned. Health Markets Inc., an insurance agency that enrolled around 7,500 people in exchange plans, said 65% of its enrollees had prior coverage. Around 10% were dropping out of employer coverage, either because the employer stopped offering its plan or because they could qualify for subsidies on the marketplaces. Fifteen percent had previous individual plans canceled, and 40% decided to switch into coverage bought through an exchange from previous individual plans. At Michigan-based Priority Health, only 25% of more than 1,000 enrollees surveyed in plans that comply with the law were previously uninsured, said Joan Budden, chief marketing officer. The trend underscores a central test for the health law, whose marketplaces are meant to steer a broad cross section of new paying customers to private insurers. “One of the intents of the law was to address the uninsured problem in our country,” said David M. Cordani, chief executive of insurer Cigna Corp. Cigna doesn’t yet know what coverage its health-marketplace enrollees

previously held. Explore how America’s health-care overhaul will affect you on this first-person adventure. CLICK THE IMAGE to start interactive experience. Many health plans and providers are looking for the expansion of coverage to fuel growth. Insurers need to draw healthy uninsured people to offset costs, given that plans can no longer deny coverage to people with pre-existing conditions. People have until the end of March to choose plans under the law, so more of the uninsured could still flock to the marketplaces. “We are in the middle of a sustained six-month open-enrollment period, and we have seen a strong interest in the product overall across the range of demographics so far,” said Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services. which is overseeing the rollout. “We are ramping up outreach activities so that more Americans learn how they can now benefit from affordable health insurance.” Department of Health and Human Services officials have said they don’t yet know the number of people who have signed up for coverage through the exchanges who had insurance at the time of their enrollment. The health law is chipping away at the number of uninsured consumers in other ways. At least four million people

are expected to join Medicaid rolls in the coming months. But so far, health-plan executives say, subsidies to buy insurance in the marketplace, and broader changes to the law, seem to be encouraging many already-insured people to seek better rates. In addition, some small companies are cutting back on coverage now that their workers can buy through the marketplaces, insurers and brokers say. At Priority Health, about 25% of health-law customers had employer-supported plans last year, Ms. Budden said, while 50% bought their own coverage last year. Of the latter group, about half are getting subsidies. Michigan insurers collectively expected 400,000 of the state’s 1.2 million uninsured people to join private plans this year, Ms. Budden said, citing an internal analysis of insurers’ rate filings. As of the end of December, only 76,000 enrollees had arrived, many of whom were previously covered. “I don’t know we’re growing the number of people with insurance here, so much as we’re just adding complexity,” said Geoff Bartsh, vice president for policy at Medica Health Plans in Minneapolis. It isn’t surprising that some percent of new purchasers of private health insurance are people who had insurance before. About 66% of people buying new individual health plans in early 2011 were covered by employer-backed plans in late 2010, according to a Kaiser Family Foundation analysis of federal survey data prepared for The Wall Street Journal. About 20% of enrollees in early 2011 were previously uninsured, the analysis found. There is “massive churn in the individual market, and always has been,” said Larry Levitt, senior vice president at Kaiser. “It wouldn’t surprise me if many [health-law enrollees] were insured in the last year,” he said, but “that doesn’t mean they wouldn’t have ended up uninsured if not for the exchanges.” Large insurers including Aetna Inc. and WellPoint Inc., and plans like Blue Cross & Blue Shield of Tennessee and Blue Shield of California, said they weren’t yet sure of what prior coverage their health-law enrollees may have maintained. Danny Robins, a Columbus, Ohio-based insurance broker for LyfeBank, a national consultant, said he has dismantled about 50 small employer-backed plans, some of which are steering workers to the new marketplaces. The 47-worker StateWide Ford dealership in Van Wert, Ohio, ended group coverage effective Jan. 1. About 23 workers previously covered by the StateWide-sponsored plan gained other coverage. Two enrolled in Medicaid, several joined their spouse’s employer-backed plans, and at least two gained federal subsidies to buy coverage in an health-law exchange. All but one worker got coverage at a better price, said Andy Czajkowski, the dealership’s owner. Now that insurers can’t charge unhealthy people higher rates, he said, the workers are better off on their own. “Last year, we couldn’t make that choice,” Mr. Czajkowski said. Irene Brunstein, of Queens, N.Y., who saw her coverage canceled under the plan, was quick to sign up for new health-law coverage to avoid disruptions. Ms. Brunstein, a semiretired 64-year-old lawyer, saw her Emblem Health plan canceled her $407-a-month plan in December because it didn’t comply with the

law. By New Year’s Day, she had chosen

and paid for a new health-law plan offered by the same insurer. The new policy costs less, $333 a month, and she’s eligible for a $94-a-month subsidy, further lowering the costs. She’s still frustrated by the new plan, which has a $3,000 deductible, higher, she says, than her prior coverage. “I don’t even think I have $500 a year in medical bills,” Ms. Brunstein said. “That’s a mighty tall mountain to climb.”