Health Care Reform News

Fox Business by kate Rogers – April 9, 2014: The increased coverage requirements mandated under the Affordable Care Act are shifting the payment landscape for other types of insurance, including auto insurance, and worker’s compensation. Automobile, worker’s compensation and general business liability insurance costs could potentially fall under the law, according to http://clanofthecats.com/ nonprofit research organization RAND. On the other hand, medical malpractice coverage costs could tick higher. The report says there could be as much as a 5% change of costs in those three insurance policies in certain states, but adds there is “considerable uncertainty” around these estimates. Researchers examined how the ACA might operate across different liability lines and how those lines might vary across states given existing laws, population demographics and other factors. RAND reports that liability insurance companies reimburse tens of billions of dollars annually for medical care related to auto accidents, workplace injuries and more. David Auerbach, RAND policy researcher, says the impacts are small but noteworthy, and have the potential to evolve overtime. “We don’t know how this will play out and if the ACA will lead to lower costs overall,” Auerbach says. “Insurers could see their costs going down, but there free phone games no download are things that could change within specific markets.” More Americans are projected to be gain health insurance under the ACA, with 7.1 million people having selected plans on both state and federal exchanges according to President Obama’s latest enrollment announcement. This means the costs of providing auto insurance, workers compensation and homeowners insurance could fall for providers. It’s important to note, as RAND does, that cost changes may ultimately hit consumers. The study also cautions that with more people being covered under the ACA, the number of medical malpractice claims made against doctors and

providers could increase, making these costs higher. “There’s more care being provided, so naturally there’s more that can go wrong,” Auerbach says. The ACA mandated that every individual in the country have insurance by March 31, or they will face a fine of $95 a year or 1% of their annual income for failing to comply.

HHS Plans to Delay Key Aspect of SHOP Exchanges

(A key provision of forthcoming reform is the availability of employee choice within the SHOP exchanges. This option has been delayed by the 33 state exchanges which the Federal government will provide to states who do not establish their own SHOP>)

On March 11, 2013, HHS issued a proposed rule that would amend some of the standards for SHOP Exchanges. Most notably, the proposed rule creates a transition policy regarding an employee’s choice of qualified health plans (QHPs) in the SHOP. The transition policy would delay implementation of the employee choice model as a requirement for all SHOPs for one year, until 2015.

Beginning in 2014, individuals and small employers will be able to purchase health insurance through online competitive marketplaces, or Exchanges. The Affordable Care Act (ACA) requires each state that chooses to operate an acheter cialis france Exchange to also establish a Small Business Health Options Program (SHOP) Exchange. The SHOP Exchange is intended to assist eligible small employers in providing health insurance for their employees.

HHS will establish and operate a federally-facilitated Exchange (FFE) in each state that does not establish its own Exchange. The FFE will include both individual market and SHOP components.

Small employers with up to 100 employees will be eligible to participate in the Exchanges. However, until 2016, states may limit participation in the SHOP Exchanges to businesses with up to 50 employees. Beginning in 2017, states may allow businesses with more than 100 employees to participate in the Exchanges.

Functions of SHOP

On March 27, 2012, HHS issued a final rule on establishment of the Exchanges. This final rule describes the minimum functions of a SHOP. The final rule provides that a SHOP must allow employers the option to offer employees all QHPs at a level of coverage chosen by the employer—bronze, silver, gold or pla

tinum. In addition, the final rule permits SHOPs to allow a qualified employer to choose one QHP for its employees.

In a separate final rule issued in March 2013, HHS provided that the federally-facilitated SHOP (FF-SHOP) would give employers the choice of offering only a single QHP, as employers customarily do today, in addition cheap viagra canada to the choice of offering all QHPs at a single level of coverage.

In the proposed rule, HHS provides a transition

policy for 2014 plan years that is intended to provide all SHOPs (both state SHOPs and

the FF-SHOP) with additional time to prepare for the employee choice

model.

Under the transition policy, for plan years beginning on or after Jan. 1, 2014, and before Jan. 1, 2015, state SHOPs would not have to allow employers to offer their employees a choice of QHPs at a single level of coverage. However, a SHOP may decide to provide this option to employers for 2014 plan years.

In addition, for plan years beginning on or after Jan. 1, 2014, and before Jan. 1, 2015, FF-SHOPs would not allow qualified employers to offer their employees a choice of QHPs at a single level of coverage. For 2014 plan years, the FF-SHOP would assist employers in choosing a single QHP to offer their qualified employees.

According to HHS, the transition policy would increase the stability of the small group market while providing small groups with the benefits of SHOP in 2014 (for example, choice among competing QHPs and access for qualifying small employers to the small business health insurance tax credit).

The 2012 final rule also included a premium aggregation function for the SHOP that was designed to assist employers whose employees were enrolled in multiple QHPs. Because this function will not be necessary in 2014 for SHOPs that delay implementation of the employee choice model, the proposed rule would make the premium aggregation function optional for plan years beginning before Jan. 1, 2015.

Effective September 23, 2012 as outlined in the Affordable Care Act (ACA), employers that offer a group health plan MUST provide a Summary of Benefits and Coverage (SBC) to their employees. Employers must comply upon their plan renewal on or after No

vember 1, 2012.

The health insurance carrier is responsible for creating the SBC”s and making them available to the employer for distribution. Most carriers have published

them online, however some are mailing them until they establish permanent guidelines. Please feel free to contact us

for information specific to your carrier.

More informtion about SBC requirements, including penalites for non-compliance can be found by http://arbonpublishing.com/ visiting the DOL website.

The ObamaCare Carnival of Perverse Incentives
Opinion – WSJ – January 24, 2014
John C. Goodman

With fewer glitches to deter them, millions of Americans are now logging on to the ObamaCare health-insurance-exchange websites. When they get there, many are discovering some unpleasant surprises:

The deductibles are higher than what most people are used to, the networks of doctors and hospitals are skimpier (in some cases much skimpier), and lifesaving drugs are often not on the insurers’ formularies. Even after the government’s income-based subsidies are taken into account, the premiums are often higher than what people previously paid.

Why is this happening? Because the new law gives insurance buyers and sellers perverse incentives to behave in ways that create these problems. Things will only get more out of whack as more and more unhealthy people enter a system designed to be paid for by premiums from healthy people.

Under the Affordable Care Act, the benefits insurers must offer are strictly regulated. The law piles on benefits for which everyone must have coverage, whether they could ever use the benefits or not. At the same time, insurers set their own premiums and choose their own networks of doctors and hospitals.

To keep premiums as low as possible, the insurers are offering very narrow networks, often leaving out the best doctors and the best hospitals. In September, the Los Angeles Times reported that Blue Shield will have only about half the doctors in its exchange plan as it has in its traditional plan. One of the exchange plans in Colorado includes only a single Denver hospital, the one that usually treats Medicaid patients.

Narrow networks can be good or bad. Wal-Mart WMT -0.25% has selected a half-dozen centers of excellence around the country for its employees, places carefully chosen for their high quality and low costs. The exchange health plans, by contrast, appear to care only about cost. They are offering low fees—sometimes even lower than the rock-bottom fees Medicaid pays health-care providers—and accepting only those providers who will take them.

Under the Affordable Care Act, insurers are required to charge the same premium rate to anyone who wants to sign up, regardless of health status; and they are required to accept anyone who applies. This means that to make ends meet they must overcharge the healthy and undercharge the sick. It also means insurers have strong incentives to attract the healthy (on whom they make a profit) and avoid the sick (on whom they incur losses) by, in effect, making their plans less appealing to the sick.

Here’s how they seem to be doing it: In structuring the plans they offer on the ObamaCare exchanges, the insurers apparently assumed that the healthy will choose the plan they buy based on its price, while ignoring other features of the plan. It makes sense: If I am healthy why wouldn’t I shop for the lowest price? If I later develop cancer, I can move to a plan that has the best cancer care. By law, these plans will be prohibited from charging me more than the premium paid by a healthy enrollee.

Insurers also assume that people who already are ill or otherwise expect to use a lot of health care pay much closer attention to the cost of deductibles and which doctors and hospitals are in the insurer’s network. To have any hope of balancing their books, insurers must then attract the maximum number of customers who are likely to stay healthy and thus not use so much of the care they paid for, while unhealthy people in effect use more than they paid for. This is why most plans are apparently designed to attract people willing to overlook high deductibles and less access to health care in return for lower premiums.

Yet no matter how narrow the provider network, health plans are going to cost more if they enroll more people with above-average health-care costs. And that is what is about to happen. higher premiums charged to everyone enrolled in the plans.

To make matters worse, cities and towns with unfunded health-care commitments are getting ready to dump their retirees on the state exchanges. Since retirees are above-average age, they have above-average expected costs. The city of Detroit, for example, is planning to dump the costs of about 10,000 retirees on the Michigan exchange.

Then there are the job-lock employees—people who are working only to get health insurance because they are uninsurable in the individual market. Under ObamaCare, their incentive will be to quit their jobs and head to the exchanges.

In sum: A lot of high-cost patients are about to enroll through the exchanges. This will force up premiums further for all other buyers.

At some point, politicians of both parties will realize that we can do better than this. That will require a real market for health insurance with premiums that reflect real risks. There is a role for government in helping people with severe health problems. That is why risk pools exist. What we didn’t need was to destroy the market for the many in order to give aid to the few.

Mr. Goodman is president of the National Center for Policy Analysis and the author of “Priceless: Curing the Healthcare Crisis” (Independent Institute, 2012).

For some years, the federal government and some states have operated and subsidized risk pools. These allowed the chronically ill and other high-cost people who were “uninsurable” to purchase insurance for the same premium healthy people pay. Under ObamaCare, however,

the pools are due to shut down and send their enrollees

to the exchanges, where the above-average cost of their care will be implicitly borne by

March 15, 2013 Major insurers surveyed about potential premium increases in six major markets expect premiums to increase by an average of 169 percent in 2014 for younger and healthier individuals. American Action Forum asked insurers about the impact of the

Affordable Care Act (ACA) in the Chicago, Phoenix, Atlanta, Austin, Milwaukee and Albany markets. Despite variation by geography, the overall trend showed that younger and healthier male individual policyholders are expected to see the highest premium insurance, 189 percent, in 2014. The survey (PDF) does note that since individual premiums can be as low as $50 a month for young and healthy individuals, an increase can appear very large when measured on a percentage basis. The trends for young and healthier individuals also

applied for small employers with a predominantly younger and healthier work force. For older and less healthy individuals, premiums are predicted to decline by an average of 22 percent while small group premiums for employers with older less healthy workers will decline an average of 26 percent. The decline is attributed to the spread of risk across a larger base broadened by expanded coverage for younger individuals and workers under ACA reforms. (The American Action Forum is a forward-looking

policy institute dedicated to keeping America strong, free and prosperous. It seeks to promote common-sense, innovative, and solutions-based policies that will reform government, challenge out-dated assumptions, and create a smaller, smarter government that will serve its citizens better.)

Politico by Natalie Villacorta –

April 7, 2014:

Obama administration officials hoping to exhale after the viagra online cheap big finish to Obamacare’s first enrollment season may need to hold their breath a while longer.

All the confusion and mixed messages out there are bound to combust if people decide they were misled — an echo of the “you can keep your plan if you like it” fiasco.

“If there’s been a failing with the Obama administration [communication], it’s the failure to adequately plan for that kind of extensive, repeated interaction with people at the community level,” said Larry Jacobs, an expert on health politics at the University of Minnesota. Successful outreach doesn’t depend on just one jingle, he stressed. “It’s repeated and unceasing outreach at multiple levels.”

Some of the missed points and mixed-up details could bite the administration almost immediately as people start using their new plans and blame surprises on the White House. Other lingering public misconceptions could feed Republican attacks through the November midterm elections.

Here are six big danger points.

1. I’m sick! Why can’t I get covered?

Coverage of pre-existing conditions was a big selling point of the law, but not everyone realizes that they can’t just sign up the minute a condition is diagnosed. The regular dates and deadlines for enrolling still apply, no matter when you get appendicitis.

Yet 6 in 10 uninsured Americans didn’t know March 31 was the cutoff for getting 2014 coverage, according to a Kaiser Family Foundation poll last month. They didn’t know that missing the deadline meant they’d be locked out until November (unless they’re eligible for Medicaid, which has no such restriction.)

“Since they don’t even know that there’s a deadline, I don’t think that they could know the next step, which is that they can’t enroll for the rest of the year,” said Mollyann Brodie, executive director of public opinion and survey research at Kaiser.

“It’s going to be a shock, and we are going to be fielding a lot of calls,” said Michael Mahoney, a senior vice president with the online insurance broker GoHealth. “But there’s not much you can do to help.”

One reason for the confusion might have been all those delays and extensions. Just before March 31, the administration granted people with special circumstances or sign-up difficulties a bit more time.

“There’s almost an assumption that there’s never a real deadline on anything,” said Tom Miller, a fellow at the American Enterprise Institute and a critic of the law.

The risk: Anyone who gets sick and thinks they can just waltz in and get insurance is in for a shock. They just might blame it on Obamacare — or President Barack Obama. And then when they get hit with a penalty for not having insurance, they’ll be even angrier.

2. The $95

mandate myth

Most people know there’s a penalty for being uncovered. But they are wrong about the amount.

“You have to pause and say, ‘It’s not one Ben Franklin, it’s probably closer to three,’” said Brian Haile, senior vice president for health policy at Jackson Hewitt Tax Service Inc. Customers constantly walked in and declared that they were going to forgo coverage and cough up the $95 penalty, he said. Then they’d learn that it was actually $95 or 1 percent of income, whichever is greater. In 2016, the amount increases to $695 or 2.5 percent of income.

“They say, ‘Well, that’s a lot more than what my congressman told me, or what I read in the newspaper or heard on television,’” Haile said. “They’re sort of flummoxed.”

The government didn’t stress the penalty during much of the outreach. “I have a strong feeling that the kind of vagueness about the mandate and penalty was deliberate,” said Jacobs, the political scientist. “It’s better to attract people with the benefit than threaten them the IRS is going after them.”

Ceci Connolly, managing director of the Health Research Institute at PricewaterhouseCoopers, said she’s not sure that was a smart strategy. Her research found that Massachusetts’s emphasis on a penalty when its own health reform

law took effect motivated people to sign up.

Of course, Obamacare won’t hit anyone with a fine until Americans start to do their 2014 taxes next year. That means it comes due in 2015 — after the November midterms but in time for the 2016 presidential campaign.

The risk: a delayed but nasty surprise at tax time.

3. I can’t afford Obamacare

Four in 10 uninsured Americans still don’t know that the Affordable Care Act offers financial assistance to low- and moderate-income individuals, according to that Kaiser poll. Plus, many of the GOP attacks on the law that people hear are about its cost.

Enroll America found that perception of high costs was the single biggest barrier to enrollment in this first season. Over the course of the enrollment period, the group fine-tuned its messaging to stress the availability of financial help and interest soared. “Once the connection is made, the likelihood of those people enrolling goes through the roof,” Enroll’s field director John Gilbert said.

But sometimes people who knew generally about the assistance didn’t realize that they themselves might qualify, said Christine Barber, a senior policy analyst at Community Catalyst. “People are really surprised that they can get financial help and that the law can benefit them,” she said.

And subsidies don’t prevent sticker shock for everyone; the aid gets “thinner” as people move up the sliding income scale. “That will be off-putting for some,” said Karen Pollitz, a senior fellow at Kaiser.

It’s impossible to know how many people never applied for coverage — or sidestepped an exchange and bought a policy elsewhere at full cost — because they didn’t understand how much help was available.

The risk: People who learn that they missed out on a good (or a better) deal will want to blame someone — and it probably won’t be themselves.

4. “Sort of a bait and switch”

People who end up making more than they anticipated during the year, and don’t realize that they should report it, may have to pay back some of their tax credit when they file their taxes. But for many people, matching up what they got versus what they should

have gotten is going to be “highly problematic,” said Jackson Hewitt’s Haile.

Folks who suddenly find their tax refunds reduced may feel like the government has “raided their piggy bank” — forgetting, of course, that the piggy bank was bigger in the first place because of the financial help in purchasing health insurance. “You run the risk of it creating very negative perceptions of the marketplace. Sort of a bait and switch, if you will,” he said.

The risk: What do you mean I don’t get a tax refund? I want my piggy bank!
5. It’s not free?

Many people who signed up for Obamacare are insured for the first time — or the first time in a long time — and they are now confronting an array of befuddling terms. They don’t necessarily understand that a monthly premium isn’t the only bill they have to pay. The co-pays, deductibles and other costs they’ll encounter when they go see a provider could be a real shock.

“Messages get very simplified, and it sounds like, ‘enroll in the Affordable Care Act and your worries are over for medical bills,’” AEI’s Miller said.

Groups and programs that helped consumers choose a plan say they tried hard to explain it all. For instance, Jodi Ray, who oversees the navigator programs at the University of South Florida, said they were “careful about explaining deductibles, co-pays and premiums and when they’re used, when they’re needed, when they’re going to kick in, when they’re expected to pay them.” And they tried to connect people to an in-network physician. But it’s all still complicated.

The risk: EOB-alarm. Unhappy people who get one of those Explanation-of-Benefits statements for the first time.

6. The reality of costs

Remember that “save $2,500 on your insurance” promise that presidential candidate Obama made in 2008? It took a few different forms and was couched with different time frames. Sometimes it was promised by the end of Obama’s first term. But all the nuances of economic modeling and different cost-growth curves never made it into the sound bites. People with insurance heard promises of big savings and — except for some on the exchanges — they haven’t experienced that.

The overall rate of growth in national health spending including Medicare has slowed, Connolly noted. But for individuals? Neither premiums nor out-of-pocket spending has dropped — most certainly not by the $2,500 that people thought they were promised.

It’s little comfort that their costs might have been even higher without the health care law, if they even understand that.

And premiums could go up sharply next year in some or most states depending on who did get covered this year and how young, old, sick or healthy they are.

“That’s another possible premium shock,” Miller predicted. “I don’t think it will happen in all 50 states, but I think it’ll happen enough to be noticeable.”