Top Dem Sees 'train wreck' for PPACA
Source: https://www.lifehealthpro.com
By Ricardo Alonso-Zaldivar
A senior Democratic senator who helped write the Patient Protection and Affordable Care Act (PPACA) stunned administration officials last Wednesday, saying openly he thinks it's headed for a "train wreck" because of bumbling implementation.
"I just see a huge train wreck coming down," Senate Finance Committee Chairman Max Baucus, D-Mont., told Obama's health care chief during a routine budget hearing that suddenly turned tense.
Baucus is the first top Democrat to publicly voice fears about the rollout of the new health care law, designed to bring coverage to some 30 million uninsured Americans through a mix of government programs and tax credits for private insurance that start next year. Polls show the public remains confused by the complexity of the law, and even many uninsured people are skeptical that they will be helped.
A six-term Democrat, Baucus expects to face a tough re-election in 2014. He's still trying to recover from approval ratings that nosedived amid displeasure with the health care law in his home state.
Normally low-key and supportive, Baucus challenged Health and Human Services Secretary Kathleen Sebelius at Wednesday's hearing.
He said he's "very concerned" that new health insurance exchanges for consumers and small businesses will not open on time in every state, and that if they do, they might just flop because residents don't have the information they need to make choices.
"The administration's public information campaign on the benefits of the Affordable Care Act deserves a failing grade," he told Sebelius. "You need to fix this."
Responding to Baucus, Sebelius pointedly noted that Republicans in Congress last year blocked funding for carrying out the health care law, and she had to resort to raiding other departmental funds that were legally available to her.
The administration is asking for $1.5 billion in next year's budget, and Republicans don't seem willing to grant that, either.
At one point, as Sebelius tried to answer Baucus' demand for facts and figures, the senator admonished: "You haven't given me any data; you just give me concepts, frankly."
"I don't know what he's looking at," Sebelius told reporters following her out of the room after Baucus adjourned the hearing. "But we are on track to fully implement marketplaces in Jan. 2014, and to be open for open enrollment."
That open-enrollment launch is only months away, Oct. 1. It's when millions of middle-class consumers who don't get coverage through their jobs will be able to start shopping for a private plan in the new exchanges. They'll also be able to find out if they qualify for tax credits that will lower their premiums. At the same time, low-income people will be steered to government programs, mainly an expanded version of Medicaid.
But half the states, most of them Republican-led, have refused to cooperate in setting up the infrastructure of Obama's law. Others, like Montana, are politically divided. The overhaul law provided that the federal government would step in and run the new markets if a state failed to do so. Envisioned as a fallback, federal control now looks like it will be the norm in about half the country, straining resources.
Administration officials say their public outreach campaign will begin in earnest over the summer. They question the wisdom of bombarding consumers with insurance details now, when there's not yet anything to sign up for. Baucus said in his state, that vacuum has mostly been filled by misinformation.
While some other Democratic lawmakers have privately voiced similar frustrations, most have publicly lauded Sebelius for her department's work. Democrats from reliably blue states have less to worry about, since their governors and legislatures have embraced the law and are working to make it succeed.
In Montana, the legislature rejected Democratic Gov. Steve Bullock's bid for a state-run insurance exchange. The governor is now trying to find a compromise on expanding Medicaid.
Republicans are certain to remind Montana voters next year that Baucus' fingerprints are all over the health care law, even though a similar strategy failed to knock off fellow Democratic Sen. Jon Tester last year.
After the hearing, Baucus' office clarified that he still thinks PPACA is a good law, but he questions how it is being carried out.
Sebelius Says We Have Built the Exchange Hub
Source: https://www.lifehealthpro.com
By Allison Bell
Photo: United States Mission Geneva / Wikimedia Commons / CC-BY-2.0
U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius told members of the House Ways and Means Committee that the exchanges are coming.
"We are confident we will launch the health insurance exchanges," Sebelius testified today at a hearing the committee organized on the Obama administration's HHS budget proposal for fiscal year 2014. "We will be open for open enrollment Oct. 1."
The data hub to be at the heart of the exchange system is "basically completed and paid for," Sebelius said.
The Obama administration has asked for $78 billion in discretionary budget authority for HHS for 2014. HHS could be responsible for a total of $967 billion in outlays over the next 10 years.
Much of the spending would be on programs related to the Patient Protection and Affordable Care Act of 2010 (PPACA). PPACA calls for HHS to work with the states and the District of Columbia to set up a system of exchanges, or Web-based health insurance markets, in all 50 states and the District of Columbia by Oct. 1, with the first coverage sold to take effect Jan. 1, 2014.
In response to questions about some states' resistance to participating in the exchange program, Sebelius said that 31 states and the District of Columbia are either setting up their own exchanges or working with HHS to set up "partnership" exchanges.
In some other states, officials are saying that their states might take over exchange services once HHS sets up the exchanges, Sebelius said.
Rep. Charles Rangel, D-New York, asked about the possibility that congressional resistance to funding the exchange program could interfere with efforts to get the exchanges started on time.
"It would be helpful" if Congress responds positively to HHS requests for funding, Sebelius said.
But "I think we are definitely on track to implement the law as it is anticipated," Sebelius said.
In response to reports that employers are worried about what PPACA will do to insured and self-insured group health plans, Sebelius said she is meeting regularly with employers to allay the concerns and hopes that, once the exchanges are open, employers will like them.
For some employers that are now unable to find or afford coverage, the new PPACA system might increase their ability to offer health benefits, Sebelius said.
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HealthyWage puts a little betting in competitive weight loss
Source: https://ebn.benefitnews.com
By Tristan Lejeune
Jon Whicker had a weight-loss problem. The finance manager and father of two from Utah, who at his heaviest weighed in at about 400 pounds, had joined a dieting competition with some family members. Several weeks in, things were going great until Whicker, 37, encountered an unusual dilemma: He had lost too much too quickly.
HealthyWage is a weight-loss initiative with an interesting twist — participants have bet their own money and stand to gain considerable payouts — but for health and safety reasons they place limits on shed poundage in a given timeframe, limits Whicker had broken. For the $10,000 prize Matchup competition, rules cap loss at 16.59% of starting weight over a 12-week period.
“I maxed out,” Whicker says. “I was 1% above that, like 17%.” Many people would call that an enviable problem, and indeed Whicker could sense success.
“Once that competition was over, I wanted to keep going; I wasn’t ready to stop yet, so I actually got a group of people from my office to do it with me,” he says. “So we competed in a second challenge in which I lost 16.4% of my body weight.”
That’s of his new starting body weight. All told, Whicker has lost 125 lbs. and gained $2,200 through the HealthWage programs, and he’s not done — he wants to get rid of another 50.
“Having some skin in the game encourages you not to give up, that is for sure,” Whicker says. “I could see teams giving up if they really hadn’t put any money out there. For me, just the competition keeps me motivated.”
That “skin in the game,” HealthyWage officials say, is significantly more of a motivator than the traditional incentives that employers offer with weight-loss programs. The wagered risk (and competitive nature) of betting on your own diet and exercise is seeing marked success, they report. HealthyWage officials says they offer a 49% and 29% success rates, respectively, for 5%+ and 10%+ weight loss.
HealthyWage offers three basic competition formats, all of which it says suit the workplace perfectly: The Matchup, in which teams of five compete together to lose the most weight (again, up to 16.59%); the 10% Challenge, where participants can double their money if they lose 10% of their body weight in six months; and the BMI Challenge, which rewards achieving a healthy body mass index.
Hottest Retirement Plan Improvement in 2013?
Source: https://ebn.benefitnews.com
By Robert C. Lawton
Many employer plan sponsors are expressing a high level of interest in adding Roth 401(k) in-plan conversions as an option to their 401(k) plans in 2013. The recently passed Taxpayer Relief Act of 2012 made it possible for retirement plan participants to convert existing 401(k) plan balances to Roth 401(k) balances, whether or not the participant is distribution eligible.
The benefits? All contributions and earnings that have been in the plan five years after the Roth clock starts are distributable tax free (assuming they are distributed due to an eligible event).
The cost? It is necessary to pay taxes on any 401(k) balances converted into Roth 401(k) balances in the year of conversion.
The logic of executing a Roth 401(k) in-plan conversion lies in a belief that tax rates are low now and will be higher in the future. If a participant believes that is true, it may make sense to pay taxes now on retirement plan balances.
Younger individuals just starting their careers may find this option valuable. Imagine building a nest egg over a 40-year career and having your entire 401(k) account balance available tax-free at your retirement! This option may also appeal to higher balance, older individuals who may be involved in tax planning, or individuals who are looking for additional taxable income in a particular year (e.g.: due to the realization of a loss).
There appears to be no downside associated with adding this option to a 401(k) plan. It will not cost anything additional to administer each year and is a nice option to have available for employees to elect.
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Upper-income Seniors Face Medicare Hike
Source: https://www.benefitspro.com
By Ricardo Alonso-Zaldivar - Associated Press
President Barack Obama's new plan to raise Medicare premiums for upper-income seniors would create five new income brackets to squeeze more revenue for the government from the top tiers of retirees.
The administration revealed details of the plan on April 12th after Health and Human Services Secretary Kathleen Sebelius testified before the Congress on the president's budget. The details had not been provided when the budget was released earlier in the week.
The idea of "means testing" has been part of Medicare since the George W. Bush administration, but ramping it up is bound to stir controversy. Republicans are intrigued, but most Democrats don't like the idea.
The plan itself is complicated. The bottom line is not: more money for the government.
Obama's new budget calls for raising $50 billion over 10 years by increasing monthly "income-related" premiums for outpatient and prescription drug coverage. The comparable number last year was $28 billion over the decade.
Currently, single beneficiaries making more than $85,000 a year and couples earning more than $170,000 pay higher premiums. Obama's plan would raise the premiums themselves and also freeze adjustments for inflation until 1 in 4 Medicare recipients were paying the higher charges. Right now, the higher monthly charges hit only about 1 in 20 Medicare recipients.
House Budget Committee Chairman Paul Ryan, R-Wis., asked Sebelius about the new proposal last Friday, noting that it would raise significantly more revenue. Part of the reason for the additional federal revenue is that Obama's 2014 budget projects an additional year of money from the proposals. The rest of the answer has to do with the administration's new brackets.
Starting in 2017, there would be nine income brackets on which the higher premiums would be charged. There are only four now.
If the proposal were in effect today, a retiree making $85,000 would pay about $168 a month for outpatient coverage, compared to $146.90 currently.
Under current law, the next bump up doesn't come until an individual makes more than $107,000. Under Obama's plan, it would come when that person crosses the line at $92,333. If the plan were in effect today, the beneficiary would pay about $195 a month for outpatient coverage under Medicare's Part B, rather than $146.90.
The top income step — currently more than $214,000 — would be lowered to $196,000. And individuals in the new top tier would pay 90 percent of the cost of their outpatient coverage, compared to 80 percent currently.
The administration did not provide a comparable table for the effects on married couples.
The impact on monthly premiums for prescription drug coverage is hard to calculate, since different plans on the market charge varying premiums.
Sebelius told lawmakers the Medicare proposals in the budget are intended to strike a balance between cutting health care spending to reduce the deficit and maintaining services for people who depend on them.
"This proposal would improve Medicare's long-term financial stability by reducing the federal subsidy for people who can afford to pay more for their coverage," said Medicare spokesman Brian Cook.
Commitment to employer-sponsored health plans on the rise
Source: https://www.benefitspro.com
By Kathryn Mayer
What a difference a year can make. A new industry report finds that significantly more employers than last year say they will “definitely” continue to provide health care coverage when health exchanges come online next year.
According to preliminary survey results from the International Foundation of Employee Benefit Plans, 69 percent of employers said they will definitely continue to provide employer-sponsored health care in 2014, while another 25 percent said they are very likely to continue employer-sponsored health care.
That’s a 23 point increase from 2012, when 46 percent reported being certain that they would continue employer-sponsored health care.
Opponents of President Obama’s Patient Protection and Affordable Care Act have argued that employers are likely to drop health coverage as an unintended consequence of the law that will negatively affect employees who want to stick with the coverage they know and like.
Estimates have varied widely on just what reform will do to employer-based health coverage. A Deloitte report last summer estimated that one in 10 employers will drop coverage for their employees, while consulting firm McKinsey & Co. drew fire when it stated 30 percent of respondents will “definitely” or “probably” stop offering employer-sponsored health insurance after 2014.
The IFEBP survey found the vast majority of employers (90 percent) have moved beyond a “wait and see” mode, and more than half are developing tactics to deal with the implications of reform. Organizations maintaining a wait-and-see mode decreased from 31 percent in 2012 to less than 10 percent in 2013.
Since the foundation’s first survey regarding reform’s impact on employer-sponsored coverage in 2010, employers have most commonly said keeping compliant was their top focus. In 2013, for the first time, most employers said their top focus is developing tactics to deal with implications of the law.
Still, the survey found estimates of cost increases directly associated with the PPACA have increased from 2012 to 2013. Employers with 50 or fewer employees are reporting the largest anticipated cost increase. Conversely, larger employers are the least likely to see significant cost increases.
Reform is expected to have a bigger impact on smaller employers than larger ones. Small businesses are making more employment-based decisions with hiring, firing and reallocating hours than larger employers, and they are more likely to drop coverage due to PPACA.
Despite employers' commitment to employer-sponsored health coverage, Gallup reported earlier this year that 44.5 percent of Americans got employer-based coverage in 2012, the lowest percentage since President Obama took office.
Results are based on survey responses submitted by more than 950 employee benefit professionals and practitioners through March 26.
Important Transition Relief for Non-Calendar Year Plans
Source: United Benefit Advisors
The January 1, 2014 effective date of the Pay-or-Play requirements under health care reform presents special issues for employers with non-calendar year plans. Prior to the release of the proposed regulations under the shared responsibility rules, employers with non-calendar year plans would either need to comply with the Pay-or-Play requirements at the beginning of the 2013 plan year or change the terms and conditions of the plan mid-year in order to comply. Recognizing that compliance as of January 1, 2014 caused a special hardship for non-calendar year plans, the proposed regulations, provide special transition relief. Employers with non-calendar year plans in existence on December 27, 2012 can avoid the Pay-or-Play penalties for months preceding the first day of the 2014 plan year (the plan year beginning in 2014) for any employee who was eligible to participate in the non-calendar year plan as of December 27, 2012 (whether or not they actually enrolled). Under this relief, the employer would not be subject to Pay-or-Play penalties for any such employees until the first day of the plan year beginning in 2014, provided they are offered coverage that is affordable and provides minimum value as of the first day of the 2014 plan year.
A walk-through on full-time vs. part-time for PPACA
Source: https://eba.benefitnews.com
By L. Scott Austin and David Mustone
With a substantial portion of the Patient Protection and Affordable Care Act set to go into effect in 2014, employers are working to determine how the law will impact them, their business and their employees. Because the law will require most employers to provide affordable minimum essential health insurance coverage to full-time employees or face financial penalties, employers must understand how the law defines full-time workers, as well as the penalties that businesses can face for failing to comply or choosing not to provide coverage.
Under provisions called the employer shared responsibility rules, the PPACA requires large employers (generally those with 50 or more full-time employees) to provide affordable group health coverage with sufficient value to full-time employees and their dependents. Full-time employees are generally defined as those who work on average at least 30 hours per week. Employers that fail to comply with these rules can face penalties.
What are the potential penalties?
The failure to offer coverage penalty applies if at least one full-time employee obtains subsidized coverage on an exchange where the employer does not offer coverage to at least 95% of its full-time employees and their dependents. This penalty – which can be up to $2,000 per year for each full-time employee (in excess of 30) – will be based on the total number of full-time employees an employer has, regardless of how many employees have government-subsidized exchange coverage.
The insufficient coverage penalty applies if the employer offers full-time employees coverage, but the coverage is either unaffordable (individual premium cost exceeds 9.5% of the employee’s household income) or does not provide minimum value (plan pays less than 60%of the covered costs). Proposed regulations released by the IRS provide guidance and alternative safe harbors for calculating whether health coverage is unaffordable, including use of an employee’s W-2 earnings. The potential penalty for insufficient coverage is $3,000 per year for each employee who obtains government-subsidized coverage on an exchange.
Employers also should note that in determining whether an employer is subject to these provisions (i.e., is a “large employer”), the IRS controlled group rules are applied – meaning that all affiliated employers for which there is 80% or greater common ownership will be treated as a single employer. However, compliance with the employer shared responsibility rules – and any associated penalties – will generally be assessed on an employer-by-employer basis.
Who is considered a full-time employee?
As an employer, the determination of who is a full-time employee will be crucial in evaluating your options for complying with the employer shared responsibility rules, and equally important, designing your group health plan’s eligibility and participation requirements.
Because there can be various ways of assessing what constitutes a full-time employee eligible for coverage under the PPACA, the IRS has issued guidance in the form of several notices, as well as temporary regulations. These guidelines set out criteria and standards that can help employers make accurate determinations when hiring new employees, including:
- Initial measurement period – A designated period of not less than three months or more than 12 months used in determining whether a newly hired variable or seasonal employee is full-time.
- Standard measurement period – An annual designated period of not less than three months or more than 12 months used to determine whether an ongoing variable or seasonal employee is full-time.
- Administrative period – A period of up to 90 days for making full-time determinations and offering/implementing full-time employee coverage.
- Stability period – An annual designated period of not less than six months (and not less than the corresponding measurement period) during which the employer must offer affordable minimum essential health coverage to all full-time employees, or face financial penalties for not doing so.
- Full-time employees – If a new employee is reasonably expected to average at least 30 hours per week at the time of hire, the employee must automatically be treated as full-time and offered group health coverage within three months of hire.
- Variable hour and seasonal employees – A variable hour employee is someone whom the employer cannot reasonably determine will average at least 30 hours per week at the time of hire. No definition is provided for a seasonal employee, but presumably it would include anyone who works on a seasonal basis. Employers may use the initial measurement period to determine whether a newly hired variable or seasonal employee actually averages at least 30 hours per week, and the standard measurement period to determine whether an ongoing variable or seasonable employee actually averages at least 30 hours per week. If the employee does average at least 30 hours per week during the initial measurement period or standard measurement period, the employer must offer affordable minimum essential health coverage during the stability period, or face financial penalties for not doing so.
- Transition from new to ongoing employee status – Once a new employee has completed an initial measurement period and has been employed for a full standard measurement period, the employee must be tested for full-time status under the ongoing employee rules for that standard measurement period, regardless of whether the employee was full-time during the initial measurement period.
Understanding Exchanges Still a Struggle for Consumers
Source: https://www.benefitspro.com
By Kathryn Mayer
Yet another poll is out underscoring one of the main concerns over health reform — that consumers just don’t get it.
According to this survey, released Thursday by InsuranceQuotes.com, 90 percent of Americans don’t know when the new health insurance exchanges will open.
A major component of the Patient Protection and Affordable Care Act, the new health insurance exchanges will be available for online and telephone enrollments beginning Oct. 1. Coverage begins on Jan. 1, 2014. Exchanges are intended to give families and small-business owners accurate information to make apples-to-apples comparisons of private insurance plans and get financial help to make coverage more affordable if they’re eligible.
The exchanges are a core component of the individual mandate that will require all Americans to obtain health insurance or pay a fine. As a result, tens of millions of previously uninsured Americans are expected to gain access to health insurance.
The survey of roughly 1,000 U.S. adults found that 40 percent expect health reform to have a major effect on their lives, while 39 percent think the law will have a minor effect and 19 percent expect no effect.
The survey found that Americans were more knowledgeable about other aspects of health reform. For instance, 73 percent correctly answered that health plans cannot deny coverage based on preexisting health conditions. And 66 percent accurately said that health plans must extend coverage to dependent children up to age 26. Those two provisions have been among the most popular.
Still, insurance experts say having only some knowledge isn’t enough.
“A lot of people need to study up on health care reform and what it means to them,” said Laura Adams, senior insurance analyst at InsuranceQuotes.com. “We found a very inconsistent understanding of the Affordable Care Act, and we fear that many people will miss key deadlines and benefits because they don’t adequately understand the new law.”
Uninformed consumers who are unaware of what the exchanges do and what health reform means for them has been a huge hurdle of PPACA. It’s something that government officials are working to alleviate. In January, The Department of Health and Human Services relaunched healthcare.gov, a website aimed at informing consumers about the health reform law while giving them a place to purchase insurance.
In total, 39 percent of Americans said they are somewhat knowledgeable about PPACA, 28 percent said they aren’t too knowledgeable, 21 percent said they aren’t at all knowledgeable and only 10 percent said they are very knowledgeable.
The survey was conducted March 7-10 by telephone by Princeton Survey Research Associates International.