Two Months After Hurricane Maria, A Growing Majority Of Americans Say Puerto Ricans are Not Yet Getting the Help They Need

Two months after Hurricane Maria struck Puerto Rico, a growing majority of Americans say that Puerto Ricans affected by the devastating storm are not yet getting the help they need, the November Kaiser Family Foundation Tracking Poll finds.

This month, 70 percent of the public say that people in Puerto Rico are not yet getting the help they need, up from 62 percent in October 2017. These perceptions vary by party, and half of Republicans (52%) now say Puerto Ricans aren’t yet getting needed help, up significantly from October (38%).

When asked whether the federal government is doing enough to restore electricity and access to food and water in Puerto Rico or not, a majority of the public (59%) says the federal government is not doing enough, up from 52 percent in October. Most Democrats (86%) and independents (59%) say the federal government is not doing enough, but most Republicans (63%) say it is doing enough.

In contrast, Americans see the recovery efforts in Texas following Hurricane Harvey in late August progressing more positively. Most (60%) of the public says Texans are getting the help they need, twice the share (31%) who say Texans aren’t yet getting needed help.

puertoricopoll.png

The poll finds similar shares of Americans they are closely following news about recovery efforts in Puerto Rico (63%) and in Texas (58%).  Democrats are somewhat more likely to report closely following news about the Puerto Rico recovery (75%) than are independents (61%) and Republicans (54%). In contrast, there are no partisan differences for those following news about Texas.

Designed and analyzed by public opinion researchers at the Kaiser Family Foundation, the poll was conducted from November 8 – 13, 2017 among a nationally representative random digit dial telephone sample of 1,201 adults. Interviews were conducted in English and Spanish by landline (415) and cell phone (786). The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on subgroups, the margin of sampling error may be higher.

 

You can read the original article here.

Source:

Kaiser Family Foundation (20 November 2017). "Two Months After Hurricane Maria, A Growing Majority Of Americans Say Puerto Ricans are Not Yet Getting the Help They Need" [Web blog post]. Retrieved from address https://www.kff.org/other/press-release/poll-two-months-after-hurricane-maria-a-growing-majority-of-americans-say-puerto-ricans-are-not-ye-getting-the-help-they-need/

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Data transparency, debt consolidation and ID protection lead open enrollment wish list

In the thick of open enrollment season, savvy employers and benefit advisers have eased the onslaught of information with complex benefit jargon by spreading out employee sign-up before the mad fall rush. Employee Benefit Adviser spoke with Jeffrey Faber, HUB International Midwest’s chief operating officer, to discuss how employers are urging employees to save with data transparency tools, use interactive services to learn about new benefits and to sign up for identity protection.

EBA: How is open enrollment going for you and your clients?

Faber: We’re in the middle of open enrollment season and we are trying to lock down the last-minute decisions our clients have. Predominantly our business is a renewal business.

Our large groups have made their decisions already but our smaller groups are just finding out what their renewals are from the major medical carriers. We have our hands full trying to make sense of it all. But open enrollment is the focus. This is absolutely our busiest time of year. From mid-August to Halloween, and even mid-November, it seems to be getting longer and longer every year with all the nuances our clients require.

EBA: How does this enrollment season differ from previous years? Is there confusion over the ACA’s status? Is there a greater emphasis on voluntary benefits?

Faber: On the repeal of Obamacare, a lot of those decisions have been made too late for our employers to really have to pivot and they are unaffected largely by the executive orders and the talk from Congress. Of course, there's the specter that Congress will act and make a decision in the next couple of weeks, but that impact would probably be a 2019 event instead of a 2018 event.

On the voluntary benefits side, our clients are asking for financial and holistic tools to meet the employees where they live in regard to student loans, tuition assistance and debt consolidation services. ID theft has been a big conversation point in the last three or four months and has been heightened by the Equifax breach, but it started three years ago with the Target breach. A lot of employers want to understand their role in their employee’s lives,

And for voluntary benefits, most of our customers are moving to the consumer-driven model with higher deductibles, so accident insurance, critical injury insurance, and hospitalization – those are all nice bolt-on benefits for the medical benefits they have. It almost allows the employee to self-insure their own health. And HSAs and HRAs are still popular. We see a large uptick year over year over year.

EBA: Any other trends for this year’s open enrollment?

Faber: A few years ago, we joked that overall enrollment was the HR Super Bowl. It happened once a year, it was a three hour event with a bunch of commercials and no one really talked about it a week or two later.

Our clients have asked, what can we do the other 11 months a year? We have seen an increase in requests for interactive PDFs, on-demand video, and interactive guides directing folks to microsites or apps on their phone. We introduce these in April, May or June and if the employee needs this, they don't have to go back into their memory bank and access it, they can get it online. It is that year round learning that engages the customer.

EBA: Is this because employees are bombarded with information during open enrollment?

Faber: Yes and no. There is a lot of information that is required and that is distributed this time of year and there are a lot of decision points that they have to make for themselves and the benefit of their families. We put in place decision helping tools like Jellyvision’s ALEX and some other proprietary tools, that can help employees better make decisions.

But I think it is more toward trying to be a circuit breaker in an employee's head when they are accessing healthcare. That makes them stop and check, “Is this in network, do I have to get pre-authorization? How do I check for a lower cost across the street from a benefit provider?”

These things come out of the workshops this time of year, but if you are not hitting employees where they live at the time of use, you are missing those opportunities for significant cost savings. And not on just on the employer side but the employee side especially with high-deductible plans.

EBA: Is data transparency a big push for this open enrollment season?

Faber: Yes, especially when you consider that standalone imaging facilities are three to eight times less expensive than an in-house hospital facility. Employees need to understand that they will pay 100% of that cost until they meet that deductible in that consumer-driven plan, so there is every effort being made to make sure the employee is checking those transparency tools.

At open enrolment time, we make every effort to employees in the room to ID the nearest urgent care and ER facility, to write those down on a note card and put it in the visor of their car. So, they know at the moment of crisis to know where those places are and make decisions ahead of time.

EBA: Accountants say that from January to April 15, they don't see their families. Is it the same for you during open enrollment?

Faber: (Laughs) I grew up in an accounting family and I can attest to that. It is all hands on deck but our goal is to help clients get their decisions out of the way in Q1 and Q2. We try to help them with decisions that don't require immediacy and don’t have to be made right away, like life and disability insurance, and voluntary and wellness benefits. You can make a lot of those decisions in April, May and June.

 

 

Source:
Albinus P. (30 October 2017). "Data transparency, debt consolidation and ID protection lead open enrollment wish list" [Web blog post]. Retrieved from address https://www.employeebenefitadviser.com/news/data-transparency-debt-consolidation-and-id-protection-lead-open-enrollment-wish-list-says-hub-international-midwest-coo-jeffrey-faber?feed=00000152-1387-d1cc-a5fa-7fffaf8f0000

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us capitol

Understanding your Letter 226-J

Letter 226-J is the initial letter issued to Applicable Large Employers (ALEs) to notify them that they may be liable for an Employer Shared Responsibility Payment (ESRP). The determination of whether an ALE may be liable for an ESRP and the amount of the proposed ESRP in Letter 226-J are based on information from Forms 1094-C and 1095-C filed by the ALE and the individual income tax returns filed by the ALE’s employees.

What you need to do

  • Read your letter and attachments carefully. These documents explain the ESRP process and how the information received affects the computation.
  • The letter fully explains the steps to take if you agree or disagree with the proposed ESRP computation.
  • Complete the response form (Form 14764) indicating your agreement or disagreement with the letter.
  • If you disagree with the proposed ESRP liability, you must provide a full explanation of your disagreement and/or indicate changes needed on Form 14765 (PTC Listing). Return all documents as instructed in the letter by the response date.
  • If you agree with the proposed ESRP liability, follow the instructions to sign the response form and return with full payment in the envelope provided.

You may want to

  • Review the information reported on Forms 1094-C and 1095-C for the applicable year to confirm that the information filed with the IRS was accurate because the IRS uses that information to compute the ESRP.
  • Keep a copy of the letter and any documents you submit.
  • Contact us using the information provided in the letter if you have any questions or need additional time to respond.
  • Send us a Form 2848 (Power of Attorney and Declaration of Representative) to allow someone to contact us on your behalf. Note that the Form 2848 must state specifically the year and that it is for the Section 4980H Shared Responsibility Payment.

Answers to Common Questions

Why did I receive this letter?
The IRS used the information you provided on Forms 1094/5-C and determined that you are potentially liable for an ESRP.

Where did the IRS get the information used to compute the ESRP?
The IRS used form 1094/5-C filed by the ALE and the individual income tax returns of your full-time employees to identify if they were allowed a premium tax credit.

Is this letter a bill?
No, the letter is the initial proposal of the ESRP

What do I need to do?
Review the letter and attachments carefully and complete the response form by the date provided.

What do I do if the information is wrong or I disagree?
Follow the instructions in the letter to provide corrected information for consideration by the IRS. The IRS will reply with an acknowledgement letter informing you of their final determination.

Do I have appeal rights?
Yes, the acknowledgement letter that you receive will spell out all your rights, including your right to appeal.

General Information

For more info visit ACA information center for Applicable Large Employers

Here’s an excerpt from the 226J letter, and a link to the official sample.

 

Source:

IRS (9 November 2017). "Understanding your Letter 226-J" [Web blog post]. Retrieved from address https://www.irs.gov/individuals/understanding-your-letter-226-j


The Latest: House passes sweeping GOP tax overhaul

WASHINGTON (AP) — The Latest on House consideration of the tax overhaul (all times local):

1:50 p.m.

The House has passed a sweeping Republican tax bill cutting taxes for corporations and many people. It puts GOP leaders closer to delivering to President Donald Trump a crucial legislative achievement after nearly a year of failures.

The House voted 227-205 along party lines to approve the bill, which would bring the biggest revamp of the U.S. tax system in three decades.

Most of the House bill’s reductions would go to business. Both the Senate and House would slash the 35 percent corporate tax rate to 20 percent and reduce levies on millions of partnerships and certain corporations, including many small businesses.

Personal income tax rates for many would be reduced through some deductions, and credits would be reduced or eliminated. But projected federal deficits would grow by $1.5 trillion over the coming decade.

U.S. President Donald Trump has arrived at the Capitol to encourage House Republicans who are about to push a $1.5 trillion tax package through their chamber. (Nov. 16)

___

12:15 p.m.

Democrats are using new projections by Congress’ nonpartisan tax analysts to call the Senate Republican tax bill a boon to the wealthy that boosts middle-income families’ taxes.

The Joint Committee on Taxation estimated that starting in 2021, many families earning less than $30,000 would have tax increases under the bill. By 2027, families earning up to $75,000 would face higher levies, while those earning more would get tax cuts.

Republicans say the new calculations reflect two provisions in the bill.

The Senate measure ends personal income tax cuts beginning in 2026 because Republicans needed to reduce the bill’s costs to obey the chamber’s budget rules.

It also abolishes the requirement under former President Barack Obama’s health care law that people buy insurance. That means fewer people getting federally subsidized coverage — which analysts consider a tax boost.

___

11:35 a.m.

President Donald Trump has arrived at the Capitol to encourage House Republicans who are about to push a $1.5 trillion tax package through their chamber.

The closed-door meeting comes as GOP leaders hope that by Christmas, they will give Trump and themselves their first legislative triumph this year.

House approval was expected later Thursday of the plan to slash corporate tax rates and reduce personal income tax rates while eliminating some deductions and credits.

The Senate Finance Committee is aiming to pass its separate version by week’s end. But some GOP senators want changes.

Republicans say the final measure will bestow lower levies on millions of Americans and spur economic growth by reducing business taxes. Democrats say the measure is disproportionately tilted toward corporations and the wealthy.

___

10:45 a.m.

Republicans drove a $1.5 trillion tax overhaul toward House passage Thursday. But Senate GOP dissenters also emerged in a sign that party leaders have problems to resolve before Congress can give President Donald Trump his first legislative triumph.

Trump was heading to the Capitol for a pep rally with House Republicans, shortly before the chamber was expected to approve the measure over solid Democratic opposition. There were just a handful of GOP opponents in the House, unhappy because the measure sharply curbs deductions for state and local taxes, but all agreed that passage seemed certain.

Like a similar package nearing approval by the GOP-led Senate Finance Committee, most of the House measure’s reductions would go to business. Personal income tax rates for many would be reduced, but some deductions and credits would be reduced or eliminated. Federal deficits would grow by $1.5 trillion over the coming decade.

U.S. President Donald Trump has arrived at the Capitol to encourage House Republicans who are about to push a $1.5 trillion tax package through their chamber. (Nov. 16)

You can read the original article here.

Source:

Associate Press (16 November 2017). "The Latest: House passes sweeping GOP tax overhaul" [Web blog post]. Retrieved from address https://apnews.com/b3297c1e443b40049beebcd832aaadc8?utm_campaign=SocialFlow&utm_source=Twitter&utm_medium=AP

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Trump picks former Lilly drug executive as health secretary

We're sure you've seen it trending. Here is the latest on Alex Azar of Eli Lilly & Co - President Trump's nominee for head of the Department of Health and Human Services.


(Bloomberg) – President Donald Trump named former Eli Lilly & Co. executive Alex Azar to lead the Department of Health and Human Services after agency’s past chief resigned amid blowback over his taxpayer-funded private jet travel.

“Happy to announce, I am nominating Alex Azar to be the next HHS Secretary. He will be a star for better healthcare and lower drug prices!” Trump tweeted Monday.

If confirmed, Azar will take over the administration’s management of the Affordable Care Act. Trump and Congressional Republicans have called to repeal the health law, and the administration has taken steps to destabilize it, such as cutting funding for some programs and refusing to pay subsidies to health insurers. He’ll also be a key figure on drug costs.

Bloomberg/file photo

Trump has been highly critical of the drug industry, saying that pharmaceutical companies are “getting away with murder” and threatening to use the federal government’s buying power to bring down prices.

Drug Costs

However he’s taken no concrete action yet to do much on prices, and the former drug executive’s appointment may continue the trend of strong talk but little action, said Spencer Perlman, director of health-care research at Veda Partners, a policy analysis firm.

“It is very unlikely the administration will take aggressive regulatory actions to control prescription drug prices,” Perlman said in a note to clients Monday. “The administration’s tepid response to drug pricing has not matched the president’s heated rhetoric.”

Dan Mendelson, president of Avalere Health, a consulting firm, also didn’t think Azar represented a change in direction on pharmaceutical policy. “His appointment will not change the president’s rhetoric,” Mendelson said in a phone interview.

Before his time at Lilly, Azar served as deputy secretary at HHS under President George W. Bush. One former Obama administration official said that experience could help him at the agency.

“While we certainly differ in a number of important policy areas, I have reason to hope he would make a good HHS secretary,” said Andy Slavitt, who ran the Centers for Medicare and Medicaid Services under the last administration and who has been a frequent critic of efforts to derail Obamacare. Slavitt said he hoped Azar would “avoid repeating this mistakes of his predecessor over-politicizing Americans’ access to health care.”

Running Obamacare

Azar, who ran Indianapolis-based Lilly’s U.S. operations until earlier this year, has been an advocate for more state flexibility under Obamacare. That matches up with what Republicans have pushed for, such as in a seemingly stalled bipartisan bill to fund insurer subsidies that help lower-income people with health costs.

As secretary, Azar would have broad authority over the program.

“I’m not one to say many good things about Obamacare, but one of the nice things in it is it does give a tremendous amount authority to the secretary,” Azar said during an interview with Bloomberg TV in June. “There are still changes that can be made to make it work a little better than it has been.”

There are signs that the law is gaining popular support despite the repeal efforts. In recent state elections in Virginia, Democrats won a competitive governors race that saw health care emerge as a top issue. In Maine, residents voted to expand Medicaid under the Affordable Care Act. Early enrollment in Obamacare plans earlier this month was also up considerably compared to last year.

Trump’s first HHS secretary, Tom Price, resigned in September after his extensive use of private and military jets at taxpayer expense was revealed. Azar must be approved by the Senate.

Senate Confirmation

Senator Orrin Hatch, who heads the Senate Finance Committee that will review Azar’s nomination, called on Trump’s pick to help “right the wrongs of this deeply flawed law.”

“For too long, hardworking, middle-class families have been forced to bear the brunt of Obamacare’s failures in the form of higher premiums and fewer choices,” Hatch said in a statement.

Ron Wyden, the senior Democrat on the panel, said he would closely scrutinize Azar’s record.

“At every turn, the president has broken his promises to American families to lower health care costs, expand access, and bring down the high price of prescription drugs,” Wyden said in a statement.

Azar left Lilly in January, several months after another senior executive was named to succeed then-CEO John Lechleiter. A lawyer by training, Azar previously clerked for Antonin Scalia on the Supreme Court.

You can read the original article here.

Source:

Employee Benefit Advisors (13 November 2017). "Trump picks former Lilly drug executive as health secretary" [Web blog post]. Retrieved from address https://www.employeebenefitadviser.com/articles/trump-picks-former-lilly-drug-executive-as-health-secretary?tag=00000151-16d0-def7-a1db-97f024b50000

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IRS to reject returns lacking health coverage disclosure

 Where does the IRS stand on ACA (Affordable Care Act)? It's time to know. Check out this article from Benefits Pro for more information.


The Internal Revenue Service has announced that for the first time, tax returns filed electronically in 2018 will be rejected if they do not contain the information about whether the filer has coverage, including whether the filer is exempt from the individual mandate or will pay the tax penalty imposed by the law on those who don’t buy coverage.

Tax returns filed on paper could have processing suspended and thus any possible refund delayed.

The New York Times reports that the IRS appears to be acting in contradiction to the first executive order issued by the Trump White House on inauguration day, in which Trump instructed agencies to “scale back” enforcement of regulations governing the ACA.

The move by the IRS reminds people that they can’t just ignore the ACA, despite the EO. Although only those lacking coverage have to pay the penalty, everyone has to indicate their insurance coverage status on their filing.

While the uninsured rate for all Americans dipped to a historic low of 8.6 percent in the first three months...5 states with lowest, highest uninsured rates

According to legal experts cited in the report, the IRS is indicating that although the administration may have leeway in how aggressively it enforces the mandate provision, it’s still in effect unless and until Congress specifically repeals it.

While many people thought they didn’t have to bother with reporting, and many insurers have raised rates anticipating that the lack of a mandate would lead to lower enrollments and higher costs for them, that’s not the case. Initially the IRS did not reject returns because the law was new.

The penalty is pretty steep; for those who don’t have coverage, it can range from $695 for an individual to a maximum of $2,085 for a family or 2.5 percent of AGI, whichever is higher. Not everyone without coverage would be penalized, though; if their income is too low or if the lowest-priced coverage costs more than 8.16 percent of their income, they’ll avoid the penalty.

That said, it’s not known how stringently the IRS will be in enforcing the mandate. But at least taxpayers will know whether they’re exempt from the penalty or whether they’re obligated to buy coverage.

 

 You can read the original article here.
Source:
Satter M. (23 October 2017). "IRS to reject returns lacking health coverage disclosure" [Web blog post]. Retrieved from address http://www.benefitspro.com/2017/10/23/irs-to-reject-returns-lacking-health-coverage-disc?ref=hp-top-stories&slreturn=1509378329

Pagers, AI, And Google: 3 Tales Of Technology And Medicine

 As a society, we owe technology applause for helping improve our medical abilities tenfold. Today, we thought it would be fun to take a look back on how technological advancements have succeeded in making our medicine better than ever, and how they continue to do so. Take a moment of your time to read this article from Forbes on Pagers, AI, and Google.


Medicine and technological advancement have been intimately intertwined, from the invention of the stethoscope to the latest innovations in MRI scanning. But the road isn’t always smooth. There can be interesting bumps and glitches along the way, as illustrated by these three recent stories.

1) Old tech can linger

The Guardian recently reported that the UK National Health Service uses more than 10% of the world’s pagers. The pagers cost £6.6 million ($8.9 million) per year. Furthermore, the UK will soon only have one provider of pagers nationwide after Vodafone exits the market.

One critic noted, “Taxpayers will wonder why the NHS is spending millions on outdated technology, especially at a time when savings need to be made.”

As a young doctor in the 1990s, I carried a pager. But nowadays, most physicians I know use cell phones to take emergency calls. However, The Guardian notes that there are still a few advantages to pagers, namely:

...[S]lightly more reliability. Where mobile phone networks can be patchy, or slow, or overloaded, the separate paging network offers a modest improvement in reception and reach, especially in rural areas. Compared with modern smartphones, pager batteries also last much longer.

I can see pagers lingering on for special niche applications. But for most people, their time has passed.

By Jakez (Own work), Creative Commons BY-SA 3.0, via Wikimedia Commons.

An old pager/beeper.

2) New tech can be overhyped

I believe that artificial intelligence (AI) will some day have a major impact in the practice of medicine. But STAT News reporters Casey Ross and Ike Swetlitz have described how the IBM Watson AI system “isn’t living up to the lofty expectations IBM created for it.”

Specifically, the Watson for Oncology was intended to help improve cancer care by helping physician with treatment recommendations based on the best available worldwide data

Ross and Swetlitz reported:

While it has emphatically marketed Watson for cancer care, IBM hasn’t published any scientific papers demonstrating how the technology affects physicians and patients. As a result, its flaws are getting exposed on the front lines of care by doctors and researchers who say that the system, while promising in some respects, remains undeveloped...

Perhaps the most stunning overreach is in the company’s claim that Watson for Oncology, through artificial intelligence, can sift through reams of data to generate new insights and identify, as an IBM sales rep put it, “even new approaches” to cancer care. STAT found that the system doesn’t create new knowledge and is artificially intelligent only in the most rudimentary sense of the term.

Because of problems with Watson, the highly-regarded MD Anderson Cancer Center (part of the University of Texas) cancelled its partnership with Watson “amid internal allegations of overspending, delays, and mismanagement.”

I still believe that AI will revolutionize medical care, even if specific products might not (yet) be ready for prime time. I take heart in the fact that the Apple Newton was also a product not ready for prime time — but it did set the stage for the much more successful Apple iPhone and the current mobile technology revolution. Similarly, I think the long-term future of medical AI remains bright, even if specific products may struggle to meet expectations.

3) Current technology can alter the doctor-patient relationship in unexpected ways

Many patients routinely use search engines like Google to find good doctors or to learn more about their physician’s professional qualifications. But to what extent should doctors be searching for information on their patients?

Erene Stergiopoulos discusses this issue in a fascinating essay, “Getting Googled by Your Doctor”:

Searching for patients’ information online gives physicians a way to gather collateral data about a patient who either cannot or will not communicate important clinical information, says Paul Appelbaum, a psychiatrist, professor at Columbia University, and world expert in medical ethics and the law...

That online collateral information is especially useful [in the acute setting, Applebaum] says, where patients may be psychotic, intoxicated, or suicidal. In these acute settings, social media can provide clinicians with valuable context to make decisions — whether the patient uses drugs or alcohol, has self-harmed, or has family support...

However, Stergiopoulos notes that patients can feel betrayed if content from their social media posts ends up in their medical record without their consent.

Furthermore, this can create medico-legal problems:

As more and more providers Google to guide their decisions, they may be shifting the clinical standards to which all practitioners are held... If practitioners neglect that standard, and something preventable goes wrong, they risk accusations of malpractice. In other words, if patient-targeted online searches become the new standard of care, then clinicians could become liable for information patients post online. If a patient leaves a suicidal message on Facebook, and the clinician misses it, there’s a future — seemingly more plausible by the day — in which that clinician could be sued for malpractice if the patient then attempts suicide.

In informal discussions with other health professionals, some colleagues have said they never Google their patients. Others do so selectively. Yet others consider it a legitimate part of conscientious medical practice. And some physicians feel strongly that if patients can Google their doctors, they as physicians should similarly be able to Google their patients.

Clearly, this is an area where medical and legal standards are still evolving. In the meantime, if patients are uncomfortable with their physicians Googling them, they might wish to make their preferences clear ahead of time, before they and their doctor suffer a misunderstanding.

You can read the original article here.
Source:
Hsieh P. (25 September 2017). "Pagers, AI, And Google: 3 Tales Of Technology And Medecine" [Web blog post]. Retrieved from address https://www.forbes.com/sites/paulhsieh/2017/09/25/pagers-ai-and-google/3/#67ac15ab7a47

New Regulations Broadening Employer Exemptions to Contraceptive Coverage: Impact on Women


You can read the original article here.

Source:

Sobel L., Salganicoff A., Rosenzweig C. (6 October 2017). "New Regulations Broadening Employer Exemptions to Contraceptive Coverage: Impact on Women" [Web Blog Post]. Retrieved from address https://www.kff.org/womens-health-policy/issue-brief/new-regulations-broadening-employer-exemptions-to-contraceptive-coverage-impact-on-women/

The Trump Administration has issued new regulations that significantly broaden employers’ ability to be exempt from the Affordable Care Act’s (ACA) contraceptive coverage requirement.  The regulation opens the door for any employer or college/ university with a student health plan with objections to contraceptive coverage based on religious beliefs to qualify for an exemption. Any nonprofit or closely-held for-profit employer with moral objections to contraceptive coverage also qualifies for an exemption. Their female employees, dependents and students will no longer be entitled to coverage for the full range of FDA approved contraceptives at no cost.

On October 6, 2017, the Trump Administration issued two new regulations greatly expanding the types of employers that may be exempt from the Affordable Care Act’s (ACA) contraceptive coverage requirement.  These regulations are a significant departure from the Obama-era regulations that only granted an exception to houses of worship.  One of the regulations allows nonprofits or for-profit employer with an objection to contraceptive coverage based on religious beliefs to qualify for an exemption and drop contraceptive coverage from their plans.  The other regulation also exempts all but publicly traded employers with moral objections to contraception from rule. These new policies, effective immediately, also apply to private institutions of higher education that issue student health plans. The immediate impact of these regulations on the number of women who are eligible for contraceptive coverage is unknown, but the new regulations open the door for many more employers to withhold contraceptive coverage from their plans.

New regulations from the Trump administration greatly expand exemption from #ACA contraceptive coverage rule

Contraceptive coverage under the ACA has made access to the full range of contraceptive methods affordable to millions of women. This provision is part of a set of key preventive services that has been identified by the Health Resources and Services Administration (HRSA) for women that must be covered without cost-sharing. Since it was first issued in 2012, the contraceptive coverage provision has been controversial. While very popular with the public, with over 77% of women and 64% of men reporting support for no-cost contraceptive coverage, it has been the focus of litigation brought by religious employers, with two cases (Zubik v Burwell and Burwell v Hobby Lobby)  reaching the Supreme Court. This brief explains the contraceptive coverage rule under the ACA, the impact it has had on coverage, and how the new regulations issued by the Trump Administration change the contraceptive coverage requirement for employers and affect women’s coverage.

How do the new regulations change contraceptive coverage requirements for employers?

Since they were announced in 2011, the contraceptive coverage rules have evolved through litigation and new regulations. Most employers were required to include the coverage in their plans. Houses of worship could choose to be exempt from the requirement if they had religious objections. This exception meant that women workers and female dependents of exempt employers did not have guaranteed coverage for either some or all FDA approved contraceptive methods if their employer had an objection. Religiously affiliated nonprofits and closely held for-profit corporations were not eligible for an exemption, but could choose an accommodation. This option was offered to religiously affiliated nonprofit employers and then extended to closely held for-profitsafter the Supreme Court ruling in Burwell v. Hobby Lobby. The accommodation allowed these employers to opt out of providing and paying for contraceptive coverage in their plans by either notifying their insurer, third party administrator, or the federal government of their objection. The insurers were then responsible for covering the costs of contraception, which assured that their workers and dependents had contraceptive coverage while relieving the employers of the requirement to pay for it.

As of 2015, 10% of nonprofits with 5,000 or more employees had elected for an accommodation without challenging the requirement. This approach, however, has not been acceptable to all nonprofits with religious objections.1 In May 2016, the Supreme Court remanded Zubik v. Burwell, sending seven cases brought by religious nonprofits objecting to the contraceptive coverage accommodation back to the respective district Courts of Appeal. The Supreme Court instructed the parties to work together to “arrive at an approach going forward that accommodates petitioners’ religious exercise while at the same time ensuring that women covered by petitioners’ health plans receive full and equal health coverage, including contraceptive coverage.”2

On October 6, 2017, the Trump Administration issued new regulations greatly expanding eligibility for the exemption to all nonprofit and closely-held for-profit employers with objections to contraceptive coverage based on religious beliefs or moral convictions, including private institutions of higher education that issue student health plans (Figure 1).  In addition, publicly traded for-profit companies with objections based on religious beliefs also qualify for an exemption. There is no guaranteed right of contraceptive coverage for their female employees and dependents or students. Table 1 presents the changes to the contraceptive coverage rule from the Obama Administration in the new Interim Final regulations issued by the Trump Administration.

Figure 1: Employers Objecting to Contraceptive Coverage: Exemptions and Accommodations Under the Trump Administration Regulations

The accommodation will be available to employers that previously qualified for the accommodation.  They now will also have the choice of an exemption. The federal departments issuing the regulations posit that these new rules will have limited impact on the number of women losing contraceptive coverage.   However, it is not clear how many employers previously utilizing the accommodation will now opt for an exemption, resulting in the loss of contraceptive coverage for their employees and dependents.  In addition, there are also an unknown number of organizations that were not previously eligible for either the accommodation or exemption that may now opt for an exemption. These new regulations create two new categories of employers who can now qualify for an exemption or can voluntarily chooses an accommodation:  1) publicly traded for-profit companies with a religious objection and 2) nonprofit and closely held for-profit employers who have a moral objection to contraceptives, a considerably larger pool of employers than when the exemption was available only to those who were employees of a house of worship or who were eligible for an accommodation in the past.

Table 1: Summary of Changes in the Contraceptive Coverage Regulations for Objecting Entities
  Obama Administration
August 2012 to October 5, 2017
Trump Administration
Effective October 6, 2017
What types of contraceptives must plans cover without cost-sharing? At least one of each of the 18 FDA approved contraceptive methods for women, as prescribed, along with counseling and related services must be covered without cost-sharing. No change
Are any employers “exempt” from the contraceptive mandate?
  • Religious institutions defined as “houses of worship”
  • Grandfathered plans
  • No notice to employees is required. Women workers and female dependents must pay for their own contraceptives.
  • Religious institutions defined as “houses of worship”
  • Grandfathered plans
  • Nonprofit or  for-profit employers (including publicly traded companies), insurers, or private colleges or universities that issue student insurance plans with a religious objection to contraceptive coverage
  • Nonprofit or closely held for-profit employers, insurers, or private colleges or universities that issue student insurance plans with a moralobjection to contraceptive coverage
  • Notice is only required if the plan previously included contraceptive coverage. Women workers and female dependents must pay for their own contraceptives.
Who pays for contraceptive coverage for employees of organizations receiving an exemption?
  • The cost of contraceptives is borne by women workers and female dependents.
  • There is no guarantee of contraceptive coverage for employees of an exempt organization.
  • The employer may choose to cover some methods, but has no obligation to cover all 18 FDA methods without cost sharing
No change

What type of employers may seek an “accommodation” to avoid paying for contraceptives in their plans?  
  • Closely held for-profit corporations and religiously affiliated nonprofits with religious objections to contraception can opt out of providing and paying for contraceptive coverage
  • Notice must be provided to either their insurer, third party administrator, or the federal government of their objection.
  • Women workers and female dependents receive no cost contraceptive coverage.
  • Any entity (except for houses of worship) eligible for an exemption can choose the accommodation instead of the exemption.
  • Notice must be provided to either their insurer, third party administrator, or the federal government of their objection.
  • Women workers and female dependents receive no cost contraceptive coverage.
Who pays for contraceptive coverage for employees of organizations receiving an accommodation?
  • Insurance companies of firms obtaining an accommodation must pay for contraceptive coverage.
  • Third-party administrators (TPA) of self-funded health plans must cover the costs of contraceptives for employees. The costs of the benefit are offset by reductions in the fees the TPA pays to participate in the federal exchange.
No change
When can entities change from an accommodation to an exemption? N/A
  • When an employer or private college or university currently using the accommodation opts for an exemption, the revocation of contraceptive coverage will be effective on the first day of the first plan year that begins 30 days after the date of the revocation or 60 days notice may be given in a summary of benefits statement.
  • The issuer or third party administrator is responsible for providing the notice to the beneficiaries.

How has the contraceptive coverage rule affected women?

Contraceptive use among women is widespread, with over 99% of sexually-active women using at least one method at some point during their lifetime.3 Contraceptives make up an estimated 30-44% of out-of-pocket health care spending for women.4 Since the implementation of the ACA, out-of-pocket spending on prescription drugs has decreased dramatically (Figure 2). The majority of this decline (63%) can be attributed to the drop in out-of-pocket expenses on the oral contraceptive pill for women.5 One study estimates that roughly $1.4 billion dollars per year in out-of-pocket savings on the pill resulted from the ACA’s contraceptive mandate.6  By 2013, most women had no out-of-pocket costs for their contraception, as median expenses for most contraceptive methods, including the IUD and the pill, dropped to zero.7

Figure 2: The Contraceptive Coverage Policy Has Had a Large Impact on Out-Of-Pocket Spending in a Short Amount of Time

This provision has also influenced the decisions women make in their choice of method. After implementation of the ACA contraceptive coverage requirement, women were more likely to choose any method of prescription contraceptive, with a shift towards more effective long-term methods.8  High upfront costs of long-acting methods, such as the IUD and implant, had been a barrier to women who might otherwise prefer these more effective methods.  When faced with no cost-sharing, women choose these methods more often9, with significant implications for the rate of unintended pregnancy and associated costs of childbirth.10

Finally, decreases in cost-sharing were associated with better adherence and more consistent use of the pill. This was especially true among users of generic pills.  One study showed that even copayments as low as $6 were associated with higher levels of discontinuation and non-adherence,11 increasing the risk of unintended pregnancy.

Do states with no-cost contraceptive coverage laws allow exemptions to objecting entities?

The federal standards under Affordable Care Act created a minimum set of preventive benefits that applied to most health plans regulated by the federal government (self-funded plans, federal employee plans) and states (individual, small and large group plans), including contraceptive coverage for women with no cost-sharing.  States have also historically regulated insurance, and many have had mandated minimum benefits for decades. State laws, however, have more limited reach in that they only apply to state regulated fully insured plans, do not have jurisdiction over self-funded plans, where 61% of covered workers are insured.12 In self-funded plans, the employer assumes the risk of providing covered services and usually contracts with a third party administrator (TPA) to manage the claims payment process. These plans are overseen by the Federal Department of Labor under the Employer Retirement Income Security Act (ERISA) and are only subject to federally established regulations.13  The ACA sets a minimum standard of coverage for preventive services for all plans. However, state laws regulating insurance, including contraceptive coverage, can require fully insured plans to provide coverage beyond the federal standards.

Eight states have strengthened and expanded the federal contraceptive coverage requirement (CA, IL, MD, ME, NV, NY, OR, VT).  Another 20 states have contraceptive equity laws that require plans to cover contraceptives if they also provide coverage for prescription drugs but they do not necessarily require coverage of all FDA-approved contraceptives or ban cost-sharing (Figure 3).

Figure 3: Many States Have Contraceptive Coverage Requirements

Many of the 28 states that have passed contraceptive coverage laws (both equity and no-cost coverage) have a provision for exemptions, but the laws vary from state to state and only apply to fully insured plans.  This means that there may be a conflict between the state and federal requirements when it comes to religious exemptions.  In some states with a contraceptive coverage requirement, some employers who are eligible for an exemption under federal law will not qualify for an exemption under state law (Table 2). Employers in those states will have to have to meet the standards established by their state even though they may qualify for an exemption based on the new federal regulations.  This conflict may set the stage for future litigation.

Table 2: State Requirements for No-Cost Contraceptive Coverage
StateDate Effective Applies to Coverage required without cost sharing Exemptions allowed
  Private plans Medicaid With RX all FDA approved OTC Vasectomy Religious Moral
CaliforniaJanuary 2015 X MCOs X Narrowly defined nonprofit religious employers None
IllinoisJanuary 2017 X X X
except male condoms
Any employer, or insurer with a religious objection Any employer, or insurer with a moral objection
MarylandJanuary 2018 X X X X X Religious organizations if the coverage conflicts with the organization’s bona fide religious beliefs and practices None
MaineJanuary 2019 X X Narrowly defined nonprofit religious employers None
NevadaJanuary 2018 X X X Insurers affiliated with a religious organization None
New YorkAugust 2017 X X Narrowly defined nonprofit religious employers* None
OregonAugust 2017 X X X Narrowly defined nonprofit religious employers None
VermontOctober 2016 X X – and all other public health assistance programs X X None None
NOTES: *Requires the insurer to offer a rider to policyholders so that women will have contraceptive coverage.
SOURCE: Kaiser Family Foundation analysis of state laws and regulations.

Conclusion

The Trump Administration’s new regulations substantially expand the exemption to nonprofit and for-profit employers, as well as to private colleges or universities with religious or moral objections to contraceptive coverage. It is unknown how many of these employers and colleges will maintain coverage through the accommodation as before and how many will now opt for the exemption leaving their students, employees and dependents without no-cost coverage for the full range of contraceptive methods. As a result of the new regulation, choices about coverage and cost-sharing will be made by employers and private colleges and universities that issue student plans. For many women, their employers will determine whether they have no-cost coverage to the full range of FDA approved methods.  Their choice of contraceptive methods may again be limited by cost, placing some of the most effective yet costly methods out of financial reach.

You can read the original article here.

Source:

Sobel L., Salganicoff A., Rosenzweig C. (6 October 2017). "New Regulations Broadening Employer Exemptions to Contraceptive Coverage: Impact on Women" [Web Blog Post]. Retrieved from address https://www.kff.org/womens-health-policy/issue-brief/new-regulations-broadening-employer-exemptions-to-contraceptive-coverage-impact-on-women/


4 Main Impacts of Yesterday's Executive Order

Yesterday, President Trump used his pen to set his sights on healthcare having completed the signing of an executive order after Congress failed to repeal ObamaCare.

Here’s a quick dig into some of what this order means and who might be impacted from yesterday's signing.

A Focus On Small Businesses

The executive order eases rules on small businesses banding together to buy health insurance, through what are known as association health plans, and lifts limits on short-term health insurance plans, according to an administration source. This includes directing the Department of Labor to "modernize" rules to allow small employers to create association health plans, the source said. Small businesses will be able to band together if they are within the same state, in the same "line of business," or are in the same trade association.

Skinny Plans

The executive order expands the availability of short-term insurance policies, which offer limited benefits meant as a bridge for people between jobs or young adults no longer eligible for their parents’ health plans. This extends the limited three-month rule under the Obama administration to now nearly a year.

Pretax Dollars

This executive order also targets widening employers’ ability to use pretax dollars in “health reimbursement arrangements”, such as HSAs and HRAs, to help workers pay for any medical expenses, not just for health policies that meet ACA rules. This is a complete reversal of the original provisions of the Obama policy.

Research and Get Creative

The executive order additionally seeks to lead a federal study on ways to limit consolidation within the insurance and hospital industries, looking for new and creative ways to increase competition and choice in health care to improve quality and lower cost.


Health Care Sector Earnings: Major Companies Open The Books On Q3 Results In Weeks Ahead

In the weeks ahead, some major companies begin to showcase their Q3 results. Check out this article for some insight on the situation written by JJ Kinahan of Forbes.
You can read the original article here.

Photo Credit: Shutterstock

The health care sector has been one of the better-performing sectors in 2017, bouncing back after being the only sector in the S&P 500 to finish last year in the red. So far this year, the S&P Health Care Select Sector Index is outperforming the S&P 500 by 5.75% as of October 6.

The sector got a bump recently when Republicans’ released an initial framework for tax reform, with CNBC pointing out that some of the largest companies in the health care sector could be primary beneficiaries of the proposed repatriation tax break. For the sector’s upcoming earnings, analyst estimates are calling for low to mid-single-digit growth for both earnings and revenue.

Within the S&P 500, the health care sector is expected to report year-over-year revenue growth of 4.8% and earnings growth of 2.5%, according to FactSetwith profit margins estimated to decline from 10.3% to 10.1% across the sector. Those estimates are slightly below the sector’s estimated revenue and earnings growth rates expected for the full year.

Beyond the proposed tax reform, below we’ll take a look at what’s been happening in the sector as companies prepare to report earnings in the upcoming weeks.

S&P Health Care Sector Index compared to S&P 500 and Nasdaq Biotechnology Indexthinkorswim

After underperforming by a large margin in 2016, the health care sector has been recovering in 2017. The S&P Health Care Select Sector Index, charted above, is up 18.49% year-to-date, compared to a 12.74% increase in the S&P 500, the teal line. The Nasdaq Biotechnology Index, the purple line, has outperformed both and climbed 25.6% year-to-date. Chart source: thinkorswim® by TD Ameritrade. Data source: Standard & Poor’s. Not a recommendation. For illustrative purposes only. Past performance does not guarantee future results.

Biotech Industry Outperforming

So far this year, the biotechnology industry has outpaced the broader health care sector, with the Nasdaq Biotechnology Index up 25.6% versus a 18.49% increase in the S&P Health Care Select Sector Index. However, looking at 2016, the Nasdaq Biotechnology Index fared far worse than the S&P Health Care Select Sector Index, declining 22.01% when the latter only declined 4.37%.

Stocks in the biotech industry are notoriously volatile and it can take many years, even decades, for a company to undergo research and development, and the clinical trial process. A 2014 study by Tufts University’s Center for the Study of Drug Development found that only 11.8% of drugs that enter clinical trials end up being approved by the FDA.

Washington on Health Care

Drug pricing scrutiny has been an ongoing focus in Congress, but there’s yet to be concrete legislation pushed forward to address the issue. Dr. Scott Gottlieb, the head of the Food and Drug Administration (FDA), recently said high drug prices are a “public health concern” and in a post on the FDA’s official blog, outlined several steps the agency is taking to make the generic approval process for complex drugs easier.

On October 17, the Senate Health Committee is scheduled to hold a second hearing as part of its investigation into high drug prices. Representatives from drug company and pharmacy benefit managers—essentially middle men between pharmacies and drug companies—have been invited to speak before the panel. Depending on how that hearing goes, there could be heightened volatility in healthcare stocks.

Due to the costly process of developing drugs, companies often go to great lengths to protect patents. Those practices have also started to come into scrutiny in Congress as well. Allergan announced last month it had transferred the patent rights for its drug Restasis to the St. Regis Mohawk Indian Nation, which would license them back to Allergan in exchange for ongoing payments to the tribe.

The tribe’s sovereign immunity would potentially shield the drug from certain patent reviews. “Allergan has argued that the legal maneuver is aimed at removing administrative patent challenges through inter partes review by the U.S. Patent Trial and Appeal Board, and not challenges in federal court”, according to Reuters.Shortly after Allergan transferred the patent rights, U.S. Senator Claire McCaskill quickly announced she had drafted a bill to prevent tribal sovereign immunity from being used to block U.S. Patent and Trademark Office review of a patent in response to the move.

Aging Demographics and More Disease as Population Grows

There are some trends that analysts anticipate to be tailwinds for the sector for years to come. One of them is aging demographics and the other is growth of certain diseases. Approximately 10,000 baby boomers turn 65 every day, according to Pew Research, and that trend is expected to continue until 2030, when the last of the boomers reach retirement age and roughly 18% of the U.S. population is projected to be 65 and older.

As world populations grow and age, certain diseases are expected to have a greater prevalence than others and a large portion of health care spending is likely to go towards them. By 2020, Deloitte projects that 50% of global health care expenditures, about $4 trillion, will be spent on cardiovascular diseases, cancer and respiratory diseases.

These trends could be a tailwind for healthcare companies, but at the same time a lot could change in the regulatory environment as well as with the treatments available in the years ahead.

Looking Ahead to Earnings

The first major company in the sector to report earnings is Johnson & Johnson, which will release results before market open on Tuesday, October 17. The following companies report later in the month: Eli Lilly & Co. before market open on Tuesday, October 24, Gilead Sciences after market close on Thursday, October 26, Merck before market open on Friday, October 27 and Pfizer before market open on Tuesday, October 31.

 

You can read the original article here.

Source:

Kinahan J. (10 October 2017). "Health Care Sector Earnings: Major Companies Open The Books On Q3 Results In Weeks Ahead" [Web Blog Post]. Retrieved from address https://www.forbes.com/sites/jjkinahan/2017/10/10/health-care-sector-earnings-major-companies-open-the-books-on-q3-results-in-weeks-ahead/#417bef6a44bb