Efforts To Fix Health Care Draw Mixed Reviews
Originally posted November 18, 2013 by Pamela Dockins on https://insurancenewsnet.com
WASHINGTON - U.S. President Barack Obama is taking steps to correct problems that have plagued his health care reform program since its launch in October. There is debate over whether the president has made enough changes to the program to quell discontent.
The Obama administration says it is working to fix problems with the government's health care website.
Many Americans have been frustrated by the site's technical glitches, which have prevented them from buying health insurance.
This past week, Obama offered a fix to another problem that is causing some Americans to lose their health care policies under his new program. The president said insurance companies could now give these people the option of keeping their old plans for an extra year.
"Now this fix won't solve every problem for every person but it is going to help a lot of people," said the president.
Michael Consedine, the insurance commissioner of Pennsylvania and secretary-treasurer of the National Association of Insurance Commissioners, said the president's fix could wind up causing confusion. "That fix is a very temporary one and may ultimately cause far greater harm to the insurance marketplace in allowing different products and different policies to continue in a marketplace where we thought there would be a lot more uniformity."
On Friday, the Republican-majority House of Representatives voted to make even more changes. A bill passed with the support of some House Democrats that would allow insurance companies to sell policies that lack all the health care reform mandates and renew customer policies that had been canceled.
The bill's fate in the Senate is uncertain.
Consedine said rapid changes in insurance policies and rates could become problematic at the state level. "We really are feeling like sort of like a ship out on the waves being tossed and turned. The prevailing winds go one direction one day and another the next."
Anne-Marie Slaughter is a former director of policy planning at the State Department and the current head of the New America Foundation, a public policy institute. On VOA's Press Conference USA, she predicted Obama would be able to weather the health care storm.
States to decide which plans are PPACA-compliant
Originally posted November 21, 2013 by Arthur D. Postal on https://www.lifehealthpro.com
States will be the ultimate determinant as to whether they will allow insurers to renew existing health insurances plans in 2014 even though these policies may not comply with the new Affordable Care Act, President Obama and state insurance regulators agreed at a White House meeting last night.
The meeting with several insurance commissioners and Ben Nelson, chief executive officer of the National Association of Insurance Commissioners, was held as the White House continued itsefforts to smooth the troubled political waters caused by the rocky rollout of the federal exchange that will be used by residents of 36 states to buy individual and small group policies mandated by the law.
The state regulators used the occasion to raise other issues with the president, including their relationship with federal insurance regulators given a voice in insurance regulation left to the states for 150 years. A major issue brought up with the president was the role they want to play in establishing international insurance standards.
As for the healthcare, law, under the Patient Protection and Affordable Care Act, everyone must have health insurance by March 31, 2014, or pay a penalty. However, the exchange website unveiled Oct. 1 has proved unequal to its task, and there are questions whether it will be fully up to speed by the end of the month, as promised by the administration.
The inability of people to access the website, plus the realization that the president’s commitment to allow everyone to “keep their existing policies if they like them” contradicts the law’s mandate that each insurance policy must contain certain essential benefits, has generated a major political problem for the president.
These essential benefits include providing insurance to people with pre-existing conditions, free preventative care, maternity coverage and other benefits. Also included is a requirement to provide contraceptives for women.
However, the realization that most existing policies didn’t include such benefits created a major practical problem as insurers notified thousands of affected consumers that their existing policies would be cancelled.
As the meeting was being held, CareFirst BlueCross Blue Shield, which serves Maryland, announced that it would allow more than 55,000 policyholders to retain their policies for one year even though the policies don’t contain some of the essential benefits mandated by the new law. CareFirst acted one day after the Maryland insurance commissioner said he would approve such action. Other health insurers in the state said they would also do so; others said they would not.
Other states, like Florida, said they would also allow consumers to keep their existing policies for one year. But, others, like New York, Washington and Indiana, said they would not comply. CaliforniaInsurance Department officials said they would announce their decision today.
At the meeting, the state insurance regulators emphasized their concern that different rules for different policies would be detrimental to the overall insurance marketplace and could result in higher premiums for consumers, without addressing the underlying concern of gaps in coverage. They also emphasized the importance of deferring to the states to protect consumers, and highlighted the track record of effective regulation by insurance departments across the country.
However, they acknowledged that they are just standard-setters, not policymakers and reiterated, as stated by Jim Donelon, NAIC President and Louisiana insurance commissioner, that PPACA is “the law of the land."
“Since the passage of ACA, state regulators have been working to ensure that plans are compliant with the new rules,” Donelon said at the meeting.
He said the proposed changes announced by the president in an executive order last Thursday in response to the uproar over the cancellations and the difficulty consumers are having buying policies on the federal website has creating “a level of uncertainty that we must work together to alleviate.”
Donelon made clear, however that state regulators “share the President’s goal of affordable coverage for consumers, and we will work with the insurance companies in our states to implement changes that make sense while following our mandate of consumer protection.”
Donelon attended the meeting with NAIC Chief Executive Officer Senator Ben Nelson, Connecticut Insurance Commissioner Thomas B. Leonardi, and North Carolina Insurance Commissioner Wayne Goodwin.
The group discussed practical implications of implementing the delay in enforcement as well as outstanding questions regarding what specific provisions would be impacted, and talked to reporters at length at what was accomplished at the meeting in a conference call afterwards.
Amongst the presidential aides attending the meeting was Kathleen Sebelius, secretary of the Department of Health and Human Services. Sebelius and officials of the Centers of Medicare and Medicaid Services, which oversaw development of the website, have been under intense fire because the website has failed because of the huge numbers of people who sought access to it, and because testing designed to prove it worked was not even started until a week or so before the Oct. 1 rollout.
The White House released a statement saying the state regulators had been given full authority as to whether to accept the grandfathering. According to the statement, Obama said that his executive order requires that health plans that offer such renewals provide consumers with clear information about consumer protections lacking in those plans and their options and possible tax credits through the exchanges. The statements said that Obama acknowledged that, “States have different populations with unique needs, and it is up to the insurance commissioner and health insurance companies to decide which insurance products can be offered to existing customers next year.”
Additionally, according to the White House statement, the president emphasized that he wants to hear any ideas that insurance commissioners “may have as implementation continues to ensure that Americans across the country have the information they need to get affordable, quality coverage for themselves and their families.”
Groups defend small self-insured plans
Originally posted November 14, 2013 by Allison Bell on www.benefitspro.com
Defenders of self-insured health plans testified on Capitol Hill today that the plans are tools for employers to get more control over benefits programs, not get-out-of-federal-health-regulation free cards.
The witnesses — including Robin Frick, a Madisonville, La., benefit plan administrator, who spoke on behalf of the National Association of Health Underwriters, and Michael Ferguson, the president of the Self-Insurance Institute of America, appeared at a hearing on self-insurance organized by the House Small Business Committee health subcommittee.
Some health policy watchers, including Linda Blumberg of the Urban Institute, who also testified at the hearing, have suggested that young, healthy small groups could use self-insurance simply to escape from Patient Protection and Affordable Care Act requirements, and that a flight toward self-insurance could destabilize the small-group health insurance market.
Frick told subcommittee members that most PPACA market protection rules will apply to self-insured groups as well as to insured groups.
"Further, some protections, like non-discrimination testing, already apply to all self-funded plans," Frick said, according to a written version of his remarks posted on the committee website.
The U.S. Department of Health and Human Services is giving more flexibility to insured plans in some areas, such as employee participation requirements, than to self-insured plans, Frick said.
Ferguson gave a list of some of the many PPACA rules that apply to non-grandfathered self-insured plans, including the ban on annual and lifetime benefits limits, preventive services coverage requirements, benefits summary requirements, disclosure requirements, external claim denial review requirements, limits on waiting periods, and an emergency services coverage mandate.
Many of the PPACA provisions that exempt self-insured groups, such as PPACA health insurance rate rules, are irrelevant to self-insured groups, because the self-insured plan sponsors already have an obvious incentive to try to hold down administrative costs, Ferguson said.
Survey: Employees still under-informed on ACA, wellness
Originally posted November 8, 2013 by Tristan Lejeune on ebn.benefitnews.com
Only 15.1% of workers at large employers say they are “knowledgeable” or “very knowledgeable” about health care reform and the Affordable Care Act’s public exchanges, and nearly one in five can’t say for sure if their company has a wellness program or not, according a recent survey. The poll’s results, released this month, speak to a population that has confidence in the communication efforts of their benefits administrators, and that points out some serious shortfalls in that communication.
The survey, which spoke with 400 employees at companies with north of 2,000 each, found that only 29.5% could correctly identify times when they can make changes to their health plans, like open enrollment, according to the Jellyvison Labs. Jellyvision, which created ALEX, a virtual employee benefits counselor, says all but one of the employers involved in the survey offer health insurance, but employees still demonstrate large education gaps on their own benefits.
More than 90% of surveyed workers say it’s at least “somewhat important” to understand ACA and its implications, but less than a fifth actually consider themselves knowledgeable. The good news is employee confidence in their employers’ ability to communicate the necessary information is high: nearly 80% think their companies can properly bring them up to speed, and more than one in three rate their confidence levels on this point at eight or higher on a 10-point scale.
Some 77.6% of those polled agree that it is at least “somewhat important” for their organizations to offer a wellness program, but almost one-fifth don’t know with any certainty whether or not their company does so.
“One of the most important things we learned from this data,” says Josh Fosburg, vice president of business development for the Jellyvision Lab, “is employees aren’t getting everything they need to know about their employers’ wellness programs and other benefits. For instance, nearly half of employees in our survey think they have to pay something in order to take advantage of the wellness programming that will help them manage their weight, stay on top of their prescribed medications, or cease smoking. That’s bananas.”
Jellyvision says employers need to “up their communications game” in order to help employees take advantage of everything included in their benefits offerings.
For one year, White House revives health plans canceled under ACA
Originally posted November 14, 2013 by Tristan Lejeune and Brian M. Kalish on https://ebn.benefitnews.com
President Barack Obama announced that Americans whose health care plans have been canceled because they fall short of Affordable Care Act standards have been granted a one-year reprieve. With the decision, state governors and insurance commissioners would have the authority to keep would-be canceled plans active until the end of 2014.
“The Affordable Care Act is going to work for the American people,” Obama said from the White House briefing room in remarks that opened with sympathy and support for the typhoon-ravaged Philippines. Obama acknowledged that his team “fumbled the roll-out of the health care law,” but he hopes that extending existing plans will help win “back the confidence of the American people.”
The decision, which helps live up to a promise Obama made when pushing for passage of health reform, is couched as an administrative fix that says following ACA will not require insurance companies to upgrade their plan for individuals who have been in these existing plans so far. In what the White House is calling “an extension of grandfathering principle” Americans should now all be able to re-enroll in their current coverage so long as it is still offered by their provider.
“Two important things we require from insurance companies,” says the administration, “one is they notify consumers what protections these renewed plans do not include. And two, they notify consumers that they will have new options available on the marketplace that offer better coverage, and tax credits are available for many people.”
Insurers and participants in the individual and small group markets will not be considered noncompliant in these plans next year. This is a policy “targeted and very targeted” to those individuals who are in those policies today, it is not allowing to be sold to people not in plans. IN other words, the policy change only applies to extant plans; all new plans must comply with Obamacare in full.
Next year is an election cycle for 33 senators and the entire House of Representatives. This move will widely be seen as trying to appease voters furious about having their plans canceled after pledges were repeatedly made that exactly that would not happen.
State authorities can still decide to consider plans non-compliant next year and insist insurers get up to speed.
Obama said that Healthcare.gov enrollment is “absolutely not” where he wants it to be, “but there’s no question that there’s great demand for high-quality health care,” and he urged health care consumers not to try to throw out the baby with the bathwater and return to the landscape circa 2009.
“It’s important that we pretend that that’s not a place worth going back to,” Obama said. “And that’s why I will not accept proposals that are just a brazen attempt to overturn the law and go back to a broken system.”
He added: "This fix won't solve every problem for every person but it will help a lot of people. Doing more will require work with Congress."
Make Tax Day Also Enrollment Deadline, One Health Expert Says
Originally posted November 7, 2013 by Julie Appleby on kaiserhealthnews.org
With one small fix, the administration could satisfy calls from some members of Congress to extend the time people have to enroll in new health insurance through online marketplaces, a health policy expert says.
The fix would not create problems in the industry and would move the deadline to a point when many people have a little extra money, says Brian Haile, senior vice president for health policy at tax preparation firm Jackson Hewitt.
Haile says pushing the current March 31 deadline to April 15 would ensure more people have cash from tax refunds to buy insurance – and would not really change the effective date of coverage beyond the current deadline.
That’s because there is a mid-month cutoff for coverage to begin on the first day of the following month. Policies for those who sign up at the end of March or on tax day would be the same: May 1.
While no specific new open enrollment end date has been proposed by lawmakers, several members of Congress of both parties are considering legislation amid the ongoing difficulties with healthcare.gov, the federal insurance website operating in 36 states.
Insurers are generally opposed to an extension, saying they based their premium rates for next year on the idea that the enrollment period would end March 31. Delaying the penalty for not having coverage or extending the open enrollment period could result in higher premiums in the future, the industry’s trade lobby has warned.
Actuaries say that insurers assumed in their premium calculations that most people would sign up by mid-December for coverage to begin Jan. 1, granting them an entire year of premium revenue.
Insurers also are concerned that the problem-plagued federal healthcare.gov website has increased chances that the people who soldier through the hassles of enrolling are likely to be those with costly medical conditions who were shut out of coverage previously. Healthy customers are needed to balance the risk – and cost — in the insurance pool. Add to that the talk of extending enrollment deadlines, and insurers see more revenue slipping away, eaten up by medical inflation and fewer months to collect premium payments during the year.
Looking at expected medical inflation for next year, every month’s delay probably corresponds to an average of two-thirds of 1 percent higher cost for the insurers, said David Axene, fellow of the Society of Actuaries. “That starts to creep into the amount of margin built into rates.”
Haile, a former director of the Insurance Exchange Planning Initiative of Tennessee, argues that granting a short enrollment extension could help insurers pick up additional younger or healthier consumers. Some of those customers may have been sitting on the sidelines because they are strapped for extra cash until they get their tax returns.
Insurers “are not going to lose revenue, but will pick up some young invincibles,” Haile said.
Although federal officials are not talking about changing the enrollment period – they see getting the website fixed as the top priority — the administration has moved to resolve an issue about timing. The problem was that even though the law allows the enrollment season to continue until the end of March, anyone purchasing a policy after Feb. 15 would have faced a penalty. So the administration granted an extra six weeks for people to avoid a penalty in 2014 for not having coverage. The tax penalty is $95 or 1 percent of household income, whichever is greater.
Why employers need to pay attention to ACA's insurance exchanges
Originally posted November 06, 2013 by Al Karr on www.federaltimes.com
When the Affordable Care Act first passed, most self-insured employers thought they wouldn't need to pay much attention to the new health insurance exchanges (or marketplaces) created by the law. After all, they were intended to help uninsured people get access to insurance, and their employees were obviously insured. And President Obama did promise that if people liked their employer coverage, they would get to keep it. So there wasn't really anything for self-insured employers to worry about, right?
Well, it turns out that things aren't that simple. Employers do need to pay attention to the exchanges that have launched in their states — either by the state or the federal government — because even if their employees don't use them, the functioning of the exchanges depends pretty heavily on some critical interactions among exchanges, employers, and their employees.
Most employers are aware by now that the requirement for large employers to offer coverage has been delayed for one year. But there are still many provisions in the ACA that place burdens and obligations on employers related to the exchanges. Most importantly, all employers (regardless of whether they currently offer insurance) must still provide notification to their employees describing the exchanges, and explaining the implications of applying for a tax credit on the exchange. There are also regulatory processes for exchanges to verify with employers information that individuals provide on exchange enrollment applications.
So employers are starting to realize that they really do need a communications strategy for how to tackle exchange education with their employees. Simply mailing the required notification form to all employees and calling it a day won't cut it.
Confused employees
Employees are going to have questions — lots of them. Some have been following the health care reform discussion, and those that hadn't been following it probably are now, thanks to the major issues the federal exchange has been having since its launch on October 1. Employees are seeing TV ads, print ads in magazines and newspapers, in addition to the media coverage on the exchange launch. And policy experts have noticed that some of these advertisements are totally devoid of any mention that the exchange is Obamacare or the ACA, and most don't mention anything at all about the individual mandate and that the exchanges are how to fulfill the mandate.
Employees could come into contact with navigators, certified application counselors, or in-person assisters (individuals hired by exchanges to assist with enrollment), all of which will be emphasizing the exchanges and the individual mandate, but probably don't know much about employer-sponsored plans in general, let alone each individual's circumstances regarding employer-sponsored coverage.
Recent polls have shown that as many as half of Americans believe the ACA was either repealed, or held unconstitutional, so these messages will no doubt be confusing for employees to hear. Despite all of the media coverage of the disastrous exchange launch, there are still people out there who might know about exchanges, but don't know what the ACA means to them.
Employers should be taking action now to devise a communications strategy aimed at their employees that is relevant to their workforces and fits appropriately within their company cultures. We all know that employees don't read the volumes of (boring) information employers provide during open enrollment season. Educating employees about exchanges is going to require a different and more ongoing approach. Some of the tactics employers should consider include:
- Human resources staff should be meeting with executive leadership to devise and invest in an employee communications strategy
- Contracting with a call center to do outbound calling to every employee
- Requiring all employees to meet face-to-face with an HR staff member
- Producing short videos about the exchanges for use in company communications
- Requiring attendance at "all staff" meetings
- Creating one-pagers to post on company intranet sites or to distribute through company newsletters
Navigators
One thing that has been discussed by some employers, but that may not be the best thing to rely on as a sole tactic, are the navigators. While a lot of organizations have become navigators, there is general agreement among policy makers that the program itself is woefully underfunded. And since some exchanges are run by states themselves, and the federal government runs others, it’s anticipated that the number of navigators hired and the training they will receive will vary from state to state. Also, there is no statutory requirement that navigators be trained on the nuances of employer-sponsored coverage, so there is no guarantee that they will be able to answer employees' questions about the coverage they are offered at work.
Almost Half Of Workers Don’t Know What Impact Affordable Care Act Will Have On Them
Originally posted November 06, 2013 on https://www.insurancebroadcasting.com
Online resources cited as most reliable source of information about law
COLUMBIA, S.C.--(BUSINESS WIRE)--A survey conducted online by Harris Interactive on behalf of Colonial Life & Accident Insurance Company shows nearly half of American workers don’t feel knowledgeable about how the Affordable Care Act will impact them personally.
“Despite all the attention the Affordable Care Act has received in the past few years, nearly half of American workers still say they don’t know much about it”
In a poll of more than 1,000 U.S. employees (full-time and/or part-time)1, 47 percent of workers say they are not very knowledgeable or not at all knowledgeable about the impact the Affordable Care Act will have on them. Thirty-three percent say they’re not very knowledgeable about the law and its proposed personal impact, and 14 percent say they’re not at all knowledgeable.
“Despite all the attention the Affordable Care Act has received in the past few years, nearly half of American workers still say they don’t know much about it,” says Steve Bygott, assistant vice president of core market services at Colonial Life.
In other survey findings, 48 percent of workers say federal government websites are the most reliable source of information about the ACA and its personal impact on them. They rated internet or other online news sources as the next most reliable, cited by 44 percent of employees. Other sources viewed as reliable options include:
Their employers or HR departments
36 percent
Insurance company websites or literature
30 percent
TV news programs
25 percent
Printed magazines or newspapers
20 percent
Family or friends
18 percent
Other
8 percent
“Workers clearly need help understanding this law and its personal impact on them and their families,” says Bygott. “Because employers are viewed as one of the top three sources of reliable information on this topic, they have a tremendous opportunity to help their workers get the information they need when they communicate their benefits programs.”
Survey results were included as part of a white paper recently published by Colonial Life called “Beyond Health Care Reform.” The research paper outlines what employers should know about health care reform, employee benefits and the subsequent need for increased benefits education.
Survey Methodology
This survey was conducted online within the United States by Harris Interactive on behalf of Colonial Life from September 3-5, 2013 among 2,046 adults ages 18 and older, among whom 1,023 are employed full-time or part-time. This online survey is not based on a probability sample and therefore no estimate of theoretical sampling error can be calculated. For complete survey methodology, including weighting variables, please contact Jeanna Moffett at Colonial Life at JMoffett@ColonialLife.com.
1 Online survey conducted within the United States for Colonial Life & Accident Insurance Company by Harris Interactive, Sept. 3-5, 2013, among 2,046 U.S. adults age 18 and older, among whom 1,023 are employed full-time or part-time.
Cost of benefits, ACA compliance main concerns of midsized businesses
Originally posted by Andrea Davis on https://ebn.benefitnews.com
The cost of health coverage, the Affordable Care Act and the volume of government regulations are the top three concerns of midsized business owners and executives, according to a new survey from the ADP Research Institute.
Seventy percent of midsized businesses – those with between 50 and 999 employees – surveyed said their biggest challenge in 2013 is the cost of health coverage and benefits. ACA legislation came in as the No. 2 concern, cited by 59%, a 16% increase over last year. And rounding out the top three list of concerns was the level and volume of government regulations, cited by 54%.
“What was a surprise to us was that midsized business owners’ level of confidence in their ability to comply with the laws and regulations doesn’t reflect reality,” says Jessica Saperstein, division vice president of strategy and business development at ADP.
For example, the survey finds that, overall, 83% of midsized businesses are confident they’re compliant with payroll tax laws and regulations, nearly one-third reported unintended expenses – fines, penalties or lawsuits – as a result of not being compliant.
“The majority say they’re confident but many of them are experiencing these fines and penalties,” says Saperstein. “On average, it’s about six times a year and the average cost of one of these penalties or fines is $90,000.”
Nearly two-thirds of benefits decision-makers at midsized companies are not confident they understand the ACA and what they need to do to be compliant. Ninety percent aren’t confident their employees understand the effects of the ACA on their benefits choices.
Self-insured win partial PPACA fee exemption
Originally posted October 28, 2013 by Dan Cook on www.lifehealthpro.com
Self-insured employers and self-administered health plans are about to catch a break, thanks to fine-tuning of the Patient Protection and Affordable Care Act by the Department of Health and Human Services.
In a soon-to-be-published compendium of rule modifications, HHS says it will exempt certain self-insured employers from the second two years of paying the reinsurance fee.
HHS says the proposed modifications — of which there are quite a few — are the result of its “listening” sessions with interested parties about specific requirements of the act. The full list can be found in the proposal, “Program Integrity: Exchange, Premium Stabilization Programs, and Market Standards; Amendments to the HHS Notice of Benefit and Payment Parameters for 2014.”
HHS doesn’t offer a whole of detail on the exemption matter. It says in order to address employer feedback that the fees are burdensome, it will accept payment of the fee in two chunks instead of one (at the beginning of 2014 and at the end of the year) and will “exempt certain self-insured, self-administered plans from the requirement to make reinsurance contributions for the 2015 and 2016 benefit years” in future rulemaking and/or guidance proposals.
However, all employers will be required to pay the first-year fee for the program, which begins in 2014.
The 2014 fee for the three-year Transitional Reinsurance Program was set at $63 per plan participant. Fee levels have not been set for 2015 and 2016.
The fees are designed to yield $25 billion over the three-year program – money that would help offset costs incurred by insurers covering high-cost individuals purchasing coverage in public insurance exchanges.
HHS’s missive addressed other matters, including what happens when a small company buys small group insurance, and then it becomes a large company. The employer can keep the small group insurance package as long as it doesn’t make substantial modifications to it. But if discontinues small group coverage, it will then have to purchase insurance through the large group exchanges.
HHS also promised to provide further guidance on the sticky issue of what constitutes a fulltime employee for purposes of the all-important employee head count.
The proposals are scheduled to be published in the Federal Register on Wednesday.