BREAKING: Health Care Bill Moves to Debate on Senate Floor with 51-50 vote
In case you haven't heard, the motion to debate a version of the Health Care Bill after multiple renditions that has been dragging it's way through congress and stalled in the Senate has just been successfully passed with a narrow vote of 51-50 in favor with Vice President Pence casting the tie-breaking vote. The bill has a long road ahead and likely a vast number of revisions.
You can keep an eye on relevant news from our Navigator page right here on our own website. We know it is overwhelming to try to keep up with all of the news from all of the disparate sources. Our Navigator resource simply works to curate content from a variety of trusted, non-partisan sites across the internet and bring them to a central location to provide you a trusted place to stay-up-to-date on Health Care news at a glance.
Source: Wall Street Journal, Daniel Nasaw,Michelle Hackman
Access Live Updates on the Motion Here: https://www.wsj.com/livecoverage/senate-obamacare-repeal-and-replace-vote
Moments ago:
Vice President Mike Pence just broke the 50-50 tie. The motion to proceed passes and the Senate will now begin debate on a bill to repeal and replace the Affordable Care Act.
With the motion passed, Senators will now proceed to 20 hours of debate on several proposals repealing parts of the 2010 Affordable Care Act, including their replacement package and a separate bill repealing the law with a two-year delay.
They are expected to debate numerous amendments – not counted toward the 20 hours – including proposals put forward by Democrats....
Revised GOP Healthcare Bill Still Good for Employers
Has the uncertainty surrounding the BCRA left you worried about your company's healthcare plan? Here is an interesting article by Victoria Finkle from Employee Benefit News illustrating all the positives the BCRA will bring to employers and their company's healthcare program.
The latest version of the Senate Republican healthcare bill contains some significant changes, but provisions impacting employer-sponsored plans remained largely untouched.
The plan, unveiled on Thursday, retains a number of important changes for employers that were included in an earlier draft of the legislation made public last month. GOP lawmakers have been working for months on an effort to undo large swaths of the Affordable Care Act.
“Generally, the changes that were applied didn’t significantly change the dynamics of the Senate bill as it relates to large employers,” says Michael Thompson, president and chief executive of the National Alliance of Healthcare Purchaser Coalitions, a nonprofit network of business health coalitions.
Employer groups have been supportive of several major provisions highlighted in the earlier version of the Better Care Reconciliation Act that remain in the new proposal. Those include measures to remove the penalties associated with the employer mandate and a delay to the Cadillac tax for high-cost plans.
The latest Senate bill also retains important changes to health savings accounts that, for example, allow employees to allocate more funds into the accounts and that permit the money to be used on over-the-counter medications. It also reduces the penalty associated with redrawing funds from the account for non-qualified medical spending.
Providing more flexibility around the use of HSAs — tax-advantaged accounts that accompany high-deductible health plans — benefits employers and employees alike, says Chatrane Birbal, senior adviser for government relations at the Society for Human Resource Management.
“As healthcare costs arise, more employers are embracing high-deductible plans and this is a good way for employees to plan ahead for their medical expenses,” she says.
There is one small fix related to health savings accounts that made it into the revised draft, explains James Gelfand, senior vice president of health policy for the ERISA Industry Committee.
The updated language now permits out-of-pocket medical expenses for adult children up to 26-years-old who remain on a parent’s health plan to be paid for out of the primary account holder’s HSA. There were previously limitations on use of those funds for those over 18 who remained on a parent’s plan, based on Internal Revenue Service guidelines.
“One of the little tweaks they’ve put in to improve the bill is changing the IRS code to say, actually, yes, an adult dependent still counts and can use an HSA to help save on their healthcare costs,” he says.
Experts note, however, that a key change in the new bill related to HSAs — the ability to use the pre-tax money to pay insurance premiums — does not appear to apply to employer-based plans.
There are several other provisions in the revised legislation that are likely to be debated by the Senate in coming weeks, but that do not directly impact employers.
One controversial measure, developed by Republican Sens. Ted Cruz of Texas and Mike Lee of Utah, would allow insurers to offer lower priced, non-ACA-qualified plans in the individual market in addition to plans that meet Obamacare requirements. The latest bill also would provide more funding for the opioid epidemic.
Sen. Lindsey Graham, R-S.C. and Sen. Bill Cassidy, R-La., meanwhile, announced this week that they are developing an alternative proposal to the one unveiled by Republican leaders. Initial details for the alternative proposal were released on Thursday. The legislation is centered on a strategy to send more federal funding directly to the states through block grants.
“Instead of having a one-size-fits-all solution from Washington, we should return dollars back to the states to address each individual state’s healthcare needs,” Graham said in a statement on Thursday.
Those representing employer-based plans said they have reservations about the Graham and Cassidy proposal.
Gelfand notes that the alternative plan is expected to keep in place many of the taxes stemming from the ACA, such as the Cadillac tax and a tax on branded prescription drugs, and is unlikely to contain some of the BCRA revisions around the use of HSAs.
“It basically provides none of the relief that the BCRA would provide,” he says.
See the original article Here.
Source:
Finkle V. (2017 July 16). Revised GOP healthcare bill still good for employers [Web blog post]. Retrieved from address https://www.benefitnews.com/news/revised-gop-healthcare-bill-still-good-for-employers?tag=00000151-16d0-def7-a1db-97f024b50000
Senate’s Revised Obamacare Repeal Bill: What’s Different and is it Enough?
Do you know how the Senate's health care bill differs from Congress' bill? Check out this great article by Jared Bilski from HR Morning and find out the 6 key differences that separate the BCRA from the AHCA.
After failing to garner enough support for a vote before the July 4th recess for the Better Care Reconciliation Act of 2017 — aka the ACA repeal bill — the Senate went back to the lab and made some changes. Now the revised bill is out, and HR pros are anxiously waiting to see what happens next.
Although the Senate did leave many of provisions in the original bill intact, it did make some notable changes geared toward appeasing right-leaning Senators who didn’t feel the bill went far enough to repeal and replace the current health reform law.
6 key differences
Those changes:
1. Pared-down benefit requirements
Where the ACA requires insurers to meet minimum requirements that include coverage for 10 essential health benefits, the revised bill would allow insurers to offer cheaper, slimmed-down coverage if the insurers offer at least one plan which meets the ACA standards.
)Note: Healthcare experts warn this change would severely threaten access to coverage for sick patients.)
2. Opioid-crisis funding
The revised bill would provide $45 billion to states to help combat the national opioid crisis. While this is well short of what experts say is needed to address the issue, it’s still more than the $2 billion the original Senate bill had earmarked for opioid-crisis funding.
3. Controversial tax cuts removed
Although the new Senate bill would keep some of the ACA taxes, it would kill two tax cuts that benefited the wealthy and do away with a tax break for high-earning health insurance execs. Both the cuts and the tax breaks were highly criticized aspects of the original Senate bill.
4. Catastrophic health plans
Under the Senate bill revision, people eligible for subsidies to receive tax credits would be able to purchase catastrophic health plans. Plus, anyone would be allowed to buy catastrophic coverage.
The ACA does allow young adult and some additional individuals to buy high-deductible, catastrophic plans featuring low premiums. But federal subsidies aren’t available for these plans — an attractive incentive for healthy individuals with fewer healthcare needs.
5. HSA-premium payments
The bill would allow individuals to use HSA funds to pay for healthcare insurance premiums.
6. Market stabilization
In an effort to help states reduce premiums in order to stabilize their insurance marketplaces, the revised Senate bill provides $182 billion in funding, an $112 billion increase from the $70 billion set aside in the first draft of the bill.
See the original article Here.
Source:
Bilski J. (2017 July 14). Senate's revised obamacare repeal bill: what's different and is it enough [Web blog post]. Retrieved from address https://www.hrmorning.com/senates-revised-obamacare-repeal-bill-whats-different-and-is-it-enough/
4 Ways Employers can Prepare for Healthcare Changes
With all the proposed changes coming to healthcare. Take a look at this article by Mark Johnson from Employee Benefit News and see what you can do to prepare yourself and your employees for that call the changes coming to healthcare.
The new healthcare bill, revealed by U.S. Senate Republicans Thursday, could bring significant changes to organizations and their employees. Granted, there’s a long way to go before any Obamacare replacement legislation is signed. But health insurance is a complex component of running any business, and it’s important that employers start preparing for what might come.
Here are four actions items employers should be addressing now.
1. Create a roadmap. A compliance calendar is a helpful tool in identifying major deadlines. Employers are legally obligated to share health insurance and benefits updates with their employees by certain dates. Employees must be given reasonable notice — typically 30 days prior — of a major change in policy. There will likely be a set date for compliance and specific instructions around notice requirements that accompany the new legislation.
One step to compliance is adhering to benefit notice requirements. Benefit notices (i.e., HIPAA, COBRA, Summary Plan Descriptions, Special Health Care Notices, Health Care Reform, Form 5500 and others) vary by the size of the organization. Other steps can be more involved, such as required changes to plan design (e.g., copays, deductibles and coinsurance), types of services covered and annual and lifetime maximums, among others. Create a compliance calendar that reflects old and new healthcare benefit requirements so you can stay on track.
2. Rally the troops. Managing healthcare compliance spans several departments. Assemble key external and internal stakeholders by department, including HR, finance, payroll and IT.
Update the team on potential changes as healthcare legislation makes its way through Congress so they can prepare and be ready to execute should a new bill be signed. HR is responsible for communicating changes to employees and providing them with information on their plan and benefits. Finance needs to evaluate how changes in the plan will affect the company’s bottom line. Payroll must be aware of how much of an employee’s check to allocate to health insurance each month. In addition, payroll and Human Resources Information Systems (HRIS) are used to track and monitor changes in employee population, which helps employers determine benefit notice and compliance requirements. All departments need to be informed of the modified health insurance plan as soon as possible and on the same page.
3. Get connected. It’s essential to verify information as it’s released, via newsletters, seminars, healthcare carriers, payroll vendors and consultants. These resources can help employers navigate the evolving healthcare landscape. Knowledge of changes will empower an organization to handle them effectively.
4. Evaluate partnerships. There’s no better time for employers to examine their current partners, from an insurance consultant or broker to the accounting firm and legal counsel. An employer’s insurance consultant should be a trusted adviser in working on budgeting and benchmarking the company plan, administering benefits, evaluating plan performance and reporting outcomes. Finding an insurance solution that meets a company’s business goals, as well as its employee’s needs, can be accomplished with a knowledgeable, experienced insurance partner.
Staying ahead of healthcare changes is essential for organizations to have a smooth transition to an updated healthcare plan. Strategic planning, communication among departments and establishing the right partnerships are key. Employers must be proactive in addressing healthcare changes so they are ready when the time comes.
See the original article Here.
Source:
Johnson M. (2017 June 23). 4 ways employers can prepare for healthcare changes [Web blog post]. Retrieved from address https://www.benefitnews.com/opinion/5-ways-employers-can-prepare-for-healthcare-changes
Employees Aren't so Sure About Their Benefits Options
Are your employees having a hard time understanding all the benefits that are offered to them? Take a look at this article by Katie Kuehner-Hebert from Benefits Pro and find out the major questions that most employees seem to have about their employee benefits.
Employers have a conundrum: One-fifth of workers regret the health care benefit choices they make, but the same percentage of workers also concede they ignore any written educational materials about benefits their employers provided.
To make matters worse, according to Jellyvision’s 2017 ALEX Benefits Communication Survey, two-thirds don’t like in-person consultations -- not even if it’s within a group or one-on-one with a benefits expert.
So what’s an employer to do?
“The challenge is most people don’t want ‘education’ on these topics,” says Jellyvision chief executive Amanda Lannert. “No one wakes up with a burning desire to learn about HDHPs. In our experience, people respond best to plain-English communication that feels like they’re talking about benefits with a friend -- if benefits were a thing friends ever talked about.”
The good news is 82 percent of the 2,043 U.S. adults surveyed by Harris Poll say they’re satisfied with their employer’s benefits communication, and 86 percent feel their company has provided them with enough information to make informed decisions. A majority (69 percent) say they personally have spent either “a great deal” or “a lot” of time learning about their company’s benefits offerings.
However, while 89 percent say they generally understand their benefit options, more than a few aren’t too sure about all of the details.
For example, only 59 percent are correct in identifying the full cost of their health care plan, including their contribution and their employer’s contribution, and half (50 percent) say they are not knowledgeable about high-deductible health plans. More than half (54 percent) are unsure whether they can make changes to their insurance during qualified life events, and 43 percent are unclear on where to direct their health insurance questions.
“We think the number one biggest take-away of this entire survey is… employees want your help when choosing their health plans,” the authors write.
Indeed, more than half (55 percent) of all employees whose company offers health insurance say they would like help from their employer when choosing a health plan. Roughly half (49 percent) say the decision-making process is very stressful, and 36 percent feel the open enrollment process at their company is extremely confusing.
Jellyvision’s survey asked respondents to react to a possible repeal of the Affordable Care Act, particularly as it relates to employer-provided health insurance plans, and found a majority (61 percent) don’t think a repeal would affect them personally.
When asked about keeping certain provisions of the ACA, 80 percent say it’s “absolutely essential” or “very important” to keep coverage of preexisting conditions, 78 percent say that about free preventative care, and 67 percent say that about coverage of adult children up to age 26.
See the original article Here.
Source:
Kuehner-Hebert K. (2017 June 22). Employees aren't so sure about their benefits options [Web blog post]. Retrieved from address https://www.benefitspro.com/2017/06/22/employees-arent-so-sure-about-their-benefits-optio
Rising Healthcare Costs Hurting Retirement Contributions
The rising costs of healthcare are starting to have a negative impact on employees. Find out how employees are having trouble saving for their retirement thanks to the rise of healthcare costs in the interesting article by Paula Aven Gladych from Employee Benefit News.
Rising healthcare costs have had a dramatic impact on the ability of workers to save for retirement and other financial goals.
The latest Bank of America Merrill Lynch Workplace Benefits Report finds that of the workers who have experienced rising healthcare costs, more than half say they are contributing less to their financial goals as a result, including more than six in 10 who say they are saving less for retirement.
What’s more, financial stress also is playing a big role in employee physical health with nearly six in 10 employees saying it has had a negative impact on their physical well-being. This stress weighs most heavily on millennials at 68%, compared with baby boomers at 51%, according to the research.
Because of these dire statistics, more and more employees are looking to their employer to help them through financial challenges.
“We spend a lot of our waking time working and a lot of our finances are made up of the compensation and benefits our employer provides,” says Sylvie Feast, director of financial guidance services for Bank of America Merrill Lynch. “[Employer’s] healthcare and 401(k) plans are really valued by employees. I don’t think it’s surprising that they are looking to their employer that provides essential benefits to help provide access to ways to better manage their finances.”
And because employers offer healthcare and retirement benefits, it isn’t a stretch for workers to expect their employers to offer financial wellness as a benefit as well, Feast says.
“There’s no silver bullet, but a continuing evolution of trying new things to see what works and has an impact with the workforce,” Feast says. “Culture has something to do with it.”
Online tools, educational content, professional seminars in the workplace and personal consultations can be especially effective offerings, Feast says, adding that those options can help employees get more comfortable talking about their finances at work and at home with their family.
“People are pretty private about their finances,” Feast says. “I think there’s this access the employer needs to provide, but there also needs to be an arms-length distance so it is not the employer delivering it.”
Retirement savings is the area most workers want help with, according to Bank of America Merrill Lynch’s survey. More than half of baby boomers (54% ), 53% of Generation X and 43% of millennials say they need help saving for retirement, with 50% of all respondents ranking it as their No. 1 financial issue.
For millennials, good general savings habits and paying down debt were their next most important financial priorities. For Generation X, paying down debt, good general savings habits and budgeting all tied for second, and for baby boomers, planning for healthcare costs and paying down debt were their next biggest financial priorities.
Eighty-six percent of employees surveyed say they would participate in a financial education program provided by their employer, according to Bank of America Merrill Lynch.
Financial education is a slow, but worthy process, Feast says.
“People don’t just automatically start to show an immediate impact to their behavior,” she says. But, “if [employees] take steps, [they] will start to gain control and get more confidence.”
See the original article Here.
Source:
Gladych P. (2017 June 7). Rising healthcare costs hurting retirement contributions [Web blog post]. Retrieved from address https://www.benefitnews.com/news/rising-healthcare-costs-hurting-retirement-contributions
Millennials Lead Generational Split on Health Benefits
Did you know that millennial employees are more likely to focus on the benefits and costs associated with their healthcare plans compared to older employees? Take a look at this article by Amanda Eisenberg from Employee Benefit Adviser on why millennials are so much more involved with their healthcare plans.
Millennials are more likely to partake in cost-saving healthcare decisions than their older counterparts, according to new analysis from EBRI.
Employees born in 1977 or later, the millennial age range in this analysis, are well informed about their health plan and report higher levels of satisfaction with the health plan choices and financial aspects of their health plans than baby boomers and Gen Xers, according to the 2017 “Consumer Engagement in Health Care and Choice of Health Plan” report.
Millennials also are more likely to ask for a generic instead of a brand name drug (47%), develop a budget to manage healthcare expenses (35%) and check whether the health plan would cover care or medication (57%) compared to Generation X or baby boomers, according to the Employee Benefit Research Institute, a nonpartisan research institute based in Washington, D.C.
Paul Fronstin, co-author of the study, attributed the generational attitude differences to the frequency employees interact with the health system and familiarity with technology.
“Older people are not used to using tools like online calculators to figure out health costs,” says EBRI’s director of health research and education program.
On the other hand, older generations have more experience buying and using healthcare than millennials, who are unlikely to contact cancer, heart disease and other illnesses that generally plague middle-aged and older employees, says Fronstin.
“It may be less stressful to pick the wrong plan and it may be coming out in [millennials’] attitudes,” he says. “Millennial attitudes could easily change as they get older and use more healthcare.”
The data comes from a 2015 poll of polled 3,590 adults between the ages of 21 and 64 who had health insurance provided through an employer (82%), purchased directly from a carrier or purchased through a government exchange.
The data, while two years old, doesn’t change the underlying attitudes toward healthcare options and costs, says Fronstin.
Yet determining those attitudes and a corresponding benefits plan is a major struggle for employers, he says.
Baby boomers and millennials “are both big segments of the population that most employers rely on,” Fronstin says. “You’ve got different groups here. If you want to be as effective as possible and get the most productivity, you need to understand where they’re coming from.”
See the original article Here.
Source:
Eisenberg A. (2017 May 29). Millennials lead generational split on health benefits [Web blog post]. Retrieved from address https://www.employeebenefitadviser.com/news/millennials-lead-generational-split-on-health-benefits?brief=00000152-1443-d1cc-a5fa-7cfba3c60000
How the Senate Better Care Reconciliation Act (BCRA) Could Affect Coverage and Premiums for Older Adults
The Senate is on the verge of voting for the Better Care Reconciliation Act (BCRA) a new replacement to the ACA. Find out how the passing of the BCRA will impact older Americans and their healthcare in this informative article by Kaiser Family Foundation.
Prior to the Affordable Care Act (ACA), adults in their 50s and early 60s were arguably most at risk in the private health insurance market. They were more likely than younger adults to be diagnosed with certain conditions, like cancer and diabetes, for which insurers denied coverage. They were also more likely to face unaffordable premiums because insurers had broad latitude (in nearly all states) to set high premiums for older and sicker enrollees.
The ACA included several provisions that aimed to address problems older adults faced in finding more affordable health insurance coverage, including guaranteed access to insurance, limits on age rating, and a prohibition on premium surcharges for people with pre-existing conditions. Following passage of a bill to repeal and replace the ACA in the House of Representatives on May 4, 2017, the Senate has released a discussion draft of its proposal, called the Better Care Reconciliation Act of 2017 (BCRA) on June 26, 2017, that follows a somewhat different approach.
The Senate BCRA discussion draft would make a number of changes to current law that would result in an increase of four million 50-64-year-olds without health insurance in 2026, according to CBO’s analysis.
The Senate proposal would disproportionately affect low-income older adults with incomes below 200% of the federal poverty level (FPL): three of the four million 50-64-year-olds projected to lose health insurance in 2026 would be low-income. CBO projects the uninsured rate for low-income older adults would rise from 11% under current law to 26% under the BCRA by 2026.
The increase in the number and share of uninsured older adults would be due to several changes made by the BCRA to private health insurance market rules and subsidies, as well as changes to the Medicaid program.
CHANGES AFFECTING PRIVATE HEALTH INSURANCE
Age Bands. Under current law, insurers are prohibited from charging older adults more than 3-times the premium amount for younger adults. The Senate bill would allow insurers to charge older adults five-times more than younger adults, beginning in 2019. States would have flexibility to establish different age bands (broader or narrower). CBO estimates that age rating would increase premiums significantly for plans at all metal levels for older adults. The impact of age rating would be such that, for a 64-year-old, the national average premium for an unsubsidized bronze plan in 2026 would increase from $12,900 (current law) to $16,000 (BCRA). The wider age bands permitted under the BCRA would result in higher premiums for an unsubsidized bronze plan than the premium for an unsubsidized silver plan under the current law age-rating standard.
Tax Credits. The Senate’s BCRA makes three key changes affecting premium tax credits for people in the non-group insurance market. First, it changes the income eligibility for tax credits, extending eligibility to people with income below the FPL but capping eligibility at income of 350% FPL. Under current law, income eligibility for tax credits is 100%-400% FPL. This change has the effect of reducing premiums for people with incomes below poverty in the marketplace who are not otherwise eligible for Medicaid (discussed further below) while increasing premiums for people with incomes between 350%-400% FPL.
Second, BCRA changes the level of subsidy for people based on age. Under both current law and the BCRA, individuals must pay a required contribution amount, based on income, toward the cost of a benchmark plan; the premium tax credit equals the difference between the cost of the benchmark plan and the required individual contribution. Under current law, the required contribution rate is the same for all people at the same income level regardless of age. However, under the BCRA, the required contribution amount would increase with age for people with an income above 150% FPL. For example, under current law, at 350% FPL, individuals are required to contribute the same percentage of income toward the benchmark plan, regardless of age (9.69% in 2017). Under the BCRA, starting in 2020, a 24-year-old would contribute about 6.4% of income, while a 60-year-old would have to contribute 16.2% of income.1
Third, the Senate proposal reduces the value of the benchmark plan used to determine premium tax credits from a more generous silver-level plan (under current law) to the equivalent of a bronze plan (under BCRA). Deductibles under bronze plans are much higher than under silver plans (in 2017, on average, $6,105 for bronze plans vs. $3,609 for silver plans). Under current law, silver plan deductibles are further reduced by cost-sharing subsidies for eligible individuals with incomes below 250% FPL (on average to $255, $809, or $2,904, depending on income). The BCRA eliminates cost-sharing subsidies starting in 2020. As a result, people using tax credits to buy a “benchmark” bronze plan would face significantly higher deductibles under the Senate proposal than under current law.
For older adults with income above the poverty level, the combined impact of these changes would be to increase the out-of-pocket cost for premiums at all income levels. For example, a 64-year old with an income of $26,500 would see premiums increase by $4,800 on average for a silver plan in 2026; a 64-year old with an income of $56,800 could see premiums increase of $13,700 in 2026, according to CBO.
Premium tax credits under the BCRA would continue to be based on the cost of a local benchmark policy, so results would vary geographically. Older adults living in higher cost areas could see greater dollar increases, while people living in lower cost areas could see lower increases.
For a bronze plan, the national average premium expense for a 64-year old could increase by $2,000 for an individual with an income of $26,500 in 2026 and by as much as $11,600 for an older adult with $56,800 in income.
Under current law, people with income below 100% FPL generally are not eligible for premium tax credits. The ACA extended Medicaid eligibility to adults below 138% FPL, but the Supreme Court subsequently ruled the expansion is a state option. To date 19 states have not elected the Medicaid expansion, leaving 2.6 millionuninsured low-income adults in this coverage gap.
For older adults with income below 100% FPL who are not eligible for Medicaid, CBO estimates the extension of premium tax credit eligibility will significantly reduce the net premium expense for a 64-year-old in 2026 relative to current law (e.g., by more than $12,000 for an individual at 75% FPL).
However, CBO estimates that few low-income people would purchase any plan. Even with relatively low premiums, older adults with very low incomes may choose to go without coverage due to relatively high, unaffordable deductibles. For example, an individual with an income of $11,400 (75% FPL) who is not eligible for Medicaid, would pay $300 in premiums in 2026 under BCRA but face a deductible in excess of $6,000 – which amounts to more than half of his or her income that year.
On average, 55-64 year-olds would pay 115% higher premiums for a silver plan in 2020 under the BCRA after taking tax credits into account. Low-income 55-64-year-olds would pay 294% higher premiums relative to current law.
CHANGES TO MEDICAID
Changes to Medicaid proposed in the Senate bill also contribute to the increase in the projected increase in the number of uninsured older adults nationwide. The BCRA would limit federal funds for states that have elected to expand coverage under Medicaid for low-income adults, phasing down the higher federal match for these expansion states over three years (2021-2023). This provision, coupled with a new cap on the growth in federal Medicaid funding over time on a per capita basis, would result in an estimated 15 million people losing Medicaid coverage by 2026 according to CBO, some of whom are counted among the four million older adults projected to lose health insurance under the BCRA, shown in Figure 1. In 2013, about 6.5 million 50-64-year-olds relied on Medicaid for their health insurance coverage, a number that has likely increased due to the Medicaid expansion.2 Since 2013, Medicaid enrollment overall has grown by nearly 30%.
IMPACT ON OLDER ADULTS ON MEDICARE
The loss of coverage for adults in their 50s and early 60s could have ripple effects for Medicare, a possibility that has received little attention. If the BCRA results in a loss of health insurance for a meaningful number of people in their late 50s and early 60s, as CBO projects, there is good reason to believe that people who lose insurance will delay care, if they can, until they turn 65 and become eligible for Medicare, and then use more services once on Medicare. This could cause Medicare spending to increase, which would lead to increases in Medicare premiums and cost-sharing requirements.3
The proposed BCRA changes to Medicaid are also expected to affect benefits and coverage for older, low-income adults on Medicare. Today, 11 million low-income people on Medicare have supplemental coverage under Medicaid that helps cover the cost of Medicare’s premiums and cost-sharing requirements, and the cost of services not covered by Medicare, such as nursing home and home- and community-based long-term services and supports. The BCRA reduces the trajectory of Medicaid spending, with new caps on the growth of benefit spending per person; these constraints are expected to put new fiscal pressure on states to control costs that could ultimately affect coverage and benefits available to low-income people on Medicare. Under the BCRA, the growth in Medicaid per capita spending for elderly and disabled beneficiaries is dialed down to a slower growth rate, from CPI-M+1 to CPI-U beginning in 2025, below currently projected growth rates, just as the first of the Boomer generation reaches their 80s and is more likely to need Medicaid-funded long-term services and supports.
DISCUSSION
The Senate bill to repeal and replace the ACA, known as the Better Care Reconciliation Act of 2017 (BCRA), if enacted, would be expected to result in an increase of four million uninsured 50-64-year olds in 2026, relative to current law. The increase is due to a number of factors, including higher premiums at virtually all income levels for older adults, potentially unaffordable deductibles for older adults with very low incomes, , and reductions in coverage under Medicaid. Reductions in coverage could have unanticipated spillover effects for Medicare in the form of higher premiums and cost sharing, if pre-65 adults need more services when they age on to Medicare as a result of being uninsured beforehand. The BCRA would also impose new, permanent caps on Medicaid spending which could affect coverage and costs for low-income people on Medicare.
Other changes in BCRA will affect Medicare directly. The BCRA would repeal the Medicare payroll tax imposed on high earners included in the ACA. This provision, according to CMS, will accelerate the insolvency of the Medicare Hospital Insurance Trust Fund and put the financing of future Medicare benefits at greater risk for current and future generations of older adults – another factor to consider as this debate moves forward.
See the original article Here.
Source:
Nueman T., Pollitz K., Levitt L. (2017 June 29). How the senate better care reconciliation act (BCRA) could affect coverage and premiums for older adults [Web blog post]. Retrieved from address https://www.kff.org/health-reform/issue-brief/how-the-senate-better-care-reconciliation-act-bcra-could-affect-coverage-and-premiums-for-older-adults/
Coverage Losses by State for the Senate Health Care Repeal Bill
The Congressional Budget Office has just released its score on the Better Care Reconciliation Act (BCRA). Find out how each state will be impacted by the implementation of BCRA in this great article by Emily Gee from the Center for American Progress.
The Congressional Budget Office (CBO) has released its score of the Senate’s health care repeal plan, showing that the bill would eliminate coverage for 15 million Americans next year and for 22 million by 2026. The CBO projects that the Senate bill would slash Medicaid funding by $772 billion over the next decade; increase individual market premiums by 20 percent next year; and make comprehensive coverage “extremely expensive” in some markets.
The score, released by Congress’ nonpartisan budget agency, comes amid an otherwise secretive process of drafting and dealmaking by Senate Republicans. Unlike the Senate’s consideration of the Affordable Care Act (ACA), which involved dozens of public hearings and roundtables plus weeks of debate, Senate Republican leadership released the first public draft of its Better Care Reconciliation Act (BCRA) just days before it hopes to hold a vote.
The Center for American Progress has estimated how many Americans would lose coverage by state and congressional district based on the CBO’s projections. By 2026, on average, about 50,500 fewer people will have coverage in each congressional district. Table 1 provides estimates by state, and a spreadsheet of estimates by state and district can be downloaded at the end of this column.
The coverage losses under the BCRA would be concentrated in the Medicaid program, but the level of private coverage would also drop compared to the current law. The CBO projects that, by 2026, there will be 15 million fewer people with Medicaid coverage and 7 million fewer with individual market coverage. Our Medicaid numbers reflect that states that have expanded their programs under the ACA would see federal funding drop starting in 2021 and that the bill would discourage expansion among states that would otherwise have done so in the future.
Like the House’s repeal bill, the Senate’s version contains a provision allowing states to waive the requirement that plans cover essential health benefits (EHB). The CBO predicts that half of the population would live in waiver states under the Senate bill. The CBO did not specify which states it believes are most likely to secure waivers; therefore, we did not impose any assumptions about which individual states would receive waivers in our estimates. Even though the demographic composition of coverage losses would differ among waiver and nonwaiver states, for this analysis we assume that all states’ individual markets would shrink.
CBO expects that state waivers could put coverage for maternity care, mental health care, and high-cost prescription drugs “at risk.” CBO projects that “all insurance in the nongroup market would become very expensive for at least a short period of time for a small fraction of the population residing in areas in which states’ implementation of waivers with major changes caused market disruption.” Note that health insurance experts have noted that in addition to directly lowering standards for individual market coverage, waivers would also indirectly subject people in employer coverage to annual and lifetime limits on benefits.
The CBO’s score lists multiple reasons why out-of-pocket costs for individual market enrollees would rise under the bill. One reason is that bill’s changes to premium subsidies means that most people would end up buying coverage resembling bronze-level plans, which today typically have annual deductibles of $6,000. In addition, EHB waivers would force enrollees who could not afford supplemental coverage for non-covered benefits out of pocket while also allowing issuers to set limits on coverage.
In summary, the CBO projects that the effects of the Senate bill would be largely similar to those of the house bill: tens of millions of people would no longer have coverage, and those who remained insured see the quality of their coverage erode substantially. In just a few days, the Senate will vote to turn these dire projections into reality.
Methodology
Our estimates of coverage reductions follow the same methodology we used previously for the House’s health care repeal bill. We combine the CBO’s projected national net effects of the House-passed bill on coverage with state and local data from the Kaiser Family Foundation, the American Community Survey from the U.S. Census, and administrative data from the Centers for Medicare & Medicaid Services (CMS).
Florida, North Carolina, and Virginia redrew their district boundaries prior to the 2016 elections. While the rest of our data uses census estimates corresponding to congressional districts for the 114th Congress, we instead used county-level data from the 2015 five-year American Community Survey to determine the geographic distribution of the population by insurance type in these three states. We matched county data to congressional districts for the 115th Congress using a geographic crosswalk file provided by the Kaiser Family Foundation.
Our estimates of reductions in Medicaid by district required a number of assumptions. CBO projected that a total 15 million fewer people would have Medicaid coverage by 2026 under the Senate bill: 5 million fewer would be covered by additional Medicaid expansion in new states, and 10 million fewer would have Medicaid coverage in current expansion states and among pre-ACA eligibility groups in all states. The CBO projected that, under the ACA, additional Medicaid expansion would increase the proportion of the newly eligible population residing in expansion states from 50 percent to 80 percent by 2026. It projected that just 30 percent of the newly eligible population would be in expansion states. Extrapolating from the CBO’s numbers, we estimate the Senate bill results in a Medicaid coverage reduction of 3.3 million enrollees in current expansion states by 2026.
We then assume the remaining 6.7 million people who would lose Medicaid coverage are from the program’s pre-ACA eligibility categories: low-income adults, low-income children, the aged, and disabled individuals. We used enrollment tables published by the Medicaid and CHIP Payment Access Commission (MACPAC) to determine total state enrollment and each eligibility category’s share of the total, and we assumed that only some of the disabled were nonelderly. We then divided state totals among districts according to each’s Medicaid enrollment in the American Community Survey. Because each of the major nonexpansion categories is subject to per capita caps under the bill, we reduced enrollment in all by the same percentage.
Because we do not know which individual states would participate in Medicaid expansion in 2026 in either scenario, our estimates give nonexpansion states the average effect of forgone expansion and all expansion states the average effect of rolling back eligibility. We divided the 5 million enrollment reduction due to forgone expansion among nonexpansion states’ districts proportionally by the number of low-income uninsured. We made each expansion state’s share of that 3.3 million proportional to its Medicaid expansion enrollment in its most recent CMS report and then allocated state totals to districts proportional to the increase in nonelderly adult enrollment between 2013 and 2015. For Louisiana, which recently expanded Medicaid, we took our statewide total from state data and allocated to districts by the number of low-income uninsured adults.
Medicaid covers seniors who qualify as aged or disabled. Although the CBO did not specify the Medicaid coverage reduction that would occur among seniors under per capita caps, applying to elderly enrollees the same percentage reduction we calculated for nonexpansion Medicaid enrollees implies that 900,000 could lose Medicaid.
Lastly, our estimates of the reduction in exchange, the Basic Health Plan, and other nongroup coverage are proportional to the Kaiser Family Foundation’s estimates of exchange enrollment by congressional district. The House bill reduces enrollment in nongroup coverage, including the exchanges, by 7 million relative to the ACA. To apportion this coverage loss among congressional districts, we assumed that the coverage losses would be largest in areas with higher ACA exchange enrollment and in states where we estimated the average cost per enrollee would increase most under an earlier version of the AHCA.
The CBO projects that the net reduction in coverage for the two categories of employer-sponsored insurance and “other coverage” would be between zero and 500,000 people in 2026. We did not include these categories in our estimates.
See the original article Here.
Source:
Gee E. (2017 June 27). Coverage losses by state for the senate health care repeal bill [Web blog post]. Retrieved from address https://www.americanprogress.org/issues/healthcare/news/2017/06/27/435112/coverage-losses-state-senate-health-care-repeal-bill/
6 Favorable Changes to HSAs Under GOP Health Bill
With the passing of the AHCA, Health Savings Accounts (HSAs) are on the verge of expansion. Check out this article by Emily Zulz of Benefits Pro and see how this new legislation will impact HSA's.
Current legislature sitting in Congress -- including the American Health Care Act -- indicates favorable changes for health savings accounts.
Since the new Congress began in January, there have been more than 20 bills proposed that impact consumer-directed health care, and more specifically HSAs. In May, the House of Representatives narrowly passed the American Health Care Act.
A new report from HSA Bank provides insight into specific impacts on HSAs and consumer-directed health care outlined in the American Health Care Act, as well as examines the other proposed legislation.
“Whether they get passed or not, I don’t expect that to have a negative impact on HSAs,” Chad Wilkins, executive vice president and head of HSA Bank, told ThinkAdvisor. “We’ll continue to see that kind of growth going forward. And if they do get passed, we’ll see more wind at the back of high-deductible health plans and HSAs.”
HSAs, which can be as much a retirement savings vehicle as a health care financing plan, have grown in popularity recently.
The number of people enrolled in HSAs continues to grow, although more slowly than in previous years. According to America's Health Insurance Plan report, 20.2 million U.S. residents were covered through HSA-compatible, individual, small-group or large-group plans in 2016.
A Fidelity analysis shows a surge in health savings account in the third quarter of last year.
Wilkins, who co-authored the report with Kevin Robertson, senior vice president and chief revenue officer, attributes the growth in HSAs to both the cost standpoint for employers offering plans, as well as the cost savings for individuals both today and in retirement.
And he predicts this growth and popularity will continue to expand -- despite what happens in Congress.
“There’s been a lot of changes in legislators over the past 10 years and HSAs have stayed relatively stable in that world,” Wilkens said.
The report provides insight into the six specific impacts on HSAs and CDH plans outlined in AHCA, as passed by the House, with a focus on how they will positively impact individuals' ability to own their health.
The top-ranking Democrat on the Senate side of the Joint Economic Committee, though, has said expanding the health savings account program would do little to help ordinary Americans cope with cuts in Affordable Care Act coverage expansion programs.
According to Robertson, these impacts “focus on expanding access to health savings accounts and CDH plans for Americans.”
1. Raises HSA contribution limits to the high-deductible health plan (HDHP) out-of-pocket maximum.
The current 2017 HSA contribution limits are $3,400 for a single plan and $6,750 for a family plan. The proposed 2018 contribution limits would increase that to $6,550 for a single plan and $13,100 for a family plan.
2. Repeals the ACA contribution limit on flexible spending accounts (FSAs) (currently $2,600 for 2017)
Approximately 20 percent of Americans covered by private insurance are able to contribute to an HSA since they are enrolled in a qualified HDHP, according to the report. For those not covered by an HDHP, this change effectively allows for significantly higher contributions to help cover large out-of-pocket expenses.
3. Allows spouses to make catch-up contributions to the same HSA
“The most significant obstacle to maximizing spousal contributions has been the aggravation of having to open a second account,” the report says.
This change will make it easier for seniors to maximize their savings for retirement years, both in terms of lower administration costs, and simplification of the contribution process.
4. Repeals the prescription requirement for over-the-counter medications as qualified medical expense distributions from HSAs, FSAs, and health reimbursement arrangements (HRAs)
The ACA raised the prices for anyone purchasing over-the-counter medications, and with this repeal, it will immediately lower healthcare costs for people using HSAs, FSAs, and HRAs to purchase these products, according to the report.
5. Lowers the penalty for non-qualified HSA distributions made prior to age 65 from 20 percent to 10 percent
This penalty exists to ensure that HSAs are used as health care savings tools and not tax shelters for assets. The report says a lower penalty would make HSAs more attractive since “the fear of a 20 percent penalty may have been a detractor in individuals using HSAs as a savings account.”
6. Allows for qualified distributions to reimburse medical expenses incurred within 60 days of HDHP coverage but before HSA account is established
“Even though an individual may be covered by an HSA-qualified health plan, they are not allowed to claim their medical expenses as qualified distributions until they have met the legal requirements of establishing their HSA,” according to the report.
This provision would give individuals a 60-day window to cover these instances.
See the original article Here.
Source:
Emily Zulz (2017 June 16). 6 favorable changes to HSAs under GOP health bill [Web blog post]. Retrieved from address https://www.benefitspro.com/2017/06/16/6-favorable-changes-to-hsas-under-gop-health-bill?ref=hp-news&page_all=1