ACA replacement proposal leaked: Some of the finer points for HR
Does the repeal of the ACA have you worried? Checkout this great article about some of the changes that will come with the repeal of the ACA by Jared Bilski.
A draft of the Republicans’ Affordable Care Act (ACA) replacement bill that was leaked to the public is likely to look a lot different when it’s finalized. Still, it gives employers a good indication of how Republicans will start to deliver on their promises to “repeal and replace” Obamacare.
It should come as no surprise to employers that the GOP replacement bill, which was obtained by POLITICO, would scrap a cornerstone of the ACA — the individual mandate — as well as income-based subsidies and all of the laws current taxes (at least one replacement tax is included in the legislation).
According to the discussion draft of the replacement bill, it would offer tax credits for purchasing insurance; however, those credits would be based on age instead of income.
For example, a person under the age of 30 would receive a credit of $2,000. A person over the age of 60, on the other hand, would receive double that amount.
Some of the other highlights of the leaked legislation include:
End of ACA essential health benefits
Obamacare’s essential health benefits mandates require health plans to cover 10 categories of healthcare services, which include:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription medications
- Rehabilitative and habilitative services and devices
- Lab services
- Preventive and wellness services and chronic disease management, and
- Pediatric services, including oral and vision care.
Under the bill, individual states would make the decisions about what types of services plans must cover — beginning in 2020.
A Medicaid expansion overhaul
The Medicaid expansion under Obamacare that has covered millions of people will be phased out by 2020 under the GOP bill. The replacement proposal: States would receive a set dollar amount for each person.
There would also be variations in the funding amounts based on an individual’s health status. In other words, more money would be allocated for disabled individuals, which is a huge departure from the open-ended entitlement of the current Medicaid program.
Pre-existing conditions, older individuals
One of the most popular elements of the ACA would apparently remain untouched under the GOP bill: the Obamacare provision that prohibits health plans from discriminating against people with pre-existing conditions.
However, the legislation does take aim at older individuals. The GOP would allow insurers to charge older people up to five times more for healthcare than younger individuals. The current ACA limits that difference to three times as much.
The bill does aim to remedy this discrepancy by providing bigger tax credits for older people.
Taxes get axed
There is a slew of taxes built into the ACA — the manufacturer tax, and taxes on medical devices, health plans and even tanning beds — and the Republican bill would repeal those taxes.
But those taxes help cover the cost of the ACA. So to make up for the shortfall that would result in killing those taxes, the GOP is floating the idea of changing the tax treatment of employer-based health insurance. As employers are well aware, employer-sponsored health plan premiums currently aren’t taxed. Under the GOP proposal, this would be changed for some premiums over a certain threshold — although the specifics of such a change remain murky.
Such a move would surely be met by fierce opposition from the business community. In fact, major employer groups are already preparing to fight such a proposition.
See the original article Here.
Source:
Bilski J. (2017 March 01). ACA replacement proposal leaked: some of the finer points for HR [Web blog post]. Retrieved from address https://www.hrmorning.com/aca-replacement-proposal-leaked-some-of-the-finer-points-for-hr/
Employers embrace new strategies to cut healthcare costs
Are you looking for a new solution for cutting your healthcare cost? Take a look at the great article from Employee Benefits Advisor about what other employers are doing to cut their cost healthcare cost by Phil Albinus
As employers await a new health plan to replace the Affordable Care Act and consensus grows that high deductible health plans (HDHPs) are not the perfect vehicle for cutting healthcare costs, employers are incorporating innovative strategies to achieve greater savings.
Employers are offering HSAs, wellness incentives and price transparency tools at higher rates in an effort to cut the costs of their employee health plans. And when savings appear to plateau, they are implementing innovative reward plans to those who adopt these benefits, according to the 2017 Medical Plan Trends and Observation Report conducted by employee-engagement firm DirectPath and research firm CEB. They examined 975 employee benefit plans to analyze how they functioned in terms of plan design, cost savings measures and options for care.
The report found that 67% of firms offer HSAs while only 15% offer employee-funded Health Reimbursement Arrangements. As “use of high deductible plans seem to have (at least temporarily) plateaued under the current uncertainty around the future of the ACA, employer contributions to HSAs increased almost 10%,” according to the report.
Wellness programs continue to gain traction. Fifty-eight percent of 2017 plans offer some type of wellness incentive, which is up from 50% in 2016. When it comes to price transparency tools, 51% of employers offer them to help employees choose the best service, and 18% plan to add similar tools in the next three years. When these tools are used, price comparison requests saw an average employee savings of $173 per procedure and average employer savings of $409 per procedure, according to CEB research.
“What was interesting was the level of creativity within these incentives and surcharges. There were paycheck credits, gift cards, points that could be redeemed for rewards,” says Kim Buckey, vice president of client services at DirectPath. “One employer reduced the co-pays for office visits to $20 if you participated in the wellness program. We are seeing a level of creativity that we haven’t seen before.”
Surcharges on tobacco use has gone down while surcharges for non-employees such as spouses has risen. “While the percentage of organizations with spousal surcharges remained static (26% in 2017, as compared to 27% in 2016), average surcharge amounts increased dramatically to $152 per month, a more than 40% increase from 2016,” according to the report.
Tobacco surcharges going down “is reflective of employers putting incentives in, so they are taking a carrot approach instead of the stick,” says Buckey.
Telemedicine adoption appears to be mired in confusion among employees. More than 55% of employees with access to these programs were not aware of their availability, and almost 60% of employees who have telemedicine programs don’t feel they are easy to access, according to a separate CEB survey.
Employers seem to be introducing transparency and wellness programs because the savings from HDHPs appear to have plateaued, says Buckey. She also noted recent research that HSAs only deliver initial savings at the expense of the employee’s health.
“With high deductible plans and HSAs, there has been a lot of noise how they aren’t the silver bullet in controlling costs. Some researchers find that it has a three-year effect on costs because employees delay getting care and by the time they get it, it’s now an acute or chronic condition instead of something that could have been headed off early,” she says.
“And there is a tremendous lack of understanding on how these plans work for lower income employees, [it’s] hard to set aside money for those plans,” she says.
Educating employees to be smarter healthcare consumers is key. “What is becoming really obvious is that there is room to play in all these areas of cost shifting and high deductible plans and wellness but we can no longer put them in place and hope for the best,” she says. We have to focus on educating employees and their families,” she says. “If we are expecting them to act like consumers, we have to arm them with the tools. Most people don’t know where to start.”
She adds, “we know how to shop for a TV or car insurance but 99% of people don’t know where to start to figure out where to shop for prescription drugs or for the hospital where to have your knee surgery. Or if you get different prices from different hospitals, how do you even make the choice?”
When asked if the results of this year’s report surprised her – Buckey has worked on the past five – she said yes and no.
Given that the data is based on information from last summer for plans that would be in effect by 2017, she concedes that given the current political climate “a lot is up in the air.” Most employers were hesitant to make substantive changes to their plans due to the election, she says. We may see the same thing this year as changes are made to the ACA and the Cadillac Tax, she adds.
“What I was interested in were the incremental changes and some of the creativity being applied to longstanding issues of getting costs under control,” she says.
See the original article Here.
Source:
Albinus P. (2017 March 05). Employers embrace new strategies to cut healthcare costs [Web blog post]. Retrieved from address https://www.employeebenefitadviser.com/news/employers-embrace-new-strategies-to-cut-healthcare-costs?brief=00000152-1443-d1cc-a5fa-7cfba3c60000
Health Law’s 10 Essential Benefits: A Look At What’s At Risk In GOP Overhaul
Great article from Kaiser Health News about all the changes that could be coming with the ACA overhaul by Michelle Andrews
As Republicans look at ways to replace or repair the health law, many suggest shrinking the list of services insurers are required to offer in individual and small group plans would reduce costs and increase flexibility. That option came to the forefront last week when Seema Verma, who is slated to run the Centers for Medicare & Medicaid Services in the Trump administration, noted at her confirmation hearing that coverage for maternity services should be optional in those health plans.
Maternity coverage is a popular target and one often mentioned by health law critics, but other items also could be watered down or eliminated.
There are some big hurdles, however. The health law requires that insurers who sell policies for individuals and small businesses cover at a minimum 10 “essential health benefits,” including hospitalization, prescription drugs and emergency care, in addition to maternity services. The law also requires that the scope of the services offered be equal to those typically provided in employer coverage.
“It has to look like a typical employer plan, and those are still pretty generous,” said Timothy Jost, an emeritus professor at Washington and Lee University Law School in Virginia who is an expert on the health law.
Since the 10 required benefits are spelled out in the Affordable Care Act, it would require a change in the law to eliminate entire categories or to water them down to such an extent that they’re less generous than typical employer coverage. And since Republicans likely cannot garner 60 votes in the Senate, they will be limited in changes that they can make to the ACA. Still, policy experts say there’s room to “skinny up” the requirements in some areas by changing the regulations that federal officials wrote to implement the law.
Habilitative Services
The law requires that plans cover “rehabilitative and habilitative services and devices.” Many employer plans don’t include habilitative services, which help people with developmental disabilities such as cerebral palsy or autism maintain, learn or improve their functional skills. Federal officials issued a regulation that defined habilitative services and directed plans to set separate limits for the number of covered visits for rehabilitative and habilitative services.
Those rules could be changed. “There is real room for weakening the requirements” for habilitative services, said Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms who has reviewed the essential health benefits coverage requirements.
Oral And Vision Care For Kids
Pediatric oral and vision care requirements, another essential health benefit that’s not particularly common in employer plans, could also be weakened, said Caroline Pearson, a senior vice president at Avalere Health, a consulting firm.
Mental Health And Substance Use Disorder Services
The health law requires all individual and small group plans cover mental health and substance use disorder services. In the regulations the administration said that means those services have to be provided at “parity” with medical and surgical services, meaning plans can’t be more restrictive with one type of coverage than the other regarding cost sharing, treatment and care management.
“They could back off of parity,” Palanker said.
Prescription Drugs
Prescription drug coverage could be tinkered with as well. The rules currently require that plans cover at least one drug in every drug class, a standard that isn’t particularly robust to start with, said Katie Keith, a health policy consultant and adjunct professor at Georgetown Law School. That standard could be relaxed further, she said, and the list of required covered drugs could shrink.
Preventive And Wellness Services And Chronic Disease Management
Republicans have discussed trimming or eliminating some of the preventive services that are required to be offered without cost sharing. Among those requirements is providing birth control without charging women anything out of pocket. But, Palanker said, “if they just wanted to omit them, I expect that would end up in court.”
Pregnancy, Maternity And Newborn Care
Before the health law passed, just 12 percent of health policies available to a 30-year-old woman on the individual market offered maternity benefits, according to research by the National Women’s Law Center. Those that did often charged extra for the coverage and required a waiting period of a year or more. The essential health benefits package plugged that hole very cleanly, said Adam Sonfield, a senior policy manager at the Guttmacher Institute, a reproductive health research and advocacy organization.
“Having it in the law makes it more difficult to either exclude it entirely or charge an arm and a leg for it,” Sonfield said.
Maternity coverage is often offered as an example of a benefit that should be optional, as Verma advocated. If you’re a man or too old to get pregnant, why should you have to pay for that coverage?
That a la carte approach is not the way insurance should work, some experts argue. Women don’t need prostate cancer screening, they counter, but they pay for the coverage anyway.
“We buy insurance for uncertainty, and to spread the costs of care across a broad population so that when something comes up that person has adequate coverage to meet their needs,” said Linda Blumberg, a senior fellow at the Health Policy Center at the Urban Institute.
See the original article Here.
Source:
Andrews M. (2017 February 21). Health law's 10 essential benefits: a look at what's at risk in GOP overhaul [Web blog post]. Retrieved from address https://khn.org/news/health-laws-10-essential-benefits-a-look-at-whats-at-risk-in-gop-overhaul/
Employees desperately need more information on health plans, study says
Did you know that a lot of your employees may be unaware of the health care options your company offers? Take a peek at this great article from HR Morning on how to improve your employees knowledge of their healthcare options by Jared Bilski
As an increasing number of employees are being asked to make smarter healthcare spending decisions, communication is more important than ever. Unfortunately, it looks like many firms have a lot of room for improvement.
That’s one of the alarming takeaways from healthcare administrator Alegeus’ recent “State of Denial” study.
A number of the stats from the study point to a major employee healthcare problem that’s only getting worse. That problem: While employees’ health options are becoming increasingly complex, most workers don’t have the knowledge and/or accountability to make wise decisions involving those options.
Unaware and overwhelmed
Here are some of the most alarming stats from the study:
- 63% of employees said they don’t know the benefit of an HSA
- 50% don’t know how to predict current or future out-of-pocket healthcare expenditures and can’t select the best savings vehicle or rate
- 26% of HSA accountholders don’t know they can use HSA funds beyond the immediate plan year, and
- 41% of HSA accountholders were unaware they could invest HSA funds.
The study also highlighted some of the contradictions between what employees said they wanted or needed, and how they acted.
For example, although 70% of employees said they’d like to take a more active role in their healthcare decisions, just 50% intend to conduct more due diligence when purchasing healthcare in 2017.
The importance of one on one
One of the most effective ways to improve employees’ benefits understanding is through one-on-one communications.
To help ensure this is effective, here are three things HR pros should keep in mind, according to Winston Benefits, a voluntary benefits plan provider:
1. Prepare the right materials
When you’re doing a large-scale benefits presentation, you generally just hand out the materials, and employees look through and use those materials as they see fit.
But with individual sessions, benefits pros have to be prepared to explain those materials in any way an employee requests.
Example: Walking a worker through a tool or calculator in a step-by-step manner.
2. Look to your broker
In many cases, benefits brokers are willing to go on site for one-on-one sessions, and companies should take advantage whenever possible.
Employees will be comfortable knowing there’s an in-house HR or benefits pro at the broker, and a broker’s expertise can really improve workers’ overall understanding.
3. Allot enough time
The point of these meetings is to give employees all the time they need to understand their options and make informed decisions.
Rushing workers through these meetings will ensure the one-on-one education falls flat.
See the original article Here.
Source:
Bilski J. (2017 February 17). Employees desperately need more information on health plans, study says [Web blog post]. Retrieved from address https://www.hrmorning.com/employees-desperately-need-more-information-on-health-plans-study-says/
Where exactly are we in the ACA repeal process?
Worried about the ACA repeal process? Check out this informative article from HR Morning about the status of the ACA's repeal by Christian Schappel,
President Trump, along with other Republican lawmakers, have promised to “repeal and replace” the Affordable Care Act (ACA). But it hasn’t happened yet. Here’s why, as well as a timeline for what’s to come.
In his “Contract with the American Voter,” Donald Trump promised to repeal Obamacare within his first 100 days in office. But the reality is he can’t do it on his own. He needs votes to get it repealed outright — and he doesn’t have enough of them.
What’s the hold up?
Broad legislation that would repeal the ACA would require 60 votes in the Senate, and the GOP doesn’t control enough seats to make that a reality — or avoid a filibuster by the Democrats.
Still, that hasn’t stopped Trump from declaring war on the healthcare reform law. In one of his first acts as president, Trump issued an executive order that directs federal agencies to waive some of the requirements of the law that could impose a burden on individuals and certain businesses.
It was a clear sign from Trump that his administration plans to attack the ACA by any means necessary.
So what’s the plan now?
Congressional Republicans are now preparing to dismantle portions of the ACA using a process known as reconciliation. It will allow the GOP to vote on budgetary pieces of the health law, without giving the Democrats a chance to filibuster.
The problem for Republicans is reconciliation limits the extent to which they can reshape the law.
Parts of the law it appears they can roll back through reconciliation:
- The individual mandate (which is imposed through a tax)
- The employer mandate (which imposed through a tax), and
- The subsidies to help individuals purchase coverage (which require government funding).
The Republicans believe that through reconciliation they can knock the legs out from under the ACA and begin to implement their own health reforms.
Some of the things members of the GOP have indicated they want to do:
- Go to a more free-market approach, in which individuals would have greater ability to purchase health insurance across state lines
- Expand health savings accounts
- Allow individuals to deduct the cost of health insurance premiums from their income taxes, and
- Let states manage Medicaid funds.
Two popular ACA provisions Republicans said they plan to keep in health plans:
- The prohibition on denying coverage to those with pre-existing conditions, and
- The ability for children to stay on their parents’ plans until age 26.
So when is it all going to happen?
When it comes to a timeline for when the GOP hopes to initiate reforms, things are a little murky. The problem is, due to the reconciliation process — and complaints from insurers about what the requirement to provide coverage to those with pre-existing conditions will do to risk pools and pricing — things aren’t as cut and dried as employers would like them to be.
But here’s what we know:
- In late January, at its annual retreat, the GOP said it wants to bring a final reconciliation package to the floor of the House by late February or early March
- In a pre-Super Bowl interview with Fox News’ Bill O’Reilly, President Trump said the repeal and replace process is “complicated” and could take until “sometime next year,” and
- Just a few days after Trump’s statements to O’Reilly, House Speak Paul Ryan (R-WI) said the president’s remarks won’t alter the timeline for the House GOP to introduce significant repeal and replace legislation by the end of 2017. Still, Ryan did indicate that even if such legislation is passed, it could take some time for it to be fully implemented.
Bottom line: Employers are likely looking at a long legislative process, and an even longer implementation period.
Bills that could chip away at law
While Congress mulls larger-scale changes to the ACA, a few bills have been introduced for lawmakers to chew on.
The following could chip away at certain elements of reform:
- The Middle Class Health Benefits Tax Repeal Act (H.R. 173) would kill the 40% deductible excise tax (a.k.a., “the Cadillac tax”) on high-cost employer health plans
- The Health Savings Account Expansion Act (H.R. 247 and S. 28) would permit the reimbursement of health insurance premiums and increase the maximum allowable contribution, and
- The Healthcare Tax Relief and Mandate Repeal Act (H.R. 285) would kill both the individual and the employer health insurance mandates.
See the original article Here.
Source:
Schappel C. (2017 February 10). Where exactly are we in the ACA repeal process? [Web blog post]. Retrieved from address https://www.hrmorning.com/where-are-we-aca-obamacare-repeal-trump/
How Obama’s last healthcare legislation is further hurting the ACA’s chances of survival
Due to the most recent changes President Obama made to the ACA before leaving office, ACA repeal is looking more and more like a possibility. Take a look at this great article from Employee Benefits Advisors to see how the changes will affect the ACA repeal process by Craig Hasday
President Trump is delivering on what many had viewed as an unrealistic campaign promise: The repeal of Obamacare is right on track. In finalizing the budget, the GOP can now line out any ACA items with a fiscal impact, thanks to an executive order issued by Trump on his first day in office. By lining out the individual and employer penalty and eliminating some of the ACA taxes – voila – the ACA is gone.
The market reforms will stay, however (no pre-existing conditions, guaranteed issue coverage and dependents covered to age 26). But there is an enormous “if.” If the insurance carriers stay in the market.
One of the reasons the ACA is not working is the adverse selection issue. Insurance carriers must take all comers, and since the individual penalty for not obtaining coverage is full of loopholes, and not large enough to dissuade the young and healthy from rolling the dice, the risk pool has performed horrifically. That should be no surprise – I have been writing about it for years; a few examples here, here, here and here.
But if the individual penalty is repealed, it is going to get even worse. The healthy are going to leave and the risk pools will be left with a lot of expensive sick people who love the idea of guaranteed coverage, premiums and unlimited maximums.
The problem with QSEHRAs
The prior Congress and former President Obama didn't help matters with the passage of the 21st Century Cures Act, which was signed into law in December 2016. This law allows small employers who don't offer a group health plan to create a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA). Employers can provide money to employees on a tax-free basis to pay for individual health insurance policies and to reimburse employees for certain medical expenses. This is going to make the small group pools worse and, my guess is, increase adverse selection even more.
Given the losses incurred to date and the additional selection being imposed on the healthcare system, the big question is will the health insurance carriers stay in the marketplace? If mainstream carriers refuse to offer policies – BOOM – the system implodes.
To quote the best show on Broadway, “Hamilton,” I would love “to be in the room where it happens.” This is going to be interesting to watch.
See the original article Here.
Source:
Hasday C. (2017 February 06). How Obama's last healthcare legislation is further hurting the ACA's chances of survival [Web blog post]. Retrieved from address https://www.employeebenefitadviser.com/opinion/how-obamas-last-healthcare-legislation-is-further-hurting-the-acas-chances-of-survival
9 questions employees have about ACA – and how to answer them
Have your employees been asking more questions about the ACA? Check out this great article from HR Morning about some of the question your employees might ask and how to answer them by Christian Schappel
Even under the Trump administration, the Affordable Care Act (ACA) is still a real, enforceable law. You already know this. But do all of your employees?
Chances are, once employees start getting their ACA-mandated 1095 forms from you in the next few weeks, some of them are going to have questions — à la: What is this? I thought Trump did away with Obamacare.
Here are some of the questions employees are asking — and are bound to ask — along with how HR can answer them:
1. Didn’t Trump repeal Obamacare?
No. While he has promised to “repeal and replace” the ACA, all he has done so far is sign an executive order that directs federal agencies to grant certain exemptions from the law, as well as waive any requirements that they’re able to by law.
Surely, the executive order will eventually weaken some parts of the ACA — and maybe even lead to some repeals — but nothing concrete has happened yet. As a result, employers still have to comply with the “play or pay” mandates, and individuals still have to carry health insurance or risk penalties.
2. Didn’t Republicans in Congress start repealing the law?
No. Republicans in Congress don’t have the votes they need to repeal the ACA outright. They can’t avoid a Democratic filibuster.
As a result, what they have done is state their intention to attack the law through a process known as reconciliation. It’ll allow Republicans to vote on budgetary pieces of the law — like the individual mandate (which is imposed with a tax) and healthcare subsidies — without giving the Democrats a chance to filibuster.
The problem for Republicans, though, is that reconciliation limits how they can reshape (or repeal) Obamacare.
3. Then when will Obamacare be repealed?
All you can tell employees right now is that it hasn’t happened, and there is no clear answer on when (or even if) it will happen in its entirety.
However, Republicans recently made two things clear at its recent annual retreat in Philadelphia:
- They plans to use the reconciliation process to “repeal and replace” parts of the law.
- The GOP will bring a final reconciliation package to the floor of the House of Representatives by late February or early March.
Chances are, we’ll find out more once Trump’s cabinet picks — specifically his pick to lead the Department of Health and Human Services — have been confirmed.
4. If I have a pre-existing condition, will I have trouble finding a health plan?
President Trump, as well as Republicans in Congress, have stated their intentions to attempt to keep two popular requirements of the ACA in place:
- The need for insurance companies to offer coverage to individuals with pre-existing conditions.
- The ability for children to be able to stay on their parents’ health plans until age 26.
Form 1095 questions
5. What is this form?
Form 1095 is a little like Form W-2: The employer or insurer sends one copy to the Internal Revenue Service (IRS) and one copy to the employee. It describes whether the person obtained the minimum required level of health insurance under the ACA in 2016.
It also informs the IRS, and the employee, if the person was eligible for a premium tax credit in 2016.
6. If Obamacare is going to be repealed, do I still need this form?
Yes. The reason is because the ACA was in effect for all of 2016, and this form is for reporting information that reflects what happened in 2016.
7. What do I have to do with it?
In most cases, no action will be necessary. When filing taxes for 2016, individuals will be asked if they obtained minimum insurance coverage. This form will help individuals answer that question.
8. Do I have to wait to receive the form to file my taxes?
Again, in most cases, the answer is no. Only those who received insurance via an exchange or the “marketplace” will have to wait for their 1095 to file their taxes.
If a person received insurance through an employer, that person doesn’t have to wait for Form 1095 to file his or her taxes, assuming the person already knows whether or not they had minimum coverage throughout the year. In that case, the person can just keep the form for their records.
If a person’s unsure whether he or she had minimum coverage for the entire year, that person can wait for the form to file their taxes or ask their employer whether he or she had minimum coverage.
9. How will I receive the form(s)?
Individuals may receive their form(s) in one of three ways:
- hand delivery, or
- electronically (if they have consented to receive it electronically).
See the original article Here.
Source:
Schappel C. (2017 February 1). 9 questions employees have about ACA- and how to answer them [Web blog post]. Retrieved from address https://www.hrmorning.com/employee-questions-aca-obamacare-repeal-answers/
What Trump’s ACA executive order means for employers
Great article from Benefits Pro by Nick Otto.
President Donald Trump wasted no time in fulfilling one promise he made time and again on his campaign trail in undoing the Affordable Care Act on day one in office.
On Friday, Trump issued an executive order directing members of his administration to take steps that will facilitate the repeal and replacement of the ACA, but experts note employers should continue with business as usual until solid formalities come out.
From an employer’s perspective, “every regulation they need to comply with, they still need to until they hear differently,” says Steve Wojcik, vice president of public policy at the National Business Group on Health.
What Trump’s order did was send a signal to everyone that his administration is prioritizing to repeal major parts of the ACA and to replace it with something else.
“In terms of specifics, nothing changes now, and it makes it clear that some changes may take longer than others because of the regulatory process to revise existing regulations,” Wojcik notes.
This specific order reiterates that it is administration policy to seek the repeal and replacement of the ACA and directs relevant agencies like Health and Human Services, Treasury and Labor, to utilize their authorities under the act “to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market,” according to the order.
But the different agencies will have to follow the law that requires notice and commenting periods before any final regulation is put in place, adds Chatrane Birbal, a government relations senior advisor with the Society for Human Resource Management.
“Trump’s administration is drawing a line in the sand,” she says. “While Congress is working on making its changes on a legislative front, Trump wants to move forward with the regulatory side.”
The most immediate focus will be whether the IRS acts to delay the employer reporting requirements under the employer shared responsibility provisions of the law, points out Joy Napier-Joyce, principal and leader of the employee benefits group at labor & employment law firm Jackson Lewis P.C.
“Employer reporting is key to assessing employer penalties under the employer mandate, [but it] represents a significant burden to employers and the deadlines are fast approaching,” she says. Similarly, Napier-Joyce says, “we have not seen enforcement of employer penalties under the employer mandate to date.”
Especially given Trump’s announcement Monday of a hiring freeze for federal workers and the known shortage of resources at the IRS, employers will be eager to glean hints as to any non-enforcement stances, she says. Much of the requirements under the employer mandate have been formalized through statute and regulation, so in order to effectively and completely reverse course, formal processes will need to be followed, which will in turn take time.
“For now, employers should stay the course, but stay tuned as we await how and when the agencies, particularly the IRS, choose to exercise discretion,” Napier-Joyce adds.
One issue Birbal advises keeping an eye on is that the executive order calls for greater flexibility to states.
“This could be a concern for employers because it doesn’t recognize ERISA preemption,” she notes. “It has provided employers and employees with a workable regulatory framework for benefits, offering uniform set of benefits to employees throughout out the U.S.”
“We believe the flexibility and certainty of the ERISA framework already in place has been a success to the employers sponsored system and we hope that’ll be maintained,” she adds.
Another area to note, says NBGH’s Wojcik, is how providers could be impacted by the order.
“There are a lot of punitive delivery reform regulations that are in various stages of completion or haven’t been issued,” he says. “To the extent that that affects hospitals and physicians, it could be an area where you see a lot of impact besides issues like the individual mandates and excise tax.”
As for policies that were still in the works, “if something hasn’t come out yet, it’s likely that it won’t come out ever based on executive order,” Wojcik notes.
See the original article Here.
Source:
Otto N. (2017 January 23). What trump's ACA executive order means for employers [Web blog post]. Retrieved from address https://www.benefitnews.com/news/what-trumps-aca-executive-order-means-for-employers?feed=00000152-18a4-d58e-ad5a-99fc032b0000
Why technology is not just a ‘thought but a necessity’
Are you utilizing your technology to its advantages? Check out this article from Employee Benefits Advisors about the importance of technology in today's marketplace by Brian M. Kalish
More than half of all brokers nationwide are still using paper and have no online database of their clients — but the industry is about to reach a tipping point, where those still using old processes will be left behind.
According to a recent survey of 10,000 brokers by hCentive, 54% still use paper and 53% have no online database.
Having no online database is the most challenging part, Lisa Collins, director of business development at hCentive said a recent event for brokers sponsored by the company in Reston, Va. Those brokers, she said, lack a central place for their resources.
But for brokers still using these old processes, the industry is reaching a tipping point, she said, where “technology is not just a thought [but] a necessity.”
It will become necessary, she explained, because the industry is demanding technology solutions as employers look to their brokers to provide more services with less commissions. On top of that, HR broker tech startups, such as Zenefits, Namely and Gusto are taking business away. These firms offer technology solutions for free and become the broker of record — and they are moving upmarket, Collins added. The tech startups, Collins added, are taking business from more traditional brokers.
These tech startups are directly approaching adviser’s clients, she said. Clients are responding to these HR tech startups because of challenging and changing requirements of HR, including Affordable Care Act compliance.
“Clients are asking for more than ever,” she said. “It used to [broker’s] sold insurance. Now they are a true consultant and risk mitigator.”
“Clients want more and more and it is challenging with less commission dollars to work with,” she added. “You have more competition than you have ever had.”
Advisers need to provide value, as benefits are likely to be a top three expense for an employer, added Brian Slutz, regional sales manager at hCentive.
The future
Looking toward the future, many questions still remain about President Donald Trump’s plans for healthcare and employee benefits, but a few things are likely to be consistent, which can be streamlined with technology, including:
- Consumer-driver healthcare is staying, Collins said, and with that comes the growth of health savings accounts. As a result, more voluntary products can be sold. Technology enables that through decision support tools that suggest these products to employees.
- Cost transparency tools: “A really critical tool,” Collins said. Viable systems are hitting the marketplace now and technology provides answers employees are seeking on healthcare costs
- Personalized communications: With more choice and more complication comes the need for education, Collins said. Technology solutions are becoming more customized to speak to an individual employee with targeted communication to a particular generation.
See the original article Here.
Source:
Kalish B. (2017 January 31). Why technology is not just a 'thought but a necessity' [Web blog post]. Retrieved from address https://www.employeebenefitadviser.com/news/why-technology-is-not-just-a-thought-but-a-necessity?brief=00000152-1443-d1cc-a5fa-7cfba3c60000
IRS may have big ACA employer tax woes, advocate says
IRS may play a big part in your company's ACA tax filing. Checkout this article from Benefits Pro about what the IRS will be looking for in companies ACA filings this year by Allison Bell
An official who serves as a voice for taxpayers at the Internal Revenue Service says the IRS may be poorly prepared to handle the wave of employer health coverage offer reports now flooding in.
The Affordable Care Act requires "applicable large employers" to use Form 1095-C to tell their workers, former workers and the IRS what, if any, major medical coverage the workers and former workers received. Most employers started filing the forms in early 2016, for the 2015 coverage year.
This year, the IRS is supposed to start imposing penalties on some employers who failed to offer what the government classifies as solid coverage to enough workers.
Nina Olson, the national taxpayer advocate, says the IRS was not equipped to test the accuracy of ACA health coverage information reporting data before the 2016 filing season, for the 2015 coverage year. The IRS expected to receive just 77 million 1095-C forms for 2015, but it has actually received 104 million 1095-C's, and it has rejected 5.4 percent of the forms, Olson reports.
"Reasons for rejected returns include faulty transmission validation, missing (or multiple) attachments, error reading the file, or duplicate files," Olson says.
Meanwhile, the IRS has had to develop a training program for the IRS employees working on employer-related ACA issues on the fly, and it was hoping in November to provide the training this month, Olson says.
"The training materials are currently under development," Olson says. She says her office did not have a chance to see how complete the training materials are, or how well they protect taxpayer reports.
Olson discusses those concerns about IRS efforts to administer ACA tax provisions and many other tax administration concerns in a new report on IRS performance. The Taxpayer Advocate Service prepares the reports every year, to tell Congress how the IRS is doing at meeting taxpayers' needs.
In the same report, Olson talks about other ACA-related problems, such as headaches for ACA exchange plan premium tax credit subsidy users who are also Social Security Disability Insurance program users, and she gives general ACA tax provision administration data.
APTC subsidy
The ACA premium tax credit subsidy program helps low-income and moderate-income exchange plan users pay for their coverage.
Exchange plan buyers who qualify can get the tax credit the ordinary way, by applying for it when they file their income tax returns for the previous year. But about 94 percent of tax credit users receive the subsidy in the form of an "advanced premium tax credit."
When an exchange plan user gets an APTC subsidy, the IRS sends the subsidy money to the health coverage issuer while the coverage year is still under way, to help cut how much cash the user actually has to pay for coverage.
When an APTC user files a tax return for a coverage year, in the spring after the end of the coverage year, the user is supposed to figure out whether the IRS provided too little or too much APTC help. The IRS is supposed to send cash to consumers who got too little help. If an APTC user got too much help, the IRS can take some or all of the extra help out of the user's tax refund.
Another ACA provision, the "individual shared responsibility" provision, or individual coverage mandate provision, requires many people to obtain what the government classifies as solid major medical coverage or else pay a penalty.
Individual taxpayers first began filing ACA-related tax forms in early 2015, for the 2014 coverage year. Early last year, individual taxpayers filed ACA-related forms for the second time, for the 2015 coverage year.
Only 6.1 million taxpayers told the IRS they owed individual mandate penalty payments for 2015, down from 7.6 million who owed the penalty for 2014.
But, in part because the ACA designed the mandate penalty to get bigger each year for the first few years, the average penalty payment owed increased to $452 for 2015, from $204 for 2014.
The number of households claiming some kind of exemption from the penalty program increased to 8.6 million, from 8.4 million.
The number of filers who said they had received APTC help increased to 5.3 million for 2015, up from 3.1 million for 2014. And the amount of APTC help reported increased to $18.9 billion for 2015, from $11.3 billion in APTC subsidy help for 2014.
That means the 2015 recipients were averaging about $3,566 in reported subsidy help in 2015, down from $3,645 in reported help for 2014.
Olson says her office helped 10,910 taxpayers with ACA premium tax credit issues in the 12-month period ending Sept. 30, 2016, up from 3,318 in the previous 12-month period.
One of her concerns is how the Social Security Disability Insurance program, which is supposed to serve people with severe disabilities, interacts with the ACA provision that requires people who guess wrong about their income during the coverage year to pay back excess APTC subsidy help.
SSDI lump-sum payment headaches
Some Social Security Disability Insurance recipients have to fight with the Social Security Administration for years to qualify for benefits. Once the SSDI recipients win their fights to get benefits, the SSA may pay them all of the back benefits owed in one big lump sum.
The big, lump-sum disability benefits payments may increase the SSDI recipients' income for a previous year so much they end up earning too much for that year to qualify for ACA premium tax credit help, Olson says in the new report.
The SSDI recipients may then have to pay all of the ACA premium tax credit help they received back to the IRS, Olson says.
So far, IRS lawyers have not figured out any law they can use to protect the SSDI recipients from having to pay large amounts of premium tax credit help back to the government, Olson says.
For now, she says, her office is just trying to work on a project to warn consumers about how accepting any lump-sum payment, including an SSDI lump-sum benefits payment, might lead to premium tax credit headaches.
See the original article Here.
Source:
Bell A. (2017 January 16). IRS may have big ACA employer tax woes, advocate says [Web blog post]. Retrieved from address https://www.benefitspro.com/2017/01/16/irs-may-have-big-aca-employer-tax-woes-advocate-sa?page_all=1