Obama administration touts health law an hour before possible ruling
By Elise Viebeck
Source: The Hill
Federal health officials touted a popular provision of the healthcare law — which would result in $1.1 billion in insurance rebates to consumers — just an hour before the Supreme Court could issue its ruling.
A ruling could happen Thursday at 10 a.m. After that, the next possible decision date is Monday, June 25.
The Obama administration continues to talk up provisions of the law as they are implemented. As a whole, the Affordable Care Act remains unpopular with the public.
Health and Human Services (HHS) Secretary Kathleen Sebelius said Thursday morning that 12.8 million Americans will receive $1.1 billion in rebates from insurers this summer as a result of the law. This will average about $151 per insured family, the agency estimated.
The rebates will stem from the law's medical loss ratio, which mandates that insurers spend roughly 80 percent of all premiums on healthcare rather than marketing, executive bonuses or other administrative costs.
"The 80/20 rule helps ensure consumers get fair value for their health care dollar," Sebelius said in a statement.
Materials from HHS said that consumers will likely see a rebate check in the mail, a lump sum reimbursement to the account they use to pay premiums or a reduction in their future payments. Insurers must issue checks by Aug. 1, unless the law is struck down in the next two weeks.
Poll: Healthcare reform must stay on Washington's agenda
Americans strongly support further efforts to reform the healthcare system if the Affordable Care Act is declared unconstitutional, a new poll finds.
The overwhelming desire for a new reform effort — supported by more than 75 percent of the public — was comprised of backers and opponents alike of the law known as "ObamaCare," according to The Associated Press-GfK poll.
Neither party is expected to launch a comprehensive reform effort if the court strikes down the law in the next two weeks. Republicans in the House have said they will immediately repeal whatever portions of the law are left standing and approach other reform attempts step by step.
The White House, meanwhile, is expected to continue implementing any parts of the law that remain.
The poll found that even among Tea Party supporters — the most vocal objectors to the original healthcare law — nearly 60 percent said they want Washington to continue some kind of healthcare reform effort. This represented the lowest level of support found by the poll, according to the AP.
Overall, 47 percent opposed the law, including only 21 percent of independents, and just over a majority said the 2012 presidential contest will have a big effect on the healthcare system.
The poll was conducted June 14-18 and had a margin of error of 4 points.
Health Care Reform Update
The U.S. Supreme Court is expected to publish its decision on the legality of the Patient Protection and Affordable Care Act, or PPACA (also called health care reform, HCR and ACA), by the end of June. What they will decide is anyone's guess. Here are the possibilities (in no particular order), and a brief overview of what the decision would mean to employers that sponsor group health plans.
Entire Law is Constitutional
If the Court decides that all parts of the law are constitutional, employers will need to move forward with implementing the changes that the law requires. For 2012 and 2013, these include:
- Providing summaries of benefits coverage with the first open enrollment on or after Sept. 23, 2012
- Reporting the value of medical coverage on the 2012 W-2
- Reducing the maximum health flexible spending account (FSA) contribution to $2,500 (beginning with the 2013 plan year)
- Paying the Patient Centered Outcomes fee (due July 31, 2013)
Note: Details on these requirements are included in recent Employer Compliance Alerts.
Part of the Law is Constitutional and Part is Not
The Court could decide that the requirement that individuals obtain health coverage or pay a penalty (the "individual mandate") exceeds Congress' authority but that other parts of the law are permissible. They could then either specify which parts should stay and which should go, or they could send the case back to a lower court to determine the details. Either way, employer obligations to comply with the law would continue, and the actions needed for 2012 and 2013 would continue to apply.
Entire Law is Unconstitutional
The Court could decide that the entire law is flawed, in which case employers will not need to implement the changes that were to take effect for 2012 and later. There would be some uncertainty (and choices) with respect to the parts of the law that have already been implemented. Keep in mind that if the plan or policy has been amended or written to include the 2010 and 2011 changes, the plan document or policy will need to be revised to remove the changes -- the mere fact that the law is unconstitutional will not void the changes in the plan or policy.
Several carriers -- Aetna, Humana and UnitedHealthcare -- have stated that they will continue to administer their policies to include many of the changes that have already been implemented, even if that is not legally required. Employers that have self-funded plans will need to decide -- and those who have fully insured plans may need to decide -- if they want to roll back changes such as:
- Covering dependent children to age 26 (there will be tax issues with this unless the IRS provides a waiver)
- Elimination of lifetime and annual maximums for most benefits
- Elimination of pre-existing condition limitations for dependents under age 19
- First-dollar coverage for preventive care
- Excluding over-the-counter prescription drugs for health FSA and health savings account (HSA) coverage
The Supreme Court decision is unlikely to end the debate over PPACA, particularly with the fall congressional and presidential elections looming. If the Supreme Court upholds the law, House Republicans have pledged to introduce legislation to repeal it, but they likely do not have the votes in the current Congress to prevail.
Bigger Changes May Be in Store for FSAs
A recent IRS clarification regarding contribution limits for some health flexible spending accounts (FSAs) comes at a time when the agency and Congress are seriously rethinking some of the other constraints to the accounts.
In late May, the IRS released a notice that clarified that the $2,500 annual contribution limit to FSAs that was imposed by the Patient Protection and Affordable Care Act (PPACA) is effective for plans that begin in 2013 -- meaning noncalendar-year plans in 2012-2013 do not have to comply, according to a post on the E is for ERISA website.
That change, however, may do little good for proactive employers with noncalendar-year plans that already made adjustments. The notice does not contain guidance about changing the contribution limit midyear, so it appears that employers that made changes to the contribution limits at the start of the 2012-13 plan year must stick with them, according to ftwilliam.com, a division of Wolters Kluwer.
This adjustment could be the first in a number of significant changes to rules governing FSAs. The IRS is considering a change to the "use-it-or-lose-it" rule, which requires participants to spend their FSA balance annually or lose the money, according to a report in Business Insurance. The report notes that the IRS acknowledges that the cap under PPACA "limits the potential for using health FSAs to defer compensation," and so a rework of the use-it-or-lose-it rule likely is due.
The U.S. House of Representatives also is stepping into the debate, as legislators recently passed a bill that would ease the use-it-or-lose-it rule, according to Business Insurance. The House bill allows workers to withdraw up to $500 in unused balances from the accounts, although the funds would be taxable.
The bill also abolishes an unpopular rule that restricts the purchase of over-the-counter medications with FSA money. Under the PPACA rule, tax-advantaged health accounts, including FSAs and health savings accounts, cannot be used to purchase over-the-counter medications without a prescription. The bill strikes that provision from the law, the Business Insurance report said.
However, the Obama administration already has pledged to veto the bill if it makes it through the Senate because the legislation also would eliminate a tax on makers of medical devices -- a tax that the administration sees as vital to funding the health care reform law, according to a Workforce online report.
Preparing for the SCOTUS ruling
By Brian M. Kalish
June 18, 2012
Industry groups are being proactive in preparing their membership for the Supreme Court’s ruling on health care reform — which is expected at any time — as they know no matter the ruling, the business has changed forever.
At the National Association of Health Underwriters they have readied their membership by covering the topic across numerous mediums, including weekly e-newsletters, town halls and web seminars, says Jessica Waltman, NAHU’s SVP of government affairs.
After the decision comes out, NAHU members will want to know what will happen, Waltman says, adding she believes the ruling may come out during the organization’s annual convention, which begins June 24 in Las Vegas, so they are making plans to have plenty of time to discuss it.
“We need to inform our membership, so we have a variety of information tools that we are preparing that cover the eventualities as far as we can see them,” she says. “We believe no matter the ruling; [our] members will start receiving calls from their clients. … Our goal is to have tools at the ready so they can best assist their clients.”
The Council of Insurance Agents & Brokers is taking a similar approach, and has already had discussions with its membership about the potential impact of the ruling, says Scott Sinder, partner, Steptoe & Johnson LLP, and The Council’s general counsel.
The Council and its attorneys at Steptoe & Johnson LLP “have folks anxiously awaiting and ready to read the opinions,” and the organization intends to send notice to its members within hours of the ruling that reports on “the big picture,” which will be followed up with more in depth analysis within 24-28 hours.
A series of web seminars, including an initial one for its membership and a second one for members to share with their clients, will follow.
One broker, who says he started his business expecting health care reform, says he’s enjoyed watching the buildup to the ruling. “In the last three to four months it’s been interesting to see brokers still holding onto that hope that we’re going to go back five or six years and broker commissions will go back up and we’re not going to have government involvement in health care. But I don’t see that scenario occurring,” says Reid Rasmussen, owner of Benefit Brainstorm, Inc, adding he believes 30% of brokers will leave the business in the next two years.
“That will open opportunity up to the insurance professionals that are still left figure out how to better serve their clients,” he says. “Smart agents are expanding their horizons and serving their client better than ever before. … It’s not going to make a difference in the end what the Supreme Court rules.”
Even so, Waltman says, NAHU cannot wait for the ruling to come out, as presently “it’s very difficult to plan anything and it affects a lot of our dealings [and] feelings. … It affects everything we are doing.”
“Just having the closure will be very helpful,” she adds. “I think we are looking for that and then we can plan accordingly. No matter what the Court does … there needs to be changes to market reform in the coming year.”
OVERNIGHT HEALTH: Still waiting for SCOTUS
06/18/12
Source: thehill.com
By Sam Baker and Elise Viebeck
The Supreme Court’s landmark healthcare ruling is just days away. More than 10,000 users tuned in for live updates Monday morning at SCOTUSblog but, as expected, the court didn’t release its highly anticipated healthcare ruling. The next possibility is Thursday, though the odds still seem to favor a ruling next week.
As the decision nears, focus is turning once again to the important issue of severability — whether the healthcare reform law’s individual mandate would have to take the whole law down with it, if it’s found to be unconstitutional. The justices can do just about anything they want on the severability question: strike down the whole law; strike out only the mandate; or strike the mandate and certain other provisions.
Any decision is sure to stir up a partisan firestorm, but a new poll released Monday indicates that the firestorm might be a bit softer if the court only strikes the mandate. In a new poll from the Pew Center for People and the Press, 43 percent of Republicans said they’d be happy with a decision striking down just the mandate, while 47 percent said they’d be unhappy. Among Democrats, 56 percent said they’d be unhappy losing just the mandate — a majority, sure, but smaller than the 74 percent who said they’d be unhappy if the court strikes down the entire law.
How Supreme Court Could Rule on ACA
The Supreme Court is expected to hand down a decision this month on Preisdent Obama's health reform law, which is called the Affordable Care Act by Democrats and Obamacare by Republicans. There are several different questions before the court, including when to decide, whether an individual mandate is constitutional, and whether the Congress can force states to expand Medicaid by placeing restrictions on federal funds.