Justices Seem Unlikely to Strike Down Entire Affordable Care Act
The U.S. Supreme Court appears hesitant to invalidate the Affordable Care Act (ACA) in its entirety, based on questions the justices posed during oral argument Nov. 10.
The ACA requires that most Americans either maintain a minimum level of health care coverage or pay a specified amount to the Internal Revenue Service. In a 2012 opinion written by Chief Justice John Roberts Jr., the Supreme Court upheld this mandate as a legitimate exercise of Congress' taxing power. In 2017, and effective in 2019, Congress amended the ACA to set the penalty to zero, making the individual mandate provision unenforceable.
In two consolidated cases, California v. Texas and Texas v. United States, the Supreme Court has been asked to decide whether reducing the penalty to zero rendered the minimum-coverage provision unconstitutional—and, if so, whether the rest of the ACA can remain enforceable without it.
"The justices seem to be leaning toward, at a minimum, finding the individual mandate severable and preserving the remainder of the law," observed Benjamin Conley, an attorney with Seyfarth Shaw in Chicago. The most notable takeaway from the arguments, he said, was that Roberts and Justice Brett Kavanaugh "all but stated that they believe the individual mandate is severable."
Questions Before the Court
The court will first consider whether the plaintiffs have standing to challenge the ACA, then it will move to the merits of the case. Texas and other states that challenged the ACA argued that "Congress may not use its power to regulate interstate commerce to order Americans to buy health insurance" and that the only reason the individual mandate survived a legal challenge was because it was "fairly possible" to read the ACA's mandate as a tax trigger. "Because the mandate raises no revenue, it can no longer be read as a tax," they wrote in a brief to the Supreme Court.
The U.S. House of Representatives and a group of Democrat-led states are fighting to keep the ACA intact. If Texas successfully challenges the ACA, "more than 20 million Americans could lose their health care coverage, 130 million Americans with pre-existing conditions could lose protections, and drug costs could skyrocket for seniors," House Speaker Nancy Pelosi tweeted Nov. 10.
In December 2019, the 5th U.S. Circuit Court of Appeals sided with Texas, holding that the mandate is unconstitutional since there is no longer a penalty for people who fail to buy health insurance.
But the Supreme Court justices raised doubts about that argument. "I think it's hard for you to argue that Congress intended the entire act to fall if the mandate were struck down when the same Congress that lowered the penalty to zero did not even try to repeal the rest of the act," Roberts said during oral argument. "I think, frankly, that they wanted the court to do that. But that's not our job."
Justice Amy Coney Barrett, the court's newest justice and sixth conservative on the bench, has previously raised concerns with the Supreme Court's 2012 ruling. "Justice Barrett has criticized Justice Roberts' decision to uphold the ACA," said Sage Fattahian, an attorney with Morgan Lewis in Chicago. "The general view is that her vote may be the deciding vote in invalidating the ACA, but all of that remains to be seen."
Seyfarth Shaw's Conley noted that votes from Roberts and Kavanaugh, plus the three liberal justices—Justices Stephen Breyer, Elena Kagan and Sonia Sotomayor—would be enough to preserve the remainder of the law.
"The most interesting questions and comments, for me, came from Justice Kavanaugh," Fattahian observed. At oral argument, Kavanaugh said he thinks there is "a very straightforward case for severability" under Supreme Court precedent.
"Chief Justice Roberts also asked questions that seemed to indicate that the proper remedy in this case would be to sever the individual mandate from the rest of the ACA," Fattahian said. "This would mean that the ACA's plan mandates and employer mandate, along with ACA reporting requirements, would all remain intact."
Employer Takeaway
So what will a ruling in the case mean for employers? "While a ruling striking down the entire law could definitely have an impact in the long term, we don't think any short-term action is required," Conley said.
Even if, for instance, the Supreme Court invalidates the provision of the law allowing dependents to remain on their family's plans until age 26, an employer could certainly continue to offer such coverage even if it is no longer required. "So any plan-driven changes resulting from the ruling would be more incremental and long term," Conley added.
A decision in the case is not expected until June 2021. "In the meantime, employers should note that the health care law remains fully in effect during the litigation, including all coverage obligations and reporting requirements," said Chatrane Birbal, vice president of public policy for the Society for Human Resource Management. If there are changes to the health care law, employers should be aware that the changes will not take effect immediately, she noted.
Fattahian said, "Employers should continue down the path of compliance. Should the ACA be held to be unconstitutional, it will remain to be seen how it will all unwind and what, if anything, will take its place."
Here's your employee checklist for open enrollment
The COVID-19 pandemic has focused consumer attention on health care, germs and the impact a single illness can have on their lives, livelihoods and loved ones. With the fall open enrollment season almost here, you have the opportunity to think more critically about the specific plans you choose for yourself and your family, as well as any voluntary benefits that may be available to you, including childcare, elder care and critical illness. In a world where it feels like health is out of the individual’s control, we all want, at the very least, to feel control over our coverage.
As we know all too well, there’s a lot to consider when it comes to choosing and using health care benefits. The most important piece of becoming an informed health care consumer is ensuring you have access to — and understand — the benefits information you need to make smart health care choices.
While open enrollment may seem daunting, devoting an hour or two to reviewing your plan options, the programs available to support you and your family physically, mentally and financially, and how to get the most from the coverages you do elect, can go a long way towards providing peace of mind as we face the unknowns of 2021. Here are five tips to keep in mind as you prepare for and participate in open enrollment.
Don’t forget that preventive care is covered by most plans at 100% in-network regardless of where that care is received. Schedule your appointments as soon as possible (and permissible in their area), and research other venues for receiving care, such as pharmacies, retail clinics and urgent care facilities. Most are equipped to provide standard vaccinations and/or routine physicals.
Unfortunately, there are also the long-term implications of COVID-19 to consider. Research suggests that there are serious health impacts that emerge in survivors of COVID-19, such as the onset of diabetes and liver, heart and lung problems. And many who were able to ride out the virus at home are finding it’s taking months, not weeks, to fully recover. As a result, you should prepre for the possibility that you, or a loved one, may be ill and possibly out of work for an extended period of time. Be sure to evaluate all of the plans and programs your employer offers to ensure your family has the financial protections you need. For some, a richer health plan with a lower deductible, voluntary plans such as critical illness or hospital indemnity insurance, and buy-up life and disability insurance may be worth investigating for the first time.
As hospitals reopen, it may be difficult to schedule a procedure due to scheduling requirements and pent up demand. A second opinion may be in order if your condition stabilized, improved or worsened during the delay; there may be other treatment options available.
A delay in scheduling also provides an opportunity to “shop around” for a facility that will provide needed care at an appropriate price — especially if you are choosing to go out-of-network or have a plan without a network. Researching cost is the best way to find the most affordable providers and facilities with the best quality, based on your specific needs.
Many medical plans offer second opinion and transparency services, and there are independent organizations who provide “white glove,” personalized support in these areas. Read over your enrollment materials carefully, or check your plan’s summary plan description, to see what your employer offers. If nothing is available, ask your employer to look into it, and don’t hesitate to do some research on your own. Doing so can often result in substantial cost savings, without compromising on quality of care.
Be sure to check up on your preferred health care providers — especially those you might not see regularly — to confirm they are still in business and still in network (if applicable). If you live in a rural area, you may have to travel farther to reach in-network facilities. If you’re currently covered by an HMO or EPO, you may want to evaluate whether that option still makes sense, if your preferred in-network providers are no longer available.
When was the last time you changed your medical plan? If you’ve been keeping the same coverage for years, it might be time to look at what else is available. Your employer may have introduced new plans, or you may find that a different plan makes more sense financially based on how often you need health care. Don’t forget — the cheapest plan isn’t always the one with the lowest premiums.
You may also want to consider setting aside funds in a health savings account or health care flexible spending account (if available). If your employer offers a wellness program, this might be an opportunity to start adopting better health habits to ensure you’re better equipped physically and mentally to deal with whatever lies ahead.
Overview of COVID-19 Law and Guidance for Health and Welfare Plans
The business operations of many small and large companies have been significantly affected due to the coronavirus pandemic. During this time, health and benefit plans are also being affected. Read this blog post to learn more.
The COVID-19 pandemic has significantly affected the business operations of small and large employers alike. To mitigate the harm from the pandemic to employers, the government has enacted major legislation and issued numerous guidance in the past few months pertaining to COVID-19, including rules that address various aspects of employee benefits.
This article provides an overview of significant COVID-19 legislation and guidance related to employer-sponsored health and welfare benefit plans that has been enacted or issued to date.
Some of these changes are mandatory for group health plans. Other are optional. Employers should carefully review these rules to determine any compliance obligations as well as any opportunities to benefit their businesses and respective employees.
Mandated Coverage of COVID-19 Testing (Mandatory)
Effective March 18, 2020 and until the end of the national emergency period for COVID-19, the Families First Coronavirus Response Act (FFCRA) requires group health plans to cover:
- COVID-19 diagnostic testing.
- Certain items and services that result in an order for, or administration of, the testing.
Plans must provide this coverage without imposing any requirements for cost-sharing, prior authorization, or medical management.
CARES ACT
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which was signed into law on March 27, 2020, amended the FFCRA's coverage mandate to:
- Expand the scope of COVID-19 diagnostic tests that must be covered.
- Include rules regarding the rate at which a plan must reimburse a health care provider for the mandated services.
- Require coverage of preventive services and vaccines for COVID-19 as of 15 days after such a service or vaccine is given an "A" or "B" rating in a recommendation by the U.S. Centers for Disease Control and Prevention (CDC) or U.S. Preventive Services Task Force.
ADDITIONAL GUIDANCE
On April 11, 2020, the FFCRA and CARES Act FAQs provided additional information about this COVID-19 mandate. Items included details on required coverage of COVID-19 antibody tests, rules regarding required disclosures of the new coverage to plan participants, and which items and services related to COVID-19 testing must be covered by a plan.
Continuation of Health Benefits During Certain Leaves of Absence (Mandatory)
The FFCRA also requires (with some exceptions) employers with fewer than 500 employees to provide certain paid sick leave and family and medical leave related to certain COVID-19 reasons, as follows:
- Paid sick leave. An applicable employer must provide two weeks of emergency paid sick leave (EPSL) to an employee who is unable to work (or telework) due to certain reasons related to COVID-19. Reasons include quarantining of an employee (due to a Federal, state or local order or advice from a health care provider) experiencing COVID-19 symptoms, caring for an individual who is quarantined, and caring for a child under age 18 whose school or child care provider is closed.
- Family and medical leave. The employer must also provide up to twelve weeks of expanded Family Medical and Leave Act (FMLA) leave (ten of which is paid) for an employee who has been employed for at least 30 days and who is unable to work (or telework) due to a bona fide need for leave to care for a child whose school or child care provider is closed or unavailable for reasons related to COVID-19.
During FMLA leave, an employer is required to allow the employee to continue his or her group health coverage at the same premium rate as that of active employees. The DOL has also issued FAQs stating that employers must continue employees' coverage during EPSL, as well. Note, there are also implications for retirement plans under the FFCRA and CARES Act. Although those retirement plan rules are not discussed in this article, some of the CARES Act rules are conceptually similar for retirement plans (e.g., 401(k) plans may allow participants to take "Coronavirus-related" 401(k) plan distributions due to certain COVID-19 reasons).
High-Deductible Health Plans and Health Savings Accounts (Optional)
IRS GUIDANCE
IRS Notice 2020-15 (March 11, 2020), which was issued prior to passage of the FFCRA and CARES Act, provided that a high-deductible health plan (HDHP) will not lose its HDHP status if it covers COVID-19 testing and treatment before the statutory minimum HDHP deductible is met. Therefore, the plan can cover those COVID-19 related services without causing participants to be ineligible to contribute to a health savings account (HSA). IRS Notice 2020-29 (May 12, 2020) clarified that the provisions in Notice 2020-15 apply to an HDHP's reimbursement of expenses incurred on and after January 1, 2020.
CARES ACT
The CARES Act amended the HSA rules to provide that, for plan years before December 31, 2021, an HDHP does not lose its HSA-eligible status if it covers telehealth and other remote healthcare services before the HDHP deductible is met. This CARES Act provision is broader than the IRS Notices, as it provides that an HDHP can cover telehealth services regardless of whether the services are related to COVID-19. The CARES Act also allows participants to use their HSAs, health flexible spending accounts (FSAs), and health reimbursement arrangements (HRAs) to pay for certain over-the-counter drugs without a prescription as well as certain menstrual care products.
Extended Form 5500 Filing Deadline for Certain Plans (Optional)
IRS Notice 2020-23 (April 9, 2020) extended certain deadlines for a plan to file the required annual Form 5500. Under Notice 2020-23, the Form 5500 deadline was extended to July 15, 2020 for any plan whose plan year ended in September, October, or November 2019 (or any plan that was given a filing extension between April 1 and July 15, 2020). Ordinarily, a plan must file its Form 5500 (absent an extension) by the last day of the seventh month following the end of the plan year.
Relief for Certain Disclosures Required by ERISA (Optional)
EBSA Disaster Relief Notice 2020-01, which was issued by the DOL on April 28, 2020, extended the deadlines for plans to provide certain notices and disclosures under Title I of the Employee Retirement Income Security Act of 1974 (ERISA). Under Notice 2020-01, a plan will not be treated as violating ERISA if it fails to timely furnish a notice, disclosure, or document required by Title I of ERISA between March 1, 2020 and 60 days after the announced end of the national emergency declaration for COVID-19. The plan fiduciary, however, must act in good faith to furnish the notice, disclosure, or document as soon as administratively practicable. For this purpose, a plan fiduciary can meet the "good faith" standard by furnishing a document electronically if it reasonably believes that the recipient has access to electronic communication.
Extensions of Certain Plan Deadlines (Mandatory)
A joint notice issued by the DOL and IRS (published May 4, 2020) required group health plans to extend certain timeframes for participants during the "outbreak period" (defined as the period from March 1, 2020 until 60 days after the announced end of the national emergency for COVID-19). Those plans are required to disregard the outbreak period for purposes of determining the following periods and dates:
- The 30-day/60-day special enrollment period under the Health Insurance Portability and Accountability Act (HIPAA).
- The 60-day deadline for a qualified beneficiary to elect continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).
- The deadlines for a COBRA qualified beneficiary to pay his or her required COBRA premiums.
- The deadline for an individual to notify the plan of COBRA certain qualifying events (e.g., divorce).
- The deadlines for a participant to file benefit claims, appeals, and external review requests with the plan (or to perfect an external review request).
Because of this joint notice, a group health plan must essentially "pause" the above deadlines during the outbreak period. For example, if an individual experienced a COBRA qualifying event on March 1, 2020, the individual would have until 60 days after the end of the outbreak period (rather than 60 days after March 1) to elect COBRA coverage. This is because the joint notice requires a group health plan to pause the 60-day timeframe for COBRA elections during the outbreak period. Also, because the joint notice was issued on May 4 and is retroactive to March 1, plans may be required to re-process previous claim denials that were based on a participant's failure to meet one of the above deadlines between March 1 and May 4.
Cafeteria Plans and Flexible Spending Accounts (Optional)
2020 MIDYEAR ELECTION CHANGES
IRS Notice 2020-29 (May 12, 2020) relaxed the rules regarding cafeteria plan pre-tax elections in light of the COVID-19 pandemic. Under Notice 2020-20, employers may (but are not required to) amend their cafeteria plans to allow participants to make the following mid-year, pre-tax election changes in 2020:
- An election to enroll in the health plan by an eligible employee who previously declined coverage (e.g., someone who waived coverage during open enrollment).
- An election to change plan options (e.g., from an HMO to a PPO) or add dependents.
- An election to drop coverage by a participant.
- An election to enroll in or drop health FSA or dependent care FSA coverage or to increase or decrease health FSA or dependent care FSA contributions.
An employer that wishes to adopt any of all of the above cafeteria plan changes must disclose the changes to employees and amend its cafeteria plan by no later than Dec. 31, 2020 (i.e., an amendment is not required in advance of making the changes).
EXTENDED GRACE PERIOD TO INCUR FSA CLAIMS AND INCREASE OF MAXIMUM HEALTH FSA CARRYOVER AMOUNT
Notice 2020-29 also permits employers to amend their health and dependent care FSAs to allow employees to incur eligible claims through the end of the 2020 calendar year for any FSA plan year (or for any FSA grace period that ends in 2020). For example, if a health FSA has a grace period until March 15, 2020 for a participant to incur eligible claims for the 2019 plan year, the FSA can allow participants to incur expenses through 2020 and use their 2019 elections to pay for those expenses.
This change does not apply to FSAs with a carryover provision. IRS Notice 2020-33 (May 14, 2020), however, provides for a permanent FSA carryover increase based upon annual indexing. For the 2020 plan year, employers may amend a cafeteria plan with carryover provision to allow participants to carry over up to $550 in unused health account balances in the 2021 plan year. An employer that adopts the extended FSA grace periods or the increased carryover limit must amend its cafeteria plan or FSA (as applicable) by no later than December 31, 2021.
Tax-Free Payment of Employees' Student Loans (Optional)
The CARES Act amended Section 127 of the Internal Revenue Code (education assistance programs) to permit employers to pay up to $5,250 of an employee's student loans on a tax-free basis. This provision applies from the date of enactment of the CARES Act (March 27, 2020) through the end of 2020. The payment must be for either the principal or interest of a qualifying education loan incurred by the employee, and the employer can make payment either directly to the lender or as a reimbursement to the employee.
Takeaways for Employers
As employers grapple with the impact of the COVID-19 pandemic and return to normal business operations, it is important for them to be aware of their compliance obligations under the FFCRA, CARES Act and other guidance issued by governmental agencies. Employers should also carefully review the guidance and legislation for potential avenues of benefit for their business and employees.
Additional guidance for both mandatory and optional items is likely forthcoming as well, and COVID-19 continues to have a major impact on both companies and individuals as new infections spike in numerous states. Accordingly, employers would be well-advised to keep a close eye out for new legislation and guidance in the coming months and periodically evaluate their benefits programs for compliance and competitive considerations.
SOURCE Tyler Hall, A.; Schillinger, E. (16 July 2020) "Overview of COVID-19 Law and Guidance for Health and Welfare Plans" (Web Blog Post). Retrieved from https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/overview-of-covid-19-legislation-and-guidance-for-benefits-plans.aspx
How Hospitals Can Meet the Needs of Non-Covid Patients During the Pandemic
As there has been many waves of coronavirus cases for many months, health care has seemed to only point to helping those who have been impacted by the virus. Although there are still many cases that test positive for the virus, there has been a dramatic decline in other non-COVID related health issues. Read this blog post to learn more.
During the initial wave of the Covid-19 pandemic, hospitals worldwide diverted resources from routine inpatient critical care and outpatient clinics to meet the surge in demand. Because of the resulting resource constraints and fear of infection, clinicians and non-Covid patients deferred “non-urgent” visits, evaluations, diagnostics, surgeries and therapeutics. Indeed, early in the pandemic physicians and leading public health officials noted a dramatic decline in non-Covid-related health emergencies, including upwards of a 60% decrease in patients with acute myocardial infarctions and strokes.
Drawing on key principles from operations management and applying a health-systems perspective, we propose four strategies to facilitate care of non-Covid patients even as hospitals are stretched to absorb waves of patients with Covid-19.
1. Innovate outpatient management to reduce demand at downstream bottlenecks.
To reduce future bottlenecks in emergency departments (EDs) and hospitals, outpatient clinicians should expand their proactive management of patients at high risk of needing acute or inpatient services, such as those with poorly managed hypertension or diabetes, and triage patients with acute needs to EDs now in order to reduce more serious complications later. This will help reduce potential future spikes in demand on EDs and inpatient beds from non-Covid patients.
While most clinicians have rapidly adopted some form of telemedicine, they will need to increase their digital engagement with high-risk patients in a more targeted fashion. Clinicians should evaluate their patient panels to identify high-risk individuals and initiate telemedicine visits, rather than relying on patients to initiate contact, similar to the process for proactive disease management used by several community health care organizations.
Although high-risk patients will vary by specialty, targeted populations may include patients recently discharged from the hospital and those at high risk for hospitalization, including those with uncontrolled heart failure or active malignancy. To facilitate remote patient monitoring of high-risk patients, clinicians may opt to send telehealth kits tailored to patients’ medical and technological needs. These kits may include connected health devices such as blood pressure monitors, pulse oximeters, and heart rate monitors, and even mobile technology devices such as tablets or smart phones. To most effectively leverage telemedicine during the pandemic, clinicians must also promote multidisciplinary virtual collaboration across primary care clinicians, specialists, social workers, home health clinicians, administrative support, and patients and their caregivers.
2. Combine essential non-Covid inpatient services across hospitals.
To balance demand across hospitals, public health officials should apply a version of the logistics strategy known as “location pooling,” combining demands from multiple locations. Rather than each hospital in a region redundantly providing the full suite of essential inpatient non-Covid clinical services, each of these services should be concentrated at one location. For example, each region should have a single designated cancer center, transplant center, stroke center, and trauma center. Implementing this strategy is fraught with challenges as hospitals are currently organized independently and compete with one another for patients and revenue. Nevertheless, during the initial Covid-19 wave, several hospitals in Boston collaborated to share data on the availability of hospital beds to efficiently route patients based on their clinical need and the available capacity. And centralization of acute stroke care, in which patients are taken to central specialty hospitals rather than the nearest hospital, demonstrates both the feasibility and potential improved outcomes of utilizing this approach in several countries including the United States, Canada, the Netherlands, Denmark, and Australia.
Crises require all possible realizations of economies of scale. Location pooling mitigates variability in service-specific demand faced by each hospital. As demand falls for specific non-Covid services at an individual hospital (e.g., for acute stroke care), hospital administrators can close those services and repurpose the specialty capacity to care of Covid-19 patients with underlying conditions, as discussed below. If all hospitals implement this strategy, not all non-Covid services will be available at every hospital. However, location pooling draws demand from across hospitals, ensuring that as a given hospital loses some patients it gains others, allowing it to maintain sufficient census to remain fiscally viable.
Centrally coordinated regional organization, similar to mass casualty planning, is critical to ensure that each essential service remains fully operational for routine emergencies, while adapting to dynamic changes in the region’s hospital capacity. The number of hospitals to include in location pooling should be determined by weighing the tradeoff of efficiency gains from pooling across more locations versus inefficiencies from increased travel time incurred by patients and emergency medical services.
3. Group hospitalized Covid-19 patients by their underlying clinical conditions.
At the same time that hospitals should be location-pooling specialty services for non-Covid patients, to the extent possible they should place their Covid-19 patients who have serious underlying health issues (e.g., cardiac conditions) with other Covid-19 patients with the same condition. In each of these “cohorted wards,” redeployed clinical staff from the relevant specialty service, such as cardiology, can provide essential specialty care alongside clinicians addressing patients’ Covid-specific care needs.
While such cohorting limits efficiency gains from pooling all Covid-19 patients in one ward, it maintains specialty care for patients who still need it while reducing the additional inpatient capacity strain resulting from patients being dispersed across the hospital. Indeed, prior research demonstrates that displacing patients from cohorted specialty units is associated with prolonged hospital length of stay and more frequent readmissions.
4. Discharge patients into post-acute care based on Covid-19 status.
Nursing home, rehabilitation hospital, and long-term acute care facility leadership should collaborate to establish separate regional, specialized, post-acute care facilities for Covid-19 and non-Covid patients. Sending patients to specialized post-acute care facilities based on their Covid-19 status will facilitate discharge planning, improving patient flow out of the hospital for Covid-19 and non-Covid patients alike. This will relieve strain at ED and hospital bottlenecks while maintaining care quality. Furthermore, having dedicated post-acute care facilities for Covid-19 patients will preserve post-acute care capacity for those recovering from non-Covid illnesses, while lowering their risk of becoming infected.
Challenges to this model include ensuring timely access to Covid-19 testing and rapid test results to guide appropriate patient routing. To prevent discharge delays due to testing constraints, hospitals need to implement rapid tests more widely, and post-acute care facilities should designate quarantine areas for patients to receive care while awaiting results.
* * *
These strategies will undoubtedly be challenging to implement. But now is the time to rethink health care delivery and adopt operations management strategies with demonstrated success that are most promising. This will allow us to be better prepared for future waves of the Covid-19 pandemic.
SOURCE; Song, H.; Ezaz, G.; Greysen, S. Ryan.; Halpern, S.; Kohn, R. (14 July 2020) "How Hospitals Can Meet the Needs of Non-Covid Patients During the Pandemic" (Web Blog Post). Retrieved from https://hbr.org/2020/07/how-hospitals-can-meet-the-needs-of-non-covid-patients-during-the-pandemic
U.S. Health Care Is in Flux. Here’s What Employers Should Do.
The coronavirus pandemic has brought uncertainty in many areas of day-to-day lives and is now bringing uncertainty into health care. Read this blog post to learn more.
Emergencies naturally draw our attention — and our resources — to the present. The U.S. response to Covid-19 is no exception. Yet the problems exposed by the pandemic point to the urgent need to prepare now for the next waves of this crisis, including new clusters of infection and new crises of debt and scarcity. They also highlight the opportunity to develop a more resilient health system for the future. Employers can and should play a central role in this effort.
For employers, this period of exceptional economic strain has exacerbated the longstanding challenges of managing the health care costs of their employees. The future course of the disease and economy may be uncertain. But businesses that are rigorous in the way they purchase health care benefits, leverage digital health technologies, and partner with hospitals and physicians will be able to better manage an expected roller coaster in health care costs and premiums.
Dealing with Covid-19 itself is expensive: Covered California estimated that the costs to test, treat, and care for Covid-19 patients this year will be between $34 billion and $251 billion; America’s Health Insurance Plans predicts the cost will total $56 billion to $556 billion over a two-year period. Yet the total costs of U.S. health care this year will likely drop due to the postponement or cancellation of regular clinical services and elective procedures due to the virus. According to one estimate, Americans may spend anywhere from $75 billion to $575 billion less than expected on health care this year. Another actuarial firm projects that self-insured employers may see a 4% reduction in their employees’ health costs this year.
Nonetheless, health insurance premiums for employers are expected to rise in 2021. An analysis by Covered California projected that nationally, premiums will increase between 4% and 40% — and possibly more. Recent filings with the District of Columbia’s Department of Insurance, Securities and Banking related to the individual market and small groups for 2021 show that Aetna filed for an average increase of 7.4% for health maintenance organization (HMO) plans and 38% for preferred provider organization (PPO) plans, while UnitedHealth proposed an average increase of 17.4% for its two HMOs and 11.4% for its PPO plans.
What explains this projection of higher premiums in 2021? Will second and third waves of Covid-19 lead to more expensive intensive-care unit and hospital stays? Will patients flood clinics for the hip replacements, cataract operations, and other “non-urgent” services they delayed during the lockdown? Will hospitals try to charge commercial insurers more to compensate for their losses in 2020?
The answer to all these questions is a definite “maybe.” Ironically, the fundamental reason rates are expected to rise is the cost of uncertainty itself. And the situation may only get murkier if the pandemic resurges.
Even if premiums stay as they are, employers may still be unable to afford them amid plummeting revenues. Before Covid-19, premiums for employer-sponsored plans had been consistently outpacing inflation. In 2019, the Kaiser Family Foundation reported that the average annual premium for employer-sponsored health insurance was a whopping $20,576 for a family of four (and $7,188 for an individual) — a 54% increase over the previous 10 years. That dwarfs the average inflation-adjusted increase of 4% in wages in the same 10-year period from 2009 to 2019.
Given these rising costs, employers should look beyond 2021. They should not seek a short-term fix by raising copayments, deductibles, and other out-of-pocket costs for next year. While this strategy may initially reduce spending on health care, studies show that it will disincentivize employees to seek preventative treatment. In fact, families with higher deductibles are less likely to take their children to see the doctor, even when the visit is free. Over time, this leads to worse health outcomes for employees and their families, which also means much higher costs.
Here are three strategies that can help employers weather the inevitable ups and downs of 2021 and beyond and improve employee health:
1. Manage health care benefits like all other purchases.
Business leaders, especially the CEO, need to make it a priority to understand the health care benefits business. Employee health benefits consume more than $15 million annually per 1,000 employees, and employers should treat costs with the same rigor and expertise that they assess other major expenses. Whether it’s through their broker, insurance company, or consultants, businesses should examine these costs closely and understand where they are deviating from benchmarks and why. A car manufacturer should not overpay for care anymore than it overpays for steel.
For example, when employees experience a common ailment like uncomplicated back pain, do their doctors tend to order MRI and back surgery, driving up costs unnecessarily in an overeager fee-for-service model of treatment? Or do they follow more cost-efficient, preventative guidelines that lead with rest and physical therapy?
By challenging providers with these types of questions, large employers such as Walmart and Boeing have redesigned their employee benefits plans to encourage employees to seek second opinions and have even gone so far as to allow them to expense travel to medical centers that offer better care at lower costs. Employers may also find that forming alliances or joining cooperatives can expand the scale of their data, help them identify and exploit opportunities for improving the quality and cost of treating specific conditions, and enhance their purchasing power for health care.
2. Leverage technology.
The Covid-19 pandemic will open unprecedented opportunities for employers to leverage technology that helps employees seek, manage, and receive health care over the internet. During the emergency, public and private insurers lifted provider restrictions on telehealth, and the increasing willingness of both clinicians and patients to use digital technologies is changing the landscape of health care, especially for those who have chronic conditions that require ongoing monitoring. Given that Medicare is likely to sustain these changes, employers should work with their private insurance partners to ensure continued coverage of telehealth for their employees.
Virtual chronic care solutions are also gaining traction. Take people with type 2 diabetes, who now comprise about 10% of all Americans and whose care costs more than $325 million per year. Technologies like a Bluetooth-enabled continuous glucose monitor (CGM) obviate the need for daily finger pricks and glucometer checks for monitoring blood sugars. (Verily, the company I work for, is developing a next-generation CGM with Dexcom.) This technology, when paired with a smartphone app that records meals (a quick photo of the food is sufficient), exercise, and medications, can help individuals understand the impact of their actions on their health. Onduo, a digital health company managed by Verily, combines this technology with telehealth and chat features to connect employees to health coaches and physicians. It offers a virtual diabetes clinic on demand.
Amid a burgeoning marketplace of digital health offerings and innovations, employers should shop and negotiate for health care solutions with the same rigor they shop for their business needs. They should challenge vendors to demonstrate the cost-effectiveness of their programs to produce better health and improve productivity, presenteeism, and quality of life for their employees. They should even consider demanding money-back guarantees like some health systems now provide.
3. Partner with hospitals and physicians.
As health systems struggle with their own financial crises, this is a good time for employers to partner more closely with hospitals and doctors. If the CEOs of businesses have much to learn about health care, perhaps health care has much to learn from these CEOs. Whether it’s lessons in improving operations from a manufacturing plant or ways to deliver better customer service from a retail perspective, employers can offer their own industry-specific expertise to help hospitals and medical facilities practice safer, more efficient, patient-friendly, and cost-effective care. For example, Intel shared its expertise in supply chain and “lean” management to improve clinical care in metropolitan Portland, Oregon. Most hospitals and health systems have a community advisory or governance board. By serving on these committees, employers can begin to understand — and perhaps even improve — the care their employees and their families receive.
Employers’ actions must be decisive precisely because the future is so uncertain. By partnering with the health systems that provide care for their employees, establishing clear expectations for high quality and low-cost care, and leveraging telehealth and virtual care solutions to achieve these goals, businesses can help their employees better weather the ups and downs of Covid-19. In doing so, employers can build a more robust and affordable model for the good of their businesses, the economy, and the health of millions of Americans.
SOURCE: Lee, V. (15 June 2020) "U.S. Health Care Is in Flux. Here’s What Employers Should Do." (Web Blog Post). Retrieved from https://hbr.org/2020/06/u-s-health-care-is-in-flux-heres-what-employers-should-do
Meal program provides healthy lunches to remote workers
The coronavirus pandemic has placed many disruptions in the day-to-day lives of employees, which has caused both mental and physical challenges. Research has shown that more people are now snacking or eating more now, due to the quarantine brought upon many. Read this blog post to learn more.
Disruptions from the coronavirus have infiltrated the daily lives of employees, causing challenges to both our mental and physical well-being. Focusing on proper nutrition is on the back burner for many.
Twenty-seven percent of people reported snacking more during coronavirus, and 15% said they are eating more often than usual, according to a study by the International Food Information Council. Forty-two percent have been relying more on pre-packaged foods than in the previous month, despite believing they are a less healthy option.
“The quality of fuel we put in our body ultimately controls the output,” says Michael Wystrach, CEO of Freshly, a meal subscription service. “So how well our brain functions, how our emotions and hormones are released, how productive we are, it really does start with diet.”
The coronavirus has exacerbated the challenge of accessing healthy food for many across the United States. While there has been a skyrocketing demand for groceries and grocery delivery services during the pandemic, 37 million Americans are considered “food insecure,” meaning they lack access to affordable and nutritious food options.
To address those concerns, Freshly created a new meal service called Freshly for Business to provide healthy and affordable meals for employees working remotely. The program allows employers to offer free or subsidized meal plans consisting of up to 12 meals per week. Employers including PwC and KPMG, among others, are partnering with Freshly, which costs an average of $8 per meal per employee.
“We used our platform to solve the needs of customers who are saying, we have a lot of employees working at home who are working hard but are strained and have a lot of challenges on their plates,” Wystrach says. “Employers wanted to provide them a benefit of healthy food by signing up a few dozen to thousands of employees very quickly.”
Lack of proper nutrition can have devastating and expensive consequences: In the U.S., 40% of adults are obese, and 90% of overweight individuals have prediabetes or Type 2 diabetes, a condition often caused by poor diet. According to the American Diabetes Association, the cost of medical expenditures and lost productivity due to diagnosed diabetes was $327.2 billion in 2017, the most recent data available.
“Type 2 diabetes is the fastest growing disease in America, and it’s principally caused by poor diet. It takes a huge toll on employers and employees,” Wystrach says. “One of the challenges now is the traditional lunch hour is gone and convenience is the pinnacle. But we make poor decisions when we rely on convenience with our food.”
Providing food in the workplace is a much desired benefit, with 73% of employees saying they want healthy cafeteria and snack options at work, according to a survey by Quantum Workplace and Limeade. However, just 32% provided free snacks and food, and only 17% had an onsite cafeteria available for workers, according to the Society for Human Resource Management.
As employers begin considering their return-to-work strategies and how they will make their offices safe and their benefits supportive of the health and well-being of their employees, providing meal options should be a major consideration, Wystrach says.
“Especially as we think about social distancing, the less you’re sending your employees out, the safer everyone is,” he says. “Employers will also be thinking about healthcare costs post-COVID. How do they keep overall healthcare costs down? It’s really in everyone’s benefit to provide benefits that promote health and wellness.”
Meal offerings and proper nutrition are a win-win for employers and their workers, Wystrach says.
“Health and happiness ultimately creates a more productive employee,” he says. “When you’re trying to find a win-win for everyone, it drives productivity, it creates happy employees, and it reduces cost over time. There will continue to be a focus on benefits that provide that.”
SOURCE: Place, A. (12 May 2020) "Meal program provides healthy lunches to remote workers" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/news/meal-program-provides-healthy-lunches-to-remote-workers
What employers need to know to combat coronavirus
As the coronavirus is a trending topic of discussion, it is important for employers to keep their employees safe regarding any illness. Having set protocols and preventative guidelines set in place could keep symptoms from spreading. Continue reading this blog post to learn more about the importance of protocols around this flu season.
The coronavirus is continuing to spread rapidly, spurring employers such as Starbucks and PwC to implement workplace practices that protect their employees and offset growing fear and anxiety over the outbreak.
Since December, over 28,000 cases of coronavirus have been reported, and 565 people have died in China, which is at the epicenter of the outbreak. The disease has currently spread to 28 countries. In the U.S., there have been 293 cases reported and 11 people have tested positive for the virus in five states, according to the Centers for Disease Control and Prevention.
“There is a tension we’re seeing between being cautious and panicky,” says Joseph Deng, an employment law partner at Baker McKenzie law firm. “Companies want to communicate in a way that reassures the employee population while taking reasonable measures to protect employees.”
Employers like Facebook, Starbucks and WeWork, among others, have enacted a variety of preventative measures to handle the spread of the outbreak, including closing office locations in China and asking employees to self-quarantine in their homes for up to three weeks. Companies including accounting giant PwC and LG have placed mandatory travel bans to and from China.
“We are confident that the disease can be contained if everyone — including corporations doing business in China — is prudent and makes the safety of their employees their number one priority,” LG said in a statement.
Because of the changing nature of the pandemic and the speed in which it’s spreading, employers need to have essential protocols in place to protect employees and avoid misinformation. Often, employers feel unprepared but typically already have a blueprint for other disasters, Deng says.
“If you don’t have a pandemic policy, you as an employer will very likely have analogous policies that can be used in this situation,” Deng says. “When planning for this scenario, you need to ask what are the objective facts and what are your options.”
A critical first step to carrying out proper protocol is establishing a senior-level point person who can gather information, communicate across teams and report to upper management to implement the plan if necessary.
“You have to have someone who has the right touch and that can be subjective,” Deng says. “Find a person now who is the most knowledgeable and has the time and resources to gather information, assemble a cross functional team, and has access to a decision-making authority.”
Additionally, workplaces should focus on basic disease prevention measures, like promoting proper hygiene and encouraging workers to stay home if they’re not feeling well.
“If you feel you have symptoms, make prudent decisions. Do not travel or go into the workplace where you could spread the illness,” says Kathleen O’Driscoll, vice president of the Business Group on Health.
Taking these smaller, preventative measures early on will prepare both the employer and the employee in the event more extreme measures need to be taken. A more measured approach will make employees feel confident and protected.
“Think about how you want to be seen by your employees when this is over. You don’t want your employees to say, they didn’t tell me what to do or I had no support,” Deng says. “You’re not just preparing for an emergency. You’re working on how to come out with a better, stronger and more resilient workforce.”
SOURCE: Place, A. (06 February 2020) "What employers need to know to combat coronavirus" (Web Blog Post). Retrieved from https://www.benefitnews.com/news/what-employers-need-to-know-to-combat-coronavirus
Reminder: Medicare Part D Notices Are Due to CMS by Feb. 29
The federal Centers for Medicare & Medicaid Services (CMS) require disclosures regarding coverage that is either "creditable" or "non-creditable" each calendar year. The notice and disclosure deadline for those who provide prescription drug coverage is due February 29, 2020. Read this blog post to learn more about the Medicare Part D notice.
Each year, group health plan sponsors that provide prescription drug coverage to individuals eligible for Medicare Part D must disclose to the federal Centers for Medicare & Medicaid Services (CMS) whether that coverage is "creditable" or "non-creditable." Prescription drug coverage is "creditable" when it is at least actuarially equivalent to Medicare Part D prescription drug coverage.
The disclosure obligation applies to all plan sponsors that provide prescription drug coverage, even those that offer prescription drug coverage only to active employees and not to retirees. Calendar year plans must submit this year's disclosure by Feb. 29, 2020.
Background
Individuals who fail to enroll in Medicare Part D prescription drug coverage when first eligible may be subject to late enrollment penalties if they go 63 consecutive days or longer without creditable prescription drug coverage. Because of this potential penalty, both Medicare Part D-eligible individuals and the CMS need to know whether a group health plan's prescription drug coverage is creditable or non-creditable.
Plan sponsors that provide prescription drug coverage must furnish Part D-eligible individuals with a notice disclosing the creditable or non-creditable status of their coverage before the beginning of the Medicare Part D annual enrollment period and at certain other times.
Plan sponsors must also disclose to CMS, on an annual basis and at certain other times, whether the coverage they provide is creditable or non-creditable. The submission deadline for this year's disclosure to CMS by calendar year plans is approaching.
Creditable Coverage Disclosures to CMS
Plan sponsors generally must disclose creditable coverage status to CMS within 60 days after the beginning of each plan year. Disclosure is made using the Disclosure to CMS Form on the CMS website. An entity that does not offer outpatient prescription drug benefits to any Part D-eligible individual on the first day of its plan year is not required to complete the CMS disclosure form for that plan year. Plan sponsors that contract directly with Medicare as a Part D plan or that contract with a Part D plan to provide qualified prescription drug coverage are also exempt from the CMS disclosure requirement for individuals who participate in the Part D plan.
In addition to the annual disclosure, plan sponsors must submit a new disclosure form to CMS within 30 days following any change in the creditable coverage status of a prescription drug plan. This includes both a change in the coverage offered so that it is no longer creditable (or non-creditable) and the termination of a creditable coverage option. A new disclosure form must also be submitted to CMS within 30 days after the termination of a prescription drug plan.
The disclosure requirement applies to all plan sponsors that provide prescription drug coverage to Part D-eligible individuals, even those that do not make prescription drug coverage available to retirees.
Calendar year plans must submit this year's disclosure to CMS by Feb. 29, 2020.
| Is disclosure required If an employer doesn't offer retiree coverage? | ||
| All Part D-eligible individuals covered under an employer's prescription drug plan — regardless of whether the coverage is primary or secondary to Medicare Part D — should be included in the disclosure. "Part D-eligible individuals" are generally age 65 and older or under age 65 and disabled, and include active employees and their dependents, COBRA participants and their dependents, and retirees and their dependents. Even employers without retiree coverage may need to file the disclosure. |
Information Needed to Complete Disclosure
In preparing the disclosure to CMS, plan sponsors need to:
- Identify the number of prescription drug options offered to Medicare-eligible individuals. This is the total number of benefit options offered, excluding any benefit options the plan sponsor is claiming under the retiree drug subsidy (RDS) program (i.e., benefit options for which the plan sponsor is expected to collect the subsidy) or that are employer group waiver plans (EGWPs).
For example, a plan sponsor with a PPO and an indemnity option covering actives and an option for retirees for which it is receiving RDS would report two prescription drug options. - Determine the number of benefit options offered that are creditable coverage and the number that are non‑creditable.
- Estimate the total number of Part D-eligible individuals expected to have coverage under the plan at the start of the plan year (or, if both creditable and non-creditable coverage options are offered, estimate the total number of Part D-eligible individuals expected to enroll in each coverage category). This includes Part D-eligible active employees, retirees, and disabled individuals and any of their Part D-eligible dependents and any individuals on COBRA who are Part D eligible.
The estimate should not include any Part D-eligible retirees being claimed under the RDS program or retirees in an EGWP (because that coverage is Medicare Part D coverage).
Individuals who will become Part D eligible after the start of the plan year should not be included in the count for that year. However, they must be provided a notice of creditable or non-creditable coverage prior to their initial Part D enrollment period. - Provide the most recent calendar date on which the required notices of creditable or non-creditable coverage were provided.
| Why doesn't the disclosure requirement apply to EGWPs or retiree plans where employer is receiving RDS payments? | ||
| Employers that provide prescription drug coverage through a Medicare Part D employer group waiver plan are exempt from the disclosure requirement because an EGWP is Medicare Part D coverage.
An employer participating in the retiree drug subsidy program must have already certified to CMS that its drug coverage is creditable. |
In Closing
Plan sponsors should review the instructions carefully before completing the Disclosure to CMS Form to make sure that they have all necessary information, and calendar year plans should report the information by Feb. 29, 2020.
Richard Stover, FSA, MAAA, is a principal at HR advisory firm Buck. Leslye Laderman, JD, LLM, is a principal in the Knowledge Resource Center at Buck. This article originally appeared in the Feb. 5, 2020 issue of Buck's For Your Information. © 2020 Buck Global LLC. All rights reserved. Republished with permission.
SOURCE: Stover, R.; Laderman, L. (06 February 2020) "Reminder: Medicare Part D Notices Are Due to CMS by Feb. 29" (Web Blog Post). Retrieved from https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/reminder-medicare-part-d-notices-due-to-cms.aspx
Quality trumps convenience among employees
Convenience, or quality? Take a look into why researchers are saying quality of a doctors visit outshines convenience when scheduling the next appointment.
Faced with the choice between going to a conveniently located doctor’s office or a more qualified physician, group health plan members are four times more likely to embrace the better-perceived medical professional.
“Traditional metrics like patient ratings, prescribing rates and volume of patients seen were not nearly as compelling to respondents as more qualitative, contextualized statements about a doctor’s clinical expertise,” according to Nate Freese, senior director of data strategy at Grand Rounds, a healthcare service provider for employees in need of local and remote specialty care.
The data is based on a study of 1,100 members covered by Grand Rounds, which is headquartered in San Francisco.
While surprising, Freese says that result depends on the information and messaging that’s provided to employees. Just 14% of respondents based their choice on clinical expertise if they saw traditional physician profiles, whereas it was 69% if they saw contextualized profiles. Contextualized profiles offered more information in complete sentences compared to traditional profiles. These profiles also compared data against other doctors and specialists, such as appointment wait times, expertise and patient satisfaction.
Freese is encouraged by these findings, which were recently presented at the National Healthcare Ratings Summit. “Don’t sell employees short in terms of their ability to appreciate quality and willingness to sacrifice convenience,” he says.
Offering more subjective interpretation of hard quality metrics would be helpful, Freese explains, as long as employers and their advisers are careful not to “overstep what can be reasonably inferred based on available data.”
Another caveat to consider is that finding high quality providers may not be inherently more difficult in narrow networks. Rather, he says, the issue is when health plan members “lack the ability to identify them. And so, it’s more about presenting information in the right way.”
Providing compelling quality information can achieve the same results of a narrow network, he notes. But he hastens to add that even narrow networks must be sufficiently broad enough for members to have a reasonable amount of choice. Geography also plays a role. “You could be in the broadest network, but by virtue of where you live, have reduced choice,” he says.
Michael Hough, executive vice president and U.S. founder of Advance Medical, believes the quality metrics that are currently available are insufficient for several reasons. “We’re looking at things like frequency and whether the outcomes are horrible,” he says. “But just because the outcomes weren’t horrible doesn’t mean they were good, either.” Desired outcomes depend on what’s going on with patients and whether their objectives are being achieved.
The context of care is “extremely important,” Hough explains, noting the importance of relationships between the patient and a trained physician based on human interaction, as well as the delivery of services. Also, while he believes the rise of telemedicine and self-service “is good for many parts of our lives,” Hough cautions that it’s not necessarily true for healthcare because meaningful relationships trump convenience.
SOURCE:
Shutan, B (22 June 2018) "Quality trumps convenience among employees" [Web Blog Post]. Retrieved from https://www.employeebenefitadviser.com/news/quality-trumps-convenience-among-employees?tag=00000151-16d0-def7-a1db-97f0240f0000
How Are Health Centers Responding to the Funding Delay?
Unfortunately, the funding delay is impacting healthcare centers everywhere - and not in a great way. Get the information you need to know in this article.
Health centers play an important role in our health care system, providing comprehensive primary care services as well as dental, mental health, and addiction treatment services to over 25 million patients in medically underserved rural and urban areas throughout the country. Health care anchors in their communities and on the front lines of health care crises, including the opioid epidemic and the current flu outbreak, health centers rely on federal grant funds to support the care they provide, particularly to patients who lack insurance coverage. However, the Community Health Center Fund (CHCF), a key source of funding for community health centers, expired on September 30, 2017, and has since been extended through only March 31, 2018. The CHCF provides 70% of grant funding to health centers. With these funds at risk, health centers have taken or are considering taking a number of actions that will affect their capacity to provide care to their patients. This fact sheet presents preliminary findings on how health centers are responding to the funding uncertainty.
WHAT FUNDING IS AT STAKE FOR HEALTH CENTERS
The Community Health Center Fund represents 70% of federal grant funding for health centers. Established by the Affordable Care Act, the CHCF increased federal grant fund support for health centers, growing from $1 billion in 2011 to $3.6 billion in 2017.1Authorized for five years beginning in 2010, and extended for two years through September 2017, the CHCF also provided a more stable source of grant funding for health centers that was separate from the annual appropriations process. Prior to the CHCF, federal 330 grant funds were appropriated annually. In fiscal year 2017, federal section 330 grant funding totaled $5.1 billion, $3.6 billion from the CHCF and $1.5 billion from the annual appropriation.
Federal health center grants represent nearly one-fifth of health center revenues. Federal Section 330 grant funds are the second largest source of revenues for health centers behind revenues from Medicaid. Overall, 19% of health center revenues (including US territories) come from federal grants; however, reliance on 330 grant funds varies across health centers. Federal grant funds are especially important for health centers in southern and rural non-expansion states where Medicaid accounts for a smaller share of revenue (Figure 1).2 These funds finance care for uninsured patients and support vital services, such as transportation and case management, that are not typically covered by insurance
Figure 1: Federal Section 330 Grants as a Share of Total Health Center Revenues, 2016
HOW ARE HEALTH CENTERS RESPONDING TO THE LOSS OF FEDERAL FUNDS?
Health centers have taken or are considering taking a number of actions that will affect their ability to serve their patients. Overall, seven in ten responding health centers indicated they had taken or planned to take action to put off large expenditures or curtail expenses in face of reduced revenue. Some of these actions involve delaying or canceling capital projects and other investments or tapping into reserve funds. Other actions, however, have or will reduce the number of staff or the hours they work, which may in turn, affect the availability of services. Already 20% of health centers reported instituting a hiring freeze and 4% have laid off staff. Another 45% are considering a hiring freeze and 53% said they might lay off staff. While health centers seemed to focus on shorter-term actions that could easily be reversed were funding to be restored, 3% of responding health centers had already taken steps to close one or more sites and an additional 36% indicated they are considering doing so (Figure 2).
Figure 2: Actions Taken or Considered by Health Centers in Response to Funding Uncertainty
Health centers are considering cuts to patient services. While most health centers have not yet taken steps to cut or reduce patient care services, many reported they are weighing such actions if funding is not restored (Figure 3). Over four in ten indicated they might eliminate or reduce some enabling services, such as case management, translation, or transportation services. Additionally, over a third of reporting health centers indicated they might have to reduce the dental, medical, and/or mental health services they provide while 29% said cuts to addiction treatment services are being contemplated. Fewer health centers reported that cuts to pharmacy services might be made.
Figure 3: Services Health Centers Are Considering Eliminating or Reducing in Response to Funding Uncertainty
WHAT ARE THE IMPLICATIONS OF THE FUNDING DELAY?
Continued delays in restoring funding will likely lead to cuts in health center services and staff. To date, health centers have tried to mitigate the effects of the funding delay by forgoing major investments or dipping into reserve funds. However, the longer the funding delay continues, the greater the likelihood health centers will be compelled to cut services and staff, actions they are currently considering but have not yet adopted in large numbers. These cuts could reverse gains health centers have made in recent years in increasing patient care capacity and expanding the range of services they provide, particularly in the areas of mental health and addiction treatment. Health centers play a particularly important role in rural and medically underserved areas. The failure to reauthorize the CHCF and restore health center funding could jeopardize access to care for millions of vulnerable patients.
SOURCE: Kaiser Family Foundation (1 February 2018). "How Are Health Centers Responding to the Funding Delay?" [Web Blog Post]. Retrieved from address https://www.kff.org/medicaid/fact-sheet/how-are-health-centers-responding-to-the-funding-delay/
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