What Americans think about health insurance & hiring practices
Originally posted July 25, 2014 by Lynette Gil on https://www.lifehealthpro.com
In a recent survey from Gallup, the majority (58 percent) of Americans said that they would justify charging higher health insurance rates to smokers. And about 39 percent said that they would justify raising health insurance rates to those significantly overweight.
Both percentages have gone down slightly since 2003, when Gallup asked these questions for the first time: from 65 percent for smokers having to pay higher rates and 43 percent for those significantly overweight.
The results are part of Gallup's July 7-10 2014 Consumption Habits survey, in which telephone interviews were conducted with a random sample of 1,013 adults, aged 18 and older, living in all 50 U.S. states and D.C.
The survey also asked participants if companies should be allowed to refuse to hire smokers or those significantly overweight. Most Americans agreed that there should not be discrimination against both. Only 12 percent said that companies should be allowed to refuse to hire people because they are significantly overweight (down from 16 percent in 2003); 14 percent said the same about smokers (up one percentage point from 13% in 2003).
Even though most Americans oppose “hiring policies that would allow companies to refuse to hire smokers or those who are significantly overweight,” it is unclear if those views are because they do not think smoking and obesity negatively affect workplace performance or they “simply reject discrimination of any kind in hiring,” the report says.
According to the report, smoking and being overweight are associated with higher health care costs, and even the Patient Protection and Affordable Care Act (PPACA) allows for higher insurance premiums for smokers. Some would argue that allowing companies to refuse to hire smokers and people who are overweight, or charging them higher health insurance rates, might help encourage healthier lifestyles.
Subsidies May Be Too High Or Low For Some Who Got Coverage
Originally posted May 19, 2014 on www.kaiserhealthnews.org.
More than a million Americans listed incomes on their health insurance applications that differ significantly from those on file with the Internal Revenue Service and therefore may be getting subsidies that are too high or low, The Washington Post says. Other media outlets report that states can decide whether to carry out a key part of the health law's small business exchanges for 2015 and that civil fines of up to $250,000 may be imposed on those who knowingly provide false information to get a subsidy.
The Washington Post: Federal Health-Care Subsidies May Be Too High Or Too Low For More Than 1 Million Americans
The government may be paying incorrect subsidies to more than 1 million Americans for their health plans in the new federal insurance marketplace and has been unable so far to fix the errors, according to internal documents and three people familiar with the situation. The problem means that potentially hundreds of thousands of people are receiving bigger subsidies than they deserve. They are part of a large group of Americans who listed incomes on their insurance applications that differ significantly — either too low or too high — from those on file with the Internal Revenue Service, documents show (Goldstein and Somashekhar, 5/16).
The Wall Street Journal: States To Decide On Key Part Of Small-Business Health Exchanges
The Obama administration said Friday it would let states decide whether to implement a key part of the health law's small-business exchanges next year, extending an earlier delay. The Department of Health and Human Services said in rules released Friday that it would be up to state insurance commissioners to decide whether employees at small businesses using the health-insurance exchanges could choose from a range of plans or be limited to just one selected by their employer (Radnofsky, 5/16).
The Associated Press: $250K Fine For Lying On Health Insurance Forms
Lying to the federal health insurance man could cost you dearly. The Obama administration Friday spelled out civil fines of up to $250,000 for knowingly and willfully providing false information to get taxpayer-subsidized coverage under the new health care law (5/16).
The Hill: HHS Opens Door To Extra Funds For Insurers
Health insurance companies can count on funds from the government if ObamaCare's risk corridor program does not sufficiently cover losses that are higher than expected this year. This news was published in regulations Friday outlining how the law's health insurance exchanges will operate in 2015 (Viebeck, 5/16).
The Fiscal Times: Senators on Botched Obamacare Websites: You Break It, You Bought It
Republican senators are demanding answers from the Obama administration on the handful of failed state exchange websites that have cost taxpayers literally billions of dollars. Some even say that the states should reimburse the government for the cost of these exchange failures. So far, at least four largely inoperable state websites – in Massachusetts, Maryland, Nevada and Oregon – have cost the federal government $4 billion. That number is expected to rise as the states spend more money to replace or rebuild the bad sites (Ehley, 5/16).
Most newly insured Americans covered by employers, study finds
Originally posted April 8, 2014 on www.modernhealthcare.com by Virgil Dickson.
More than 9 million Americans obtained health insurance between September and mid-March, but most did so through employer-sponsored plans rather than through HealthCare.gov or the state exchanges, a survey by the RAND American Life Panel found.
Only 1.4 million of the 3.9 million individuals who enrolled in Patient Protection and Affordable Care Act-related exchange plans through mid-March were previously uninsured, researchers found. The survey concluded before the final enrollment surge that pushed overall marketplace enrollment past 7 million, RAND noted.
Of the 40.7 million estimated uninsured Americans in 2013, 14.5 million gained coverage, but 5.2 million of the insured lost coverage, for a net coverage gain of approximately 9.3 million. That means the share of the population that was uninsured fell from 20.5% to 15.8%, according to RAND.
Less than 1 million citizens who previously had individual market coverage became uninsured, researchers found. RAND was unable to deduce if those people lost their insurance due to cancellation, or because coverage costs were too high. People in this category represented less than 1% of those between the ages of 18 and 64.
Overall, the ACA did not change health coverage choices for most insured Americans, as 80% of those surveyed still had the same type of coverage in March 2014 as in September 2013, according to RAND.
The RAND figures comprised not only signups under the new ACA-established marketplaces, but also new enrollments in employer coverage and Medicaid. Results were extrapolated from a survey of 2,425 adults between the ages of 18 and 64, who responded to the RAND survey in both March 2014 and September 2013.
Fewer Americans getting health insurance through employers
Originally posted February 13, 2014 by Melissa Winn on https://ebn.benefitnews.com
Fewer people are getting their primary health insurance coverage through their employers, according to a Gallup Poll released Wednesday, which also reported the number of uninsured Americans has reached a five-year low.
The poll found 43.5% of Americans now get their primary health insurance coverage through their current or former employer, down from 45.5% in the fourth quarter of 2013. More people now say they have a plan fully paid for by themselves or a family member — 18% versus 17.2% at the end of last year.
The poll also found the percentage of uninsured Americans fell to 16%, down from 17.1% in the fourth quarter of 2013. While more than a month remains in the first quarter of 2014, Wednesday’s data show the uninsured rate appears to be on track to drop to the lowest quarterly level since 2008.
Although the Affordable Care Act’s requirement to have health insurance went into effect Jan. 1, it’s still too early to tell if that requirement has led to the decline in uninsured Americans, the poll says. If the uninsured rate continues to fall over the next few months, however, it could suggest the Affordable Care Act is responsible for the decline, it adds.
Several provisions of the ACA have yet to go into effect, including the mandate for employer health insurance coverage by 2015 or 2016. These provisions are expected to affect the number of uninsured Americans, as well as what types of insurance they have.
The Gallup poll also found the percentage of Americans insured through Medicaid has increased to 7.4% from 6.6% in the fourth quarter of 2013. This increase may be because some states have chosen to participate in the Medicaid expansion under a provision of the ACA, the poll adds.
In 2020, Workers Will Decide Health Benefits
Originally posted by Bill Toland February 09, 2014 on https://insurancenewsnet.com
By the end of the decade, the majority of American workers will be selecting their health benefits from an online menu of plans and paying for those benefits with a stipend from their employer, according to experts in the field.
If and when that day comes, it would mark a major shift for the nation's health care apparatus and a reversal of the method by which health insurance has been furnished to American workers for decades -- through a defined-benefits plan selected by an employer.
In 2020, private health "exchanges" will be the predominant way that health care benefits are delivered in this country, said Eric Grossman, a senior partner at Mercer and the exchange business leader in his company's benefits division.Mercer, based in New York with an office in Pittsburgh, is a global human resources, benefits and financial services consultant.
Mr. Grossman, like many other experts in the field, likens the transition in health insurance to the ongoing transition in retirement planning -- where once the "defined-benefit" pension was commonplace, now many companies offer "defined contributions" which employees can steer to a 401(k) or an investment mix of their choice.
That transition took two decades, but now, for anyone under the age of 35, employer-subsidized retirement -- where it still exists, that is -- generally means a defined contribution.
"Our prediction in health care is that a similar transition will happen, [but] it will happen more quickly," Mr. Grossman said.
Private health insurance exchanges -- some of which already exist -- work like this: Instead of an employer negotiating a standard benefits plan or two for its employees, companies instead make a defined cash contribution to employee accounts. Employees then use the cash to select from a menu of a half-dozen or so health plans, with varying price levels of coverage.
Exchanges are set up and managed by health insurers (such as Highmark), benefits consultants (such as Mercer), traditional benefits brokers and online brokers. Plans included in exchanges can be a mix of plans from regional and national insurers, depending on who is the sponsor. A Highmark exchange would offer only its own plans, for example, while a Mercer exchange would offer plans from several companies.
Businesses have dozens of plans to choose from within the exchange "universe" -- health as well as dental, vision and others -- but that list is whittled down to a handful before the plans are finally offered to employee groups.
These are called private, or closed, exchanges because the policies are available only to company employees -- not to the population at large, as is the case with the national and state-based marketplaces that came online Oct. 1 as part of the Affordable Care Act.
Right now, said Bill Brown, Highmark's manager of digital distribution, national marketplace penetration for private exchanges is about 3 percent and adoption rate among Highmark's client base is about the same. Large companies with more than 250 employees have been particularly cautious.
Highmark began offering large employers access to its "MyBenefits" exchanges Jan. 1.
"There's a lot of interest," Mr. Brown said. "But they're not ready to jump."
That's partly because, despite the 401(k) analogy, there's not much immediate cost savings in a health exchange, particularly for large groups. When big employers moved away from pensions and toward defined contributions, the point was to reduce immediate retirement costs and unload a major financial liability going forward. Today, less than 30 percent of Fortune 100 companies offer a defined-benefit retirement plan to new salaried employees.
But with health exchanges, big, self-insured employers that now pay all of their own medical claims will continue to do so. The impetus to move to an exchange, at least among larger employers, won't come from claims savings but rather the opportunity to offer a wider array of health plans to employees and to offload some of the benefits administration now handled by human resources departments.
The real savings will come for fully-insured small-and-mid-sized groups, Mr. Brown said.
They'll be able to offer far more variety to employees, and the entire process will happen online. "It really streamlines administration," he said.
If they "move onto [the] exchange, they get five medical options, four dental, four vision" plans, he said. Employees can choose the plan that is best for them and their family.
While the pension analogy is the one most commonly used to describe the shift, Mr. Brown said a comparison to the world of retail shopping might be more appropriate. Where once customers went to a store and were able to select from whatever the store had in stock, now they can go to Amazon.comand buy anything.
A decade or so ago, people might have been skeptical of the online shopping process, but not anymore -- at least, not in retail.
Mr. Brown believes that will be proven true in health insurance: 14 years ago, Highmark test-launched an online ("paperless," the press release described it) defined-contribution platform called BlueChoice. "It kind of fizzled out. Nobody was ready at that time."
But they soon will be. Part of it is just the ubiquity of the Internet. Part of it is getting used to health care as a retail market. And part of it, said Mr. Grossman of Mercer, is getting people to separate work from health insurance. If people don't buy auto or mortgage insurance through their employers, why do they get health insurance that way?
"The mindset for decades was, for most people, 'My employer provides it,' " Mr. Grossman said, and employers have done so, and continue to do so, for competitive reasons. Employer-sponsored health insurance became the norm in the U.S. following World War II, driven by recruiting needs and labor unions.
That era is ending, and Mercer is of the opinion that the "employee is in the best position to decide the best plan," Mr. Grossman said.
Mr. Brown predicted that in the next 18 months, up to 40 percent of small employers will be offering benefits through some kind of exchange and up to a quarter of midsized companies will do the same.
"The one thing I'm waiting for is someone really big to make a move [to exchanges] -- Walmart, McDonald's," Mr. Brown said. "That's the tipping point. And the entire market is going to start to switch."
Most workers happy with their benefits, salaries
Originally posted December 20, 2013 by Amanda McGrory-Dixon on https://ebn.benefitnews.com
When it comes to their health benefits, most employees say they’re happy with their current offerings and lack interest in altering their balance of benefits and wages, according to a new survey by the Employee Benefit Research Institute.
Specifically, 12% of respondents say they are extremely satisfied with their plans, 39% of respondents say they are very satisfied, and 37% of respondents say they are somewhat satisfied. Just 10% responded in a negative fashion. Since the survey was first initiated, the number of respondents who report feeling happy with their benefits has generally been high.
“By far, health insurance, in particular, continues to be the most important employee benefit to workers,” says Paul Fronstin, director of EBRI’s Health Research and Education Program and author of the survey.
The survey also finds that there is uncertainty whether employers will still offer health insurance for employees in the future because of the Affordable Care Act; however, benefits are a key factor in choosing a job.
“While there may be a lot of questions about the future of the American health insurance system, the majority of those who have health coverage like the plan they have,” says Ruth Helman of Greenwald and Associates, co-author of the report.
If changes to tax preferences for employment-based health coverage were implemented, making benefits taxable, 39% of respondents report that they would keep their current amount of coverage. This is nearly at the same level of 40% in 2012, though up from 31% in 2011.
According to the survey, most respondents agree they would like more choices in health plans; however they are not sure that they could choose health insurance, much less the best plan, using an objective rating system, which is included in the exchange system.
Instead, 35% of respondents say they prefer to keep receiving health insurance from their current plans while 45% of respondents report that they would rather choose their insurance and have their employers pay what they are paying now for that coverage. Another 21% say they would prefer their employers give them money to spend on health insurance as they please.
Health insurance methods to shift in post-PPACA world
By Brian M. Kalish
Source: eba.benefitnews.com
With health reform moving full steam ahead, most employers will continue to offer employee coverage, but will make alterations to how they provide it, said a speaker at the Workplace Benefits Transitions conference Tuesday.
An overwhelming majority of employers plan to stay in the health care business, said Cheryl Larson, vice president of the Midwest Business Group on Health, whose members represent senior HR benefits professionals who annually spend more than $4 billion on health care. Her group’s research shows that only 4% of members plan to drop health coverage. They will stay in the game for three main reasons, she said, as they:
- Don’t want to deal with the penalty for not offering coverage;
- Don’t want to “gross up” employer salaries to allow them to buy coverage on their own; and
- Need to stay competitive.
Speaking in the opening keynote at the conference co-sponsored by Employee Benefit Adviser in Chicago, Larson noted, however, that there will be some key differences come 2014, including an exit strategy of dropping coverage for retirees (53%) and part-time employees (33%), according to a National Business Group on Health survey.
In practice, it will be interesting to see what employers actually do, Larson said. While they say publically they are not walking away from providing health care, privately “in the boardroom they will say, ‘If so and so goes, so will we.’ That’s scary,” she said.
Larson also predicted an increased focus on consumerism and wellness. “Ten years ago, that was not important to employers,” she said. “I’ve been a real passionate person about engaging employees and their families with knowledge and information. We’ve forgotten about teaching people how to deal with navigating the health care system.”
An MBGH survey further found that employers of all sizes plan to offer consumer-directed health plans, such as an HSA/HRA option. Of those surveyed, among small group employers – 200 or fewer employees – 50% plan to offer a form of CDHP, for large groups – more than 5,000 — that increases to 100%. Further, employers of all sizes will be shifting their dental and vision coverage to a voluntary offering by 2017-2018. Specifically, 59% of small and 49% of large employers plan to do so.
Employer-Provided Health Insurance and the Market
By Casey B. Mulligan
Source: https://economix.blogs.nytimes.com/
The future of employer-provided health insurance is better considered together with the future of total employee compensation, both cash and fringe benefits like health insurance. From that perspective, the likelihood that most employers will continue to offer health insurance is not necessarily good news for employees.
The Patient Protection and Affordable Care Act, President Obama’s initiative, offers large health-insurance subsidies to the majority of the population beginning in 2014, but only if their employer does not offer affordable insurance. The subsidies are frequently much larger than the subsidies coming through the tax exclusion of employer-provided health insurance.
Some economists are predicting that eligible employees, especially those in line for the largest subsidies, will prefer employers who do not offer affordable insurance. As a result, they say, many more employers will not offer insurance.
Others have different expectations, pointing out that employers dropping insurance will pay penalties and throw away the tax exclusion for their employees who are not subsidy-eligible (typically the ones who earn more). Moreover, perhaps because people are comfortable with their existing coverage even if it is not subsidized, employer coverage did not decline in Massachusetts when it began a similar plan (by my estimate, only 5 percent of the people in Massachusetts who could get subsidized individual-market insurance actually receive it, largely because they have coverage through the employer of the head of the household or that person’s spouse). Note that Massachusetts has lower subsidies and a narrower eligible population than the Affordable Care Act and lower employer penalties for dropping coverage.
How many employers will drop their coverage when the new health care law gets under way? The answer makes for a nice headline, but that’s the wrong question. Would it be so bad if many employers dropped their coverage but replaced it with huge cash raises? Or would it be so good if every employer continued to offer coverage but required employees to take big pay cuts?
All sides agree that some otherwise subsidy-eligible employees will work for employers that keep their coverage, and other subsidy-eligible employees will work for employers that drop it. Market forces must be considered, because some employees will be moving between these two types of employers.
Low-income employees will ultimately cost less to employers without coverage (or without “affordable” coverage; the important issue is that their low-income employees are subsidy-eligible) than they cost to employers with coverage. If they didn’t, low-income employees would be better off at employers without coverage and would line up to work there. Meanwhile, the employers with coverage would find it more difficult to retain and attract low-income employees. That situation defies supply and demand.
Another way to see the same result: by getting low-income employees at lesser cost, employers without coverage can, without going out of business, compete aggressively for the high-income employees who are considering positions that offer coverage.
By the same logic, high-income employees will cost more to employers without coverage than they do to employers with coverage. Thus, high-income employees will lose one way or another — either they will lose their tax exclusion because their employer eliminates coverage or they will see their cash compensation fall below what it would have been without the Affordable Care Act.
At the same time, the low-income employees will enjoy the subsidy either way: either their employer drops coverage, in which case they receive the subsidy directly, or their employer increases their compensation above what it would be without the Affordable Care Act to attract them from the employers without coverage. Tax economists will recognize this as the Harberger model applied to the Affordable Care Act; international economists will recognize it as the Heckscher-Ohlin model.)
The same sorts of market competition will ultimately prevent most employers from dropping their coverage and thereby incurring the penalties. Employers keeping coverage will raise the pay of subsidy-eligible employees and get by with fewer of them. Those who remain will typically not want to leave for no-coverage employers because doing so would cut their pay. The same employers will hire a few more high-income employees at lesser pay, because for those employees, the alternative is a no-coverage employer.
Learn How Inflammation Can Lead to Chronic Diseases
By Dr. Ann Kulze, M.D.
Inflammation is now widely recognized as a primary driver for most all chronic diseases and it appears that losing even modest amounts of weight can effectively douse the damaging inferno of excess inflammation in the body. For this one year evaluation, 438 women were placed on a weight loss program through diet or diet and exercise. For women in the diet and exercise group, measures of C-reactive protein (a key marker for inflammation in the body) dropped 42%. In the diet only group, levels dropped by 36 percent. For both groups, losing just 5% of their initial body weight provided even larger reductions in C-reactive protein. Because higher levels of C-reactive protein have been linked to a litany of chronic diseases including heart disease, type 2 diabetes, and cancers of the breast, colon, lung and uterus, this study underscores the enormous benefits that can result from losing even small amounts of excess body fat.