Healthcare Reform

Contributor:
Dax Hill
Principal, Health & Welfare Consultant
Hill, Chesson & Woody

There is a book titled “Hope Is Not a Strategy.”  I believe this statement to be particularly true regarding the Healthcare Reform “Pay or Play” mandate.   This regulation will require great attention as employers determine their future path in offering employee benefits. 

As you are probably aware, the following penalties will apply to employers with 50 or more full time equivalent employees, effective 2014:

Contributor:
Laura Bibb, JD, GBA, Compliance Officer
Hill, Chesson & Woody

Today marks the start of the Supreme Court oral arguments over the constitutionality of healthcare reform.  Your local sports bar won’t be airing the arguments on their big screens, but you can check out the arguments on C-Span’s website at the conclusion of each day. Make sure you have plenty of wings, chips & salsa, and your beverage of choice on hand!
 
If you have a chance to watch even just a little bit of the arguments I highly encourage you to do so — being able to argue a case before the Supreme Court is a prestigious honor that few attorneys ever get to experience.  It is also rare to get the opportunity to actually observe a Supreme Court argument (although, as you can see below, there were several folks camped out to get the opportunity).

 
Here’s your play-by-play guide:

Monday (3/26) 10-11:30am – Anti-Injunction

Contributor:
Mike Beck, Health & Welfare Consultant
Hill, Chesson & Woody

Provisions of the Patient Protection and Affordable Care Act (PPACA) are causing shifts in the marketplace on all sides of the issue. Insurance carriers, employers, providers and consumers are each reacting to the government’s regulations that are designed to get everyone insured, control costs and improve health outcomes.

Three specific provisions of reform — medical loss ratio, the modified community rating and guaranteed issue of medical plans — will encourage organizations to consider a move away from fully insured funding to self insurance. Currently, only 13 percent of organizations with less than 100 employees fund their employee health plans in a self funded manner.

Because healthcare reform is reducing competition in the market place, an environment of rising healthcare costs is being fostered. Since reinsurance carriers are not bound by loss ratios or modified community ratings, employers with healthy employee demographics that shift from a fully insured medical plan to a self funded plan potentially will be able to improve their cost position and have more plan design flexibility.

Contributor:
Laura Bibb, JD, GBA, Compliance Officer
Hill, Chesson & Woody

It’s Time to Play... Kaiser Family Foundation Feud! The top 10 answers are on the board — Name Americans’ favorite provision of healthcare reform.

Many employers can quickly name provisions of healthcare reform that cause the most concern or frustration.  There are plenty of provisions that wouldn’t win a popularity contest.

But, can you name which provision of healthcare reform you like the most, if asked?

The Kaiser Family Foundation (KFF) recently asked that very question in a monthly tracking poll. Americans were asked which provisions of healthcare reform they liked and disliked.

Survey says! — The number one answer on the board is...

Contributor:
Laura Bibb, JD, GBA, Compliance Officer
Hill, Chesson & Woody

Yesterday, the Supreme Court announced it will hear arguments on the constitutionality of healthcare reform.  It is anticipated that arguments will occur in March 2012.  The timing is particularly interesting as it will allow the Court to make a decision in June 2012 (several months prior to the November 2012 election).

Of the court challenges across the country, the Supreme Court has decided to hear appeals from a ruling issued by the 11th Circuit in Atlanta finding the individual mandate unconstitutional.  While the 11th Circuit held that the individual mandate was outside Congressional authority to regulate commerce and to levy taxes, it found that the rest of the law could stand.

The justices will hear 5 ½ hours of arguments (instead of the usual one hour) from lawyers on the constitutionality of the individual mandate.

The Supreme Court will consider four issues:

Contributor:
Laura Bibb, JD, GBA, Compliance Officer
Hill, Chesson & Woody

HHS Secretary Kathleen Sebelius announced Friday October 14, 2011 that HHS will not be moving forward in implementing the CLASS Act at this time. Secretary Sebelius states “…despite our best analytical efforts, I do not see a viable path forward for CLASS implementation at this time.”

The Secretary’s report to Congress includes a reference to a memo released by the CMS Actuary on April 22, 2010 stating that “[o]ver the longer term, expenditures would exceed premium receipts, and there is a very serious risk that the program would become unsustainable as a result of adverse selection by participants.”

While this announcement doesn’t require any action on the part of employers, it may cause employers who were considering relying on the CLASS Act as their sole long-term care offering to reconsider group long-term care plans.

Contributor:
Chris Tutino, Communications Specialist
Hill, Chesson & Woody

As a writer and communicator, I revel in the challenge of boiling ideas down to one single point that clearly defines an issue at hand. I’ve been accused, in my personal life, of over-simplifying conversations that take over an hour to discuss, which I then summarize in a single statement. “So, what you’re really saying is….” Needless to say, I’m not always a favorite person during those times.

But, in the healthcare industry, there’s so much that is unclear and confusing that it’s very difficult to pinpoint exactly what should be said or how to say it. And, not in my wildest dreams would I want to be the Secretary of Health and Human Services when it comes to one of the most daunting tasks healthcare reform is posing — the defining of “essential” benefits in the impending 2014 state-run healthcare exchanges.

Contributor:
Chris Tutino, Communications Specialist
Hill, Chesson & Woody

In a recent survey on employee communications put out by Prudential, helping employees make better decisions and addressing the diverse benefits needs of a company’s employee population has moved to the bottom of the priority list.

According to the survey, one reason why there’s been a shift is because so much effort has been placed on what’s happening with reform and the resulting focus on cost containment and reduction. When it comes to helping employees make better benefits decisions, only 35 percent of plan sponsors said that it was highly important. This ranked 7th out of ten measures, with controlling healthcare-related costs coming in first with 70 percent of plan sponsors saying that was highly important.

Contributor:
Laura Bibb, JD, Compliance Officer
Hill, Chesson & Woody

 One year ago today, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law.  And so began the journey through year one of healthcare reform.  It has been quite a ride and we would like to say “CONGRATULATIONS” to all employers!

As Ferris Bueller said, “Life moves pretty fast.  If you don’t stop and look around once in a while, you could miss it.”

In honor of the first anniversary of PPACA, let’s stop and look around at what has been accomplished.

On a grand scale:

• PPACA contains 907 pages
• 960+ pages of regulations/guidance issued by the government affecting employee benefit plans

Provisions we have tackled at HCW:

Contributor: Laura Bibb, JD, Compliance Officer
Hill, Chesson & Woody

On Monday, Feb. 28, 2011, President Obama stated in a speech at the National Governors Association Winter Meeting that he supports amending reform law to allow states to opt out from these mandates in 2014, rather than in 2017, if the state puts in place an alternative means to meet the law’s coverage objectives without driving up healthcare costs.

The “Empowering States to Innovate Act,” sponsored by Senators Wyden (D-Oregon), Brown (R-Massachusetts) and Landrieu (D-Louisiana), would do just that.  In his speech to the governors, President Obama stated the proposed legislation was "a reasonable proposal, that will … give you flexibility more quickly, while still guaranteeing the American people reform."

As reform law currently stands, in 2017, states will be able to apply to HHS to opt out of certain provisions of reform.  States that can show they have alternative means to meet the objectives of reform (coverage and cost objectives) may apply for a waiver of any of the following reform provisions: