Tag Archives: Financial Services

The ACA Incentives People to Attain Health Insurance

Obamacare’s big stick doesn’t seem to be scaring many people into buying health insurance.

The health law includes many inducements for people to obtain health insurance — including free Medicaid coverage for many low-income Americans and subsidies for those with moderate incomes. But it also includes the notorious “individual mandate,” a fine for those who can afford insurance but don’t buy it.

Because the law, and the fine, are new, many policy experts expected that some people would decline to sign up for insurance until they were hit with a penalty at tax time. Forecasters have estimated a big bump in marketplace enrollment next year, the first sign-up period after people have been fined. The Congressional Budget Office, for example, estimates 10 million more people will have Obamacare plans next year. The law’s structure relies on even healthy and otherwise disinclined consumers to enter insurance markets to help stabilize prices.

Certainly, some people who might otherwise go uninsured have been persuaded by the penalty. Polls have shown that it is a well-known provision of the law. And studies of the uninsured have shown that mentioning the penalty changes some people’s thinking about health insurance. At the end of the normal enrollment period in February, about 11.7 million people had selected marketplace health plans or renewed their plans from 2014, according to the federal government.

But the Obama administration just conducted a small experiment into how much the penalty would affect the behavior of the remaining uninsured. And the results leave some experts concerned that next year’s sign-ups will come in below expectations.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

OSHA Releases New ‘It’s The Law’ Poster

The Occupational Safety and Health Administration (OSHA) has released a new version of its “Job Safety and Health – It’s The Law!” poster.

Background
Under the Occupational Safety and Health Act (OSH Act), employers have certain responsibilities, including the obligation to:

  • Provide their employees with a safe workplace;
  • Follow all relevant safety and health standards;
  • Find and correct safety and health problems in the workplace; and
  • Inform employees about workplace hazards.

Content of New Poster
The newly designed poster informs employers of their legal obligation to provide a safe workplace. It also informs workers of their right to request an OSHA inspection of their workplaces, receive information and training on job hazards, report a work-related injury or illness, and raise safety and health concerns with their employer or OSHA without being retaliated against.

Additionally, the poster has been updated to include the new reporting obligations for employers, who must now report every fatality and every hospitalization, amputation and loss of an eye. It also informs employers of their responsibilities to train all workers in a language and vocabulary they can understand, comply with OSHA standards, and post citations at or near the place of an alleged violation.

Posting and Size Requirements
Employers must display the poster in a conspicuous place where workers can see it. Reproductions or facsimiles of the poster must be at least 8 1/2 by 14 inches with 10 point type. According to OSHA,previous versions of the poster do not need to be replaced.

Note: Employers in states operating OSHA-approved state plans should obtain and post the state’s equivalent poster.

The poster is available by clicking here. Multiple languages and resolutions are available for download.

To learn about other federal notices required to be displayed in the workplace, please visit our section on Federal Poster Requirements.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

ACA Rules for Foster Children

Nathan Cox-Reed has a toothache.

He thinks he needs a root canal, but the full-time student, 22, is uninsured. He can’t afford a trip to the dentist.

“I’m only working 30 hours a week. I wouldn’t have enough money to do something like that,” said Cox-Reed, a film and video student at Columbia College in Chicago.

While many young adults are now covered by the Affordable Care Act, able to remain on their parents’ insurance until age 26, the rules are different for those like Cox-Reed, who grew up in the foster care system.

There are more than 400,000 children in foster care in the United States, the Department of Health and Human Services said last year. All are provided with health care coverage as long as they are wards of the state.

When foster kids turn 18, they age out of the system and instantly lose their coverage.

That’s about to change, when another part of Obamacare takes effect on January 1, 2014. Medicaid coverage will be extended for former foster youth until they reach 26, as long as the individual was in foster care and enrolled in Medicaid until the age of 18.

“I definitely think it would be a big relief, and I would definitely feel more secure as far as my health goes,” Cox-Reed said.

But there’s a catch. Cox-Reed has dreams of traveling across the nation and becoming a filmmaker. A future relocation could jeopardize his medical coverage.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

IRS Releases 2016 Health Savings Account Limits

The Internal Revenue Service (IRS) has announced the 2016 inflation-adjusted amounts for Health Savings Accounts (HSAs) as determined under the Internal Revenue Code.

Annual Contribution Limitation
For calendar year 2016, the annual limitation on deductions for an individual with self-only coverage under a high deductible health plan is $3,350. The annual limitation on HSA deductions for an individual with family coverage under a high deductible health plan is $6,750.

High Deductible Health Plan
For calendar year 2016, a “high deductible health plan” is defined as a health plan with an annual deductible that is not less than $1,300 for self-only coverage or $2,600 for family coverage, and the annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not premiums) do not exceed $6,550 for self-only coverage or $13,100 for family coverage.

You may view the IRS Revenue Procedure announcing the 2016 amounts by clicking here.

Be sure to check out our section on Health Savings Accounts for more on HSAs.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

IRS Fact Sheet: Determining Large Employer Status

Fact Sheet Includes Examples and Additional Resources

A fact sheet from the IRS helps employers determine, based on their size, whether the ACA’s employer shared responsibility (“pay or play”) and information reporting provisions apply to their company.

The fact sheet includes basic information on determining large employer status, along with information on:

  • Determining the number of full-time and full-time equivalent employees
  • Large employer determination examples
  • Employer aggregation rules
  • The exception for seasonal workers
  • New employers
  • 2015 transition relief for determining workforce size

More information about determining large employer status can be found here.

Visit our Pay or Play section for additional details.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

On Demand Doctor Apps are Here

New smartphone apps can deliver doctors to your doorstep.

Heal is a smartphone app similar to the on-demand car service Uber, but instead of a car, a doctor shows up at your door. Users download the app and then type in a few details such as address and the reason for the visit. After adding a credit card and a request for a family doctor or a pediatrician, the physician arrives in 20 to 60 minutes for a flat fee of $99. Heal began in Los Angeles in February, recently expanded to San Francisco and is set to roll out in another 15 major cities this year. Heal doctors are on call from 8 a.m. to 8 p.m., seven days a week, said Dr. Renee Dua, a founder and the chief medical officer of Heal.

Heal doctors arrive with a medical assistant and a kit stocked with the latest high-tech health gadgets, including tools needed to take your vitals or shoot high-definition video of your eardrum. Heal has a roster of doctors who have affiliations with respected hospitals and programs such as the University of California, Los Angeles; Columbia; and Stanford.

“We’re bringing back old-school techniques with new-school technology,” Dr. Dua said.

Obviously, Heal doctors can offer only limited services on a house call. Among other things, they can diagnose and treat moderate ailments like bronchitis, give flu shots, stitch up a nasty cut or write a prescription (they will even pick the prescription up for an extra $19). But you will have to file the insurance paperwork.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Insurance Companies at The Capital to Lobby

Health insurance companies will descend on the state capital today for two days of lobbying—and might need both of them to explain the bill at the top of their agenda.

The measure would allow businesses with 51 to 100 employees to continue purchasing stop-loss insurance next year. It’s sure to trigger a lot of quizzical looks from lawmakers, and the following questions:

Who’s taking away midsize companies’ ability to buy stop-loss policies? And why?

For that matter, what is stop-loss insurance?

For the answers, the Insider turned to Patrick Gillespie, director of state government affairs for Cigna, one of the insurers that sells stop-loss policies in New York. He could probably talk about stop-loss for weeks, were anyone inclined to listen that long. Fear not—the Insider boiled the explanations he gave during a 40-minute phone interview into a ready-to-eat meal.

The big picture: Stop-loss insurance protects employers who self-fund—that is, pay their workers’ health-care bills directly, rather than cover them through a traditional insurance policy. Self-funding can save companies money, but can destroy them if one or more employees racks up extraordinarily high medical bills. A stop-loss policy kicks in if that happens, limiting what they’ll have to pay in any given year.

If the legislature doesn’t pass (and Gov. Andrew Cuomo doesn’t sign) S.2366 and A.1154 this year, on Jan. 1, about 1,700 businesses with nearly 130,000 employees will stop self-funding because they—along with about 9,300 other midsize firms—will lose their legal right to buy stop-loss policies.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

 

Data Released to The Public on Medicare Prescription Spending

The heartburn drug Nexium — whose advertisements have long been ubiquitous on television — was prescribed to 1.5 million Medicare patients in 2013, for a total cost of more than $2.5 billion, the largest amount spent on any drug prescribed through the government program, according to data released by Medicare officials on Thursday.

The data was the most detailed breakdown ever provided by government officials about the prescription claims of Medicare beneficiaries. It included information about 36 million patients, one million prescribers and $103 billion in spending on drugs under the program’s Part D in the year 2013, the most recent year available. The data did not take into account rebates that the drug manufacturers pay to the insurers that operate the Medicare beneficiaries’ drug plans.

Although the government has previously released similar data to outside entities — including ProPublica, the nonprofit news group — officials said they decided to make the information available on a public website to encourage experts to weigh in, potentially leading to new solutions for policy challenges, like how to contain costs.

“We know that there are many, many smart minds in this country,” Sean Cavanaugh, a deputy administrator at the Centers for Medicare and Medicaid Services, said in a conference call with reporters on Thursday. “We are excited to unleash those minds and see what they can find in our data.”

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Consumers Aren’t Using Accessible Health Information

Despite the government’s push to make health information more available, few people use concrete information about doctors or hospitals to obtain better care at lower prices, according to a poll released Tuesday.

Prices for the health care industry have historically been concealed and convoluted, unlike those for most other businesses. The 2010 health law aimed to make such information more transparent. People shopping for insurance can now compare the prices of competing plans through online marketplaces, including premiums, deductibles and their share of any medical expenses. The federal government also publishes more than 100 quality ratings about hospitals, as do some large private insurers. Private groups such as Consumer Reports and U.S. News & World Report also rate providers, and Internet forums such as Yelp are now littered with easily accessible opinions.

The poll from the Kaiser Family Foundation found that about two of three people say it is still difficult to know how much specific doctors or hospitals charge for medical treatments or procedures. (KHN is an independent program of the foundation.) Only about one in five people said they had seen specific cost or quality information about a hospital, insurer or doctor.

The poll found that this information rarely makes a difference. About 6 percent of people ever used quality information in making a decision regarding an insurer, hospital or doctor. And fewer than 9 percent used information about prices, most commonly in relation to health plans. Only 3 percent said they used price information about physicians, the poll found.

This lack of practical information may be related to another major finding from the poll: people are overconfident about their ability to pay medical bills without financial strain.

A majority of people told pollsters they had enough insurance coverage or money to pay for their usual medical costs or for an unplanned hospitalization. A majority also said paying insurance premiums, deductibles and their share of medical costs was relatively easy.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Most Doctors Don’t Follow Guidelines for Patients

For all their talk about evidence-based medicine, a lot of doctors don’t follow the clinical guidelines set by leading medical groups.

Consider, for example, the case of cataract surgery. It’s a fairly straightforward medical procedure: Doctors replace an eye’s cloudy lens with a clear, prosthetic one. More than a million people each year in the U.S. have the surgery — most of them older than 65.

“The procedure itself is relatively painless and quick,” says Dr. Catherine Chen, an anesthesiologist and researcher at the University of California, San Francisco. She calls it the “prototypical low-risk surgery.”

And since at least 2002, Chen says, clinical guidelines have stipulated that no preoperative testing is needed before cataract surgery. A large study showed that procedures like chest X-rays, blood tests and EKGs — tests sometimes recommended when older people undergo more complicated surgeries — do not benefit someone who is simply having a cataract removed.

But Chen noticed that a lot of patients are having these preoperative tests done anyway. How many? Digging into the numbers, she discovered that half the ophthalmologists who performed cataract surgery on Medicare patients in 2011 ordered unnecessary tests. That’s the same percentage as in 1995.

“In about 20 years, nothing has really changed in terms of physician performance,” Chen says. She recently published those findings in the New England Journal of Medicine.

Dr. Steven Brown, a professor of family medicine at the University of Arizona, has studied doctors’ reasons for ordering unnecessary tests before a scheduled surgery. A lot of it has to do with perceived safety, he says.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary