Tag Archives: nyc employee benefits insurance

Republicans Proposed Plan to Replace The ACA

The Washington Times reports that the list of Republican plans “to deal with the potential fallout” from King v. Burwell “is growing longer, although Republicans have yet to coalesce around a game plan with just six weeks before the court is expected to rule.” Rep. Tom Price (R-GA) unveiled a “revamped version” of his ACA replacement bill last week. The proposal would repeal the health law in its entirety and offer tax credits to people to purchase insurance on their own. Another plan, from Sen. Bill Cassidy (R-LA), would allow states three ways to respond to a Supreme Court ruling against the ACA’s subsidies: “States could set up exchanges under Obamacare, do nothing and lose federal support or – and this is what the senator wants – opt into a third path titled the Patient Freedom Act.”

The Hill reported in a similar article that Republican lawmakers “are all over the map about what to do about the millions of people who could lose” subsidies if the Supreme Court rules against the ACA next month. Although Republicans agree that “they need a plan if the high court strikes down a subsidies next month,” they do “not agree about how to help people who’d lose access to healthcare – and even whether to help them at all.” Currently, “there are more than half a dozen plans floating around, with varying degrees of details.”

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

This is How The IRS Handles Marriage and Health Tax Credits

If you’re about to tie the knot, do you know how a change in marital status could affect the credit you got toward health insurance when you were single? You could end up having to repay a big chunk of the money. Here’s the question and an answer that lays out the way the IRS handles the situation.

Last year, I had single coverage through the marketplace from January through May. Then I got married and canceled my policy because I had coverage through my husband’s job for the rest of the year. When I filed my 2014 taxes, we had to repay half of the premium tax credits for the months when I had a marketplace plan. Why? Those first five months I was single and relying on my own income. Why should my husband’s income be counted

The Internal Revenue Service has a special rule to handle situations like yours when people get married during the tax year. Though not a perfect solution, without it, chances are you would have had to repay even more of your tax credit.

First, though, here’s some background. The premium tax credits that people can qualify for if their income is under 400 percent of the federal poverty level (about $46,000 for one person) make coverage purchased on the health insurance marketplace more affordable. Like you, many people opt to receive the credit in advance and have it sent directly to their insurer, which reduces their monthly bill.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Mental Health Benefits In ACA Plans Are Disappointing

Insurance coverage for mental and physical illness remains unequal despite promises that Obamacare would help level the playing field, mental health advocates and researchers say.

A new study by the Johns Hopkins Bloomberg School of Public Health found that consumer information on a quarter of the Obamacare plans that researchers examined appeared to go against a federal “parity” law designed to stop discrimination in coverage for people with mental health or addiction problems.

This makes it nearly impossible for consumers to find the best plan to cover their mental health needs, the research suggests.

“It’s critical to monitor whether these regulations are being implemented in a way that fulfills the promise of parity,” says associate professor Colleen Barry, who led the study published in the current online issue of the journal Psychiatric Services. “Clearly, better monitoring is needed.”

Barry and her colleagues examined benefit brochures offered during the first Affordable Care Act enrollment period in 2013-14 in two state-run exchanges, hoping to replicate a consumer’s shopping experience. Although she won’t name the states, Barry says one was large and the other small, and adds that the results can be extrapolated to plans offered in other states and on the federal exchange.

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Public Policy Reform Focusing on Mental Health Disparities

Chirlane McCray, the wife of Mayor Bill de Blasio, revealed on Wednesday that she had been surrounded by mental illness most of her life — first as a child of parents who had depression and later as a mother of a daughter who is recovering from depression, anxiety and substance abuse.

In a public appeal, Ms. McCray used intimate family turmoil as a springboard for public policy. She announced plans for a comprehensive review of the mental health problems that affect New Yorkers to help the city identify and address disparities in care. The review will be conducted through a partnership among the city’s health department, the Fund for Public Health and the Mayor’s Fund to Advance New York City, which Ms. McCray leads as an unpaid chairwoman.

The “road map,” as the first lady called it, will be completed by summer, and the mayor’s fund will then commit money, though she did not disclose a budget.

Ms. McCray, who has worked in publishing and as a speechwriter, made her announcement at a conference of mental health professionals at Brooklyn Borough Hall. She lightened the mood by asking people to stretch and greet one another. Then she grew serious.

“My mother, who is a daughter of immigrants, and my father, who was a veteran, a World War II veteran, both suffered from depression at times in their lives,” said Ms. McCray, 60, who grew up in Massachusetts. “They had periods of intense sadness for different reasons. To their enormous credit, they still managed to bring us up. But we knew it was there.”

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Single-Payer Health Care Bill Gets Wide Support

The Affordable Care Act has made an unwieldy system of health insurance even more complicated, and should be replaced with a centralized, tax-funded health care system.

That was the prevailing view at Tuesday’s all-day hearing on the New York Health Act, Assemblyman Richard Gottfried’s bill to create statewide single-payer health insurance that stands almost no chance of passing in the state Senate.

The handful of insurance representatives who testified for a wait-and-see approach followed their speeches with a swift exit, often to the tune of hisses and groans from patients, health care workers and unions in the audience who far outnumbered them.

“No one advancement is big enough to bend the cost curve in itself,” said Lawrence Thaul, president of Millennium Financial, an insurance brokerage. “It took many years to improve Medicare. Let us not be shortsighted and impatient—and you’ve been anything but that, chair,” he hastily added to Mr. Gottfried, who chaired the hearing.

Mr. Gottfried, who heads the Assembly’s committee on health, has carried a version of his single-payer legislation since 1999.

Many doctors and health care workers bemoaned the amount of time spent billing and collecting payment for medical care.

“I employ 24 separate billing people,” said Dr. Neil Calman, president of the Institute for Family Health, “each of whom develops a relationship with one or two paying companies.” Dr. Donald Moore, who recently stopped accepting commercial health insurance, said he used to spend the equivalent of three to four weeks every year billing for his work.

But without this back-and-forth between providers and insurance companies to drive down providers’ charges, health care would cost even more, argued insurance executives.

“Price controls would not work because there would be no one on whom to shift the excess costs,” said Craig Hasday, the legislative chair of the New York State Association of Health Underwriters. “Over time, the issue of affordability will return, but as a tax issue.”

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Employers Capping Health Care Procedures

In an effort to slow health care spending, more employers are looking at capping what they pay for certain procedures — like joint replacements — and requiring insured workers who choose hospitals or medical facilities that exceed the cap to pay the difference themselves.

But a study out Thursday finds employers might be disappointed with the overall savings. While the idea, known as “reference pricing,” does highlight the huge variation in what hospitals and other medical providers charge for the same services, the report says, it does little to lower overall health care spending.

“It’s zeroing in on a piece of the health spending puzzle that is critical, the unreasonably high negotiated prices paid by health plans … but it’s not going to get you there if you need to save a lot of money,” said co-author Chapin White. The study was done by the National Institute for Health Care Reform, a nonprofit, nonpartisan research group sponsored by auto makers and the United Auto Workers union.

The use of price limits has also drawn concern from consumer groups that it might lead to confusion — and end up sticking patients with large, unexpected bills if the programs are not clearly explained.

The Obama administration, in a document about health law implementation in May, essentially gave its blessing to large or self-insured employers to use reference pricing in their health plans.

While only about 10 percent of employers currently have such programs, about 68 percent plan to do so soon, according to a recent survey by Aon Hewitt, a management consulting firm.

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Doctor Quality Data Unuseful to Consumers

Consumers searching this fall for the best doctor covered by their new public or private insurance plan won’t get very far on a federal database designed to rate physician quality.

The Affordable Care Act requires the Centers for Medicare and Medicaid Services to provide physician quality data, but that database offers only the most basic information. It’s so limited, health care experts say, as to be useless to many consumers.

This comes as people shopping for insurance on the state or federal exchanges will find increasingly narrow networks of doctors and may be forced to find a new one. Many with employer-provided plans will face the same predicament.

A report out last week by the Georgetown University Health Policy Institute said insurers were limiting the choices of doctors and hospitals for those buying insurance on health insurance exchanges to keep premiums low.

The CMS data include only 66 group practices and 141 accountable care organizations (ACOs). There are about 600,000 doctors in the USA, tens of thousands of group practices and more than 600 ACOs, which are partnerships between doctors and hospitals to treat a group of patients efficiently.

The database lists just five areas of doctors’ effectiveness in treating diabetes and heart disease. These include whether doctors prescribed aspirin and how well they controlled diabetics’ blood pressure.

“They are behind, there’s no doubt,” says Terry Ketchersid, a kidney physician and vice president of clinical health information management for the electronic health records company Acumen.

“The goal of these sites is for the average Medicare beneficiary to go out and make an intelligent choice,” he says, but only another doctor would understand what to make of the ratings.

The CMS plans to add more quality measures and patient experience data for ACOs this year, spokesman Aaron Albright says. He says the CMS uses a “phased approach for public reporting to make sure the data are accurate and the measures reported help consumers make informed health care decisions.”

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Employers Adjusting Employee Benefits

Large businesses expect to pay between 4 and 5 percent more for health-care benefits for their employees in 2015 after making adjustments to their plans, according to employer surveys conducted this summer.

Few employers plan to stop providing benefits with the advent of federal health insurance mandates, as some once feared, but a third say they are considering cutting or reducing subsidies for employee family members, and the data suggest that employees are paying more each year in out-of-pocket health care expenses.

The figures come from separate electronic surveys given to thousands of mid- to large-size firms across the country by Towers Watson, the National Business Group on Health and PriceWaterhouseCoopers, consulting groups that engage with businesses on health insurance issues.

Bracing themselves for an excise tax on high-cost plans coming in 2018 under the Affordable Care Act, 81 percent of employers surveyed by Towers Watson said they plan to moderately or significantly alter health-care benefits to reduce their costs.

The excise tax will be levied on companies offering annual benefits that exceed $10,200 for individuals or $27,500 for families. For any costs above those amounts, businesses would be taxed 40 percent on the difference. Nearly three quarters of the businesses interviewed by Towers Watson said they are concerned they will be subject to the excise tax.

To lower their tax bill, many companies are looking to cut their premiums by raising deductibles. Many also are making greater use of health-care savings accounts.

“My takeaway from the employer surveys is that this trend is accelerating,” said Paul Fronstin of the nonprofit Employee Benefits Research Institute.

The National Business Group on Health finds 81 percent of employers offering insurance plans that include higher deductibles and an annual health savings account. The savings account allows employees to deposit money tax-free, and employers often deposit a set amount of money into these accounts at the beginning of the year.

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary

 

More High-Deductible Plans to be Offered

Anita Maina was working on an arts and crafts project she found on Pinterest — creating a table out of wood and cork — when she ripped off a fingernail while removing staples from a piece of wood.

“It is one of those things that really hurt, and I thought I should go to urgent care,” said Ms. Maina, 27.

But she ultimately skipped the visit since she had not met the $6,000 deductible on her health plan, and she knew she probably did not have much left in her health savings account, a type of tax-advantaged savings vehicle that is often used with high-deductible plans to help defray out-of-pocket costs.

Ms. Maina, an associate in a health and human services consulting agency, said her employer added the high-deductible plan earlier this year; though her monthly premiums are only $34, these plans require employees to pay for a greater share of their medical expenses upfront, before the plan starts making payments.

Next year, even more corporate workers are likely to be offered high-deductible plans — sometimes known more benignly as consumer-directed plans — and at a rising share of large companies, it will be the only option remaining.

“You can’t sugarcoat this,” said Paul B. Ginsburg, a professor of the practice of health policy and management at the University of Southern California’s Sol Price School of Public Policy. “This is a more challenging situation for consumers and it’s a reflection of how difficult it is to afford health care.”

Just as employers replaced pensions with retirement savings plans, more large companies appear to be in a similar cost-sharing shift with health plans. Besides making workers responsible for more of their care, employers hope these plans will motivate employees to comparison-shop for medical services — an admirable goal but one that some say is hard to achieve.

Several big companies started offering consumer-driven plans as their only option in the last couple of years, including JPMorgan, Wells Fargo, General Electric and Honeywell, among others; it is the only choice for Bank of America employees earning more than $100,000.

Next year, nearly a third of large employers will offer only high-deductible plans — up from 22 percent in 2014 and 10 percent in 2010, according to a study by the National Business Group on Health, which included 136 large companies that collectively employ 7.5 million workers. And 81 percent of those large employers will have added one of these plans to their lineup of choices, up from 53 percent in 2010.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Long-Term Implications of ACA and Employers

While employers are continuing to feel the impact from a multitude of changing laws and regulations, worries about the Affordable Care Act have begun to subside, to some degree. But the jury is out on the long-term implications of the ACA, and the ways benefits managers will live up to its stipulations in coming years.

“It’s not to say that employers are no longer concerned about the ACA — they are and health care reform continues to be one of the most pressing issues on the minds of all employers,” said Steven Friedman, co-chair of Littler’s Employee Benefits Practice. “However, uncertainty surrounding the ACA, as well as delays in its implementation, has [still] created confusion among employers.”

ACA Implementation

The ACA has remained one of the top regulatory issues most employers still keep a constant eye on, but many say they have felt the significance of the ACA’s impact drop. Littler Mendelsons’s annual Executive Employer Survey Report suggests worries of the ACA hover at about 41% this year, versus 57% in 2013.

More than half of the respondents say that, in response to the numerous amendments and delays to the employer mandates, they have enlisted employee benefits attorneys or consultants to help with navigating upcoming regulations and tracking areas where there will most likely be additional change.

However, 39% have said they have done nothing as they believe they are still on course despite extensions, 14% are taking a “wait and see” approach in hopes that the employer mandate will be amended or repealed and 14% have delayed planning some aspects in the event that future concessions to the mandates are granted.

Respondents also pointed to several steps they’ve taken in response to the ACA, including implementing employee wellness programs (52%), offering employees health care benefits through private health insurance exchanges (26%) or limiting more employees to 30 hours per week (25%).

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary