When will an "employee choice" model be ready for small business exchanges?

Representative Sam Graves (R-MO), Chairman of the House Small Business Committee sent a letter this week to Marilyn Tavenner, acting Secretary of Centers for Medicare and Medicaid Services, asking for an explanation on the delay in the implementation of the “employee choice” model in the new small business exchanges scheduled to launch next year. 

Earlier this month, HHS announced that employee choice would not be available in the federal-run SHOP exchanges until 2015. States that plan to set up their own exchanges may choose to delay this aspect of SHOP implementation as well. This delay in implementation raises some flags, as employee choice within the exchange was one of the health reform law’s most popular selling points as it gives the employee greater flexibility in choosing a plan that best suits them. 

“If one of the key goals of supporters of the health care law was to provide small business owners with a competitive process by which they could select from a number of affordable health insurance plans for their employees, then that goal is not in sight,” wrote Representative Graves. 

Exchanges and CDHPs: The Insurance Model of the Future

It's less than a year before the state-based health insurance exchanges are laughed in the United States. Many Americans are started to prepare now and are expressing interest in learning about what new health care options they will have starting January 1, 2014.

According to a study by J.D. Power and Associates, people with health insurance who either buy their own plan directly or have high deductible plans are looking forward to the exchanges in 2014. They reported that 73 percent of subjects who purchase their own health insurance plans will be considering the health insurance exchange to shop for coverage.

"As health care costs continue to increase and members pay a higher percentage of the premium, health plan members are increasingly aware of exactly what they are getting for their premium," said Rick Millard, Senior Director of the healthcare practice at J.D. Power and Associates. "If a member has experienced problems and perceives the possibility of having more control over costs through exchanges, this new purchasing method may become more appealing."

The exchanges will provide a variety of insurance options, including consumer-driver health care plans (CDHPs). The advantage of CDHPs is that they give the consumers a greater incentive to take medical costs into consideration with their medical decisions. They ultimately aim to reduce overall health care expenses. We shop around for the best deal on everything we spend our money on - cars, electrical work, clothes, appliances - but how about medical care? Do you shop around for the least expensive facility for your MRI? How about your prescriptions? In a system of copays, the consumer usually has no idea what the true cost of their care is; they just know what they pay (copay), and not all providers charge the same thing for the same service. CDHPs encourage you to shop around for the best pricing, which saves you money as well as the insurance companies - giving you lower premiums, which again, will save you money.

Employers are listening. In 2012, 59 percent of large employers offered at least one CDHP option (or high deductible option), according to Rand Health. Research shows that families saved between 17 and 21 percent in medical costs. As medical expenses continue to rise, this insurance model is expected to thrive.

If we translated the large employer percentage to all consumers, and we said that 50 percent of Americans will enroll in a CDHP, the research indicates that this country could save $57 Billion in total health care spending.

The night of 400 votes in the Senate

Ladies and gentlemen, please keep your seats because I have an important announcement: The United States Senate has passed a budget. I know, I know -  it hasn't happened in four years, so we all thought we'd be more likely to see February 29th again on the calendar before we saw another passed budget, but it actually happened.  Here's the skinny:

In the wee hours of a Saturday morning vote, over 400 proposed budget amendments were passed, eight of which were healthcare related. They serve as a solid indicator as to where some members stand on popular issues and what types of legislation are likely to be introduced in this Congress.

In terms of healthcare, Senator Susan Collins (R-ME) proposed an amendment (#144) that was then passed by a voice vote that would "restore a sensible definition of full-time employee for purposes of the Patient Protection and Affordable Care Act."

Senator Orrin Hatch (R-UT) proposed an amendment that would repeal the medical device tax (#297) component of PPACA. This idea has historically received bipartisan public support, passed the Senate in a 79-20 vote.

Senator Mike Johanns (R-NE) proposed a budget amendment that eventually passed by a voice vote that would repeal the $2,500 federal cap on flexible spending account contributions and the requirement that individuals must have a prescription form from their physician before purchasing an over-the-counter drug with their account funds.

Senator Ben Cardin (D-MD) introduced an amendment that would expand oral and dental healthcare, which also passed by a voice vote.

Amendments that sought to repeal the healthcare reform law, allow employers to opt out of contraception coverage, place restrictions on illegal immigrants who gain legal status from accessing the health law, a prohibition on funds to advertise the health law, and a ban on the health law's taxes on low and middle-income Americans all failed during the night of more than 400 votes.

5 Tips to Saving Money on Healthcare

With the cost of healthcare continuing to rise in the United States each year, the cost of your health insurance doesn't have to necessarily increase with it. With the right tools and tips, you can make smart decisions to drastically decrease claims, which will help lower your premiums in the future.

1. Compare the costs of different healthcare facilities before you go.

Each provider doesn't charge the same thing for the same service. You can shop around for the best price. Contact several different facilities and ask them what they charge for a particular service like an MRI before you have the test. Using that same example, an MRI can cost much more at a hospital than at a imaging or radiology center. Knowledge is power, and in this case, it's also cash money.

Don't forget to contact your insurance company to see how much they cover of the expense and verify that the provider is in your insurance network.


2. Choose generic drugs when possible. 

Generic drugs are a great alternative to brand name drugs because they the same active ingredients, strength and dosage, but they cost a lot less. Ask your doctor if there is a generic equivalent to any brand name drugs you take. In 2011, consumers saved $157 billion in healthcare costs simply by choosing the generic.

3. Use in-network doctors and in-network lab facilities.

You can save a ton of money by using in-network doctors. One, because your network provider out-of-pocket costs are lower than what you pay using your out-of-network benefits (example: office visit copay vs. deductible). Two, you get the insurance discounts with in-network doctors and hospitals.

It costs the insurance company less money too because they already have negotiated discounts with in-network providers. It is not unusual to see discounts of 40-60% off services when comparing an in-network and an out-of-network facility. That is 40-60% less that you and/or your insurance company are going to pay for the exact same service.

If your physician is recommending tests, ask if the lab is in your insurance network. This will save you money and the insurance company, too. Everybody gets a victory lap here.

4. Save emergency rooms for emergencies.

If you are experiencing an emergency, always call 911 or seek immediate attention at the closest facility. However, not every situation is an emergency and could just as easily be treated somewhere else like an urgent care facility or even a doctor's office. Things like sore throats, colds, flus and even stitches and sprains can often be treated outside of the ER. And I don't know about you, but I'd rather avoid sitting in the ER waiting are for six hours just to find out that I have strep throat.

5. Take care of health problems before they get out of control. 

If you have a health concern, it's best to seek treatment quickly. You will have a better prognosis, require less medical care, spend less out of pocket costs, and need less time out of work if you catch a problem early.

And don't forget to have your preventive care treatment. Things like pap smears, mammograms, PSA tests, colonscopies, well physicals and more are so important to maintaining your good health. And with all policies that are Healthcare Reform compliant, most preventive services are covered at 100% by your insurance company. You do not pay a copay or deductible. It protects your health and costs you nothing. I call that a good deal.

BlueCross BlueShield's Wellness Calendar

Business owners understand better than anyone that healthy living leads to a more productive workforce - fewer absences, less medical claims, and more on-the-job accomplishments. BlueCross BlueShield released a wellness calendar this week to help their groups help promote wellness in the workplace.

The calendar can be shared electronically through your intra-office communication system, email or printed and posted in the break room. It's a one-stop-shop for health and wellness topics and information.

Each month, there is a different topic and access to everything you need to run a simple campaign on it. You can decide how much or how little you want to do.

Wellness programs will become increasingly important in order to earn premium discounts under the new Healthcare Reform compliant policies in 2014 and going forward.

If you have a BlueCross BlueShield group plan for your business and haven't received your free wellness program calendar, please contact us for more information.

Do you have a small group plan with Humana? If so, read this.

Health Care Reform and the Affordable Care Act are dramatically changing the healthcare landscape. Humana released today that they are offering an Early Renewal Option.

Humana will honor requests from small business employers with 2-50 total employees to renew their medical coverage early. They will provide flexibility to change to an early renewal date in 2013, or an earlier renewal in 2014 to fit their business needs*.

Humana anticipates a higher demand of employers wanting to renew their medical coverage early because of the Affordable Care Act. All groups (new or existing) interested in renewing their medical coverage will need to inform Humana of their decision no later than four months prior to the new requested renewal date, allowing ample time for the renewal process.

Soon, we will be receiving a spreadsheet from Humana of the group's effective date and preliminary premium information to show the possible effects of the Affordable Care Act - Adjusted Community Rating. The estimated renewal change range information is subject to change, but it's a good way to start understanding what the new premiums will look like. 

By the end of the month, Humana will start notifying employers directly of the Early Renewal Option. They will also be including the Early Renewal Option Guide and Date Change Form.

If you have a small group policy with Humana and would like to know how renewing early might help you under the Healthcare Reform Law, please contact Rick Bailey & Company today.

The Energy and Commerce Committee has been busy, busy, busy

The March 13 hearing attempted to analyze the impact of health reform on job availability and employer-sponsored health coverage. Witnesses included Diana Furchtgott-Roth, senior fellow at the Manhattan Institute, Tom Boucher, owner of Great New Hampshire Restaurants Inc., who testified on behalf of the National Restaurant Association, and Linda Blumberg, a senior fellow at the Urban Institute. 

During the hearing, GOP representatives argued that uncertainty about health reform implementation is leading to hesitation by employers to hire. They discussed the potential for 49ers and 29ers—employers that try to stay under the 50 full-time equivalent threshold to avoid the shared responsibility requirements or try to hold employees to a 29-hour-a-week or less average to avoid offering them coverage. Meanwhile, Democratic ranking member Henry Waxman defended the law, citing millions of new jobs created and claiming dire assertions are unfounded. You can watch the highlights of the proceedings here.

The March 14 letter to HHS Secretary Kathleen Sebelius expressed concern about the proposed applications for health insurance exchange coverage that were released in January. (NAHU expressed similar concerns in a letter dated February 28.) The Energy and Commerce Committee letter was signed by Committee Chairman Fred Upton (R-MI), Vice Chair Marsha Blackburn (R-TN), Chairman Emeritus Joe Barton (R-TX), Heath Subcommittee Chairman Joe Pitts (R-PA), Oversight & Investigations Subcommittee Chairman Tim Murphy (R-PA) and Vice Chairman of the Health and Oversight and Investigations Subcommittees Michael C. Burgess (R-TX).

Among other things, the letter states that the draft health insurance exchange applications “are troubling for several reasons. First the applications request information not easily available to most Americans, including information on their employers’ health plans that most employees would have difficulty obtaining. For example, it is unlikely most Americans would be able to determine which of their employer health plans meet the ‘minimal value standard’ as defined by PPACA.” The members requested HHS provide a briefing and additional information on HHS’ process for reviewing applications by March 29, so stay tuned.

As for today’s hearing on coverage affordability, the witnesses will be Douglas Holtz-Eakin, the former director of the Congressional Budget Office, Christopher Carlson, actuarial principal at Oliver Wyman, and Wendell Potter, the senior analyst at the Center for Public Integrity. We expect that the impact of age rating for small employers and the new looming national health insurance premium tax on all fully insured group and individual policies will be a focus. Now would be a great time to send your lawmakers an email asking them to sign on to Representative Gingrey’s LIBERTY Act bill to address the impact of the age-rating provision.

Source: NAHU Washington Update

Should your health insurance bill look like your phone bill?

You know all those taxes and fees that are listed out at the end of your phone bill? A member of the House of Representatives believes that when it comes to taxes and fees resulting from health reform, a health insurance premium bill should look like that too. This week, Representative Greg Walden (R-OR) introduced legislation titled A Patient's Right to Know that would require insurers to inform the public about the extra costs health reform will add to their bills in the years ahead.  

The bill proposed by Walden will require insurance companies to itemize the cost of PPACA on their customer’s annual coverage summary and premium statements, including the new annual premium tax on health insurers, fees to fund the Patient-Centered Outcome Research Institute (PCORI), reinsurance contributions and proposed fees on insurance exchange users, risk corridor payments and risk-adjustment charges. The bill also calls for a review by the Government Accountability Office (GAO) to examine the impact of the law’s guaranteed issue and community rating, age rating, women’s preventive services and essential health benefits. 

While it is highly unlikely that the Walden bill will ever be signed by President Obama, we believe that similar laws could become a trend among states. In Georgia, lawmakers are currently working toward informing more Americans how much this law is really going to cost them. Georgia Senate Bill 236 would require health insurance companies doing business in the state to show how much PPACA is costing all consumers on every premium statement. The bill also requires that those who get their benefits from the state’s health benefit program receive the same information. The bill passed the Georgia Senate last week 36-17 and is currently working its way through the Georgia House Committee process. Senator Burt Jones (R-Jackson), who sponsored the bill, is obviously pleased with the outcome and has said, “It is good for us to be transparent with the consumers of Georgia and show exactly what this legislation coming down is going to do to our insurance premiums.” 

Source: NAHU Washington Update

House and Senate Budgets are as different as black and white, north and south, east and... well, you get the idea

Well folks, it’s that time again! Just this week, Representative Paul Ryan (R-WI), chairman of the House Budget Committee, published his budget plan for the coming year. In the Senate, Senator Patty Murray (D-WA) released the Senate Budget Committee version and, guess what, they look absolutely nothing alike, account for vastly different levels of federal spending over the next 10 years, and we’re not sure the kinks can be worked out. Meanwhile, both the House and Senate spent the past two weeks working on continuing resolutions just to keep the federal government from shutting down at the end of this month. 

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