“When benefits enrollment season arrives this fall, employees around the country can expect to see the impact of corporate cost-cutting on their finances.
Benefits costs will rise only 5 percent for employers that take certain cost-reduction measures, instead of 6.5 percent for companies that do not, according to a June survey of employers representing 7.5 million workers by the National Business Group on Health.
Although costs are not rising as quickly, employees are still being squeezed.
The main way companies are keeping healthcare costs in line is by shifting workers into high-deductible health plans, defined by the Internal Revenue Service as having deductibles above $1,250 for an individual. (here)
For 2015, 81 percent of employers will offer a high-deductible plan as an option, up from 72 percent last year; while 32 percent will offer such plans as the only option, up from 22 percent last year.
The challenge employers face is: “How do you keep costs from spiraling out of control but not shift all of it to the employee?” said Karen Marlo, a vice president at NGBH who authored the report.”
“Low-income consumers struggling to pay their premiums may soon be able to get help from their local hospital or United Way.
Some hospitals in New York, Florida and Wisconsin are exploring ways to help individuals and families pay their share of the costs of government-subsidized policies purchased though the health law’s marketplaces – at least partly to guarantee the hospitals get paid when the consumers seek care.
But the hospitals’ efforts have set up a conflict with insurers, who worry that premium assistance programs will skew their enrollee pools by expanding the number of sicker people who need more services.
“Entities acting in their [own] financial interest” could drive up costs for everyone and discourage healthier people from buying coverage, insurers wrote recently to the Obama administration.
Insurers are asking the federal government, which regulates the health insurance marketplaces, to restrict the practice.”
“Small and stand-alone nonprofit hospitals are facing mounting pressure from weak operating margins and lower patient volumes, with more signals of stress on the way, according a report released Wednesday from Standard & Poor’s Rating Services.
The rating agency warned the healthcare sector was at “a tipping point where negative forces have started to outweigh many providers’ ability to implement sufficient countermeasures.” Beginning in 2013 and continuing into this year, credit downgrades outpaced upgrades at an accelerating rate.
In particular, stand-alone providers are under greater pressure from physician departures, rising bad debt, and higher employee benefit costs.”
“The Obama administration’s effort to end one political crisis during the 2014 Obamacare rollout may have sown the seeds of another controversy: potential double-digit rate hikes in 2015.
If insurers have their way, some residents in politically key states like Florida, North Carolina and Iowa would face hikes of 11 percent to nearly 18 percent — far beyond the average 7.5 percent increase in proposed rates for much of the country.
Major carriers there in part blame such increases on the administration’s response to the furor that erupted when millions of Americans received notice last fall that their health policies would be canceled because they fell short of Obamacare requirements.
Facing a barrage of criticism from Republicans and some Democrats, who accused him of breaking his promise that people could keep plans they liked, President Barack Obama relented. He told insurers they could continue offering those plans if states agreed. About two-thirds of the states took him up on the offer.
But the president’s decision is now having an impact on upcoming rates, insurers say. Many younger, healthier Americans — the category companies had counted on enrolling when they set their initial prices — stuck with their existing coverage. In states with the biggest numbers of these “transitional” policyholders, their absence from the Obamacare market is pushing premiums higher.”
“BOSTON — Massachusetts officials overseeing the state’s hobbled health care exchange decided Friday to stick with new software designed to upgrade the website rather than switching over to the federal government’s health insurance market.
For the past several months the state has adopted a “dual-track” approach that called for buying software that has powered insurance marketplaces in other states while also laying the groundwork for a switchover to the federal marketplace if necessary.
On Friday, Massachusetts Health Connector officials announced that Massachusetts will remain a state-based marketplace.
In a letter to head of the Centers for Medicare and Medicaid Services, Gov. Deval Patrick said officials will be rigorously testing the new system.
“We are poised to offer consumers a streamlined, single-point-of-entry shopping experience for health care plans in time for fall 2014 Open Enrollment,” Patrick said in the letter to CMS administrator Marilyn Tavenner.
Earlier site problems dramatically slowed the state’s transition to the federal Affordable Care Act from its own first-in-the-nation universal health insurance law that provided a model for President Barack Obama’s plan.”
“SALEM, Ore. — Oracle Corp. has sued the state of Oregon in a fight over the state’s health insurance exchange, saying government officials are using the technology company’s software despite $23 million in disputed bills.
Oracle’s breach-of-contract lawsuit against Cover Oregon was filed Friday in federal court in Portland. It alleges that state officials repeatedly promised to pay the company but have not done so.
The lawsuit seeks payment of the disputed $23 million plus interest, along with other unspecified damages.
Oregon’s health-insurance enrollment website was never launched to the general public. State officials have blamed Oracle, but the company says the state’s bad management is responsible.
Gov. John Kitzhaber has called for the state to sue Oracle and recover some of the $134 million it has already paid to the Redwood City, California, company.
In June, Oregon issued legal demands for documents that could become evidence in a possible lawsuit against Oracle under the state’s False Claims Act.”
“Fresh Unlimited Inc. won’t have to provide contraceptive coverage for its employees under the Obama administration’s health-care reform law, in what may be the first exemption granted since a June U.S. Supreme Court ruling.
The parent of Freshway Foods today won an appeals court ruling that qualifies it for the same treatment the high court approved in its June 30 Hobby Lobby decision allowing family-run businesses to claim a religious exemption from the requirement to include contraceptives in their health insurance plans.
The suit by Francis and Philip Gilardi, who own Sidney, Ohio-based Freshway, is one of about 50 filed by for-profit businesses over religious objections to the Patient Protection and Affordable Care Act of 2010’s birth-control coverage mandate. The Gilardis are Roman Catholic and said that complying with the U.S. Department of Health and Human Services mandate would require them to violate deeply held religious beliefs.
U.S. District Judge Emmet Sullivan in Washington in March 2013 ruled against the Gilardis, saying that he couldn’t allow a corporation to assert the religious beliefs of individuals. The U.S. Court of Appeals reversed part of Sullivan’s decision, and the ruling was put on hold pending the Supreme Court’s resolution of the Hobby Lobby case.
In addition to carving a hole in the law, the Hobby Lobby ruling marked an expansion of corporate rights, allowing companies, like people, to claim religious freedom under federal law.”
“More Americans are enrolled in individual health insurance plans. In part, though, that’s because under Obamacare fewer are enrolled in group plans. And one health care analyst says this may be the beginning of a trend.
WellPoint Inc., the Indianapolis-based health insurance giant, reported in its latest quarterly earnings that its small-group business fell more than expected.
WellPoint said it ended 218,000 (or 12 percent) of those plans because employers dropped their group health coverage, and cited Obamacare’s tax credits as a reason for the shift, J.K. Wall wrote in the Indianapolis Business Journal.
Edmund Haislmaier, senior research fellow in health policy studies at The Heritage Foundation, told The Daily Signal that the drop in WellPoint’s employer group coverage “is in line with what we were seeing in the first quarter” for the insurance industry — a decrease in group plans but an increase in individual plans.
Haislmaier said many smaller businesses have dropped group coverage plans in instances where they have a higher number of low-income workers who would qualify for subsidies to buy insurance on Obamacare’s federal and state-run exchanges.”
“As the backlash over narrow physician networks continues to make headlines and lawmakers start the August recess, a new nationwide survey found 76 percent of likely voters support a bipartisan proposal to give Medicare patients better medication access and more choice of pharmacy.
Bait-and-switch. That’s the common refrain expressed by patients in recent articles about the narrow network trend, from Morning Consult to The New York Times to USA TODAY. Patients report either not knowing or being misinformed about restrictions on their access to the doctor of their choice. As a result some are racking up significant, unanticipated out-of-pocket costs. Now both regulators and insurance plans alike are reassessing the situation and contemplating adjustments for 2015.
It’s not just doctors, however. Patient access to medication and consultations on its proper use with the pharmacist they know and trust are also suffering. Particularly in Medicare drug plans, insurance middlemen are telling some patients to pay more – sometimes significantly more – or switch pharmacies, even if it means traveling 20 miles or more.
But perhaps unlike the physician narrow network conundrum, there is an easy, obvious solution to the narrow pharmacy network issue in Medicare drug plans: H.R. 4577, the Ensuring Seniors Access to Local Pharmacies Act.
The bipartisan proposal would give seniors in medically underserved areas more convenient access to medication at discounted or “preferred” copays at additional pharmacies that are willing to accept the plan’s terms and conditions. Currently, independent community pharmacies are usually locked out of these smaller or “preferred” networks. Moreover, when community pharmacists offer to accept the same terms and conditions they are still kept out. Independent pharmacies make up approximately half of all rural pharmacies, so their patients must pay this “rural tax” or travel great distances to reach a “preferred” pharmacy.
Three out of four likely voters (76 percent) support this proposal, according to a recent nationwide opinion survey conducted by Penn Schoen Berland, or PSB Research. Support runs across party lines as well as demographic ones, such as gender and age.”
“Businesses with fewer than 50 workers are exempt from the most stringent requirements for larger employers under the federal health-care law. But that doesn’t mean they’re off the hook entirely.
Smaller employers aren’t required under the Affordable Care Act to offer coverage for their full-time workers—as larger firms must by 2016 or face penalties, for instance. But many owners of small ventures and startup entrepreneurs are nonetheless facing big changes to how they obtain their own health coverage, as well as to the benefits they’re able to offer employees.
“It’s a myth that smaller firms aren’t being hit” by the health law, albeit in less obvious ways, says James Schutzer, president of the New York State Association of Health Underwriters, referring to employers with fewer than 50 workers.
Several thousand of the nation’s smallest business owners—sole proprietors and the self-employed—were kicked off their small-business plans by carriers earlier this year. That is because new guidelines define “employers” as having at least two full-time employees, not including a spouse, in order to be eligible for group plans.”