WGA InsureBlog

With health care costs escalating and the number of uninsured Americans estimated at 50 million, private entities as well as state and federal governments are trying to find effective solutions to ongoing health care problems. Earlier this year, Vermont passed legislation creating a single-payer healthcare system to be operational in 2017, potentially being the first state in the nation to have such a system. It is still too soon to assert that a single payer system is an effective way to combat rising health care costs and ensure coverage for all Vermont residents. Nevertheless, by taking the bold step to pass such a law, Vermont will be under scrutiny as the rest of the country watches what unfolds in the coming years. Read more…

Last Friday evening, HHS Secretary Kathleen Sebelius quietly closed the door on a key revenue component of Obamacare. The CLASS Act, a federally run long term care program that was set to launch next year and tasked with generating $80 billion in revenue over the next 10 years was cancelled. Sebelius in a press release finally openly questioned the programs ability to attract members and generate revenue for the federal government, an argument that opponents of the bill have been making since the concept was introduced.

The revenue claims attached to the CLASS Act have been highly controversial for several key reasons. Even if the wildly optimistic enrollment estimates were accurate, this program was a federally sponsored ponzi scheme in the making, Read more…

The affordability provision of the shared responsibility section of the Patient Protection and Affordable Care Act (PPACA) requires employers that offer health insurance to provide coverage that costs less than 9.5% of the modified adjusted gross income of an employee’s household. That’s a lot of technical speak, but for many, the big question is “How will we know what our employee’s household income is?”

The IRS has proposed a safe harbor test for employers to help them determine if their plans are affordable as part of the shared responsibility provisions of the Patient Protection and Affordable Care Act. They are seeking comments on this proposed safe harbor, and WGA would encourage employers that may be subject to potential penalties to review the safe harbor and provide comments. Read more…

A recently released survey of 1,300 employers by the management consulting firm, McKinsey & Company, found that 30 percent of them will probably or definitely stop providing health insurance to employees in 2014. At that time, exchanges will be operating and employers may pay a penalty whether they offer health insurance or not (go here for the entire report).

To me, the two most interesting statistics in the survey are:

1.  Over 50% of employers that have “a high awareness” about health reform provisions will follow this strategy. So, the more they know about the Patient Protection and Affordable Care Act (PPACA), the more they are thinking about such a radical change.

2. 85% of employees would remain at their jobs, but would expect higher pay to make up for what the employer has historically paid towards health insurance. So, as long as the company Read more…

On Wednesday, a federal appeals court in Atlanta heard arguments in the lawsuit that was brought by Florida and 25 other states. The three-judge panel expressed concern that some of the features of the Patient Protection and Affordable Care Act would have difficulty standing up to constitutional scrutiny. In addition to Atlanta there are two other federal panels that are set to hear challenges to the health reform law.

At the forefront of this court’s review is the “individual mandate” which requires everyone to carry health insurance or be subject to financial penalties. The acting U.S. Solicitor General who represented Health and Human Services, indicated that the individual mandate was a tax and therefore constitutional. This position is curious as it contradicts the message from the Obama administration in which individual taxes would not be increased as a result of the health reform law. See the CNN article for more details.

Connect with Anita Verheul on LinkedIn.      Photo via CNN.

An interesting article in Sunday’s New York Times points to the financial difficulties many nursing homes and home health care agencies will face starting in 2014 in order to comply with the new federal health care law. The new health care law is supposed to guarantee access to affordable coverage for all. But many nursing homes and home care agencies have started lobbying efforts seeking some kind of exemption or special treatment. Starting in 2014, the law will require employers with 50 or more full-time employees to offer affordable coverage or risk paying a penalty. For a midsize nursing home, that penalty could easily exceed $200,000 a year. The American Health Care Association, the largest trade group for nursing homes, says the problem is that reimbursement rates for Medicaid and Medicare do not pay them enough to offer their employees medical coverage. Read more…

Beginning this week and over the next month, round two of the legal challenges and defense of the Patient Protection and Affordable Care Act (PPACA) hit the appellate courts. In summary:

• Tuesday, May 10: The Fourth Circuit court will judge two different rulings in Virginia about the law. One ruling in Richmond federal court found the individual mandate unconstitutional while the opposing ruling in Lynchburg upheld the constitutionality of the individual mandate.

• Wednesday, June 1: The Sixth Circuit in Cincinnati will hear an appeal against a lower court ruling that upheld the law. This multi-state lawsuit Read more…

It’s been five years since the landmark legislation that catapulted Massachusetts to the head of the national healthcare discussion. In 2006, a republican Governor and a democratic legislature joined together to pass Massachusetts health reform. The initial intent of Chapter 58 was the expansion of healthcare to all residents of the Commonwealth. At the time there was little conversation about the overall cost or quality of the care being delivered. Sound familiar? This is not dissimilar to what we saw only a few short year’s later on the federal level.

On this fifth anniversary, the Blue Cross Blue Shield Foundation released Health Reform in Massachusetts: Assessing the Results. This is a brief, very readable summary of some of the surveys conducted by various state agencies. Below are some of the highlights that have particular relevance to Read more…

I played chess a fair amount when I was younger, and was good but never great at it.  The part of the game that I always appreciated was how, as pieces moved or were eliminated from the game, the dynamics could radically change.  One minute, you’re on the offensive and feel like you’re winning.  Two moves later,  your suddenly retreating into defense and possibly losing.  Sometimes the pace is swift; other times, it’s slow and deliberate.

Health Reform has been and continues to feel like chess, and those of us at WGA continue to follow events like a massive game with serious consequences.

In November, Republicans took back control of the House and introduced as House bill #2 an effort to repeal the Patient Protection and Affordable Care Act.  The bill passes with unanimous Republican and some Democratic support.  (Black knight moves). Sen. Harry Reid refuses to introduce the Read more…

The Boston Globe ran a front page article last week  explaining some new health plans that are being implemented as a means to control health costs. These plans are known as tiered or limited network plans that require a deductible if an employee wishes to be treated at these designated high cost facilities. The purpose of the plans is to drive employees to the lower cost facilities; however, employees can choose the higher cost facilities should they agree to pay the deductible associated with these providers or hospitals.

Typically, the deductibles for these plans can range from $500 to $2,000 per visit. These plans are different from the high deductible plans that have been available for a number of years. The high Read more…