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Steven G. Cosby, M.H.S.A.
President & CEO
Cosby Insurance Group



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The First Attacks Based on the CBO Report on Obamacare and Workers

The Congressional Budget Office report on the impact of the Affordable Care Act was released on Tuesday, and already we have the first attack ads.
The Fact Checker devoted one column to explaining what the CBO’s report actually meant. But we have long learned that all the fact checks in the world won’t stop politicians if they think an attack line moves voters. So how do these early attacks fare?

Read full article here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

BREAKING: FTC Wins Appeal in ProMedica Case

The Federal Trade Commission extended its recent winning streak in healthcare cases Tuesday when a federal appeals court agreed that a 2010 hospital acquisition by Ohio’s ProMedica system was illegal.

In a 22-page opinion, a unanimous panel of judges at the 6th U.S. Circuit Court of Appeals in Cincinnati wrote that the FTC correctly decided that Toledo-based ProMedica was extremely likely to illegally increase prices after buying the suburban St. Luke’s Hospital in Maumee, a well-to-do corner of Lucas County, Ohio.

The court upheld an earlier order from the FTC that ProMedica must divest St. Luke’s to another buyer. The judges ruled none of ProMedica’s arguments against the order were strong enough to overturn it.

“We are extremely disappointed by today’s decision and intend to appeal,” ProMedica said in a statement. “We are committed to exhausting all of our legal options.”

The decision has been closely watched because it’s likely to be appealed to the U.S. Supreme Court in an era when government regulators including the FTC are taking an increasingly aggressive stance in hospital-merger cases.

Read the full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Americans Remain Negative Toward Healthcare Law

With the open enrollment period for obtaining health insurance through a federal government exchange now over, Americans’ views on the broader healthcare law remain more negative than positive. Currently, 43% approve and 54% disapprove of the law, commonly known as “Obamacare.” The approval figure is a bit higher than Gallup’s estimates since last November, but disapproval is essentially unchanged.

Read full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Cost a Main Reason for Americans Remaining Uninsured

As of April 1, more than 7 million people have enrolled in private health insurance coverage through the Affordable Care Act. Yet, the percentage of Americans without health insurance was 15.9% as of Feb. 28, according to latest research available from Gallup. The Market Strategies International study of 2,741 adults conducted Feb. 20-March 13, found that seven-in-10 of those surveyed did not intend to enroll in coverage prior to Obamacare’s March 31st deadline. Kaiser Family Foundation estimated the number of uninsured as 47 million in 2012.

Read full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Sylvia Mathews Burwell?

Who is Sylvia Mathews Burwell? The likely new face of Obamacare.

Health secretary nominee Sylvia Mathews Burwell, from small-town West Virginia, has served in numerous government posts, including Obama’s budget director. Republicans praise her low-key manner.

President Barack Obama, stands with his nominee to become Health and Human Services secretary, Budget Director Sylvia Mathews Burwell, while speaking in the Rose Garden of the White House in Washington, Friday, April 11, 2014, where he made the announcement. Burwell would replace Kathleen Sebelius who announced her resignation Thursday. by Susan Walsh/AP

If President Obama gets his wish, Sylvia Mathews Burwell will be his new Health and Human Services (HHS) secretary – and the new face of Obamacare.

Ms. Burwell, nominated Friday by Mr. Obama to replace the embattled Kathleen Sebelius at HHS, is no stranger to that turbulent place where policy meets politics. As Obama’s budget director for almost a year, Burwell had to manage the first partial federal government shutdown in 17 years last October. And she helped lead negotiations last summer with Senate Republicans on a possible “grand bargain” to raise taxes and reform entitlements.

Those talks failed, but Republicans praised her low-key manner and genial demeanor, a style that will serve her well if she is confirmed, as expected, to run HHS. The turbulent first open enrollment period for Healthcare.gov has finished, and now Secretary Sebelius is ready to hand off the heavy lifting of continuing Obamacare implementation, running a massive government department with numerous agencies, and facing off against Republicans on Capitoll Hill.

In his announcement in the White House Rose Garden Friday, Obama offered praise for Sebelius, and spoke highly of Burwell’s leadership ability.

Burwell is “a proven manager who’s demonstrated her ability to field great teams, forge strong relationships, and deliver excellent results at the highest levels, and she’s done it both in the public and private sector,” Obama said.

The president also noted her small-town roots – she grew up in Hinton, W.V. – and praised her “common sense.”

“She brings the values of caring about your neighbor and ordinary folks to some of the biggest and most complex challenges of her time,” Obama said.

The daughter of a doctor and small-town mayor, and the granddaughter of Greek immigrants, Burwell has worked in and out of government much of her adult life. She served in a succession of posts during the Clinton administration: staff director for the National Economic Council, chief of staff to the Treasury secretary, deputy chief of staff for policy to President Clinton, and finally, deputy director of the Office of Management and Budget, which she currently runs.

In the private sector, she worked for the Bill & Melinda Gates Foundation, and more recently led the Walmart Foundation. Before joining the Clinton administration, she worked for McKinsey & Company consultancy.

Burwell also has political experience. Her mother was mayor of Hinton, and while in college, Burwell interned for Rep. Nick Rahall (D) of West Virginia. Later, she worked for the Dukakis and Clinton presidential campaigns.

Burwell received her undergraduate degree from Harvard University, and got another degree from Oxford University as a Rhodes scholar.

In person, Burwell comes across as down-to-earth. As the guest at a breakfast last month hosted by The Christian Science Monitor, she expressed concern for the welfare of federal workers, who have dealt with furloughs and frozen pay in recent years. As head of OMB, she said, maintaining and developing a high-quality federal workforce would be one of her top priorities.

“It’s a very challenging issue,” Burwell said at the breakfast. “I can’t tell you the point in time when we crash. It’s important enough we need to bear down.”

She also described the decisionmaking process she went through when she was offered the OMB directorship, and considered what it would mean for her husband, lawyer Steve Burwell, and their two young children to move from Bentonville, Ark., to Washington, D.C.

“I sat there with the yellow pad and [was] like, OK, what are the pros and cons, what will be the things that will be difficult, let me think through this before we make a decision as a family,” said Burwell.

On Facebook, Democratic strategist Peter Fenn, who lives near the Burwells, described them as “terrific neighbors.”

“Sylvia will do a wonderful job as the new head of HHS,” Mr. Fenn said. “She is solid, savvy, and smart, and can deal with Congress.”

Burwell also earned early praise from the other side of the aisle. Sen. John McCain (R) of Arizona tweeted Thursday night that Burwell was “an excellent choice to be the next HHS secretary.”

Other Republicans withheld judgment on Burwell’s nomination, but spared no words on the Affordable Care Act.

“The president’s signature domestic policy achievement is an unmitigated disaster,” Sen. Orrin Hatch (R) of Utah, ranking member of the Senate Finance Committee, said Friday in a statement. “This deeply flawed law has hurt millions of hard-working American families, job creators, and seniors in the form of rising premiums, higher taxes, and fewer choices.”

Still, Senator Hatch said he looked forward to a “frank discussion” on her nomination and would work with his committee colleagues toward a “fair and thorough vetting process.”

Another key Senate Republican was less charitable.

“I am concerned that director Burwell may have been chosen because the president believed her to be another political loyalist who would toe the party line,” said Sen. Jeff Sessions (R) of Alabama, ranking member of the Senate Budget Committee, in a statement.

“Ms. Burwell has a comparatively thin resume for the demands now placed on this position – she has never run anything on the scale of HHS – and, during her short stint as budget director, she did more to obscure the nation’s poor financial state than to illuminate it.”

This article was originally published by Linda Feldman and can be found at the Christian Science Monitor.

Read the full article here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Gibbs Predicts Employer Mandate Will Be Killed

A former longtime advisor to President Barack Obama predicted Wednesday that the employer mandate — a key piece of Obamacare — will not survive.

It was among several predictions Robert Gibbs, former White House press secretary, had for the future of the Patient Protection and Affordable Care Act in a speech at the 2014 Benefits Selling Expo.

“I don’t think the employer mandate will go into effect. It’s a small part of the law. I think it will be one of the first things to go,” he said to a notably surprised audience.

The employer mandate has been delayed twice, he noted. The vast majority of employers with 100 or more employees offer health insurance, and there aren’t many employers who fall into the mandate window, he said.

Killing the employer mandate would be one way to improve the law — and there are a handful of other “common sense” improvements needed as well, he said.

Read the full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Employers Take Wait-and-See Approach to Private Exchanges

Employers are making creative changes to employee benefit offerings to stem the tide of rising health care costs, but many are taking a wait-and-see approach to private exchanges, according to presenters at MetLife’s 10th National Benefits Symposium Monday.

Read full article here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

HR Leaders Rate ACA Concerns as a Lower-Tier Issue: Survey

New research from a North American sample of HR leaders finds that the Affordable Care Act is not a primary concern among employers, even as the landmark health care law continues to worry the masses.

Read full article here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

$1 million for each physician – Medicare Payments

On Wednesday, in response to years of pressure from media outlets and consumer groups, CMS released detailed data about payments it made in 2012 to Medicare participating providers. Overall, the data shows $77 billion in billing by 880,000 doctors and indicates that Medicare paid nearly 4,000 physicians in excess of $1 million each in 2012. The data does not indicate what providers billed private insurance carriers.

The data has raised numerous questions about the high amounts some physicians and some medical specialties in general have received. The top three providers in terms of payment are all under official federal fraud scrutiny and one of the three is awaiting trial on Medicare fraud charges. But high numbers do not necessarily mean wrong-doing. The amounts listed in the report only reflect a physician’s payments from Medicare, not their actual costs. Overhead in physician practices can be substantial, particularly in some specialty areas. Some high service payments can also be explained by the high costs of both prescription drugs and medical devices associated with treatment. For example, if a doctor is paid $1,000 for a procedure that includes a $750 medical device, the report just notes the procedure performed and the $1,000 payment. It does not show that the $1,000 paid normally reflects both the doctor’s time and the cost of the device used. Furthermore, one doctor’s billing number may have been used by many in a practice for billing purposes and errors in the data are also possible. “Using the assumptions that Medicare and the AMA make when setting payment rates, only 23 of the 4,000 biggest billers personally earned $1 million or more, according to a Washington Post analysis.”

But what does this unprecedented data really mean for consumers anyway? CMS officials noted their goal in finally releasing the information publicly was to help detect fraud, inform consumers and help promote improvements to care. Given that Medicare is our nation’s single largest insurance program; any increase in transparency is likely to spillover to the regular private market. Furthermore, analysts thoroughly reviewing the data are expected to find a treasure trove of information about what is actually driving medical care costs at least among the senior population, which could have widespread provider payment and cost ramifications for all consumers. Exposing the data could also lead to Medicare payment reforms, particularly concerning the way Medicare reimburses for certain drugs and services. The program has long been criticized as incentivizing providers to prescribe more expensive drugs and services than necessary, and the release of this data will help determine the overall validity of that charge. Furthermore, consumer groups have noted that making the data public could help individual consumers learn valuable information about their specific providers. For example, a very thorough consumer checking up on their doctor could determine exactly how many times the physician has performed certain procedures, which might be important to them given that experience is often an outcome indicator.

Bottom line, the data is enormously detailed and probably won’t be terribly helpful for the average Joe. However, we expect that the kind of health nerds who can actually perform higher math will have a field day with this information. While this is not our personal kind of health nerdity, we greatly respect the skills of others and expect their work with this information will have far-reaching cost reduction implications in the future.


The following checklist provides insurance agents/brokers, employers and benefits and payroll professionals key upcoming dates and deadlines related to health benefits. This reminder list does not constitute all of the deadlines applicable to employers and some deadlines may be different based on variations in plan year or plan design.

Read full article here.


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