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Category: Health Care Reform

Five Myths About the ACA and Midsize Businesses

ACA and Midsize Businesses: Many businesses are struggling to understand and comply with the rules of the Affordable Care Act (ACA). Here are five common myths* midsize group clients (51-100 employees) may need your help with to understand:

· Myth #1: Our business is exempt from the Affordable Care Act’s employer mandate
Companies with more than 100 full-time employees must provide health insurance to full-time workers starting this year. In 2016, your employer clients with 51-100 full-time workers also will have to provide coverage.

· Myth #2: Most businesses of our size don’t provide health insurance today
The ACA requires your midsize employer groups to change their existing coverage. But, only a small percentage will be offering coverage for the first time.

· Myth #3: Even if we are penalized for not providing coverage, we can deduct the penalty on our income taxes
Companies that fail to comply with the employer mandate are subject to a penalty. But the mandate is set up as a shared responsibility fee. This makes the penalty a tax that cannot be deducted for federal income tax purposes.

· Myth #4: We can continue to offer a limited benefit or mini-med plan
Limited benefit plans do not meet ACA rules, so any midsize group clients currently offering these types of plans will need to upgrade their coverage to meet the employer mandate.

· Myth #5: We will have to buy our insurance from a government website
The Small Business Health Options Program (SHOP) is the online Health Insurance Marketplace, or exchange, for businesses. But, let your clients know that using the exchange is optional. Employers can come to you at no extra cost and buy directly from an insurance company.

Read the full article here.

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

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Narrative Matters: On Our Reading List

“Narrative Matters: On Our Reading List” is a monthly roundup where we share some of the most compelling health care narratives driving the news and conversation in recent weeks.

End Of A Journey

For those who knew Paul Kalanithi or read about his medical journey, it was a sad month to say goodbye to the neurologist, whose battle with lung cancer was told in stages, as he came to terms with his fate and the disease that would soon overtake him. “Time for me is double-edged,” Kalanithi writes in his essay, “Before I Go,” published in the spring 2015 issue of Stanford Medicine.

“Every day brings me further from the low of my last cancer relapse, but every day also brings me closer to the next cancer recurrence – and eventually, death.” Kalanithi closes with touching words for his infant daughter, Cady, who he will not be able to see grow up. “Do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years … right now, that is an enormous thing.” Kalanithi died on March 9 at age 37.

Life After Cancer

For survivors of cancer, attention shifts from managing the disease to putting the experience behind them and moving forward with their lives. Suleika Jaouad details her own confusion, depression, and conflicting emotions surrounding her life post-cancer in “Lost In Translation,” part of the “Life, Interrupted” series for The New York Times.

“In some ways the hardest part of my cancer experience began once the cancer was gone,” she writes of her struggle to understand her feelings of depression and isolation. Jaouad notes that cancer centers need to channel more resources and energy into accommodating the myriad needs of cancer survivors as well as cancer patients.

Living With Disability

Emily Wick received a diagnosis of rheumatoid arthritis in a letter, one she read with disbelief as the life-altering news sunk in. “My first response was to laugh,” she writes. “Doesn’t something of this nature warrant a phone call? At least some bold print?” Wick, an otherwise healthy 24-year-old, details her coming to terms with the disease in her essay, “How I Kept Living When My Body Turned On Me,” published in BuzzFeed.

“It’s the embarrassment of repeated sick days, the fear of being seen as unreliable. Trying to explain the fatigue to my friends and coworkers and worry that they’re thinking, ‘Well, I’m tired too.’” Without knowing what is next, Wick views others with disabilities in a new light, in terms of a “possible future where I might be them.”

Read the full article here.

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

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Americans Slightly More Positive Toward Affordable Care Act

Americans’ views about the Affordable Care Act are more positive now than they were last fall, although overall attitudes remain more negative than positive. Half of Americans now disapprove of the 2010 law, while 44% approve — the narrowest gap since October 2013. By comparison, last November, just after the strong Republican showing in the midterm elections, 56% of Americans disapproved and 37% approved.

Americans’ support of the Affordable Care Act has fluctuated substantially in recent years, reaching as high as 48% in November 2012, just after President Barack Obama was re-elected, and dropping to as low as 38% in January 2014 and 37% last November. The latest update, based on interviewing conducted April 1-4, shows that Americans have returned to the more positive evaluation of a year and a half ago — albeit one that remains net negative. The shift in attitudes over the past four months may reflect the public’s awareness of data showing that the percentage of Americans who are uninsured has dropped substantially since the ACA-mandated open enrollment periods for obtaining insurance began to take effect.

Although opinions of the ACA have become somewhat more positive, Americans’ attitudes about the law’s impact on their own personal healthcare have not shown much change. The majority of Americans continue to say the law has had no effect on their healthcare so far, while the percentage who say it has hurt their situation continues to be marginally higher than the percentage who say it has helped.

Read the full article here.

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

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New Rules Offer Clarification about Employer-Sponsored Wellness Programs

On April 16, the Equal Employment Opportunity Commission (EEOC) published a long-awaited proposed rule on employer-sponsored wellness programs. The new regulation gives much needed guidance to both employers and employees about how wellness programs offered as part of an employer’s group health plan must comply with the Americans with Disabilities’Act (ADA) and the provisions governing wellness programs in the Health Insurance Portability and Accountability Act (HIPAA) and the PPACA. NAHU appreciates the clarification this proposed rule brings. It will be a real benefit to the many employers who offer wellness programs to their employees already and may also help other employers begin to offer more meaningful wellness opportunities to contain medical care costs and improve the health and well-being of their workers.

The proposed rule describes how Title I of the ADA applies to employee wellness programs that are part of group health plans and includes questions about employees’ health (such as health risk assessments) and medical examinations (such as screening for high cholesterol, high blood pressure or blood glucose levels). To be acceptable, such programs must be voluntary and employers must provide employees with a notice that describes what medical information will be collected as part of the wellness program, who will receive it, how the information will be used and how it will be kept confidential. Employers are bound to keep data collected as part of the program private and provide employees that opt for it with reasonable alternatives. Furthermore, the employers are bound by the financial incentive limitations of the PPACA, so financial incentives for wellness programs may not exceed 30% of the cost of coverage and smoking cessation incentives may not exceed 50%.

Read the full article here.

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

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Refocusing Philanthropy After ACA Implementation

For the past several years, many of us in health philanthropy have seen the implementation of the Affordable Care Act (ACA) as a key opportunity for attention and investment. At the New York State Health Foundation (NYSHealth), we focused resources first on supporting and sharing policy analyses and providing technical support to help our state implement the law well. In 2013 we prioritized outreach and enrollment efforts to ensure that as many New Yorkers as possible got covered.

Given the success of the new insurance program, the question for many of us leading health philanthropies is: Where should we turn our attention next?

One obvious thought is to devote more attention to keeping people healthy (and thus requiring less medical care). We at NYSHealth are devoting more of our resources to encouraging healthy communities that make it easier for residents to eat healthy and stay physically active. We are joined by many other health philanthropies that fund a broad array of initiatives focused on the prevention of health problems.

But crucial challenges remain in our medical care system; these deserve philanthropic attention and offer opportunities to help Americans get better medical care. My three favorite examples are the following:

Covering those who remain uninsured: Although we have made great progress, with approximately 20 million Americans newly insured with public or private plans since implementation of the ACA began, we still have work to do to expand coverage to those who have been left out.

One clear opportunity is to explore ways to extend coverage to undocumented immigrants, who are prohibited from purchasing health insurance through the exchanges and are ineligible for coverage using any federal Medicaid funds. President Obama’s recent executive order expanding immigration status protections for certain groups of undocumented immigrants will (if not overturned by the courts) open up some new avenues for coverage in a couple of states. In New York State, for example, we estimate that 250,000 undocumented immigrants could be covered because New York already extends state-funded Medicaid coverage to all low-income legal residents. California has a similar practice in place.

It has been estimated that nearly one-quarter of those remaining uninsured are undocumented immigrants; attention to this population could lead to substantial gains in the rate of insurance. Foundations can help support outreach and enrollment efforts to help ensure that undocumented people who are eligible can sign up for coverage. Philanthropy also has a role to play in pushing for state-level policy options to extend insurance coverage to undocumented immigrants.

A large portion of Americans also remain uninsured because of the so-called “coverage gap” in states that have not expanded Medicaid. More than 3.8 million people fall into this category, with the most residing in Texas, Florida, Utah, and Georgia. While the political climate, of course, is extremely challenging, both state and national foundations can play a role in advocating for Medicaid expansion and educating policy makers about the benefits not only to the health of residents but also to the financial health of states choosing to participate in the expansion.

Read the full article here.

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

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