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Category: Health Care Reform

Workplace Wellness Programs: Federal Agencies Weigh In

On April 15, 2015, Supreme Court Justice Alito stayed the final order of the federal Court of Appeals for the Third Circuit in Zubik v. Burwell. The Third Circuit had denied rehearing of its order denying relief in a case in which two Catholic dioceses, among other religious organizations, had challenged the administration’s latest accommodation of religious objections to compliance with the contraceptive coverage mandate issued under the Affordable Care Act. The administration had proposed the accommodation, which merely requires religious organizations to notify the government of an objection to compliance and then leaves the government responsible for ensuring compliance, in response to an earlier Supreme Court order which had indicated this approach was acceptable. Justice Alito gave the government until April 20 to respond. The contraceptive issue is now again before the Supreme Court.

Workplace wellness programs are very controversial. Employers believe that they improve employee health, reduce absenteeism, and cut the cost of employee health benefit programs. They are encouraged in this belief by wellness program vendors, who aggressively tout the benefits of their programs. Disability advocates, on the other hand, are concerned that wellness programs are perpetuating discrimination against the disabled and health status underwriting. Privacy advocates worry about who has access to the sensitive medical information that wellness programs demand of participants. Others worry about the control that employers assert over their employees’ lives through wellness programs, as employees spend hours of off-the-clock time every week meeting the demands of wellness programs while wearable devices track their footsteps.

Wellness programs are a product of the Health Insurance Portability and Accountability Act of 1996, which outlawed health status underwriting in group health benefit programs, but allowed group health plans to offer incentives to employees for participation, or penalties for nonparticipation, in wellness programs that met certain requirements. The Affordable Care Act extended HIPAA’s prohibition against health status underwriting to the individual and small group markets, but reaffirmed the wellness program exception, in fact increasing the size of incentives or penalties that employers could offer or impose. Final ACA wellness program regulations were promulgated by the Departments of Labor, Health and Human Services, and Treasury in June of 2013, defining the conditions under which wellness programs could be offered.
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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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Big Impact on Women if Supreme Court Rules Against Health Care Tax Credits

Seven months after being diagnosed with breast cancer and later undergoing a double mastectomy, LaDonna Appelbaum of St. Louis recently finished her 16th and final chemotherapy treatment.

Without the $600 monthly tax credit that pays the bulk of her insurance premium under the federal health care law, Appelbaum isn’t sure how she and her husband, Tom, would have paid for her medical care.

She still faces 33 radiation treatments, several reconstructive surgeries and a host of medical challenges.

And while she’s optimistic about the complex care that lies ahead, Appelbaum worries that the U.S. Supreme Court could declare illegal the tax credits that help make it possible.

The high court is expected to decide in June whether to continue the tax credits for Appelbaum and others who live in the 34 states where the federal government operates the health insurance marketplace.

The stakes are not only high for Appelbaum but for all women who make up a majority of marketplace plan enrollees.

Plaintiffs in the King v. Burwell case argue that a section of the Affordable Care Act says the tax credits can only go toward coverage purchased “through an exchange established by the State.”

If the plaintiffs prevail and tax credits are disallowed in Missouri and 33 other states, millions of Americans could immediately find their insurance unaffordable and subsequently drop coverage.

The majority of those coverage losses would likely fall on women. Females probably account for 54 percent of the 8.6 million marketplace plan members in the 34 states that rely on the federal exchange at HealthCare.gov.

And national trends suggest that roughly 87 percent of these women – nearly 4.2 million – receive tax credits that could be lost if the Supreme Court decides that the subsidy is illegal.

Losing their coverage means they no longer would benefit from consumer protections in the health law that outlawed discrimination against women in the individual insurance market.

Although her husband is an attorney in private practice, Appelbaum said business is slow and they can’t afford their $900-per-month insurance premiums without the subsidy.

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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The Cost And Quality Of Cancer Care

The April issue of Health Affairs contains a cluster of papers focusing on the cost and quality of cancer care. Other subjects covered in the issue: health care payment reform; the diminished number of uninsured young adults; and regulatory approval of new drugs by the FDA.

Publication of the cancer studies in the April issue was supported by Precision Health Economics and the Celgene Corporation.

Does Increased Spending On Breast Cancer Treatment Result In Improved Outcomes?

Aaron Feinstein of Yale University School of Medicine’s Cancer Outcomes, Public Policy, and Effectiveness Research Center and coauthors compared care costs and survival rates among women ages 67–94 diagnosed with stage II or III breast cancer during two time periods, 1994–96 and 2004–06. They found that over the course of a decade, median cancer-related costs increased from $12,335 to $17,396 among women with stage II disease, and their five-year survival rate improved from 67.8 to 72.5 percent.

For those women with stage III disease, costs increased from $18,107 to $32,598 with an accompanying five-year survival improvement from 38.5 to 51.9 percent. The cost increase was largely attributable to a substantial increase in the cost of chemotherapy and radiation therapy.

The authors note that the price society is willing to pay for an additional year of life remains controversial in the United States and suggest that more research is needed to determine how to best contain costs while continuing to advance patient care.

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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Florida’s Governor No Longer Supports Expanding Medicaid

A little more than two years ago, Florida Gov. Rick Scott made an announcement that shocked the political world: the Republican, who had spent a portion of his personal fortune to oppose Obamacare when it was being drafted in Congress, now supported expanding Medicaid in his state.

And it wasn’t just the policy announcement itself. It was the emotional way in which Scott described his conversion from Obamacare hater to Medicaid expansion supporter, speaking about the loss of his mother just months earlier. Expanding Medicaid to nearly 1 million low-income adults was just a matter of doing what’s right, he said in February 2013.

“While the federal government is committed to paying 100 percent of the cost of new people in Medicaid, I cannot in good conscience deny the uninsured access to care,” said Scott, a former chief executive of the nation’s largest for-profit hospital chain. Scott advocated a temporary three-year program that could be reversed in case the federal government reneged on its funding promise.

But the Florida state legislature didn’t go along, passing up tens of billions of dollars in federal support. Florida is one of 22 states that haven’t joined the Medicaid expansion.

And yet the Florida legislature now appears to be reconsidering its stance, or at least debating it again.The Senate has passed a budget that includes federal expansion funding, but the plan faces stiff opposition in the House, which shut down the expansion two years ago. And Scott’s administration is in talks with federal health officials to extend a $2 billion funding pool for health-care providers treating uninsured residents. Those providers receiving funds from what’s known as the Low-Income Pool (LIP) would presumably benefit from expanded Medicaid. The Obama administration, which wants every state to expand Medicaid, has said it won’t continue LIP funds beyond this June.

Amid these discussions, Scott now says he opposes the Medicaid expansion. Citing the LIP negotiations, Scott issued a statement that he doesn’t think the federal government will live up to its funding promise, the Associated Press reported. The federal Department of Health and Human Services pushed back in a statement, saying that “the law is clear” on how much support the federal government must provide for the Medicaid expansion.

In a way, Scott’s change of heart isn’t all that surprising. After giving that emotional speech more than two years ago, Scott didn’t campaign for expansion or pressure lawmakers from his own party. Meanwhile, two Republican governors, John Kasich of Ohio and Jan Brewer of Arizona, made full use of their executive powers to expand Medicaid in their states (and faced lawsuits from state lawmakers because of it).

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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‘Cadillac Tax’ The Next Big Obamacare Battle

A mix of business groups and labor unions are pushing to tee up the next big Obamacare fight: killing its so-called Cadillac tax.

It is, they say, the type of Obamacare “fix” that Republicans and Democrats can agree on — notwithstanding the problem of filling an $87 billion budget hole that nixing the levy would produce.

Many expect it to be the next protracted battle over Obamacare — one that threatens to become a headache for Democrats, many of whom never liked the tax despite supporting the law more generally.

It’s one of the last big parts of the Affordable Care Act to go into effect — lawmakers delayed the levy until 2018 in part because it is so controversial — but companies are wrestling with it now as they plan employee benefits. Some are already negotiating with unions over benefits that could spill into 2018.

“This is going to have a life of its own as the clock ticks closer to 2018,” said Rep. Joe Courtney (D-Conn.), a critic of the tax.

Though the nickname suggests it will apply to a select few, experts say a majority of employers could eventually face the prospect of imposing what will be the first-ever tax on health care benefits.

The IRS began last month spelling out the nitty-gritty of how exactly the tax will work, though it left out many of the details employers say they need.

At issue is a 40 percent excise tax on the health benefits companies provide their workers above a certain threshold. In 2018, the tax will hit insurance and related perks valued at more than $10,200 for singles and $27,500 for families. So for family benefits worth $30,000, the tax would apply to the $2,500 that’s above the limit.

Taxing those benefits represents a major shift in generations-old tax policy.

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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