NYBGH has Renamed and Relocated!

New York Business Group on Health has expanded to help employers across the northeast improve health care. As part of the expansion, the organization has been renamed to Northeast Business Group on Health (NEBGH). The new and improved NEBGH blog can be found at www.nebgh.org/blog, where all new posts created after November 22, 2010 will be available.

A press release announcing the name change is available by clicking here.

Please also visit us at NEBGH.org.

New York Employer Coverage Survey Released

A new report on employer-sponsored health insurance, released this week by the New York State Health Foundation, indicates that the percentage of New Yorkers covered by their employer has fallen over the last decade, from 69% in 2001 to 58% in 2009.  This percentage is, furthermore, slightly lower than the national average of 65%.  The percentage of employers actually offering coverage, though, remained steady at 70% over the same period.  Decreases in take-up are attributed to tighter eligibility rules, increased cost-shifting, and limited coverage choices.

The complete report, "Decade of Decline: A Survey of Employer Health Coverage in New York State" can be accessed by clicking here.

CMS Launches Innovations Center and Announces New York's Inclusion in an Eight-State Medical Home Demonstration

The Centers for Medicare and Medicaid Services (CMS) announced the opening of its new Center for Medicare and Medicaid Innovations and the launch of demonstration projects, one of which will include New York State.

The CMS Innovations Center was created by the Affordable Care Act in hopes to jump start innovation in health care payment and delivery reform through the promotion of quality and coordinated care. The permanent center will be guided by a diverse stakeholder group consisting of members from a broad range of the health care marketplace that includes hospitals, physicians, consumers, payers, states, employers, advocates, and other federal agencies.

In short, the Innovation Center seeks to promote better care for individuals, develop models to coordinate care to improve health outcomes, and create community care models. In addition to these specific focuses of the Innovation Center, CMS also announced the launch of three care coordination projects: Expansion of the Multi-Payer Advanced Primary Care Practice Demonstration (in which New York will participate), the Federally Qualified Health Center Advanced Primary Care Practice Demonstration, and the launch of the Medicaid Health Home State Plan Option. There will be an additional $1 million in grants provided to states for demonstration projects they design.

To learn more about the CMS Innovations Center visit http://www.innovations.cms.gov/

NYBGH Annual Meeting Tomorrow! Uwe Reinhardt Giving Keynote

Please join us for the NYBGH 2010 Annual Meeting tomorrow, November 10th from 4:00 to 7:30pm.  The business portion of the meeting runs until 6:00pm, with cocktails until 7:30pm.  Registration begins at 3:45pm.

The keynote speaker is Uwe E. Reinhardt, James Madison Professor of Political Economy and Professor of Economics at Princeton University.  His speech is titled, "The Accountable Care Act: Why Have It? What Next?"

The event is being held at Con Edison, located at 4 Irving Place (at 14th Street) in Manhattan.  To register, please visit www.nybgh.org. 

NEJM Article Examines Health Care in the Mid-Term Election

A recent article in the New England Journal of Medicine (NEJM) examines various public polls assessing the public's mood on health reform and how it might affect the results of Tuesday's mid-term Congressional election.  Robert Blendon and John Benson of the Harvard School of Public Health argue that not only will health reform affect how individuals vote, but also that Tuesday's outcome could have a significant impact on the rest of health reform implementation. 

The authors show that Americans' view of health reform remained relatively stable before and after reform's passage.  Additionally, they put forth the following six assertions:

• Americans today generally have very negative views about the general direction of the country, which can be seen in their inclination to not vote for incumbent candidates
• Health care is an important but secondary issue in the election, with jobs and the federal budget deficit being at the forefront
• More than seven months since reform's passage, a majority of Americans neither support or oppose the package; however, 38% of registered votes believe that the US economy will be worse off than better off (21%) because of the health reform law
• 41% of registered votes think that most provisions of the law should be repealed and replaced with a completely different set of proposals
• Most registered voters (73%) who intend to vote for a Democrat support the reform law, while 80% of registered votes who intend to vote for a Republican oppose the law
• Polling results indicate that there is considerable political uncertainty about the future of the health reform law

The complete article can be found by clicking here.

Health Information Exchange Decoded

A recent post by Margalit Gur-Arie on The Health Care Blog provides a beginner's guide to the concept of health information exchange.  Following its introduction, the post describes both the centralized and federated models in addition to explaining how the HITECH Act has and will continue to impact the field.

Click here to access the full post.

Health Reform Lawsuit to Move Forward

Yesterday a federal judge in Florida ruled that multi-state challenges against the individual mandate and Medicaid expansion under the new health reform law can move forward.  Florida Northern District Judge Roger Vinson did not rule that he agrees with the assertion that the law is unconstitutional, but only that it won't be dismissed outright, as the Obama administration had requested.  However, four other counts related to taxation and requirements that states enforce the law were thrown out by Vinson.

The challengers argue that the individual mandates seeks to regulate "inactivity" because it would penalize people for not buying health insurance.  In his ruling, Vinson appears open to this line of reasoning, quoting a 16 year old Congressional Budget Office (CBO) report concluding that "A mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action.  The government has never required people to buy any good or service as a condition of lawful residence in the United States."  Though, Vinson added a disclaimer in which he adds, "Of course, to say that something is 'novel' and 'unprecedented' does not necessarily mean that it is 'unconstitutional' and 'improper.'  There may be a first time for anything.  But, at this stage of the case, the plaintiffs have most definitely states a plausible claim with respect to this cause of action."

The White House, though, remains optimistic that the law will hold.  The administration's response, via The White House blog, can be found by clicking here.

Vinson's ruling can be found by clicking here.
The story, as reported by The Hill, can be found here.

Health Plan Trend Expected to Hold Steady in 2011

Segal Company's recently released 2011 Health Plan Cost Trend Survey estimates that medical and prescription drug cost trend will remain relatively unchanged from 2010.

The survey indicates that 2008 was the bottom of a downward pattern and that trend began elevating again beginning in 2009.  Also noted is that one of the short-term drivers of health plan cost trend is compliance with the new health reform law - the Patient Protection and Affordable Care Act.  

As reported by Business Wire, Key findings of the survey include:

• Compared to 2010, trend rates for indemnity plans and high-deductible health plans (HDHPs) are expected to decrease in 2011.

• Trend rate for preferred provider organizations (PPO) and point of service (POS) plans are slightly higher than in 2010.

• All 2010 medical plans types are projected to experience cost trends that are more than eight times higher than the consumer price index for all urban consumers.

• Prescription drug trend projections have remained below 10% for the last three years.

• Price inflation for inpatient hospital stays is the largest component of overall plan cost trend.

The complete findings of the 2011 Health Plan Cost Trend Survey can be found by clicking here.

Kaiser Family Foundation Launches Revamped Site

Today the Kaiser Family Foundation (KFF) launched a revamped version of their health reform gateway, chock full of resources on the new health reform law.  Included on the site are new features that provide explanations of the basics of the law, in-depth analysis of policy issues in implementation, and quick and easy access to relevant data, studies, and developments.

One of the site's new features, The Scan, provides a daily feed of easily-digestible summaries of the latest research and studies from the Foundation and others, as well as official actions and other developments related to the health law. Other new elements include:

• A customizable implementation timeline,
• A series of video clips featuring experts answering specific questions about the law and on a variety of other health policy topics,
• An interactive state map with key state-specific information related to health coverage and the health law,
• A public opinion poll tracker,
• A health reform subsidy calculator, and
• An official document finder that provides quick access to federal regulations and studies related to the health law.

Click here to access the new site.

Health Costs Projected to Continue Climbing

A new report from the Centers for Medicare and Medicaid Services' (CMS) Office of the Actuary notes that health care costs are expected to increase at a slightly higher rate over the next 10 years because of the new health reform law. The authors estimate that national health spending will reach nearly $4.6 trillion by 2019, increasing by 6.3 percent on average annually. This increase is 0.2 percentage points faster than expected before the health reform law was passed in March. Additionally, the team of economists predict that health spending will be at 19.3 percent GDP in 2019.

The report, published in Health Affairs, can be found by clicking here.
The New York Times story is available here.
And The Wall Street Journal article is here.

Texas Employers Unite to Lower Costs

On Thursday a group of nine North Texas employers announced the creation of a three-year effort called the "Texas Health Strategy Project", aimed at creating high-value benefit packages for their employees. The employers involved are Archon Group, Brinker International, the cities of McKinney and Mesquite, Energy Future Holdings, the Federal Reserve Bank of Dallas, Haggar Clothing, Interstate Batteries and Triumph Aero-Structures.

By collecting more employee-level data and improving how they manage health benefits, the group hopes to keep workers healthy and out of doctors' offices. Additionally, by banding together, the employers hope to more efficiently comply with the health reform law's new requirements. National Business Coalition on Health President Andrew Webber is quoted in the article as quipping, "As health care costs continue to rise, more employers are recognizing the value of tailoring benefits to the health risks within their employee populations."

Click here to read the complete article from the Dallas News.

NYBGH Health Reform Event

Tomorrow, August 25th, NYBGH is hosting a breakfast club event titled, "Health Care Reform: Getting Through 2011 Open Enrollment and Framing Longer-Term Strategies".  The event is sponsored by Mercer and is open to HR professionals and fund administrators only (including non-NYBGH members) and is complimentary.

Two Mercer benefits professionals will be the featured speakers: Barry Schilmeister, FSA, MAAA and Ilse de Veer.

The event will be held from 8:00 - 10:00am at the University Club of New York, located at One West 54th Street (at Fifth Avenue) in Manhattan.

To register, please visit https://www.nybgh.org/calendar/index.html or email Jen Cole at jcole@nybgh.org.

Survey Indicates How Employers are Dealing with Health Reform

Complying with the new health reform law will force some employers to hike premiums and increase cost-sharing obligations, a new survey shows. On Wednesday, the National Business Group on Health (NBGH) released the results of its 2011 annual plan design survey, which indicate that employers will be making many plan design changes to comply with the requirements of the new law.

Of the 72 large employers - representing 3.7 million employees - that were surveyed, 70 percent said they will eliminate lifetime dollar caps on overall benefits and 63 percent expect to increase 2011 premium rates, up from 57 percent in 2010.

Other findings, as reported by The Hill, include:

• Twenty-five percent of large businesses plan to hike the co-pay or co-insurance costs for prescription drug benefits at retail pharmacies, while 21 percent have the same plan for mail-order pharmacy benefits.

• Twenty-six percent will remove annual caps on overall benefits.

• Thirty-seven percent plan to alter annual or lifetime limits on specific benefits, including dental, mental health and infertility benefits.

• Thirteen percent said they will eliminate pre-existing condition exclusions for youngsters.

The complete survey results can be accessed by clicking here.

A C-SPAN broadcast of the press briefing can be found by clicking here.

Flexibility More Important than Grandfathered Status

A recent Hewitt Associates survey has found that 90 percent of large employers expect to lose their plans' grandfathered status by 2014, with the majority doing so within the next two years. Under the "grandfather" provision of the new health reform law, health plans can maintain many of their current coverage provisions and are not required to comply with certain new mandates if they do not significantly reduce benefits, change insurance carriers, or increase cost-sharing obligations.

Of the 466 companies - representing 6.9 million employees - that were surveyed by Hewitt, 72 percent expect to lost grandfathered status because of health benefit plan design changes and/or changes in cost-sharing requirements. Additional reasons cited were consolidation of health plans, changes to insurance carriers, and union negotiations. The survey also found that most self-insured plans (51 percent) are expected to lose grandfather status in 2011 and another 21 percent will lose their status in 2012. This expectation is similar for fully-insured plans.

Click here for the complete press release.

New CDHP Report Available

The number of employers offering a consumer-directed health plan (CDHP) has increased in the period from 2005 to 2009, according to a new Employee Benefits Research Institute (EBRI) report.  While fewer small businesses are offering CDHPs as an option, increasing numbers of large employers are adding the cost-savings plan to their menu of health benefits.  Actual enrollment has increased too, with 19.1 million, or 11%, of individuals with private health insurance enrolled in a CDHP.  The study's author, Paul Fronstin, also found that enrollment in CDHPs results in 1.5% savings to the employer.

The complete set of findings are available in the August EBRI issue brief and can be found by clicking here.

Health Reform 2.0: Massachusetts Style

In the last day of the legislative session last Saturday, the Massachusetts state legislature passed a bill aimed at reigning in health insurance costs and enhancing small businesses' health insurance purchasing power.  Health insurers will now be required to spend at least 88 percent of the premiums they collect on services directly tied to medical care and quality improvement activities. The New York state legislature passed a similar bill in June requiring health insurers to spend 82% of premium dollars on medical care.  Federal regulators are expected to release in the coming weeks their definition of what activities can and cannot be counted towards the medical loss ratio (MLR) calculation.  Health plans, employer groups and other business advocates are advocating for federal regulators to include wellness and disease management programs, among other things, in the numerator.

The bill also includes a provision that will now allow Massachusetts small businesses to enhance their health insurance purchasing power by forming purchasing cooperatives. Businesses with fewer than 50 employees will be able to band together to exert greater purchasing clout and insurers will be required to offer plans that include low-cost providers in their networks.  To combat consumers signing up for health insurance only right when they actually need medical services, the bill also allows insurers to restrict plan enrollment to only two open enrollment periods in 2011 and one in years thereafter.

Click here to read more.

Employers Assisting in Managing Chronic Care

Friday's Patient Money column in the New York Times highlights NYBGH member Pitney Bowes as one of the number of employers helping their employees better manage their chronic conditions.  The author briefly compares and contrasts various employer-sponsored chronic care management programs, and features Pitney Bowes as one of the companies that manages chronic conditions at their on-site health clinics.

Click here for the complete article.

New York Times Articles Highlight Industry Activity

Two recent, national articles highlight some of the work that business coalitions, like NYBGH, and employers are focusing on.  Reed Abelson, writing for the New York Times, sheds light on some employers' interest in narrowing their physician and/or hospital networks in order to save costs for both the company and their employees.  Andrew Webber, the President of National Business Coalition on Health (NBCH), is quoted in the article, quipping about the choice battle during the managed care wars of the 1990's.

This article can be found by clicking here.

In a second article, Abelson describes some physicians' groups', such as the American Medical Association (AMA), ire over how health insurers rank and rate physicians participating in their networks. In a recent letter to some of the nation's largest insurers, the AMA and 47 other groups, "called on the insurers to make public how they assessed doctors’ performance and to allow the insurers’ methods to be reviewed by independent parties."  America's Health Insurance Plans (AHIP) responded to the letter, defending insurers' practices, asserting that employers and other purchasers have asked their health plans to ardently work towards achieving greater value and improved clinical performance..

Click here to access this blog post.

HIT Meaningful Use Regulations Released

"The widespread use of electronic health records (EHRs) in the United States is inevitable", asserted Dr. David Blumenthal, the national coordinator for health information technology at the US Department of Health & Human Services (HHS), in a recent New England Journal of Medicine article.   

HHS released on Tuesday the final rules for expanding the use of electronic health records by hospitals and physicians. Eligible physicians and hospital facilities can qualify for Medicare and Medicaid incentive payments if they adopt certified EHR technology and subsequently use it to achieve specified patient health outcomes. Two regulations, in fact, were released by HHS.  The first defines the "meaningful use" goals that providers must meet in order to qualify for the bonus payments. The second rule describes the technical capabilities required for certified EHR technology. This marks the finalization of a highly scrutinized proposed rule that was released on January 13, 2010.

The program, created by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, is expected to award up to $27 billion in bonus payments over ten years.  Providers may receive up to $44,000 under Medicare and $63,750 under Medicaid.  Hospital facilities, on the other hand, may be eligible to receive millions of dollars for implementation and meaningful use of EHRs under both aforementioned public health care programs.

Click here for the HHS press release, which links to a fact sheet on and the text of the final rules.

Obama to Use Recess Appointment for Berwick

The White House yesterday announced that President Obama, to the chagrin of many Congressional Republicans, will use a recess appointment to make Don Berwick the administrator of the federal Centers for Medicare and Medicaid Services (CMS). Mr. Berwick is touted as an expert in and advocate of quality improvement in health care and is also a renowned Harvard professor and pediatrician. His appointment will remain valid until the end of the 111th Congress in January, at which time he will be subject to another confirmation, and presumably a hearing.

Click here to read more from Politico.
Kaiser Health News has released a resource guide on Mr. Berwick.  Click here to access it.

Three New Health Reform Model Notices Posted

Earlier this week, the US Department of Labor released three new model notices, each related to provisions included in the new health reform law. Each provision is effective for new plan years that begin on or after September 23, 2010.

The first pertains to the extension of dependent coverage to adult children up to age 26. It can be found at: http://www.dol.gov/ebsa/dependentsmodelnotice.doc

Next is model notice language for the prohibition on lifetime limits on "essential health benefits". This notice can be found at: http://www.dol.gov/ebsa/lifetimelimitsmodelnotice.doc

Lastly, a model notice pertaining to certain patient protections. These include an enrollee's right to designate a primary care physician or a pediatrician from within their network as well as to obtain obstetrical or gynecological services without prior authorization from their health plan. This model notice can be found at: http://www.dol.gov/ebsa/patientprotectionmodelnotice.doc

High Risk Pool Programs & New Health Insurance Website

Today the US Department of Health and Human Services (HHS) announced the creation of a new government-run health insurance website - healthcare.gov - as well as the highly-anticipated high-risk pool program. 

The new website, mandated by the new health reform law, is an information clearinghouse meant to help consumers navigate what can sometimes be a complicated health insurance market.  Only in version 1.0, the site lists the insurers selling products in a given user's particular service area.  In the autumn, the site will be enhanced with the addition of insurance products' prices and benefits information. Users can also log-on to learn more about how the new health reform law may impact them.

Also launched today, a few days past its anticipated launch date, is the new state-based temporary high-risk pool program, now called the Pre-Existing Condition Insurance Plan (PCIP).  This temporary insurance program is designed to bridge the coverage gap for those with pre-existing conditions until state-run insurance exchanges are established in 2014.  Slightly more than half of the states (29 of them) decided to run their own high-risk pool program, with the remaining 21 states allowing the federal government to step-in and administer theirs.  Coverage for those who qualify is expected to kick-in August 1st for those who apply by July 15th.

To read more on these developments, visit the HHS press release, a Wall Street Journal story, or coverage from Kaiser Health News.  

Early Retiree Reinsurance Program (ERRP) Applications Now Being Accepted

Today the US Department of Health and Human Services' Office of Consumer Information and Insurance Oversight (OCIIO) announced that they will immediately begin accepting applications for participation in the early retiree reinsurance program (ERRP).  A draft application was released earlier this month, but employers hoping to be part of this new, temporary program now can complete and submit an official application. 

The ERRP was created as part of the recently enacted federal health reform package and became effective June 1, 2010. Participating employers will be reimbursed 80 percent of certain claims between $15,000 and $90,000.  One condition of participation in ERRP is that the employer must have in place procedures and programs that have or will generate cost savings for plan participants with chronic and high cost conditions.

The application can be accessed by visiting http://www.hhs.gov/ociio/regulations/index.html.
Also available on the OCIIO site is an ERRP Fact Sheet and Application Submission Do's and Don'ts.

Connecticut First State to Expand Medicaid

Connecticut is the first state in the Union to permanently expand its Medicaid program to low-income, single adults as a result of the recently enacted federal health reform. State officials predict that over 45,000 adults will be eligible for the program under this new expansion. Childless adults, prior to health reform's passage, could enroll in Medicaid only if their state was granted a waiver. These waivers were temporary and strict criteria had to be met in order to qualify for approval and renewal. The Patient Protection & Affordable Care Act changed this and now requires state Medicaid programs to cover all low-income individuals beginning in 2014. States that take early action are able to access federal funding to enroll individuals immediately.

Click here to read the press release from the US Department of Health & Human Services.

Health Reform expected to lower the federal deficit but not health care costs to employers in the short term

In a New England Journal of Medicine perspective piece, Peter Orzag, Director of the Office of Management and Budget, and Ezekiel Emanuel, a special advisor on health policy to the OMB and chair of the Department of Bioethics at the National Institutes of Health, outline their perspectives on “Health Care Reform and Cost Control.”

They state that current projections show total health care expenditures as a percentage of GDP being 0.5% lower in 2030 than they would have been without the passage of health care reform. However, the majority of the cost savings come from Medicare and Medicaid and not from a reform to the health care delivery system, which would result in lower costs for employers to offer health care to employees. Additionally, employers will be contributing to the government’s cost savings beginning in 2018 with the onset of the tax on “Cadillac” insurance plans.

Orzag and Emanuel go on to emphasize the need for health care delivery reform, and highlight three areas they believe will have the potential to cut costs across the board. Two of these three areas have the potential to directly affect the cost of health care to employers: The Patient-Centered Outcome Research Institute, which will research the effectiveness of various medical technologies and interventions, and the Innovations Center, which will develop, test and evaluate new policies and programs that enhance the quality of care for Medicare beneficiaries, reduce their cost of care, or both.

To read the full NEJM article click here

Businesses Respond to “Grandfathered Plan” Regulations

Yesterday the Departments of Health and Human Services, Labor, and Treasury jointly released the highly anticipated regulations for status as a “grandfathered health plan.” The regulations outline the routine changes that plans existing prior to March 23, 2010 can make without losing their grandfathered health plan status. Mid range projections in the regulation estimate that about half of employers will lose their grandfathered status by 2013. By losing grandfathered status, plans will have to comply with new federal health reform regulations that include many additional provisions such as: coverage of recommended prevention services with no cost sharing and guaranteed access to OB-GYN and pediatrician services.


Kaiser Health News’ Phil Galewitz and Mary Agnes Carey published an article yesterday outlining the business community’s mixed reception to this newly released regulation. Both small and large businesses have established opinions for and against the regulations, and all seem to agree its greatest benefits lie with consumers. To access the full Kaiser article click here

How Far Does $5 Billion Go? Not Very If It's ERRP

A recent report from the Employee Benefit Research Institute (EBRI) asserts that the $5 billion appropriated for the newly created early retiree reinsurance program (ERRP) will run dry within the first two years of its initiation.

The recently passed health reform package, The Patient Protection and Affordable Care Act (PPACA), created ERRP with the aim of providing temporary reinsurance for sponsors of employer-sponsored health plans that provide retiree health benefits to retirees 55-64 years old. ERRP becomes effective June 1, 2010 and the subsidy will be available until Jan. 1, 2014 when state-based health insurance exchanges are expected to be established or whenever the funds are exhausted.

Click here to read the entire brief from EBRI.

Large Employers' Perspective on Health Reform

In the latest edition of Health Affairs, National Business Group on Health President Helen Darling describes the large employer perspective on health reform.  While the new law may indeed provide health insurance coverage to scores of Americans who were not previously covered, large employers are faced with new administrative and financing burdens.  Large employers, in addition, may have to deal with low-wage workers opting-out of employer-sponsored coverage and receiving coverage through new health insurance exchanges.  Ms. Darling, moreover, asserts that the public sector must work with the private sector to drive delivery system reform and ensure the success of cost containment efforts.

To access the complete article (Health Affairs subscription required), visit: http://content.healthaffairs.org/cgi/reprint/29/6/1220.

Prior Approval of Health Insurance Premium Adjustments Reinstated

Yesterday both chambers of the New York State Legislature approved a package of massive statewide health care spending cuts as part of Governor Paterson's emergency budget bill.  New York City nursing homes, hospitals, and other health care programs will be hit hard by the cuts, with many set to lose out on millions of dollars.  Many New York hospitals will also lose out on federal matching subsidies as a result of the state cuts, meaning greater losses than stated in the state's budget package.

A separate bill was also passed that, effective October 1, 2010, requires health insurers to receive prior approval of premium rate adjustments from the State Department of Insurance.  Health insurance plans sold in the individual and small group markets will also be required to experience medical loss ratios of 82 percent.

Click here to read more about this development from the New York Times.

Cost is Key Reason Workers Are Uninsured

A recent study published by the Employee Benefit Research Institute (EBRI), a non-profit, non-partisan research organization, demonstrates that the majority (85 percent) of uninsured workers cite cost as the number one barrier to coverage. Lack of availability of coverage was reported by 29 percent of respondents as another barrier to coverage. These individuals reported that they did not have access through their own employer, their spouse's employer, or a parent's employer. A provision in the new health reform law will allow adult dependent children up to age 26 to access coverage through a parent's employer-sponsored health plan. This new benefit becomes effective with new plan years that begin on or after September 23, 2010. The US Department of Health & Human Services (HHS) predicts that potentially over 1.20 million individuals will become newly enrolled in coverage as a result.

Click here to access the EBRI brief explaining the findings of the below referenced study.
Click here to view the complete EBRI study.

DOL to Host Webinar on EFAST2 and 2009 Form 5500

The US Department of Labor's Employee Benefits Security Administration (EBSA) will be hosting a EFAST2 and 2009 Form 5500 compliance assistance webinar on June 3, 2010 at 1:00pm EDT. 

From EBSA:

"Now that electronic filing is here, and you are using the EFAST2 system and preparing to file the 2009 Form 5500, we know that you have questions. This webcast will provide tips and address some of the most frequently asked questions the Department has received as all parties involved in filing begin to use the EFAST2 system and prepare the 2009 Form 5500.  The webcast will also feature a discussion of the new e-signature option for Form 5500 and 5500-SF that is designed to simplify the electronic filing process, especially for small businesses that use service providers to complete and file their annual reports.

 

The 2009 Form 5500 has a number of changes, including a new simplified annual reporting form for small plans with easy to value investments; expanded reporting by large plans of compensation received by plan service providers; and realignment of the reporting rules for Internal Revenue Code section 403(b) pension plans subject to Title I of ERISA to make them on par with 401(k) plans.   The EFAST2 system is a new, modernized system to handle the electronic filing of the Form 5500 and Form 5500-SF that also provides electronic public disclosure of filings."

Click here to read more and to sign up for the webcast.

Lenox Hill Enters Partnership with NS-LIJ

North-Shore Long Island Jewish Health System (NS-LIJ) yesterday announced that it would be acquiring Lenox Hill Hospital on Manhattan's Upper East Side.  The deal gives NS-LIJ a toehold in Manhattan as well as access to a population of patients who, according to a New York Times article, "seek pampering during childbirth and orthopedic surgery."  NS-LIJ Chief Executive Michael Dowling said that Lenox Hill would retain its name, board, and chief executive.

Click here to read the New York Times story.

Kingsdale Article on Health Insurance Exchanges

The New England Journal of Medicine has recently published an article on health insurance exchanges, penned by Jon Kingsdale, PhD, Executive Director of the Commonwealth Health Insurance Connector Authority.  Mr. Kingsdale asserts, plain and simply, that exchanges sell insurance and that a failure to enroll enough people is essentially a failure to achieve an exchange's core mission.  Exchanges were included in the recently passed health reform legislation - and experience widespread bipartisan agreement - because they facilitate a marketplace of managed competition where consumers can easily comparison shop for health insurance plans that fit their needs and budget.  In addition, exchanges offer administrative savings, a choice of high-value health plans, transparency in quality and price, and the ability to determine one's eligibility for subsidies and/or tax credits.

HealthPass, NYBGH's subsidiary health insurance exchange runs a similar exchange model except that it has focused on providing quality, affordable options to small businesses for over ten years.  The Massachusetts Connector, in contrast, first concentrated on enrolling eligible individuals and have only recently begun their efforts to increase the number of small businesses that offer health benefits.

Click here to access the full article.

New York Convenes Health Reform Implementation Cabinet

New York's Governor David Paterson announced Thursday that his office would be spearheading the health reform implementation effort across the state with the formation of a Health Care Reform Cabinet.  The group will be chaired by Valerie Grey, the Director of State Operations and is commissioned with:

• Identifying deadlines for the completion of interim or final steps necessary or desired to comply with the provisions of federal health care reform;
• Identifying those provisions of federal health care reform with which the State must comply and those that are optional, and evaluating whether participation in optional programs is appropriate;
• Assessing the State's capacity to carry out those provisions of federal health care reform that affect or potentially affect the State;
• Identifying any changes needed to State statute, regulation, policy or procedure in order to implement such provisions and facilitating the achievement of such changes as necessary;
• Communicating with the federal government, local governments, other states, health care providers, and other stakeholders as advisable or necessary; and
• Providing for outreach to the public to educate them on the implementation of reforms as necessary.

The Deputy Secretary for Health, Medicaid, and Oversight and the Deputy Secretary for Labor and Financial Regulation will serve as vice-chairs.  An external advisory group consisting of individuals representing providers, consumers, businesses, labor, local government, health insurers, and health policy experts will be named to assist with the implementation effort.

To read more about this, click here.

Guidance on Adult Dependent Coverage Released

Today the Department of Labor (DOL), the Treasury, and the Department of Health and Human Services (HHS) released clarifying guidance on the provisions in the new health reform law that require group health plans to cover adult dependent children up to age 26.

Highlights of the new regulation include:

• Except for children age 26 or older, the terms of the policy cannot vary for dependent coverage based on age of a child
• Additional charges (e.g. surcharges, fees, etc.) are not allowed unless the surcharge applies regardless of the age of the child
• Married adult dependents are eligible for this new benefit. However, coverage does not have to be offered to the adult child's spouse or children.
• Plans must provide a special enrollment period - that includes written notice - for at least 30 days to adult children whose coverage may have ended under a plan or who may have been previously denied coverage. This is effective no later than the first day of the first plan year beginning on or after September 23, 2010 (i.e., January 1, 2010 for most employer-sponsored plans).
• Because of the special enrollment period, the adult child is treated as a special enrollee per HIPAA laws. Therefore, employers must:
• Make available to adult children all benefit packages that are offered to other similar individuals who did not lose coverage because they lost dependent status; and
• Charge the same premium price that they charge other similar individuals who did not lose coverage because they lost dependent status
• Financial contributions set aside for this new benefit may be excluded from the employee's income for the entire taxable year the child turns 26 so long as the coverage continues until the end of that given taxable year.

On a related note, HHS released cost estimates of this new benefit, concluding that it will cost $3,380 for each dependent and thus will raise premiums by 0.7 percent in 2011 for employer plans. A little over one million young adult dependents are expected to sign up, with HHS estimating that more than half of them would have been uninsured if not for this program. While this aspect of the health reform law is effective September 23, 2010, many insurers across the country have already pledged to cover this population far in advance of September. A list of these insurers can be seen in the below referenced DOL Fact Sheet.

Click here to access the regulation.
Click here to view the DOL fact sheet.
Click here to read the FAQs, courtesy of DOL.

New NBCH-Commonwealth Fund Newsletter

National Business Coalition on Health and the Commonwealth Fund have teamed up to periodically report on developments in employer-related health policy and quality.  The third edition of the Purchasing High Performance newsletter has been released and the feature story includes a health reform implementation timeline for employers.  Also in the newsletter is an article on health insurance exchanges that highlights HealthPass, NYBGH's subsidiary commercial health insurance exchange.

Click here to access the newsletter.

Early Retiree Reinsurance Program Regulations

Today the US Department of Health & Human Services (HHS) released regulations on the new early retiree reinsurance program for employers.  Expected to be included in the federal register within the next few days, the regulations provide greater clarification regarding how employers will be reimbursed for early retiree claims costs between $15,000 and $90,000.  Of special note is that the program will go into effect June 1, 2010 in advance of the June 23, 2010 mandated effective date.  The Patient Protection and Affordable Care Act (PPACA) has allocated $5 billion dollars for this program that expires in 2014 when state-based health insurance exchanges are established.  Both self-insured and fully-insured employers are eligible to apply to participate in this program.  In the regulations, HHS states that they predict that many of the program participants will be those that receive the retiree drug subsidy (RDS) because of the similarities between the two programs.

The HHS press release can be accessed by clicking here.  A recently revised White House fact sheet on this program can be found by clicking here.

HealthPass - Health Insurance Exchange with Choice and at the Heart of Reform

In a newly released edition of the Commonwealth Fund's Purchasing High Performance newsletter, HealthPass, NYBGH's subsidiary health insurance exchange, is cited as one of only a few health insurance exchanges around the country.  A hot topic now that federal health reform has passed, health insurance exchanges like HealthPass provide small employers with choice and flexibility of plans, extensive provider networks, and an organization that works to make offering health benefits hassle-free.

Operating for over 10 years in downstate New York, HealthPass has expanded to over 35,000 members and now offers 25 medical plans along with a number of ancillary products and advocacy services to small businesses and sole proprietors.  Quoted in the article are both Vince Ashton, HealthPass Executive Director as well as Laurel Pickering, NYBGH Executive Director and Chair of the HealthPass board of directors.

Click here to read the complete article.

IRS Guidance on Dependent Coverage to Age 26

The Internal Revenue Service (IRS) has issued guidance on the tax treatment of adult dependent health care coverage under an employer-sponsored health plan.  This guidance confirms that the employer subsidy for adult children is treated with the same tax favorability as traditional health benefits.  Notice 2010-38 explains that health coverage costs for an employee's child under age 27 are excluded from gross income, and are thus not considered wages for FICA or FUTA purposes and are also exempt from income tax withholding.  Retroactively effective March 30, 2010, employees with cafeteria plans are allowed to immediately begin making pre-tax contributions to pay for this new, expanded benefit.  The new health reform law enacted in March enables adult children to be covered by their parents' health insurance plan until they reach age 26, even if they are married.  For these purposes, eligible children include a son, daughter, stepchild, adopted child or eligible foster child.  In addition, children do not have to qualify as a dependent for tax purposes to take advantage of this new health care provision.

Click here to read the IRS press release.

Transparency & Public Reporting in Hospital Safety

In a recent Commonwealth Fund perspectives piece, Dr. Lucian Leape of Harvard's School of Public Health asserts that out of three approaches to improving patient safety, transparency and public reporting are the most effective.  The other two approaches, regulation/accreditation and financial incentives, Leape contends, do not provide the same impetus for improvement that public reporting does, especially in a world where consumers increasingly and regularly access online rankings and publicly available data.

The complete piece can be found by clicking here.

Health Reform and Part-Time Employees

Bass, Berry, & Sims, PLC, a law firm based in Tennessee, has released an issue brief on the impact of health reform on part-time employees.  While the new health law does not require that employers provide coverage to part-time employees, if part-time workers are indeed provided coverage, then there is no differentiation between full-time and part-time employees when it comes to provisions in the bill that expand coverage, including those that ban lifetime and annual dollar limits on coverage, prohibiting pre-existing condition exclusions, and extending dependent coverage through age 26.

The new law, however, does distinguish between full-time and part-time employees when calculating the employer "pay-or-play" mandate.  Although the mandate applies only to full-time employees, part-time workers are employees' hours of service are calculated to determine the number of FTEs.

Click here to read the entire issue brief.

HHS Implementation Office Established

The US Department of Health and Human Services (HHS) has announced the creation of a new division to oversee and manage health reform implementation efforts.  Speculated by some to be eventually headed by Jon Kingsdale, former executive director of the Massachusetts Connector, the Office of Consumer Information and Insurance Oversight will provide leadership in implementing the new health reform law.  Within this divisions will be five different offices:

1. Office of the Director
2. Office of Oversight
3. Office of Insurance Programs
4. Office of Consumer Support
5. Office of Health Insurance Exchanges

The notice published in the Federal Register outlines the responsibilities of each office and can be found by clicking here.

Insurers to Cover Dependent Children through Age 26 Before Law Requires

A number of health insurance carriers have announced that they will begin covering adult dependent children through age 26 before the new health reform law requires it beginning on September 23, 2010.  The announcements by UnitedHealthcare, Humana, Kaiser Permanente, and WellPoint, among other health plans, come just before many of the country's college graduates potentially enter a coverage gap as they search for a job that provides employer-sponsored coverage.

More information on this developing story can be found by clicking here.

Poll Indicates Employers Will Still Offer Coverage

A recent survey by Crain Communications' publications Business Insurance and Workforce Management indicates that a majority of employers will not be eliminating their health benefits offerings. 

The new health reform law, the Patient Protection and Affordable Care Act of 2010, penalizes employers that do not offer coverage $2,000 per full-time employee.  According to the survey, 52.5% of the 3,700 responding executives strongly disagreed that it would be better for their firm to stop offering health benefits and pay the penalty.  On the other end, only 14.1% of respondents strongly believe that dropping health benefits altogether would be better for their organization.

Click here for the rest of story, from Employee Benefit News.

CMS Launches New Transparency Tool

Last week, the Centers for Medicare and Medicaid Services (CMS) released a beta version of a new interactive website that allows user to view variations in Medicare spending data stratified by state.

NPR's Shots blog reports that, "The dashboard shows the number and total cost of payments to hospitals for treating 25 top diagnoses and allows you to compare spending by state. Joint replacements lead the list with more than 400,000 performed last year. The chart also lists which hospitals were the most frequent providers of care for a given diagnosis. A separate bubble chart illustrates total spending for each state between 2006 and March of this year."

To access the site, click here. This link brings you to the descriptive web page. To launch the tool, click on "Render Dashboard BETA" near the upper-left corner.

Health Savings Accounts and Retirement Report

A recent analysis by the Employee Benefit Research Institute (EBRI) reports on the savings potential of health savings accounts.  The authors conclude that the current statutory limits on yearly contributions relegate HSAs to playing merely a minor role in covering health costs in retirement.  

Their analysis examines the potential savings of individuals who begin contributing to their HSA at age 55 and contribute $3,000 and a $1,000 catch-up contribution each year until age 65.  With a 2 percent interest rate, one would save approximately $48,300 after 10 years and if the interest rate were 5 percent, just over $55,000 would be accumulated over 10 years. 

Click here to access the complete report.

IRS Guidance on Small Business Tax Credits

The Internal Revenue Service (IRS) has launched a website explaining the new small business health care tax credits that were borne out of the new health law. Users can browse the site to find information on: eligibility as well as calculating average annual wages and full-time equivalents.

These credits are available to small businesses with fewer than 25 employees and average annual wages of less than $50,000.

To access the site, click here.

Delivery System Reform Elements in Health Reform

The Consumer-Purchaser Disclosure Project, a coalition dedicated to advocating for health care delivery system reforms, has recently published a review of some of the major delivery system reform components in the new health reform law. Major areas related to fostering improvements in how care is delivered are in this brief and include payment reform, comparative effectiveness research, promoting population health and wellness, performance measurement, quality improvement, public reporting, health information technology, and administrative efficiency.

Click here to access the summary.

Financing Health Reform

The Tax Foundation recently posted a pie chart on their website outlining how lawmakers plan to finance the new health law.

Penalty payments by employers and individuals amount to $69 billion, an increased Medicare tax on high-earners is expected to raise $210 billion, and the excise tax on high-cost "Cadillac" plans is estimated to rake in $32 billion.

Click here to read more from the Tax Foundation.

NYBGH Health Reform Resources

NYBGH has added health reform resources for employers to its home page. Under the "What's New" section, two PDF documents, one summarizing the new law and another outlining its implementation timeline, are available.

Visit www.nybgh.org to access these resources.

As always, NYBGH staff is available to help answer any health reform-related concerns our members may have. For more, please contact Shawn Nowicki, Director, Health Policy at snowicki@nybgh.org or 212.252.7440 x227.

Large Employers Immediately Feeling the Effects of Health Reform

A number of major employers, such as Caterpillar, AT&T, AK Steel, 3M, John Deere, and Valero Energy, have indicated that a provision in the new health law relating to retiree prescription drug benefits will cost them millions of dollars this year alone. Attempting to raise revenue to pay for the new bill, the legislation includes a provision that repeals a tax deduction that employers receive for offering prescription drug benefits to their retiree population. When Medicare Part D was passed in 2003, the federal government began offering a 28% tax deduction for employers that offered prescription drug coverage that is, at minimum, actuarially equivalent to coverage offered in Medicare Part D. As a result of the legislation, employers will still receive the subsidy for providing this service to their retirees, but they no longer will be able to benefit from a tax deduction.

While the provision does not go into effect until 2013, employers will have to immediately begin accounting for it in their books. Last week AT&T announced that it would take a $1 billion charge because of the provision. John Deere's parent company, Deere & Company announced a $150 million charge and their competitor Caterpillar is predicting a $100 million charge.

Click here to read more from the New York Times.

What Does Health Reform Mean to You?

Kaiser Health News has compiled a number of "explainers" that examine how health reform will affect different populations. In addition to explaining the provisions of the new law, the site also includes the full text of both the reconciliation and Senate health bills.

Click here to access the stories.

Pelosi Signs Reconciliation Bill, Puts Punctuation Mark on Debate

Congressional Democrats put a punctuation mark on the over year-long health care reform debate when House Speaker Nancy Pelosi (D-CA) signed the reconciliation "fixes" bill Thursday after it was approved by a 220-207 vote.

Members of Congress now leave Washington for a two week district work period where Democrats will be selling (and trying to explain) the benefits of the new legislation and Republicans are predicted to malign aspects of the bill as part of their campaign to win back the majority.

For more, click here to access the New York Times story.

Senate Passes Reconciliation Bill: Now Heads Back to House

Following an hours long "vote-o-rama", Senate Democrats approved the health care reconciliation "fixes" bill by a vote of 56-43, with Republicans unanimously opposed. Republicans successfully challenged some provisions related to the higher education portions of the bill, and thus were struck out by the Senate parliamentarian. One struck provision would have prevented any annual decrease in the maximum amount of Pell grants for students from low-income families. Democrats indicated they would omit the disputed provisions and expressed overall happiness with the outcome of the debate because they were able to successfully hold back 40 Republican amendments.

The legislation nonetheless will advance through Congress and now heads back to the House for one final vote, which is expected to occur Thursday evening. Final approval from the House is needed, in this case, because changes were made to the reconciliation package they approved.

For more, click here for a New York Times article.

President Obama Signs Health Reform Bill

At a ceremony in the White House this morning, President Obama signed into law the Senate health reform bill that was passed by the House of Representatives late Sunday night by a vote of 219-212. The bill is expected to cost $940 billion over the next ten years and is estimated to cover 32 million additional Americans by 2019.

The reconciliation bill that was passed by the House following the passage of the Senate reform bill is now headed to the Senate for debate. Because the measure is a reconciliation bill, special Senate debate rules apply. First, debate is limited to only 20 hours and filibusters are prohibited. Second, the Byrd Rule applies, which states that any provision that does not relate directly to the federal budget must be stricken from the bill. If Republicans are successful in challenging the bill through either a point of order or with an amendment, the bill will be sent back to the House for a final vote.

To read more about today's White House signing ceremony, click here.

New CBO Score on Health Reform Bill

The non-partisan Congressional Budget Office (CBO) this morning released a cost analysis of Democrats' recently revised health reform package. Keeping in step with President Obama's commitment to keep the price of reform below $1 trillion, this package, set to be advanced through Congress using the budget reconciliation process, is estimated to cost $940 billion over 10 years and reduce the federal deficit by $130 billion.

House Democrats are expected to use a "deem and pass" parliamentary tactic that would allow House members to avoid giving an "up or down vote" on the reform bill. By using this maneuver, the original Senate-passed health reform bill would automatically be considered passed if the reconciliation bill is passed. A memo released by the Senate parliamentarian earlier this week indicated that this tactic is indeed valid in this particular case, angering Republicans who have characterized this strategy as unrepresentative of fair and proper parliamentary procedure. The next step in enacting the health reform package would be to introduce the reconciliation bill in the Senate where only a simple majority of 51 votes would be needed to approve it. Senate Republicans are expected to delay the momentum of the bill by introducing numerous amendments and having the Senate clerk read each one.

Click here for more from the New York Times.
Additional coverage is provided by The Hill and can be accessed by clicking here.

Mental Health Parity Page

The Partnership for Workplace Mental Health has created a "Parity Page" that contains a wealth of information on the 2008 Mental Health Parity and Addiction Equity Act of 2008.

A resource for learning more about how to comply with the new federal requirements, the page includes a timeline of the parity law, an outline of the associated interim final rules, results from an employer survey on parity, and a research issue brief.

To access the parity page, click here.

COBRA Extension Fact Sheet Released

The federal Employee Benefits Security Administration (EBSA) recently updated a fact sheet on the COBRA premium reduction program. Reflecting changes made by the Temporary Extension Act (TEA) passed on March 2, 2010, the fact sheet outlines requirements to be eligible to receive the 65 percent premium reduction subsidy, among other things.

Click here to view the complete fact sheet.

March 18 Health Reform Deadline in Question

House Majority Leader Steny Hoyer (D-MD) yesterday pushed back against the President's insistence that an "up or down vote" on health reform be made before Mr. Obama leaves for an overseas trip on March 18th. In a story in The Hill newspaper, Hoyer is reported as claiming that the March 18th deadline imposed by the White House will be difficult to meet, but is not by any means an absolute deadline.

For more, click here.

HealthPass to Offer Oxford Small Group

HealthPass, a health insurance exchange serving small businesses and sole proprietors, is now offering UnitedHealthcare's Oxford small group plans. Eligible employers must have 2-50 workers and can enroll immediately for coverage effective April 1, 2010. Oxford sole proprietor plans will still continue to be offered through HealthPass.

An innovative partnership between the New York Business Group on Health, the City of New York and the health insurance industry, HealthPass provides small businesses with an array of Fortune 500-quality healthcare options through an insurance exchange.

HealthPass enables eligible employees of small businesses to individually choose a healthcare plan that fits their medical needs and budgets. There are more than 25 different coverage options from New York's leading carriers - EmblemHealth, GHI, HIP Health Plan of New York and Oxford - as well as two dental plans and a bundled product offered through Guardian. With more than 200,000 providers, HealthPass affords greater network access than any single plan. For more information, please visit www.healthpass.com

COBRA Subsidy Extended and Medicare Doc Fix Delayed

On March 2, President Obama signed into law “Temporary Extension Act of 2010,” (H.R. 4961) staving off the expiration of federal COBRA subsidies for 30 days while also delaying a 21% cut in Medicare provider payments. After the House had approved this bill last week, Senator Jim Bunning (R-KY), voicing his objections to how the bill would be financed, initiated and wouldn't back down from a filibuster until late Tuesday night.

Aimed at extending COBRA and unemployment insurance even further, the Senate is set to begin debate on a $150 billion bill introduced by Sen. Max Baucus (D-MT). The bill would extend these benefits through December 31, 2010.

For more on these development, click here to access the Kaiser Health News story.

Obama Summit Follow-Up Reaches Out to GOP

In a follow-up letter to last week's health care summit, President Obama yesterday signaled to the Congressional Republican leadership that he is open to considering four GOP health reform ideas. Specifically, they are:

1. Sending undercover federal agents to physician practices that accept reimbursements from government health program to conduct investigations to combat fraud and abuse
2. Allocating $50 million to launch demonstrations of alternatives to resolving medical malpractice disputes, including health courts
3. Increasing Medicaid provider reimbursements in a fiscally responsible manner
4. Expanding the use of Health Savings Accounts (HSA) by offering high-deductible health plans in health insurance exchanges
   

Immediately, Senators Grassley (R-IA) and McConnell (R-KY) renounced the letter as merely a show. Mr. McConnell moreover warned Democrats that if they insist on jamming a comprehensive health reform, they would surely pay for it in this year's mid-term elections.

For more, click here for a story from the New York Times.
And, to read the President's letter, click here.

Consumer Experience with a Tiered Physician Network

A recent article in the American Journal of Managed Care by Harvard researchers Meredith Rosenthal and Anna Sinaiko examines consumers' experiences with a tiered physician network, a cost-saving and quality-spurring approach used by many employers. Surveying individuals enrolled in health plans offered by the Massachuetts Group Insurance Commission, the authors find that half (49.5%) of the respondents had prior knowledge of the tiered networks in the health plans and that those who saw a specialist in the last year and those who used the Internet for health information were more likely to be aware of this special network arrangement. In addition, 35.5 percent of those surveyed did not trust the tiers to indicate which physicians were better than others. While stratifying provider networks holds promise, the authors suggest that greater success requires enhanced consumer awareness and trust in health plans.

Click here to read the complete article.

White House Summit Analysis

The Health Affairs blog provides analysis, in two separate posts, of yesterday's White House health care summit, held at Blair House in Washington, DC. Tim Jost of Washington & Lee University Law School provides the commentary.

Click here to read the first post. The second post can be accessed here.

House Votes to Repeal Insurer Antitrust Exemption

While anxiously awaiting comprehensive health reform legislation to regain a foothold, today the House of Representatives passed a narrower bill that repeals health insurers antitrust exemption. By repealing the 1945 McCarran-Ferguson Act, insurers will be less able to "fix prices, collude with each other, and set their own markets without fear of being investigated", as asserted by the bill's co-sponsors, Reps. Tom Perriello (D-VA) and Betsy Markey (D-CO). Opponents of the measure claim that the legislation is essentially a moot point because state-based regulation already prohibits insurers from engaging in antitrust-related practices. The bill now heads to the Senate where its prospects are, at this point, uncertain.

For more on this story, click here.

Cadillac Tax Would Affect Nonunion Employers

Published just prior to the White House releasing the President's 11-page health reform proposal, a report authored by Ken Jacobs and William Dow from the University of California, Berkeley's Labor Center analyzes the proposed "Cadillac" excise tax on high-cost health benefit plans. In their analysis, the authors find that the vast majority, fully 80 percent, of employees whose plans would be affected by the tax are not protected by collective bargaining agreements.

The President's proposal released on Monday raises the threshold of the excise tax from $23,000 in the Senate bill to $27,000 for a family plan and delays enforcement of the tax until 2018.

Click here to access the analysis by Drs. Jacobs and Dow.
To access the related Washington Post article, click here.
Finally, click here to explore the President's proposal.

Obama Releases Health Care Proposal

Today President Obama released his proposal for reforming America's health care system. Available on the White House website, the proposal is based on the two bills introduced last year, but resembles the current Senate health bill more than the current House health bill. An attempt to bridge the divide between the two bills and frame Thursday's upcoming summit, the President's plan is estimated to cost $950 billion over ten years, although a formal CBO analysis has yet to be released. Most notably, building on the recent debate on Anthem Blue Cross's (CA) estimated 39% rate hike in the individual market, the proposal also calls for the establishment of a federal board granted with power to review and potentially block unreasonable premium rate increases.

To read more from the New York Times, click here.

White House to Release Compromise Health Bill

In anticipation of next Thursday's bipartisan health care summit at Blair House in Washington, the White House is expected to release on Monday a "compromise" draft health reform bill. The intent is to attach the health bill to a budget bill, so as to avoid a Republican filibuster in the Senate and be advanced using a parliamentary procedure known as reconciliation, which requires only 51 votes instead of the usual 60 vote supermajority for passage. The President's plan is expected to be released, and posted on the Internet, on Monday.

Click here to read more.

Safeway NYBGH Event Rescheduled

Due to the inclement weather in the New York tri-state region, the NYBGH event with Safeway's Ken Shachmut on February 10th was canceled.

The event has been rescheduled for Tuesday, March 16th and will still be held from 8:30 to 10:30am at the University Club of New York at One West 54th Street in Manhattan.

Costs to attend:

• NYBGH Employer Members: Complimentary
• NYBGH Non-Employer Members: $50
• Non-Members: $75
  

Click here to register.

Incremental Health Fixes Buried in Jobs Bill

Embedded within the draft jobs bill floating through Congress are several health care quick fixes. Most are temporary in nature, holding in place a number of programs until Congress again addresses a more comprehensive health reform package.

Among the fixes are:

• A seven month extension to the Medicare "doc fix" that prevents a 21% cut to physician reimbursements.
• Revising the definition of "hospital based physician" under the HITECH provisions of ARRA ("the stimulus") so as to ensure certain hospital-based physicians qualify for HIT incentive rewards.
  
• Extending payments to 2010 for certain aspects of the Medicare program, such as Part B caps on therapy, and expanded payments for mental health treatment.
• Making technical corrections to reimburse critical access hospitals at 101% of their reasonable costs for specified outpatient services, and to extend various Medicare payments to long-term care hospitals and rural hospitals through 2010.

Click here to read more from HealthLeaders Media.

Health Wonk Review: What are the Next Steps?

The latest biweekly Health Wonk Review, a compendium of recent and popular health policy blog posts that is hosted on a different blog each issue, is now available at the Managed Care Matters blog and can be accessed by clicking here. This issue highlights, among other things, experts' perspectives on the fate of health reform and the underlying reasons for geographic variation in Medicare spending.

Mental Health Parity Regulations Released

The Employee Benefits Security Administration (EBSA) has posted the public inspection version of the interim final rules for the Mental Health Parity and Addiction Equity Act ("MHPAEA"). Expanding upon laws enacted by the Mental Health Parity Act of 1996, these news laws require group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.

Generally, the law became effective for plan years beginning on or after October 3, 2009, and thus January 1, 2010 for calendar year plans. The Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury will publish in the Federal Register final regulation that is effective April 5, 2010, and applicable to plan years beginning on or after July 1, 2010.

EBSA has published a fact sheet that can be found by clicking here.
Click here for the related press release.

Senator-Elect Brown to be Sworn In Feb. 11th

The Hill reports that Senator-elect Scott Brown (R-MA) will be sworn-in to his US Senate seat Thursday, February 11th, giving Republicans 41 seats in the upper chamber.

Democrats, since the Massachusetts special election, have been scrambling to form a strategy for advancing their health reform legislation through Congress and eventually reaching President Obama's desk.

For more, click here.

Event Announcement! Health Reform in New Jersey

This Thursday, February 4th, NYBGH will be hosting a half-day conference on health reform and how it might affect New Jersey employers.

Open to HR professionals and fund administrators only, the event features expert speakers such as Andy Webber, President and CEO of the National Business Coalition on Health; Joel Cantor of the Center for State Health Policy at Rutgers University; and Andrew Crighton, MD of Prudential Financial.

Beginning at 8:00 am, the conference will be held at the New Jersey Performing Arts Center in Newark, located at One Center Street.

There's still time to register! To do so, visit www.nybgh.org.

How to Pass Reform, According to Nancy Pelosi

In an interview last week with the newspaper Politico, House Speaker Nancy Pelosi indicated that the path to passing health reform legislation would take two tracks. First, incremental changes that are mirrored in both bills, such as restricting insurance underwriting practices, establishing a Medicare hospital value-based purchasing program, and providing tax credits to small businesses, will be advanced through Congress as soon as feasible. Other issues of contention will be advanced at a later time, or not at all. These include the establishment of health insurance exchanges, taxes on high cost benefit plans, and new taxes.

Click here to read the HealthLeaders Media story.

US Representative Charles Rangel to Speak at NYBGH Event

During this year's February Congressional District Work Period, U.S. Representative Charles B. Rangel (D-NY) will be speaking about health reform at an NYBGH legislative event. Representing New York's 15th Congressional district, which comprises Northern Manhattan, Harlem, and parts of Queens, Representative Rangel is the chairman of the House Ways and Means Committee, the principle Congressional body responsible for issues related to government revenue.

At the event, Rep. Rangel is expected to speak about the prospects for health reform as well as how reform will affect tri-state area employers.

The event will be held on Wednesday, February 17th from 8:30am to 10:30 am at a location to be determined.

Please stay tuned for more information.

Research Suggests Value-Based Insurance is Effective

A research group led by Harvard's Michael Chernew and the University of Michigan's Mark Fendrick recently published an article in the journal Health Affairs asserting that value-based insurance design program can be effective and do not increase total systemwide medical spending.

The authors investigated one particular value-based insurance design program and found that it led to reduced use of nondrug health care services, offsetting the costs associated with additional use of drugs encouraged by the program.

Click here to access the complete article.

COBRA and Form 550 Compliance Webcasts

The Department of Labor and the Employee Benefits Security Administration recently hosted two compliance webcasts designed to provide plan administrators guidance on administering COBRA premium reduction subsidies and filing the 2009 Form 5500.

Both archived webcasts can now be found online on the EBSA website.

To access the webcast on COBRA premium reduction subsidies, click here.

Click here to view the 2009 Form 5500 webcast.

Whole Foods Launches Healthy Eating Campaign for Workers and Customers

National organic grocery store chain Whole Foods Market recently announced the launch of its new Health Starts Here initiative aimed at improving the health of both employees and customers alike. By partnering with two healthy eating organizations, The Engine 2 Diet and Eat Right America, Whole Foods is offering in-store education so consumers can identify healthy, nutrient-dense foods. Employees are now offered increased discounts for participation in worksite wellness programs and more direct health and wellness education.

Click here to read more.

Why Wellness Incentives Belong in the Workplace

In a recent Health Affairs blog post, Jaan Sidorov asserts that wellness programs first belong in the workplace, and secondly, offering incentives for both attainment and participation is a feasible and effective component of an overall strategy.

In his post, Mr. Sidorov briefly points out a recent meta-analysis released by researchers at Harvard University that reveals the ROI of workplace wellness to be $3.27. He also points out a contrasting study recently published in the New England Journal of Medicine contending that offering incentives in wellness programs is unfair and unattainable for some segments of the population.

To access the post, click here.

DOL Webinars on 2009 Form 5500 and COBRA Premium Reduction Extension Provisions

The Employee Benefits Security Administration (EBSA) is hosting two upcoming webinars. On Thursday, January 21st at 1:00pm Eastern, staff members from EBSA and the Department of Labor (DOL) will provide plan sponsors with assistance in understanding the changes to the form and filing process. In addition, they will introduce users to the new EFAST2 electronic filing website. And, a representative from the Internal Revenue Service (IRS) will discuss filings that now will be submitted only to the IRS. The webinar can be access by clicking here.

At 1:00pm Eastern time on Friday, January 22nd, DOL and EBSA staffers will discuss the extension and provide assistance in complying with the new requirements, including the model notices and transition period. This webinar can be access by clicking here.

GOP Brown Victorious in Massachusetts

In a special election to fill the late Senator Ted Kennedy's US Senate seat, Republican Scott Brown, formerly a little-known Massachusetts state senator, claimed victory in a tight, momentum-shifting race late Tuesday night. Claiming 52 percent of the vote, Mr. Brown now will head to Washington, DC to be sworn in as Massachusetts's junior Senator and will be faced with a number of issues pressing not only GOPs, but the entire Senate, most notably health care reform. Displacing Democrats' fillibuster-proof 60 votes, Mr. Brown now forces the White House and a Democrat-controlled Congress to figure out how and when they will pass what stands to be President Obama's signature domestic policy initiative, historic health reform legislation. As Washington anxiously, or soberly, awaits Mr. Brown's arrival into the Senate, news outlets are reporting that Democratic leaders are now scrambling to salvage health reform before it gets torn and tattered by GOPs, misguided by midterm election concerns, or other pressing policy issues.

To read more on Mr. Brown's landmark victory, click on the following major media outlet links:

The Hill - Brown Snags Massachusetts Senate Seat in Stunning Upset Win for Republicans
The New York Times - GOP Takes Massachusetts Senate Seat
The Wall Street Journal - GOP Victory Upends Senate
Kaiser Health News - Republican Brown Wins Senate Seat

Health Policy Brief on Employer Mandates

In a Health Affairs Health Policy Brief published January 15th, the background and current activity surrounding employer mandates are explained and put into the context of health reform being pushed through Congress. The current state of employer-based health insurance coverage is first briefly explained, an explanation of the history of mandate proposals and the current proposals emerging from both chambers of Congress follows, and the brief closes with arguments in favor and opposed to an employer mandate.

The complete brief can be found by clicking here.

Workplace Wellness Programs Can Generate Savings

In a Health Affairs article published January 14th, Katherine Baicker, David Cutler, and Zirui Song, all of Harvard University, contend that workplace wellness programs can generate savings that outweigh costs in addition to improving health outcomes and employee productivity. This meta-analysis examines costs and savings data from studies on workplace wellness and prevention programs and concludes that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent.

For the complete Health Affairs article, click here.

Congressional & Administration Leaders Close to Health Care Deal

Throughout the week, top White House officials, Congressional Democratic leaders, and Democratic committee chairmen have been furiously working on negotiating a final health care reform bill. At issue and receiving significant mainstream media attention are, among other things, disagreements over the role of states in health insurance exchanges, subsidy levels to make insurance more affordable for middle-class Americans, an excise tax on high-priced insurance plans, the ability of the bills to contain overall health costs, and the Massachusetts special election to replace the late Sen. Ted Kennedy.

On Thursday, January 14th, media outlets reported that House Democrats had issued statements that a deal on the financing portions of the bill had been struck. The revised bill is slated to be sent to the Congressional Budget Office on Saturday to receive a cost analysis. Congressional Democrats are increasingly feeling a sense of urgency over next week's special election in Massachusetts. Republican State Senator Scott Brown, as of today, holds a slight lead, albeit within the margin of error, over his Democratic opponent, Massachusetts Attorney General Martha Coakley. Mr. Brown has indicated that if elected and present for the vote on the health bill, he would vote against it, thereby foiling Democrats' hopes of passing historic health reform.

To read more, click here for the story from The Hill.

Late Thursday, labor leaders reported that a deal had been struck on the proposal to tax high-priced "Cadillac plans". According to The New York Times, in a conference call with reports, AFL-CIO President Richard Trumka provided additional details:

• The threshold for the tax would be $24,000 for families and $8,900 for individuals. The Senate bill called for a threshold of $23,000 for families and $8,500 for individuals.
• The threshold would be increased each year by the amount of the rise in the Consumer Price Index plus 1 percent — that’s the same rate of indexation called for in the Senate bill.
• The formula will be adjusted for inflation from 2010 to 2013. The initial inflation threshold period will be adjusted upward if inflation increases above current assumptions.
• For high risk professions, the threshold would increase to $27,000.
• There would also be adjustments creating higher thresholds for employee groups whose health premiums are higher because the groups contain a disproportionate percentage of older workers and women. Those two groups tends to have higher health premiums than other workers. There would also be adjustments for those living in high-cost states.
• As of 2015, dental and vision costs would not be counted toward the threshold.
• Collective bargaining plans were to have been excluded from the exchange. Starting in 2017, collective bargaining agreements at all levels will be able to participate in the exchanges.

The New York Times also reports that "workers covered by collective bargaining agreements, as well as state and local employees, will be exempted from the tax until 2018."

For more on this, click here to access The New York Times story.

Tax on "Cadillac" Plans Likely to Survive

The Hill reports that labor leaders have conceded that the excise tax on "Cadillac", or high-cost, health plans will survive negotiations between the House and Senate on their respective health reform bills. Andy Stern, president of the Service Employees International Union (SEIU), along with other union and labor leaders have lambasted the proposed 40% tax on the cost of insurance policies worth greater than $8,400 for individuals and $23, 000 for families.

Vocal opposition to the tax has emerged as of late and some see the proposed tax as a broken promise to the American people. In his presidential campaign, Mr. Obama asserted that he would not raise taxes on anyone making less than $250,000. Others worry that including the tax in the final bill would give Republicans political ammunition, something that Democrats want to avoid in this mid-term election year.

For more on this, visit The Hill.

Additional information on this issue can be found by clicking here (Roll Call) and here (New York Times).

Health Reform's Impact on Retiree Health Benefits

The Employee Benefit Research Institute's January Issue Brief highlights the potential implications of health reform on retiree health benefits.

The report cites that the issues impacted most by reform are anticipated to be: the reinsurance program for early retirees, Medicare drug benefits, tax treatment of employer subsidies under the Medicare Modernization Act of 2003, and post-retirement benefit changes.

EBRI reports that

"The proposals’ provisions will have a mixed impact on retiree health benefits: In the short term, the reinsurance provisions would help shore up early retiree coverage and Medicare Part D coverage would become more valuable to retirees. In the longer term, insurance reform combined with new subsidies for individuals enrolling for coverage through insurance exchanges, the maintenance-of-effort provision affecting early retiree benefits, increases to the cost of providing drug benefits to retirees, and enhanced Medicare Part D coverage, would all create significant incentives for employers to drop coverage for early retirees and drug coverage for Medicare-eligible retirees."

Click here to access the complete report.

Ping Pong, Anyone?

To ensure the delivery of a health reform package to President Obama's desk in time for his State of the Union Address and to deflect any further Republican delay tactics, Democrats have indicated that party leaders will informally resolve the differences between the two bills rather than under the rubric of a formal conference committee. In this process, known as "ping-pong", leaders from each chamber would negotiate to resolve a number of the differences in the bill and then send their updated version to the other chamber until both have adopted identical bills. Media outlets are estimating that there may be only one volley, with the House adopting the Senate language and sending it back to the Senate for final approval. With a Senate vote of 60-39, just enough to pass the legislation, the final bill is predicted to reflect the Senate version more than the House version for the sake of maintaining enough votes.

The Hill reports that C-SPAN is in talks with Democrats to publicly televise the behind closed doors negotiations. Conference Committee proceedings would normally be televised, especially on such a hot-button issue, and C-SPAN wants to ensure the public access.

To read more, visit The New York Times, The Wall Street Journal, or The Hill.

Health Insurance Exchanges - Point, Counterpoint

Today's USA Today provides a point counterpoint take on the proposed health insurance exchanges in the pending health reform legislation. As both chambers of Congress head into committee to resolve differences between the two pieces of legislation, health insurance exchanges seem to be a mainstay, but intergovernmental issues are at issue. Some argue that state-based exchanges are the way to go, while others rail that one federal-based exchange would be best suited for best meeting the legislation's intent.

To access the pro-state-based argument, click here. The pro-federal-based argument can be found by clicking here.

For more information on HealthPass, a health insurance exchange in downstate New York operating for more than 10 years and covering more than 30,000 lives, click here.