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• 41% of registered votes think that most provisions of the law should be repealed and replaced with a completely different set of proposals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 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.

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.

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.

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.

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.

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.

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.