Millions of Americans’ health insurance is in jeopardy now that a federal judge in Texas ruled the Affordable Care Act unconstitutional. If upheld, it would wipe out not just protection for those with pre-existing conditions, but also a host of very popular features, including coverage for young adults, low-income subsidies, the closing of the “donut hole” for Medicare Rx drug coverage and Medicaid expansion. For employers, it could mean the end of the hated employer mandate and the looming Cadillac tax on employee health plans.
The judge determined that the individual mandate is unconstitutional and, since it can’t be severed from the rest of the ACA, the entire law is invalid. Eighteen Republican state attorneys general and two GOP governors brought the suit. Continue reading “Texas Ruling Puts Obamacare in Flux”
Two new rules from the Labor Dept. are designed to provide cheaper, and leaner, health-care coverage options to small employers and the self-employed. However, both are running into state resistance as some officials worry the rules could destabilize their insurance markets or defraud consumers.
One rule encourages the expansion of association health plans to small businesses and the self-employed. Firms will be allowed to band together if they are either in the same profession or industry or have a principal place of business within the same state or metro area. Starting in October, these AHPs will be able to sell health plans that are exempted from many Affordable Care Act coverage requirements and are therefore cheaper. They could, for example, exclude coverage for prescription drugs or mental health. However, they won’t be allowed to refuse coverage or vary premiums because someone has a pre-existing condition.
Continue reading “Trump Rollback of Obamacare Meets State Resistance”
Employers are grappling with holding down 2019 health insurance costs in a tight labor market. While expenses are likely to increase an average of 6% next year, employers are expected to tweak their plans to keep growth around 4%. That’s no small feat given the challenge these days to attract and retain workers. A recent survey by Mercer, a benefits consulting firm, found that two-thirds of workers say the health care a company offers is just as vital as pay when deciding where to work. So, employers will focus on strategies that don’t shift more costs to their employees but try to squeeze out more value for their dollars.
Managing high-cost patients is a top strategy, according to Mercer’s national survey of employer-sponsored health plans. Multimillion dollar claims for patients with complex medical issues are making up a bigger share of employers’ costs. More firms will offer patient advocate services to steer them to the right care at the right place at the right time. The idea is to avoid wasteful, unnecessary treatments while ensuring better care. “There may be five treatment options but maybe two or three have better outcomes,” says Sander Domaszewicz, a consultant with Mercer, a global consulting company. Paying for patients to get a second opinion is another popular move. Continue reading “How Employers are Managing Health Care Costs”
President Trump’s latest move to stop certain Obamacare subsidies to insurers will add more instability to an already fragile marketplace. The president’s decision to cut off the cost-sharing subsidies is the latest in a series of actions aimed at undermining the law. Payments are expected to stop as of November. Estimates put the loss for insurers at about $1.2 billion this year and $7 billion in 2018. The move comes just as insurers are regaining profitability after years of losses. Continue reading “Another Blow to Obamacare by Trump”
Expect a battle royal within the GOP ranks over health care. If the Senate passes its plan to overhaul the Affordable Care Act, odds are it would clear the House too and be signed into law by President Trump.
As expected, Senate Majority Leader Mitch McConnell’s bill is more moderate than the House version, in some respects. Medicaid expansion would be phased out more slowly than in the House legislation; people with pre-existing conditions would be protected; and there’s more financial assistance to lower-income Americans. Continue reading “Overhaul of Obamacare Edges Closer”
While Congress continues to debate changes to the Affordable Care Act, employers are faced with making decisions about their 2018 health care plans this summer. Regardless of what Congress may or may not do later, the ACA is still the law of the land for now. That law includes the so-called Cadillac tax on high-cost plans: a 40% excise tax on plans costing $10,200 for single coverage and $27,500 for family coverage. While the tax is not slated to go into effect until 2020, it will drive decisions on health plan designs in 2018, as employers take steps to avoid incurring the levy down the road.
For the past few years, the most popular way of holding down costs has been to move employees into CDHPs, or consumer-directed health plans. These plans pair tax-advantaged health savings accounts with high-deductible health insurance policies. Many employers seed the HSAs with half of the deductible…say, $1,000 of a $2,000 deductible…to encourage employees to sign up. Continue reading “How Employers Are Trying to Rein in Health Care Costs”
The war on cancer is on the verge of getting a number of new weapons. Many of them involve a novel approach known as immunotherapy, in which the body’s own immune system is engaged to fight the cancer.
One emerging immunotherapy treatment, chimeric antigen receptor T-cell (CAR-T) therapy, could be approved this year. CAR-T therapy involves genetically altering a patient’s T-cells — a type of white blood cell — to help the immune system find and kill cancer cells. The modified cells are infused into the patient after they are altered in the lab. Continue reading “Promising Cancer Drugs Coming Soon”
There’s no doubt that changes are coming to the Affordable Care Act, otherwise known as Obamacare, now that the White House and both chambers of Congress are in Republican hands.
The big questions are what will replace it and when? Part of the uncertainty is that President-elect Trump has already said he won’t kill parts of the law that are popular with consumers, such as allowing children to stay on their parents’ health plans until age 26 and requiring insurers to accept all comers, even those with preexisting conditions. The law also contains hundreds of provisions affecting Medicare, the health care workforce, prevention and many others that few associate with Obamacare. Continue reading “Changes to the Affordable Care Act (aka Obamacare)”
Once a strategy pursued only by big companies, self-insuring is being used by a growing number of smaller employers to provide health care coverage to their employees. According to a report by the nonprofit Employee Benefit Research Institute, from 2013 to 2015 the percentage of employers with fewer than 100 workers that offered at least one self-insured plan increased from 13.3% to 14.2%. The share of employers with 100 to 499 employees offering a self-insured plan rose from 25.3% to 30.1%.
Firms that self-insure bear the financial risk of employees’ health care themselves. That means they pay for each claim as it’s incurred, instead of paying a fixed premium to an insurance company. Since these employers are assuming the risk, they must have the cash flow to pay the claims. So, it may not be for everyone. But firms with as few as 15 employees can make it work.
Continue reading “Is Self-Insurance a Viable Option for Small Employers?”
Some Medicare beneficiaries could see rate increases of 22% next year.
Retirees, brace yourselves: Some participants may see double-digit premium hikes for Medicare Part B in 2017.
Congress figures to step in before the bills are due, as it did last year. But if it doesn’t, premiums for about 30% of beneficiaries could jump 22%, from $121.80 per month to $149 a month in January 2017, if the cost-of-living adjustment for Social Security is low, as expected. The COLA for next year is likely to be quite small: 0.2% to 0.8%. The actual rates for Part B (which covers the costs of doctor visits and outpatient care) will be announced in October and take effect January 1.
Continue reading “Big Price Hikes for Medicare Premiums in 2017?”