The Trump administration has taken another step in its effort to roll out short-term health insurance plans by extending the amount of time such plans can be in effect.
Under the new rule, which was issued August 1, short-term plans can be purchased for up to 12 months and policyholders can renew coverage for a maximum of 36 months.Read More
After announcing that it would stop paying risk-adjustment payments to insurance companies with plans on the individual market on July 7, the Centers for Medicare & Medicaid Services reversed course two weeks later and said it would indeed continue making the payments.
The risk-adjustment program tries to balance the medical risk in the Affordable Care Act’s insurance markets. Health insurers that are found to have healthier customers (according to a federal formula) pay money into the program, and then insurers who have sicker customers receive money out of it.Read More
As group health insurance costs continue rising every year, more employers are embracing a new plan model that aims to both cut costs and improve outcomes for patients.
This trend, known as value-based primary care, is a bit of an umbrella term for various models that involve direct financial relationships between individuals, employers, their insurers and primary care practitioners. Insurers are experimenting with different model hybrids to find better care delivery methods that reward quality outcomes and reduce costs.Read More
Most business owners know about the yearly $2,000 per-employee fine they would face for not securing health coverage for their employees under the Affordable Care Act.
But there is even a larger fine that threatens under recent regulations issued by the IRS – and it’s not for failing to secure coverage.
Regulations governing how wellness plans offer discounts on health premiums are set to sunset in January 2019, and with no prospects of replacement regulations in sight at the Equal Employment Opportunity Commission, this means that the shackles will be lifted on the plans.
The rules which allow an employer to grant up to a 30% discount on health insurance premiums to employees that fill out health questionnaires or take various health evaluation tests, were found to be “arbitrary” by an appellate court judge about a year ago. But, to avoid disruption in the marketplace and for employers who had already set their wellness plans in motion, the judge ordered the regulations to sunset on Jan. 1, 2019.
As the number of employers offering high-deductible health plans continues growing, the spotlight recently has highlighted an inconvenient truth: some employees are going broke and filing bankruptcy because they cannot afford all of the out-of-pocket expenses and deductibles they must pay in these plans – just like the bad old days in the 1990s and 2000s.
Besides being in plans with high deductibles, many employees are also paying more for coverage as employers have shifted more and more of the premium burden to their staff.
The Department of Labor in June issued its final rules for expanding employers’ access to association plans, a move that could result in some increases in premiums for other plans, including Affordable Care Act-compliant small group health plans.
The rule in its essence allows more small businesses and self-employed workers to band together to buy insurance. The final rule is part of the Trump administration’s plan to encourage competition in the health insurance markets and lower the cost of coverage.Read More
“THE CHOSEN ONE”
The internet is buzzing after the Big Three (Big Three meaning Amazon, Berkshire Hathaway, and JPMorgan) announced the new leader for their health initiative: Dr. Atul Gawande, a Harvard surgeon and staff writer for The New Yorker magazine, who comes to this position with high praise and some reservation.
Dr. Gawande could very well be the chosen one to change healthcare. The three behind the big three – Bezos, Buffet and Dimon – believe he has the essential requirements to move forward with “this challenging and worthwhile endeavor;” expert’s knowledge, a beginner’s mind and a long-term orientation.”
Beyond his vision, Gawande is known to focus on efforts that improve care and medical errors. He’s dedicated his public health career to eliminate wasteful spending – the epidemic that continues to deepen the crack in an already broken system.
In our last expert session, we pulled back the curtain on this major epidemic of unnecessary care, misdiagnosis and expendable treatment. If he can apply his background and goals to tackle this epidemic with Amazon-like accessibility, there could be some meat on these bones.
The biggest hesitation is coming from our industry. Although many companies (like Walmart and British Petroleum) have successfully implemented these strategies to cut the health spend for themselves and their employees, employers are hesitant because there is no mass social proof.
With the entire country watching, Gawande and Amazon can take on healthcare they way Bezos disrupted retail, and no one will be able to look away. Boom – social proof.
The Takeaway
When Benzos started Amazon, he said: “your margin is my opportunity.” The same applies to disrupting the healthcare space. Consumers were being overcharged for goods and he eliminated the “middle man” of fees that jacked up retail prices for shoppers.
When the same tactics are applied to make decisions for procedures and care, Americans will buy in.
Is he the chosen one? Possibly, but only if he can deliver the most critical component. Real choice.
Read the entire article here: https://www.nytimes.com/2018/06/20/health/amazon-berkshire-hathaway-jpmorgan-atul-gawande.html
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The IRS has released the inflation-adjusted amounts for 2019 used to determine whether employer-sponsored coverage is “affordable” for purposes of the Affordable Care Act’s employer shared responsibility provisions.
For plan years beginning in 2019, the affordability percentage has increased to 9.86% (from 9.56% in 2018) of an employee’s household income or wages stated on their W-2 form. The higher rate is indicative of the anticipated small group plan inflation that continues hitting premiums.Read More
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