NEW YORK Individual Open Enrollment & Social Media PSA
We know we’ve reached the lunacy of fourth quarter in our industry when social media starts spreading crazy rumors and misinformation. Clients call in panic, we feel the panic, and it all makes taking care of our health insurance needs not fun!
Every state has different Open Enrollment dates and deadlines. We understand it’s hard to keep straight, this blog reviews the DEADLINES THAT PERTAIN TO NEW YORK.
There’s a popular INACCURATE post circulating on Facebook currently that looks something like the one below.
🤓 Let’s analyze
The information in this post is almost entirely incorrect for New Yorkers! Please don’t share this if you see your friends posting.
Direct them to this 100% CORRECT graphic instead:
For enrollment information specific to your state, visit healthcare.gov.
Stop Sexual Harassment in New York State – LAW UPDATE
The 2019 New York State budget includes the nation’s strongest and most comprehensive sexual harassment package, including new resources and requirements for employers. Enacted on April 12, 2018, the law amended several of the state’s labor and other employment-related laws to provide increased protections against sexual harassment in the workplace.
Effective October 9, 2018, the amendments require every employer in the state to:
- Adopt a written sexual harassment prevention policy
- Provide the written policy to all employees; and
- Conduct annual sexual harassment prevention training for employees
Under the budget law, an employer’s written policy and training program on sexual harassment must meet or exceed standards set forth in models issued by the NYDOL.
All current employees must complete the initial required training that meets the minimum standard by Oct. 9, 2019 (this is an extension from the Jan. 1, 2019, deadline initially set forth in the draft).
If you have one employee who lives or works in New York, you must comply with the New York State’s new training requirements. It even applies to employees who are based out-of-state but work in New York for just one day as well as out-of-state companies with New York State contracts, even if no employees live or work in New York.
New York State Sexual Harassment Prevention Policy and Training Mandates:
The NYS Human rights law:
- Implemented new protections against harassment
- Requires mandatory sexual harassment prevention policy and training
The new law also prohibits:
- Mandatory arbitration clauses for sexual harassment
- Nondisclosure provisions and agreements for sexual harassment
Every employer in New York should:
- Adopt the NYDOL’s model written policy (or a written policy that meets or exceeds the NYDOL’s minimum policy standards) and ensure that its employees receive a copy of it on or before Oct. 9, 2018; and
- Adopt the NYDOL’s model training program (or a program that meets or exceeds the NYDOL’s minimum training standards) and ensure that its employees receive the training by Oct. 9, 2019.
New York City Sexual Harassment Fact Sheet and Notice
The New York City Commission on Human Rights released a new sexual harassment fact sheet and notice that employers are required to provide. The fact sheet must be distributed to each employee at the time of hire, and the poster must be conspicuously posted in the workplace. See the fact sheet and notice.
Want to know more about the New York laws? Read more here.
NY Paid Family Leave – 2019 Update
NY Paid Family Leave was signed into law in 2016, and went into effect on January 1, 2018. This program, which is the most comprehensive of paid family leave programs in the US, allows eligible employees to take time off to care for a seriously ill family member or spend time with a new child, while receiving a portion of their salary. Employees are also ensured job protection, can retain their health insurance, and are protected against discrimination or retaliation while on leave. Private employers in New York State are required to have PFL in place. If your organization has a disability benefits policy in place, PFL can typically be added to the policy as a rider.
Get In Touch to download your NY Paid Family Leave Update Today!
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Transparency & Technology: A Winning Combination for Brokers
“Employers today are faced with an overwhelming amount of decisions when it comes to health care. However, the end goal always remains the same – to provide the best, most affordable options to employees.
But it’s nearly impossible for these owners to comb through the complicated benefits, HR, and compliance landscape…without some help.
Group Health Solutions, the benefits company of SDL + GHS, is an employee benefits agency in New York helping clients navigate the complex world of group and individual health insurance. They’re also a PrimePay Broker Concierge partner.
As managing director (with a specialty in group benefits) Rob Bujan explains, technology and transparency have been key players in their quest to make clients’ lives easier. Here’s how.
The right fit.
You get a great referral from a client who you’ve done business with for years. It has the potential for being a huge deal in your book of business and you’re excited about the opportunity. But, after meeting with the business owner, you realize that what you offer might not actually align with their goals as beautifully as you imagined. Disappointment ensues. Sound familiar?
Instead of trying to come up with a customized plan and make something work that really shouldn’t, GHS leads with transparency.
“Not everybody is going to be a great fit for every broker and not every broker is going to be a great fit for every client. And we’re pretty up front and honest about that. If we’re doing an evaluation on a client and we just feel that there’s really nothing that we can bring to the table, we’ll typically say, ‘Give us five minutes. Let us explain our technology and if this is something that you think that would benefit you, then let’s continue the conversation.’ We’re just not going through an arduous sales process just to get a client on the books,” explained Bujan.
Bujan has been in the employee benefits industry for over 25 years and truly believes in this code of ethics. He understands that people are very concerned about what’s going to happen with the hot button issues of health care, mergers, the individual market, Medicare/Medicaid, etc. And though commissions have been gutted over the last 10 years, he still takes it upon himself to do all that he can to take that fear away from clients.
“We give back to the community and often provide services for individuals who need to get enrolled on Medicaid and or need guidance in the individual market. It’s not just about making money; we should really be a good corporate neighbor. We’re an expert for a reason and there’s times that we need to be able to give that expertise to our community or to our clients without expecting anything back from it,” said Bujan.
Transparency is such an important factor of a healthy business relationship. Strong relationships are built on trust and the key to gaining that trust is transparency. Proactive, honest communication will lead to better results.
In what ways have you practiced transparency at your agency?
Technology for everyone.
“No, I don’t want to have more time to focus on my work,” – said no one ever.
GHS sells themselves as a technology-driven organization with a depth of knowledge of benefits that can help solve common HR problems.
“Thanks to our technology, we have the ability to assess an employer’s need and fix their pain points of having too much to do and not enough time,” said Bujan.
Having the right tools in place to streamline processes is a necessary first step in easing your clients’ worries. The second (and crucial) step is adding the human element and support to back up that technology.
There are so many benefits to becoming a technology-driven agency. A lot of times, business owners are hesitant to add more options for coverage because of the exhausting (and tricky) paperwork. But Bujan says, “In the last two months, I have three solid examples of how we’ve been able to refocus clients on hiring and employee engagement and benefits and get them in compliance by following up on the paperwork nightmare they’re in.”
Technology can help increase ease of integration with different carriers, streamline communication and open a world full of greater efficiencies for your clients.
How has technology helped your agency?
Bonus: Integration with PrimePay and Employee Navigator.
GHS and PrimePay have been working together for several years.
“We make it easier for clients to have happier employees when we transition them from one of your competitors over to your services,” said Bujan.
And with PrimePay’s recent integration with Employee Navigator, Bujan is excited for the opportunities to come.
“When we started working with Employee Navigator, we needed to really find some more efficiencies with regard to eligibility and employee benefits. Section 125 programs are all complicated, but we felt that PrimePay offered the fix and was able to dig down and make something good happen. We talked to both Employee Navigator and PrimePay and hoped that they would be able to enter a partnership which they now have so we’re really excited about that,” he said.”
CITATION: Fausnaught, R. (2018, January). Transparency & Technology: A Winning Combination for Brokers. Retrieved from: https://primepay.com/blog/transparency-technology-winning-combination-brokers
New York Paid Family Leave – Checklist
Mandatory Paid Family Leave compliance will be here before you know it. Now is the time to start preparing to ensure success in addressing PFL. We are here to help lead you through the appropriate steps to make this transition as smooth as possible. Here is a brief checklist addressing key factors to get you ready for Paid Family Leave next year.
Will your 2017 tax return be returned by the IRS because of your health insurance?
From Managing Director of SDL + GHS, Rob Bujan’s Blog, ‘Pulling the plug on Healthcare in the US’
“When you took a test in school and you didn’t know an answer, or you just didn’t feel like answering the question, you might have skipped it. In school, that question would have been marked wrong, but more than likely, your teacher still accepted the test.
Well, the IRS is not a teacher and we live in a whole new world today.
The IRS has recently announced that when filing your income taxes you can no longer be silent on the question of whether or not you have had health insurance during the tax year. Read more about this here. If you skip this question, you will not be able to file your taxes. So – prepare now to answer the question – whether it be yes or no, they want to know and they are going to make a point of having you tell them.
Make sure to note this when having a conversation with your accountant.
And while I normally don’t need to say this, I am not an accountant or a tax attorney, nor do I play one on television – this is my personal blog that I provide information gathered in my worldly & exotic travels as a benefits consultant.”
CBO Releases Updated Score of AHCA – 51 Million to Be Uninsured, Government Savings of $119 Billion
CBO Releases Updated Score of AHCA – 51 Million to Be Uninsured, Government Savings of $119 Billion
May 26, 2017
The Congressional Budget Office (CBO) released their highly anticipated updated report on the American Health Care Act (AHCA) on Wednesday, showing that the bill would save the government $119 billion and that an additional 23 million would be uninsured to bring a total of 51 million Americans without insurance. This amounts to a net increase of 3 million additional uninsured from before the ACA was signed into law, when 48 million didn’t have coverage. The previous score released in March projected that the bill would save the government $150 billion (revised down from an initial savings of $337 billion) and would lead to 24 million newly uninsured. The CBO is the nonpartisan group tasked with determining the cost of legislation to the federal government, both in a loss of revenue and increase in spending.
The updated report was necessitated by the adoption of several amendments to the AHCA from the last time the bill had been scored. The most prominent of these was the amendment offered by Representative Tom MacArthur (R-NJ) to allow states to receive a waiver to opt out of the ACA’s essential health benefits and age and community rating provisions. These waivers would be contingent on reducing average premiums, increasing enrollment, stabilizing the market, stabilizing premiums for individuals with pre-existing conditions, or increasing the choice of health plans. In turn, states could propose one of the following:
Increase the state’s age-rating bands. The state must specify a higher age-rating band, generally defaulted at 5:1 under other sections of the AHCA, although states could opt for higher ratios.
Establish state-based requirements for essential health benefits (EHBs) in the individual and small group markets beginning in 2020. The state must precisely specify both the benefit categories and the specific benefits within the categories. This could include overriding the ACA’s prohibitions of lifetime and annual limits and cap on out-of-pocket expenditures, which could also be applied to large group and self-insured employer plans.
Permit insurers to price policies based on health status. This substitutes the AHCA’s original continuous coverage incentive’s late-enrollment penalty to allow insurers to charge higher premiums for consumers who do not maintain continuous coverage (defined as a lapse of 63 days+ over 12 months). It is important to note that the amendment would not allow states to automatically rate up consumers with pre-existing conditions. The amendment only allows for insurers to underwrite consumers with pre-existing conditions if they do not have continuous coverage in states where a waiver has met all conditions to be approved.
Waivers may be approved for a period of up to 10 years, providing they continue to meet the conditions of the waiver, and any waiver submitted by a state would be automatically approved if they are not notified of a denial within 60-days of submission. Waivers that seek to permit health status underwriting would also be contingent on the state providing financial assistance to high-risk individuals to obtain individual market coverage, providing incentives to appropriate entities to help stabilize premiums, and participating in the “Federal Invisible Risk Sharing Program,” which includes $15 billion in federal funding between 2018 and 2026 as a reinsurance mechanism to reimburse insurers for high-cost plan enrollees.
The invisible risk sharing funding was joined by two additional high-risk funding pools to bring a total of $138 billion in the amended bill overall. The original bill included $100 billion over 10 years for the Patient and State Stability Fund, and in addition to the $15 billion in invisible risk sharing, the two other amendments passed since the bill was initially considered in March include $15 billion for funding for maternity, mental health, and substance abuse care, and $8 billion specifically added for additional high-risk pool funding as a result of the MacArthur Amendment. The CBO report cautions that this funding would have a small effect and not be sufficient to reduce large increases for high-cost enrollees. For comparison, the report notes that the ACA’s pre-existing condition insurance pool covered 100,000 enrollees at a cost of $2.5 billion over two years. Further, the Patient and State Stability Fund would require significant funding by states in the out-years; states would initially only be required to provide 7% of matching funds, but this would grow to 50% required by 2026.
With these amendments and the increased state flexibility for how the AHCA would now be implemented at the state level, the CBO performed an extensive analysis of the impact of the legislation. Overall, the CBO found that it would result in a net savings to the federal government of $119 billion, a result of $1.1 trillion in reduced spending over 10 years while revenues would be reduced by $992 billion. The bulk of the reduced spending, $834 billion, comes from repealing the ACA’s Medicaid expansion and another $236 billion comes from replacing the current advanced premium tax credits ($665 billion) with less generous tax credits in the AHCA ($375 billion).
The reduced revenue is largely due to repealing the majority of the ACA’s taxes (a loss of $664 billion in revenue), of which $275 billion would come from eliminating the net investment tax, $145 billion from the health insurance tax (HIT), and additional lost revenue from taxes unrelated to health coverage proposals. The CBO also projects that delaying the Cadillac/excise tax until fiscal year (FY) 2025, as written in the AHCA, would cost the federal government $49 billion in lost revenue. Revenue would further be reduced by effectively eliminating the ACA’s individual and employer mandates by reducing those penalties to $0, although they would still statutorily exist. The employer mandate makes up most of this at $171 billion, while individual penalties would result in $38 billion in lost revenue.
The biggest cause of the increase in the uninsured rate is due to the elimination of these penalties. As with the previous report, the new report estimates that 14 million Americans would become newly uninsured next year under the AHCA, gradually increasing to 23 million for a total of 51 uninsured by 2026. The AHCA as amended would not result in as many individuals losing employer-sponsored insurance (ESI) as previously estimated. The CBO projects that there would be 1 million fewer people enrolled in ESI in 2020 (compared to 2 million in the previous estimate) and by 2026 there would be 3 million fewer enrolled in ESI, compared to 7 million as previously projected. The revised estimates are largely due to individual health insurance being far less comprehensive and individuals opting to enroll in employer coverage instead to avoid higher out-of-pocket expenses.
The employer-based market currently enrolls more than 175 million Americans in health insurance coverage and NAHU strongly supports measures to maintain this system. As with the previous CBO report, NAHU remains concerned about the impact of the AHCA on ESI. The new report reiterates the previous assumption, which projected a gradual erosion of ESI, stating that over time, some employers would decline to offer insurance to their employees due to the loss of the mandate penalties and because the AHCA’s tax credits would be available to a broader group of individuals than those under the ACA. It expects that both employers and employees would decide against coverage, with some employers opting to drop coverage as employees would be eligible for tax credits, and some individuals who are offered ESI choosing not to enroll given the absence of tax penalties for being uninsured. Notably, previous CBO reports similarly expected that the ACA would result in a drop in employer-based coverage, a projection that has not materialized.
The report notes that premiums would generally be lower in the individual market because the health plans would be less comprehensive and cover fewer benefits and a smaller share of healthcare costs for the consumer. Additionally, there would be considerable cost-shifting on enrollees with significantly more out-of-pocket expenses, particularly those enrollees who use services that are no longer covered by plans, who would see substantial increases in out-of-pocket expenses. The CBO projects that consumers in this situation, such as those who require expensive prescription drugs no longer covered by health plans, could have increases of thousands of dollars in out-of-pocket expenses each year. Some consumers may choose to purchase policies with riders for specific conditions for this reason, particularly for maternity coverage.
The report notes that while premiums would generally go down for individual market insurance, net premiums after factoring for tax credits would range considerably depending on the particular consumer. Older people with lower incomes would see dramatic increases in their net premiums, while younger people with lower incomes would see little change, and people with higher incomes would see their net premiums reduced as they could access tax credits previously unavailable to them. And while overall more individuals will be able to access the tax credits under the AHCA, those subsides are far less generous than those under the ACA. The report illustrates the effect on a 64-year-old at 175% of the poverty level; under current law with a $15,300 premium, they would have a tax credit of $13,600 and a net premium of $1,700; under the AHCA’s flat tax credits, they would only be eligible for a tax credit of $4,900 and with an adjusted premium of $21,000, they would face a net cost of $16,100 in premiums alone—nearly ten-fold over the ACA and roughly 60% of their total annual income on health insurance premiums alone.
Additionally, some individuals may be able to purchase policies that would have no net cost to them, as the existence of a baseline level of tax credits could encourage some insurers to offer skinny plans at the value of the tax credit. However, the CBO cautions that these plans would effectively not provide enough financial protection in the event of catastrophic care needs to legitimately be considered insurance.
The CBO effectively made three separate estimates based on how states could respond to the AHCA as passed with the MacArthur Amendment. The first is the group of states that choose not to apply for waivers, which cover roughly half of the population, and would likely be among the seven states that prohibited medical underwriting before the ACA. The second is those that apply for limited waivers, which cover a third of the population, and would be likely be among the 11 states that had limitations on medical underwriting. And the third is states that apply for waivers to significantly modify EHBs and community rating rules, which cover a sixth of the population, and are among the 32 states that had no limitations on medical underwriting. States with lower premiums would generally fall with those that eliminate one or more EHB categories that were not typically available prior to the ACA.
The AHCA would bring needed stability for much of the country’s health insurance markets; however, states that choose to pursue the waivers created under the MacArthur Amendment would conversely become more destabilized. The states that opt for waivers to allow for medical underwriting or to modify their EHBs to eliminate the ACA’s ban on annual and lifetime limits would lead to significant increases in expenses for some consumers. The CBO notes that many of these individuals with pre-existing conditions could face markets where coverage would be either prohibitively expensive or they might not be able to purchase coverage at all. Additionally, many consumers move in and out of the individual market as access to insurance changes and many of these could fail to meet the continuous coverage requirement. As healthier consumers move to medically underwritten plans, the community-rated plans will become increasingly filled with less healthy consumers, and therefore become increasingly more destabilized.
The updated CBO report marks an important milestone for the AHCA. Republicans tasked themselves with coming up with a reconciliation bill that would reduce the deficit by a minimum of $2 billion over 10 years. After passing the AHCA as amended without an updated score, the House had initially delayed sending it over to the Senate to ensure that it would meet the benchmarks laid out in the reconciliation instructions. Had the CBO report indicated that the bill didn’t meet these requirements, the House would have had to once again vote on an updated bill that would meet them. And had the bill already been enrolled by the Senate with a score that didn’t meet the requirements, they would no longer have been able to use the FY 2017 reconciliation vehicle for healthcare and either would have had to use the FY 2018 reconciliation vehicle they planned for tax reform, or wait until next year to try again. Because the new score by the CBO meets the requirement by projecting a net savings of $119 billion, the bill can now be enrolled with the Senate and they can formally begin deliberations on their version of health reform.
The American Health Care Act (AHCA) Passes the U.S. House
From CIGNA Informed on Reform
Today the U.S. House of Representatives passed an amended version of the American Health Care Act (AHCA) by a vote of 217-213. House Republicans crafted the AHCA as a budget reconciliation bill to repeal parts of the Affordable Care Act (ACA). The bill was previously debated on the House floor, but pulled before a full vote on March 24. Since that time, several amendments were added to the bill, paving the way for Republican leadership to reintroduce the bill for a successful vote.
Passage of the bill in the House marks a milestone in the Republican efforts to repeal and replace the ACA; however, the bill will face new challenges in the Senate. Here’s what we currently know — and don’t know — about the next steps to help you stay informed.
What’s Next: AHCA Moves to the U.S. Senate
Without bi-partisan support, Congressional Republicans cannot fully repeal the ACA in one action. By using the budget reconciliation process, only a simple majority (51 votes) is needed for passage in the Senate — and there are 52 Republican senators. Even with a Republican majority, the bill faces an unclear path forward.
The Republican leadership in the Senate will first need to decide if they want to consider and amend the House bill, or substitute their own version of a reconciliation bill, which may contain parts of the House bill.
Additionally, the Senate must follow procedural rules that don’t apply in the House. Under Senate reconciliation rules, the nonpartisan Senate Parliamentarian must first review and confirm the bill and any amendments comply with the rules for reconciliation, known as the Byrd Rule. For example, insurance market reforms that are currently in the AHCA may not be allowable under the Byrd Rule, if it is determined they don’t have direct spending impact.
The Parliamentarian’s analysis requires a Congressional Budget Office (CBO) score (cost estimate). While the CBO scored an earlier version of the AHCA, the recent amendments require the CBO to update its cost estimate, meaning it could be a few weeks before the Senate can bring a bill to the floor for debate and an eventual vote.
Identical versions of the bill must pass both chambers before being signed by the President and becoming law. If the Senate passes a bill that isn’t identical to what the House passed, there are two paths forward: 1) the House could pass the Senate bill and send it to the President; or 2) a bicameral conference committee can meet to negotiate a new compromise bill. That negotiated bill would then have to be passed by both chambers, before sending it to the President for signature. It is unclear which option might be used in this instance.
Timing is unclear for these next steps to occur, but there continues to be support from the Administration to move forward with repeal and replace of the ACA this year.
Reminder: ACA Compliance is Required Until Official Guidance Otherwise
As a reminder, ACA compliance is required until official guidance to the contrary is issued. The House passage of the AHCA is the first of several required steps before any official changes are enacted. For a customized timeline and more information about ongoing annual responsibilities and applicable employer deadlines under the ACA, visit YourACARoadmap.com.
To stay up to date on the evolving state of health care reform, visit www.InformedOnReform.com, including the new Repeal and Replace Update webpage. This page offers a snapshot of the latest regulatory and legislative activity.
AHCA Withdrawn – What’s Next?
AHCA Withdrawn – What’s Next?
Great update from CIGNA’s Informed on Reform Series
March 30, 2017
On Friday, March 24, efforts by U.S. House Republicans to utilize the budget reconciliation process to repeal portions of the Affordable Care Act (ACA) experienced a significant setback with the withdrawal of the American Health Care Act (AHCA) before a full vote. As reported in our recent update, the AHCA had been proceeding through the House legislative process and provided a strong indication of the policy direction Congressional Republicans favor on health care reform. The withdrawal of the AHCA marks a crossroads with respect to the future of the ACA.
Here’s what we currently know — and don’t know — about what could be next to help you stay informed.
ACA Remains the Law of the Land
The ACA remains the law of the land. Ongoing compliance with the law is required unless and until official guidance to the contrary is issued.
What’s Next for ACA Repeal and Replace?
The withdrawal of the AHCA signals a pause by Congressional Republicans in their repeal and replace effort without bipartisan support, but the debate about the future of the ACA is likely far from over. Now there are significant questions about what type of action, if any, Congress or the Administration will take to continue efforts to dismantle, replace or reform the ACA. Here are a few possibilities:
· Regulatory Action for Market Stabilization and Regulatory Relief
Secretary of Health and Human Services Tom Price has authority to propose changes to current ACA regulations, which could be done to help stabilize the individual marketplace and/or provide regulatory relief “to the maximum extent permitted by law” as directed in the January 20 Executive Order.
· Regulatory Non-Enforcement
Similar to directing agencies to offer regulatory relief, it is possible the Administration may adopt policies of non-enforcement of certain regulations, such as potentially directing the Internal Revenue Service (IRS) to not to enforce penalties related to specific ACA provisions.
· Comprehensive Tax Reform
The Administration and House Republican Leadership have indicated that their next priority is tax reform. It’s possible that certain ACA taxes or penalties could be repealed or changed as part of Congressional efforts to rewrite the Internal Revenue Code.
· Targeted Legislation
While the next steps for a new repeal and replace bill remain unclear, piecemeal legislation could be introduced on specific provisions, such as individual insurance market reforms. Bipartisan support will be required for this legislation to be successful in the Senate.
· Increased State Autonomy
As part of the regulatory efforts, the Administration could defer decisions on certain health care reform provisions to the state level. Recently, Secretary Price invited governors to submit State Innovation Waivers (allowed under the ACA beginning in 2017), which would grant states more autonomy in making decisions about their health care structures.
Other Marketplace Issues to Watch
In addition to any potential changes to the public Marketplaces, there is current litigation about funding for cost-sharing subsidies for individuals covered through a Marketplace. Additionally, insurers will soon submit their plans regarding if and where they will participate in Marketplaces for 2018.
Upcoming ACA Employer Compliance Deadlines and Staying Informed
With the ACA remaining in place, employers and broker partners can use Your ACA Roadmap to receive a personalized snapshot of the annual responsibilities and applicable deadlines for 2017 and 2018. Visit www.YourACARoadmap.com for more information. Additional information can also be found on Cigna’s reform website at www.InformedOnReform.com.
Cigna will communicate via updates, news alerts and web meetings as the state of U.S. health care reform continues to evolve.
Pulling the plug on Healthcare in the US – Dissecting the Regular Facts from the Alternative Facts
With all cards on the table, is this Pay or Play 2.0?
Where do we stand now?
New changes in the last 24 hours were made among them:
1. Repeal the 10 essential health benefits mandate (Conservative Caucus)
2. Add an addition $15B into a flexibility fund (for states to manage Medicaid) (Coverage Caucus – side note here – Senator Cassidy R-LA – who worked with Senator Collins R-ME on a separate bill is heading the coverage caucus as they are working to keep coverage in the Medicaid programs)
3. Keep the .9% Medicare tax for high-income earners making over $200,000 filing single for six more years – this would be to keep bringing in new revenue (This was originally in the bill to sunset as of 2018, then adjusted to sunset this year but looks to be sunsetted in 6 years)
What else did I miss?
Earlier this week, additional changes were made to the bill as it was attempted to garner enough votes to pass on the floor of the House. Most of these are changes in implementation dates to appeal to different parts of the House GOP.
1. Moving the repeal of the Tanning & Medical Device tax from 2018 to 2017
2. Moving the repeal of the business tax cap for executives in health insurance companies from 2018 to 2017
3. Sunset new Medicaid expansion for states that have not expanded from 2020 to 2017 (Kansas is currently trying to expand Medicaid as we speak)
4. NY Representatives add an amendment to move $2.3B Medicaid costs from local (county – excluding large metropolises like NYC) to the State Budget
5. Lower the medical expense deduction from 7.5% under the original bill now to a new low of 5.8% and to move up implementation from 2018 to 2017
6. Delay Cadillac tax from 2025 now pushed out to 2026
7. Repeal the maximums and over the counter medication bans on Flexible Spending Accounts from 2018 to 2017
8. Increase the HSA limits to maximum out of pocket costs from 2018 to 2017
What does this all mean? Well, to be absolutely frank – not much, if they don’t have the votes today. What does it mean in the future, though, EVERYTHING.
I don’t think you will find someone who doesn’t think we have work to do on the ACA. I am the first to say it. I also think that we have to get a bi-partisan committee to work together with consumer groups; AARP; AHIP; AHA; AMA and the healthcare consulting (i.e. the broker) community. We are in the battle on a daily basis. We know what can work and what should work and this needs to be done right and it needs to be done soon.
There are good ideas out there and we have to approach this on a more macro level and look at the outside forces that are affecting the current delivery system, i.e. lowering the cost of pharmaceuticals by introducing competition; providing incentives for smaller companies to do more development on generic alternatives; banning pharmaceutical companies from shelving generic patents when they become available; more efficient medical record data sharing; cutting out redundancy; providing affordable medical malpractice insurance programs to incent OBGYNs and other speciality providers who want to provide care but can’t afford the malpractice premiums; identifying high-cost chronic conditions and look at possibly pooling them into a national program such as Medicare, as we do with End Stage Renal Disease; providing TRANSPARENCY to the consumer by giving them the means to shop for a procedure with outcomes and cost as easily as they can today with houses; technology and cars; getting more funding and education to fight the opioid epidemic.
We cannot continue to kick the can down the road, adjust the programs to suit a small group of interest. The health of this country is at stake; the health of its citizens are at stake and millions of jobs are at stake. We need to pull this out of the halls of Congress and get the experts, who manage this, at the table now before it is too late.
There are solutions, there is a way – but we have to do this together with experts and support it as a country. This is one thing neither party should own but every party should want to see succeed.