Tag: Healthcare Reform

Health Care Reform Law Gaining Popularity

Editor note: This article was originally published here.

An April Kaiser Family Foundation poll found that support for the health care reform law surged among respondents who said they were Democrats.

Regardless of political affiliation, opposition to the 2010 health care reform law has dropped, according to a new survey.

The poll, conducted by the Kaiser Family Foundation, found that in April 43% of respondents had a favorable view of the Affordable Care Act, while 42% had an unfavorable view and 14% didn’t know.

By contrast, in January 2014, 50% of respondents had an unfavorable view of the law, while just 34% had a favorable view and 16% didn’t know.

Support for the law surged among respondents who said they were Democrats. For example, last month 70% of respondents who said they were Democrats said they had a favorable view of the health care reform law, while just 16% had an unfavorable view, and 14% didn’t know.

That’s a big pickup in support compared to January 2014 when 58% of Democratic respondents had a favorable view of the law, 26% had an unfavorable view, and 15% didn’t know.

While Republicans still overwhelmingly have an unfavorable view of the law, opposition has declined since 2014.

For example, last month, 75% of respondents who said they were Republicans said they had an unfavorable view of the law, while 16% had a favorable view, and 9% didn’t know.

By contrast, in January 2014, 81% of GOP respondents said they had an unfavorable view of the law, while 9% had a favorable view, and 10% didn’t know.

The pickup in support for the law coincides with a big improvement in a key feature of the law: the creation of public insurance exchanges in which lower-income individuals can use federal premium subsidies to purchase coverage.

In January 2014, many of the exchanges were still suffering from technology-related problems that made it difficult for applicants to smoothly choose from exchange plans and obtain coverage.

Today, those problems, observers say, have largely eased. During the latest 2015 open enrollment season, nearly 11.7 million people selected plans in the federal and state health insurance exchanges, the U.S. Department of Health and Services reported In March, a big jump over last year’s open enrollment season when just over 8 million opted for exchange coverage.

In all, 14.1 million previously uninsured adults have gained coverage due to the health care reform law since October 2013, HHS said.

The Kaiser polls are conducted by telephone and have between 1,200 and 1,500 respondents.

4 PPACA Pitfalls You Can’t Overlook

by Gentrie Pool, CSA, REBC, RHU, SGS

Editor Note: This article was written by Sterling’s Director of Sales Gentrie Pool and originally published here, by benefitspro.com – the #1 online destination for benefits professionals.

As we know, the Department of Labor, Treasury and Health and Human Services (collectively referred to in this article as the “Agencies”) are regularly releasing healthcare reform regulations and clarifications. Below is a brief summary of only some of the points that came out of 2014 from the Agencies.

What did healthcare reform give us in 2014?

1) 4980H Employer Shared Responsibility Requirements (often called “pay or play”)

  • One year delay to 2016 for excise taxes for applicable large employers (ALEs) with less than 100 full-time equivalents in 2014. They still have (Section 6056) reporting requirements for 2015 though. Note: group size is not the only requirement for the delay.
  • The look back measurement period (LBMP) applies to all employees within the same class (e.g. salaried or hourly) of applicable large employers (not just variable employees, for example).
  • An applicable large group employer member is not considered to have made an offer of coverage to a full-time employee unless the employee had the opportunity to elect coverage for his/her dependent children, if any, That coverage, if elected, would extend through the end of the month in which the child turns 26 (or if earlier, the date the coverage ended for the employee).

2) Section 6056 Reporting

  • This requires applicable large employer members to file an IRS form (similar to and in addition to a W-3) which identifies each of the employees who were full time at least one month of the calendar year and what, if any, coverage was offered. A form is also to be furnished to those full-time employees (similar to and in addition to a W-2)  – Forms (1094 and 1095-C).

3) Section 6055 Reporting

  • This requires minimum essential coverage providers to file an IRS form identifying each individual enrolled at least one day during that year. This applies to any employer who offers a self-insured plan and to individuals covered under the plan. The form also must be provided to covered individuals. Fully insured carriers will satisfy this obligation with respect to individuals covered under the policy. Employers sponsoring a self-insured plan are obligated to satisfy the requirement with respect to all individuals enrolled – Forms (1094 and 1095-B).

4) 2014 Health Insurance Reforms: Waiting Period Limitation and Out of Pocket Maximum Requirements

  • PHSA Section 2708 generally limits waiting periods for otherwise eligible individuals to 90 calendar days. Regulations clarify that terms of eligibility generally cannot be based solely on the passage of time. Eligibility based on accumulated hours, not to exceed 1200, or a “measurement period” is permissible. Employers may implement a 30-day orientation period for employees who otherwise satisfy the eligibility requirement, after which the waiting period can begin.
  • In referencing FAQs provided by the agencies, there was no mention of the dollar amount associated with out-of-pocket requirements for “reference-based pricing arrangement.” According to the FAQs, plans my treat providers who accept the plans “reference base pricing” as the only in-network providers, if certain conditions are satisfied. If those conditions are satisfied, then all services or treatment given by providers who did not accept the plans reference base pricing, including network providers, can be treated as out-of-network in the cost sharing for such services and fall outside the out-of-pocket maximum limitation. This is an important distinction because typically the out-of-pocket maximum imposed by health care reform applies to all cost sharing with respect to services or treatments provided by in-network providers, Cost sharing for out-of-network providers does not have to be applied to the out-of-pocket maximum.

Source for information in this article: Employers Council on Flexible Compensation: John Hickman, Esq., Ashley Gillihan, Esq., and Merdith Gage, Esq., Alston & Bird, LLP

Little Known Impact of Healthcare Reform: PCORI Fees

by Chris Bettner, Sterling Executive Vice President of Business Development

The Internal Revenue Service (IRS) issued a final rule on fees on health insurance policies and self-insured plans for the Patient-Centered Outcomes Research Trust Fund. The Patient Protection and Affordable Care Act (PPACA) established PCORI to promote evidence based medicine by sharing comparative data and effectiveness through research findings.  This is the funding mechanism for the research.

To fund PCORI, PPACA imposes a fee on employers who sponsor self-insured health plans and insurers providing fully insured health coverage as well.  For each policy or plan year ending on or after Oct. 1, 2012, and before Oct. 1, 2019, the first payment is due by July 31, 2013. Each year following, the fee will be due no later than July 31 following the last day of the plan year. The fee must be reported on Form 720, completed by the employer with the fee attached.

The fee is $1.00 per plan participant for the first plan year ending after Sept. 30, 2012, and $2.00 per plan participant in succeeding years.  For policy or plan years ending after Oct. 1, 2014, the fee will be increased based on increases in the projected per capita amount of national health expenditures.

The final rule clarifies that the fee required by the employer is based on the average number of lives covered under the plan during the plan year. There are several ways to calculate this.

If an employer sponsors more than one self-insured arrangement they are treated as a single plan for calculation purposes as long as the plans have the same plan year.  An example of this is a self-insured health plan and a self-insured Health Reimbursement Arrangement (HRA) attached to that health plan.

In the event that the employer has a fully insured health plan with a self-funded HRA, the fee applies to the HRA population.  Remember that the health plan will be paying the fee on the fully insured health plan side.  The employer is still required to calculate and pay for the HRA side.

This same ruling applies to employers who provide health plan coverage to a retiree population.

COBRA and other continuation coverage must also be included in the calculation.

The following plans are subject to the PCORI fee:

  • Medical plans
  • Prescription drug plans
  • Self-insured dental or visions plans (if provided without a separate election or premium charge)
  • HRAs
  • Retiree-only health plans

Excepted or Exempt Plans:

  • Self-insured dental or vision plans (if separate coverage elections and employee contributions)
  • Expatriate coverage for employees working outside the US
  • HSAs
  • Most FSAs
  • EAPs, Wellness programs, and disease management programs (that do not provide a significant benefit)

The employer can aggregate all plans that are self-insured and pay the fee once on all overlapping plan lives.  The employer must pay these fees outside of the plan, not using plan assets.

A consideration for employers who do not wish to pay the fee twice on a fully insured medical plan (the fee is added into the premium by the carrier) and again for a self-funded HRA may want to consider moving to a plan design that is HSA (Health Savings Account) compatible as HSAs are exempt from the fee. Learn more about HSAs.

Learn more about Sterling’s PCORI Fee Calculation Services.

About Chris Bettner
With over 30 years of experience in healthcare sales and management with health insurance carriers, Chris Bettner serves as executive vice president of Business Development for Sterling Health Services and was a co-founder of the company in 2004. Prior to joining Sterling, Chris was Vice President of Sales for Blue Shield of California. She held similar positions at Lifeguard, FHP, Independence Blue Cross and MetLife. Chris is also a national spokesperson on HSAs and consumer directed healthcare programs. Connect with Chris Bettner on LinkedIn.