Tag: PPACA

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

Healthcare Reform News: California Governor Signs Waiting Period Bill

Editor note: This article was originally published August 15, 2014 and can be found here.

California Governor Jerry Brown signed into law legislation to better align the state’s health coverage waiting period requirements with federal law.

While the Affordable Care Act (ACA) had established a 90-day waiting period that applies broadly to employers nationwide, California had established a 60-day waiting period. The intent of Senate Bill (SB) 1034, authored by Senator Bill Monning (D-Carmel), is to resolve confusion between the state and federal laws and to better conform to provisions of the ACA.

“We thank the governor for signing this bill, as it will help eliminate the confusion caused by conflicting state and federal waiting periods. Now it will be easier for employer groups to comply with the law,” stated Neil Crosby, Vice President of Public Affairs for the California Association of Health Underwriters (CAHU) and Director of Sales for Warner Pacific Insurance Services.

SB 1034 is a product of numerous discussions among state regulators, small business groups, health insurance organizations, consumer organizations and CAHU to provide clarity on the allowable waiting periods.

HSA Growth: Still Strong 10 Years Later & Poised to Grow Under ACA and Exchanges

by Chris Bettner

Editor Note: This article was written by Sterling’s EVP of Business Development Chris Bettner and published in the March 2014 edition of California Broker Magazine.

Health savings accounts (HSAs) will have the highest growth rate among all consumer driven healthcare accounts (CDH) in 2014, according to the Consumer Driven Health Care Institute (CDHCI). HSAs are expected to hit close to 21 million covered lives. By mid-2013, there are expected to be 18 million HSAs with assets hitting $18.1 billion and growing.

National carriers and economists confirm that HSAs are the product to watch in 2014. Growth in private exchanges, based on employer defined contributions, should accelerate HSA growth. The fear that the Affordable Care Act (ACA) would crush HSAs has been put to rest in a private study by HSA Consulting Services (December 5, 2013). The study states conclusively that HSAs will do well on the federally run exchanges. The plans are widely available and attractively priced. HSA eligible plans are 11% less expensive than older legacy plans; and families save an average of over $1,000 a year on premiums, according a report by CDHCI. Forty-four percent of the Bronze plans are HSA compatible, a critical indicator.

Cost is not the only growth factor. The basic tenants of HDHP/HSA lead people to become savvy healthcare consumers. This has been reported for the 10 years that HSAs have been available (since 2004). People make more thoughtful decisions on their healthcare spending. This does not mean that people do not get necessary care. Quite the contrary; people ask for generic medication; use emergency rooms for true emergencies; and use preventive care services at a much higher rate than do their counterparts in other products.

The triple tax advantages of a HSA, unlike a Roth IRA, never appear as income when deducted from payroll. So people have the tax advantage of money going into the account pre-tax, growing tax-free and, when used for qualified medical expenses, being used tax-free as well. Some people with a HSA never make withdrawals to cover medical expenses. These people, Baby Boomers for the most part, consider their HSA a retirement account. Other people use the money each year to pay for their deductible expenses. That’s the beauty of a HSA. They are extremely flexible, triple tax advantaged accounts.

The investment opportunity with a HSA is only limited by IRS regulations. The instrument must be liquid (stocks, bonds, mutual funds). The ability to invest is very flexible but determined by your HSA administrator. Year-over-year growth of balances in these accounts proves that people really will walk into Medicare with a nest egg.

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 Administration 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.