Wednesday, March 25, 2020

America Will Dramatically Change the Way It Provides Health Care by 2030

A benefits specialist looks ahead and sees... something for all. Not Medicare.

Sunday, March 8, 2020

Californians Must Buy Health Insurance or Face a Penalty Unless ... They Don't Want To | 24 Flavors of Exemption

At one point in time, Obamacare was up to 32 exemptions to the individual mandate as politicians (particularly those in favor of government healthcare) realized it was really bad for reelection purposes to go around penalizing the people who were likely to keep them in office.  Finally, federal politicians capitulated and congress eliminated the individual mandate penalty (tax).

What about Obamacare's pay-fors, fiscally responsible citizens might ask.  Don't be so silly.  U.S. political leaders needn't concern themselves with such trivial nuances.  As originally passed, PPACA was slated to cost just under a trillion dollars over ten years.  Now, it will cost just under two trillion.  But really, who cares about a trillion here or there when we are already $23.5 trillion in debt and neither party ever seriously makes any move to address the problem.

California is now following the same path as we in the Golden State have super-charged our version of PPACA.  In California folks can qualify for other people's money to help them buy health insurance so long as they make less than 600% of the federal poverty level (FPL).  That is right, 600 percent or a paltry $154,500 for a family of four.  That is not a typo.  Calunicorinians saw Obamacare's 400% and increased it by 50%.  Because, you know, we are Calitopia! 

In any event, I just stumbled across a fun list.  You see, California's politicians just like Obamacare's original supporters, really want no part of forcing their constituents into buying a health plan that they don't want.

Therefore, in California, you must buy health insurance for you and your family (with other people's money if you make under 600% of the FPL) unless:
  1. Your income below the state tax filing threshold.
  2. You had a coverage gap of 3 consecutive months or less.
  3. Your health coverage is unaffordable, based on actual income reported on your state income tax return when filing taxes.  This means that the cost of the lowest cost Bronze plan through Covered California or the lowest cost employer-sponsored employee-only plan is more than 8.24 percent of income on the tax return.
  4. Certain non-citizens who are not lawfully present.
  5. Citizens living abroad or residents of another state.
  6. Members of a healthcare sharing ministry
  7. A member of a recognized religious sect or division who is opposed to acceptance of the benefits of any private or public insurance.
  8. A member of a religious sect or division who relies solely on a religious method of healing.
  9. American Indians. 
  10. Alaska Natives.
  11. Incarceration.
  12. Enrolled in limited or restricted-scope Medi-Cal or other similar coverage.
  13. Experienced homelessness.
  14. You were evicted in the past six months or are facing eviction or foreclosure.
  15. You received a utility shut off notice in the last year. 
  16. You have experienced domestic violence.
  17. Death of a close family member.
  18. Natural disaster (i.e. fire, flood, or human-caused disaster).
  19. Bankruptcy.
  20. Medical expenses that resulted in substantial debt.
  21. Unexpected increases in necessary expenses or decreases in household income due to divorce/separation, unexpected or sudden disability, or caring for an ill, disabled or aging family member.
  22. Appeals decision shows eligibility for enrollment through Covered California when not actually enrolled.
  23. Medical support order.
  24. Other (granted on a case-by-case basis). The state form for the general hardship application is only 11 pages.  
So how many Californians will actually pay one of these fines?  A quick perusal of the list shows than you can skip paying a utility until the last possible moment to generate a shut off notice for yourself.  Bang!  A get out of Obamacare free card.  

This is nothing more than charade to make it look as if we have an individual mandate without really having one.  And the only folks who will actually end up paying this tax/penalty are those who are totally caught off guard or just not even trying a little bit.   

What will the fine be for those who actually do have to pay?  

The penalty will be the higher of either:
  • A flat amount, based on the number of people in the tax household ($695 per adult and $347.50 per child), or
  • Pay 2.5% of the amount of gross income that exceeds the filing threshold requirements based on the tax filing status and number of dependents.  
The state has been kind enough to provide you an example of this here.  

Tuesday, February 25, 2020

California Supreme Court: Time Spent in Security Screenings is Compensable

  • The Frlekin decision expands the scope of what is considered compensable time under state law.
  • The decision is based on the employer’s control of the employee’s time, not on whether the employee was “suffered or permitted to work.”
  • The court clarified that, in cases involving onsite employer-controlled activities, courts may and should consider additional relevant factors, including, but not limited to:
    • The location of the activity;
    • The degree of the employer's control;
    • Whether the activity primarily benefits the employee or employer; and
    • Whether the activity is enforced through disciplinary measures.

The California Supreme Court issued a decision in Frlekin v. Apple, Inc. (Frlekin) clarifying that, under state law, compensable time or “hours of work” includes the time an employee spends on the employer’s premises waiting for, and undergoing, mandatory exit searches of bags, packages, or personal technology devices (such as iPhones) that are voluntarily brought to work purely for personal convenience.

Many employers have adopted security screenings to curb employee theft, particularly in the retail and mercantile industries. In light of the Frlekin decision, California employers will need to pay close attention to the length and scope of their screening procedures and whether they need to account for the time employees wait to go through the screening process.

Hours Worked

In Frlekin, the plaintiffs sued their employer, Apple Inc. (Apple), for unpaid minimum and overtime wages for the time they spent waiting for and undergoing Apple’s exit searches. Apple required its employees to clock out before submitting to thorough security screenings at the end of their work shift and leaving Apple’s premises. The screenings could be lengthy and required employees to wait for extended periods of time.

Under California’s Wage Order 7 (the controlling law in this case), “hours worked” is defined as “the time during which an employee is subject to the control of an employer, and includes all the time the employee is suffered or permitted to work, whether or not required to do so.” (Emphasis added.)

The court in this case concluded that an employer is controlling an employee’s time when it requires the employee to submit to an exit search before exiting the employer’s premises. As a result, the court determined that the time employees spend undergoing exit searches is compensable as “hours worked” under California labor law.

The court also rejected the employer’s argument that compensable time must be tied to an activity that is “required” or “unavoidable,” because this type of language:
  • Does not exist in Wage Order 7; and
  • Is inconsistent with the history and purpose of Wage Order 7.
Issues for Employers

Even though security screening cases are uncommon under federal law, this court decision seems to contradict the U.S. Supreme Court’s decision in Integrity Staffing Solutions, Inc. v. Busk, holding that time spent awaiting bag checks was not compensable time under the Fair Labor Standards Act (FLSA). Employers will want to understand the difference between these two cases and determine whether state or federal law applies, based on their specific circumstances.

Finally, the California Supreme Court also indicated that the Frlekin decision applies retroactively, meaning that employers that adjust their security screening and other off-the-clock practices may also need to go back a few years to determine whether they are liable for unpaid wages to their employees.

Wednesday, February 19, 2020

Emergency Room or Urgent Care?

More than 12% of all emergency room visits are better addressed in either an urgent care facility or a doctor’s office.  Urgent care is commonly one-tenth the cost of an emergency room visit with urgent care costing an average of $100 per visit and emergency room visits costing an average of approximately $1,300. 

If you’re suddenly faced with symptoms of an illness or injury, how can you determine which facility is most appropriate for your condition?

The Emergency Room

Emergency rooms are equipped to handle life-threatening injuries and illnesses and other serious medical conditions. An emergency is a condition that may cause loss of life or permanent or severe disability if not treated immediately. You should go directly to the nearest emergency room if you experience any of the following:
  • Chest pain
  • Shortness of breath
  • Severe abdominal pain following an injury
  • Uncontrollable bleeding
  • Confusion or loss of consciousness, especially after a head injury
  • Poisoning or suspected poisoning
  • Serious burns, cuts or infections
  • Inability to swallow
  • Seizures
  • Paralysis
  • Broken bones
Patients at the emergency room are sorted, or triaged, according to the seriousness of their condition. For example, a patient with severe injuries from a car accident would likely be seen before a child with an ear infection, even if the child was brought in first. 

Those who go to the emergency room with relatively minor injuries or illnesses often have to wait more than an hour to be seen, depending on the severity of the other patients’ conditions. Often they could have been seen more quickly at an urgent care facility.

Urgent Care

Urgent care centers are usually located in clinics or hospitals, and, like emergency rooms, offer after-hours care. Unlike emergency rooms, they are not equipped to handle life-threatening situations. Rather, they handle conditions that require immediate attention—those where delaying treatment could cause serious problems or discomfort.

Some examples of conditions that require urgent care are these:
  • Ear infections
  • Controlled bleeding or cuts that require stitches  
  • Urinary tract infections
  • Vomiting
  • High fever
  • Flu 
  • Minor broken bones like toes or fingers 
  • Sprains or strains  
  • Urinary tract infections  
  • Skin rashes 
Urgent care centers are usually more cost-effective than emergency rooms for these conditions. In addition, the waiting time in urgent care centers is usually much shorter. Choosing the appropriate place of care can not only ensure prompt medical attention but will also help reduce any unnecessary expenses. 

Friday, January 17, 2020

2019 Compliance Review

Links to all the articles, publications, and legislative educational resources that we distributed in 2019.

Monday, December 16, 2019

Why All Democratic Approaches to Healthcare for 2020 Candidates Lead to Medicare for All by 2030 on Armstrong & Getty

Hospital Groups Sue Trump Administration Over Pricing Transparency Rule

On Wednesday, Dec. 4, 2019, four major hospital groups filed a lawsuit against the Trump administration to challenge the Nov. 15, 2019, final rule that would require hospitals to disclose their pricing information, including negotiated rates.

The Federation of American Hospitals, the American Hospital Association, the Association of American Medical Colleges, the Children’s Hospital Association and three hospitals filed the suit in the U.S. District Court for the District of Columbia, stating that the Centers for Medicare and Medicaid Services (CMS) exceeded their authority with the rule. The lawsuit also states that the pricing disclosure rule violates the First Amendment.

What’s included in the final rule?

Under the rule, hospitals are now required to provide easily accessible billing information to patients by Jan. 1, 2021. This means having all standard charges available online and in one single data file that can be “read by other computer systems,” according to a CMS press release.

The charges listed would include “the gross charges, payer-specific negotiated charges, the amount the hospital is willing to accept in cash from a patient, and the minimum and maximum negotiated charges,” to the release. Hospitals that fail to comply with the rule’s requirements would face a $300 per day civil penalty.

The hospital groups’ lawsuit contends that requiring hospitals to publish the different charges, including their privately negotiated prices with insurers, “will confuse patients and unduly burden hospitals.”
“CMS' final rule fails to offer patients easy-to understand information regarding their out-of pocket obligations for care -- so we feel obligated to contest the regulation. We contend the agency exceeded its authority and should go back to the drawing board.” - Chip Kahn, chief executive of the Federation of American Hospitals 
What’s next? 

We will continue to monitor any developments regarding this lawsuit and will provide updates as necessary.

DOL Issues Model Health Care Transparency Disclosure Documents

Thursday, September 19, 2019

California is Burning $80,665 on Healthcare for One Employee Per Year

Honestly, I have no clue how that is even possible.  The annual cost of healthcare for one person per year should be between $6,000 and $9,000.  California's state average is $9,500.  Yet we have a plethora of "public servants" costing the state over $50,000 per year.  Yet another example as to how taxpayer dollars are flat-out abused and wasted by elected officials and bureaucrats.  These amounts are so absurdly high, it is hard to imagine how this could happen without rampant fraud.  

This is from the OC Register:   
One of the most generous health insurance plans enjoyed by a California public servant last year — costing $80,665 — went to a communications manager for the obscure Water Replenishment District of Southern California. 
At the embattled Los Angeles Department of Water and Power — raided by the FBI in July, and yet to produce documents detailing how a worker earned $313,865 in overtime pay — there were 153 workers with health plans costing $57,816 each. 
In Riverside County’s Rubidoux Community Services District, the general manager received health benefits totaling $55,717. In San Bernardino County’s Cucamonga Valley Water District, the general manager’s health benefits cost $38,191 to cover his family. In Anaheim, 31 workers — mostly in public safety — had health plans costing more than $36,000 each. 
A new analysis of public spending on employee health insurance by Transparent California — whose findings were mirrored by the Southern California News Group’s own data crunching — found that workers toiling in California’s cities, counties, special districts and state offices received health benefits costing about 50 percent more than the average in California, which is $9,476.

And, surprisingly often, benefits cost two, three, four, up to even eight times as much. 
“Spending over $50,000 on a single employee’s health insurance plan is an inexcusable waste of taxpayer funds,” said Robert Fellner, executive director of Transparent California, in a statement. 
“Medical plans this expensive simply don’t exist in the broader market, which is a strong indication that providers are exploiting the fact that these governments are happy to pay inflated prices with other people’s money.”
California’s “wildly inflated health costs” bleed some $3.3 billion from taxpayers each year, Fellner calculated. ... 
And a recent survey from the Kaiser Family Foundation found that 92 percent of family medical plans cost less than $26,000....

Nationwide, workers contribute one-third of their health care premiums, according to UBA’s data. In California, government workers pay an average of 23.3 percent. 
But the Water Replenishment District of Southern California — like many public agencies here — doesn’t ask workers to pay anything. 
The district not only picks up 100 percent of premiums for workers and their dependents, but also gives them an “IRS qualified health reimbursement account” for out-of-pocket expenses of $8,196 per worker and $4,928 per dependent. Each year.

Unused funds roll over for three years, then revert to the district. ...
The full story is definitely worth your time to read.