Saturday, August 31, 2013

Hospitals Hit Hard by PPACA

This is from Danyell Jones writing at BHM Healthcare Solutions:

When it comes to the Affordable Care Act, also referred to as Obamacare or ACA, some hospital organizations are already feeling the pinch. Today we will examine the specific provisions which are impacting hospitals, and why some organizations are already worried about the changes.

Hospital Value Based Purchasing Program – Reimbursement Hit 1% in 2013; 2% by 2017

Section 3001 of the Affordable Care Act addresses value rather than volume based payments to hospitals, and measures hospitals according to certain quality measures. Some of these measures are clinical and related to patient outcomes, while others are less tangible such as patient satisfaction. Hospitals which perform well could receive incentives, but for those who are poor performing in regard to attainment and improvement it could mean a cut to payments. For under-performers, Medicare payments will be reduced this year by 1%, with additional cuts in payments equaling up to a 2% reduction in Medicare payments by 2017. This value over volume approach is really targeted toward ensuring that hospitals are providing optimal care, and to drive those who are under-performing to make changes through financial incentives and penalties.

Hospital Readmissions Reduction Program – Reimbursement Hit 1%-3%

Section 3025 of the Affordable care act which was effective beginning on Oct. 2012 penalizes hospitals which have higher than standard readmission rates. This year was the first year that cuts in reimbursement went into place, and only took into account three measures which were reported on including readmissions for Heart Attack, Heart Failure, and Pneumonia. The policy will be expanding in subsequent years to track additional conditions, and hospitals will be responsible for diligently tracking readmissions and providing appropriate reporting to CMS. Beginning in 2014 the reimbursement reduction for hospitals which have a significant readmission rate will increase to a maximum of 2%, and in 2015 it will be increased to a reimbursement reduction rate that will max out at 3%.

The Shift in Payments Related to Acquired Conditions – Reimbursement Hit 1%

Section 3008 of the Affordable Care Act is the most recent section of the Act that will begin to impact some hospitals in FY 2015. This section relates to Hospital Acquired Conditions, such as infection, and creates a numerical score for hospitals. Those hospitals which are shown to have a score in the highest quartile compared to the national average will receive a reduction in their reimbursement rates of up to 1%. This measure has been set forth to drive quality of care by targeting several hospital acquired conditions which are considered preventable is best practices are utilized. A sample of these conditions is as follows:
  • Blood incompatibility
  • Urinary tract infection
  • Falls or other injuries while at the facility (burns, dislocations, fractures, ect.)
  • Catheter Infection
  • Air Embolism
Total Hits and Disproportionate Share Hospital Payments
While it will be increasingly important for Hospitals to operate in a way which drives quality and efficiency, there has been some concern voiced over the triumverate of ACA reforms. Physicians worry that there may be less money to care for an increased population of patients, and with the influx of uninsured and under-insured that will not be covered under the Affordable Care Act, it is difficult to construct a baseline on which to build these quality measures. In fact, when you think of large populations of individuals with chronic, co-morbid, and untreated conditions that will now have access to health care you are looking at a substantial influx in the volume of complex cases that hospitals may need to deal with. Add to that the fact that the pool of money are reimbursement allowed to treat patients as whole may be decreasing and we will see less healthcare dollars needing to be used to treat more patients at less cost. It is an equation that has some deeply concerned. 
In addition to the reimbursement hits Disproportionate Share Hospital (DSH) Payments to hospitals are being decreased. DSH payments are payments that were traditionally paid to hospitals to help them cover the cost for uninsured patients which were treated. Beginning on or after Oct. 1, 2013 some hospitals will have their DSH payments reduced to 25% of what they have typically received. A fantastic breakdown on the potential impact of this, as well as detailed calculations was done by Rob Schile and can be found here. The final 75% of the typical payment will be readjusted and redistributed to hospitals. While some hospitals may experience an increase in their DSH payments, some will see significant decreases which may again contribute to potential concerns over cash shortages.
Bracing For The Impact
There are several things that Hospitals should be doing to brace for ACA Impact, at a minimum hospitals should ensure that they have an understanding of the ACA triumverate as well as predictions on how it will impact their specific organization. Mind sets should be shifting from the fee for service framework, toward a value driven approach to the provision of care. Organizations should ensure that they have appropriate internal reporting to track key measures that will be critical to their success in the ACA environment. This includes knowing your admission and readmission rates, and not only understanding Quality Measures that payments will be based on, but having the detailed data to drill down to the details of these measures. Quality Improvement plans and proactive approaches will become essential in the new environment, and specific care should be taken to ensure that Hospitals are prepared across clinical, quality, and cost metrics. Finally, detailed financial analysis, and predictive modeling should be employed so that organizations can mitigate their risk of being caught off guard by unexpected cash flow problems in the face of reform. Now is a great time to receive unbiased objective advice about your organization and to have an organizational analysis preformed.

Friday, August 30, 2013

IRS Recognizes All Same-Sex Marriages for Pretax Benefits

Under a new Internal Revenue Service ruling, employees who pay for their spouse's health insurance on an after-tax basis may treat these costs as excludable from federal income taxes, even if they live in a state that doesn't recognize their marriage. State income taxes are another matter, however.

The U.S. Department of the Treasury and the IRS ruled on Aug. 29, 2013, that same-sex couples who were legally married will be treated as married for federal tax purposes, including the pretax treatment of a spouse's health insurance coverage, in all 50 states and the District of Columbia. Revenue Ruling 2013-17 applies, in other words, regardless of whether the couple now live in a state that recognizes same-sex marriage or a state that does not recognize same-sex marriage.

The ruling implements federal tax aspects of the Supreme Court's June 26 decision in United States v. Windsor, which invalidated a key provision of the 1996 Defense of Marriage Act.

Revenue Ruling 2013-17 applies to all federal tax provisions in which marriage is a factor, including filing status, claiming personal and dependency exemptions, employee benefits, and claiming the earned income tax credit or child tax credit.

The ruling covers same-sex marriages entered into in one of the U.S. jurisdictions where such marriages are recognized as legally valid (sometimes referred to as the "state of celebration," as opposed to a couple's state of residency), as well as legal marriages performed in a foreign country. However, the ruling does not apply to registered domestic partnerships, civil unions or similar formal relationships recognized under state law.

Employee Benefits Affected

Under the ruling, same-sex couples will be treated as married for all federal tax purposes. Those who purchased same-sex spouse health insurance coverage from their employer on an after-tax basis may treat the costs of that coverage as pretax and excludable from income (for federal income tax purposes; state income taxes may still apply). 

"Same-sex spouses legally married anywhere no longer are taxed on health benefits coverage for their spouses and can pay premiums pretax, even if they live in a non-recognition state such as Florida, Texas, etc. This is a huge development and a relief for these employers and employees," Todd Solomon, a partner in the employee benefits practice group of McDermott Will & Emery LLP in Chicago, told SHRM Online. 

"However, state taxation of benefits may continue to be quite complex, although it remains to be seen how states will treat this," Solomon added. "On the flip side, the guidance may not be welcome for employers who currently do not offer same-sex partner benefits because now they are legally required to offer benefits to same-sex spouses in all states."

Treasury and the IRS intend to issue streamlined procedures for employers who wish to file refund claims for payroll taxes paid on previously taxed health insurance and other benefits provided to same-sex spouses. Treasury and IRS also intend to issue further guidance on cafeteria plans and on how qualified retirement plans and other tax-favored arrangements should treat same-sex spouses for periods before the effective date of Revenue Ruling 2013-17.

Other agencies may provide guidance on federal programs they run that are affected by the Internal Revenue Code, Treasury said.

Retroactive Application and Refund Claims

The IRS set a prospective effective date for the ruling of Sept. 16, 2013. Legally married same-sex couples must file their 2013 federal income tax return using either the “married filing jointly” or “married filing separately” filing status.

For prior tax years still open under the statute of limitations, individuals who were in same-sex marriages may opt to file original or amended returns choosing to be treated as married for federal tax purposes. Generally, the statute of limitations for filing a refund claim is three years from the date the return was filed or two years from the date the tax was paid, whichever is later. As a result, refund claims can still be filed for tax years 2010, 2011, and 2012. Some taxpayers may have special circumstances (such as signing an agreement with the IRS to keep the statute of limitations open) that permit them to file refund claims for tax years 2009 and earlier.

With respect to retroactivity for prior years, "employers are still in wait-and-see mode until the IRS issues further guidance," said Solomon. "What we know is that employees and employers have the right—but not the obligation—to file for refund claims on past taxes paid on same-sex spouse benefits in open tax years—typically 2010, 2011, and 2012."

"Employers can expect to get requests from employees for corrected Form W-2s from these prior years," Solomon noted. "But what is not clear yet is how to handle cafeteria plan participation and tax reporting for prior years and whether adjustments need to be made. The IRS will be issuing more guidance on this issue as well as the retroactive impact of the guidance on retirement benefits that have or in many cases have not been paid to same-sex spouses." 

Along with Revenue Ruling 2013-17, the IRS released two related sets of frequently asked questions and answers:

The IRS ruling "assures legally married same-sex couples that they can move freely throughout the country knowing that their federal filing status will not change,” Treasury Secretary Jacob J. Lew noted in a released statement.

The IRS yesterday announced in Revenue Ruling 2013-17 that same-sex couples who are legally married in any state or other jurisdiction that recognizes same-sex marriages (including the District of Columbia, a U.S. territory or a foreign country) will be treated as married for all federal tax purposes, even if the couple lives in a jurisdiction that does not recognize same-sex marriages.  Participants in marriage-equivalent relationships (i.e., domestic partnerships and civil unions) will not be recognized as married for federal tax purposes.  The IRS also released updated Frequently Asked Questions for taxpayers in same-sex marriages and marriage-equivalent relationships, and for employers who sponsor qualified retirement plans and health and welfare plans.

This guidance comes in the wake of the U.S. Supreme Court’s decision in U.S. v. Windsor, which struck down as unconstitutional section 3 of the Defense of Marriage Act (“DOMA”).  DOMA prohibited the federal government from recognizing an otherwise valid marriage between two persons of the same sex.  As our July 2013 Benefits Report explains, Windsor raised more questions than it answered with respect to employee benefit plans.  Yesterday’s announcement provides a clear answer to many of those questions.  Additional guidance is planned, and guidance on non-tax issues affecting employee benefit plans is expected from other federal agencies.

Impact on Plan Interpretation and Administration

As a result of yesterday’s ruling, plan sponsors must treat all individuals in same-sex (and opposite-sex) marriages as married for all federal tax purposes, effective as of September 16, 2013.  Below is a brief description of the impact of this ruling on employee benefit plans.

Revenue Ruling 2013-17 will require qualified retirement plans to:

    • Provide a qualified joint and survivor annuity and/or a qualified optional survivor annuity to all participants in same-sex marriages, if the plan is subject to the QJSA rules
    • Provide a qualified preretirement survivor annuity to a married participant’s same-sex surviving spouse, if the plan is subject to the QJSA rules (optionally, a plan may provide a pre-retirement survivor annuity to a participant’s beneficiary, including a surviving domestic partner)
    • Require the consent of a participant’s same-sex spouse to the participant’s election of an optional form of benefit (and not require such consent in the case of an unmarried participant, including a participant in a domestic partnership or civil union)
    • Require the consent of a participant’s same-sex spouse to the participant’s designation of a non-spouse beneficiary (optionally, a plan may also require the consent of a domestic partner)
    • Require the consent of a participant’s same-sex spouse to a loan from certain retirement plans (optionally, a plan may also require the consent of a domestic partner)
    • Recognize a same-sex spouse as a spouse for purposes of safe-harbor hardship distribution rules
    • Follow a qualified domestic relations order awarding benefits to a participant’s same-sex former spouse
    • Recognize a same-sex spouse as a spouse for purposes of the required minimum distribution rules and minimum distribution incidental benefit rules
    • Permit same-sex surviving spouses to elect a direct rollover to an eligible retirement plan or IRA (not just an “inherited IRA”)

In addition, health and welfare plan sponsors may:

    • Stop imputing income for the value of employer-paid health coverage provided to an employee’s same-sex spouse and permit pre-tax payroll contributions through a cafeteria plan for an employee’s share of the cost of group health coverage provided to his or her same-sex spouse
    • Make adjustments for income tax withholding that was over-withheld from an employee during the current year (employees may claim refunds of federal taxes paid on previously imputed income and after-tax employee contributions for all open years prior to the current year, i.e., generally the past three years)
    • File an amended payroll tax return to claim a refund of the employer portion (and employee portion if the employee’s whereabouts are known) of Social Security and Medicare taxes paid on previously imputed income and after-tax employee contributions for all open years
    • Permit reimbursement of qualifying medical expenses of an employee’s same-sex spouse (and spouse’s children) from Health Flexible Spending Accounts (“Health FSAs”) and Health Reimbursement Accounts (“HRAs”)
    • Permit reimbursement of qualifying dependent care assistance expenses for an employee’s eligible disabled same-sex spouse or the same-sex spouse’s child under a Dependent Care Assistance Program (“DCAP”)

Open Questions to be Addressed in Future Guidance

Yesterday’s ruling only addresses legal issues over which IRS has regulatory authority.  The IRS intends to issue future guidance regarding the retroactive effect of the Windsor decision, including a special procedure that employers can follow to claim refunds of payroll taxes paid on previously-taxed health insurance and fringe benefits provided to same-sex spouses.

In addition to further IRS guidance, we anticipate additional guidance on non-tax issues from other agencies, including the Department of Labor (“DOL”), Department of Health and Human Services (“HHS”) and Centers for Medicare and Medicaid Services.  The DOL Wage and Hour Division recently updated Family Medical Leave Act Fact Sheet 28F to recognize same-sex marriages that are valid in the employee’s state of residence.  Yesterday, HHS announced that an individual who is enrolled in a Medicare Advantage plan will have equal access to coverage in a nursing home where his or her same-sex spouse lives.

Issues not addressed by the ruling include:

    • Whether the recognition by the IRS of a participant’s same-sex marriage is a permitted election change event under Code Section 125 that would allow an employee to elect mid-year to (a) enroll his or her spouse in an employer-sponsored health and welfare plan or change benefit options, or (b) increase contributions to a Health FSA or DCAP
    • Whether and the extent to which certain ERISA-required disclosures must be provided to a plan participant’s same-sex spouse or former spouse
    • Whether plans covering only a business owner and his or her same-sex spouse are subject to ERISA 

Health Plan Cost to Increase 7% in 2014, More Growth in HSAs and HRAs

The cost of providing employee health care benefits at the largest U.S. employers is projected to increase 7 percent in 2014, according to survey results released Aug. 28, 2013, by the National Business Group on Health (NBGH), a nonprofit association of more than 265 large U.S. companies.

In response, the biggest corporations are continuing their shift to high-deductible consumer-directed plans and making other benefit design changes.

The NBGH's Large Employers’ Health Plan Design Changes Survey, based on responses from 108 of the nation’s largest businesses, was conducted in June 2013—before the Obama administration’s decision to delay for one year the implementation of the employer mandate. Among its key findings:

    • The average 7 percent projected rise in health care benefits costs for 2014 is the same increase large employers projected for 2013.
    • Some big employers believe that health insurance exchanges could be a viable option for certain populations.
    • More companies plan to offer workers a consumer-directed health plan as their only health benefits option in 2014.

Another Cost Viewpoint

Cost projections can vary depending on sample demographics, methodology and other factors. Recently, PricewaterhouseCoopers (PwC) projected that the 2014 medical-cost-increase trend in the large-employer market would be 6.5 percent; it estimated a 7.5 percent jump for 2013. PwC expects the net cost increase for large organizations, after accounting for benefit changes such as higher deductibles, will be about 4.5 percent next year (see the SHRM Onlinearticle "Study: 6.5% Growth in Medical Costs for 2014").

Despite being able to keep cost increases stable for another year, employers continue to embrace changes designed to engage workers in health management and healthy lifestyles, the NBGH found.

“Rising health care costs remain a serious concern for U.S. employers,” NBGH President and CEO Helen Darling said at an Aug. 28 press conference in Washington, D.C. “Employers spent considerable time and energy this year designing health plans that comply with the various provisions of the Affordable Care Act that would have become effective next year. And while the decision to delay provisions related to the employer mandate has provided respite from some of these requirements, the pressure remains on employers to lower costs. Interestingly, many respondents indicated that a portion of their budgeted costs for 2014 was to implement changes mandated by the ACA. With the delay, it is unclear how employer costs will be affected.”

Employee Cost-Sharing Amounts
Large employers were asked: For your most prevalent plan, what are the employee contributions to premium and in-network deductibles in 2013, and what are your expectations for 2014?



Employee % of premium

Employee only



Family coverage



In-network deductible

Employee only



Family coverage



Source: National Business Group on Health

... More Employers Embracing Total Replacement CDHPs

The survey revealed that more than one-third of respondents (36 percent) consider implementing a consumer-directed health plan (CDHP)—with either an employee-owned health savings account (HSA) or an employer-owned health reimbursement arrangement (HRA)—the most effective tactic to control rising costs. (To learn more about these tax-advantaged savings vehicles, see theSHRM Online article "Consumer-Driven Decision: Weighing HSAs vs. HRAs.")

The survey found that:

    • Nearly three-quarters of employers (72 percent) now offer at least one CDHP. This number has remained relatively steady over the past couple of years.
    • The number of businesses that are offering employees only a CDHP continues to rise, with 22 percent planning to implement a total replacement CDHP next year, up from19 percent in 2013.

Consumer-Directed Health Plan Types
Large employers were asked: What types of consumer-directed health plans are you offering in 2013 and 2014?



High-deductible health plan (HDHP) with health savings account (HSA)



HDHP with health reimbursement arrangement (HRA)



HDHP with HRA and flexible spending account (FSA)



Other plan type with HRA



Lower-deductible health plan that promotes consumerism






HDHP without a health account



Source: National Business Group on Health


Survey: Big Business May Shift Retirees, Part-Timers To Insurance Exchanges

This is from Jay Hancock writing at KHN:  
Corporate America is taking a hard look at moving retirees and part-time workers into health insurance marketplaces created by the Affordable Care Act, suggests a survey by the National Business Group on Health. ...
NBGH, an association of large employers offering what are often substantial medical benefits, polled its membership about their plans for 2014. Of 360 members, 108 responded, most with more than 10,000 employees each. The findings are likely to add to the discussion about whether the Affordable Care Act will erode traditional, employer-based coverage.

NBGH asked whether employers expected various groups "who may currently be covered by your plans will choose public exchange coverage when it becomes available in 2014."
While 40 percent predicted no change, a fifth of those responding expected part-time workers to buy exchange plans next year. The health law does not require employer coverage for those who work less than 30 hours a week. 
A fourth anticipated that retirees too young for Medicare and still on the company plan could choose exchange coverage in 2014. 
An even greater percentage -- 41 percent -- figured former employees on the company plan under COBRA provisions would buy instead in the subsidized online exchanges next year. ...
Full-time employees seeking exchange coverage in 2014 are likely to be lower-paid workers in retail and hospitality who don't take the company plan because they can't afford it, she said. The ACA marketplaces come with substantial government subsidies for those with family incomes of up to about $94,000. 
Fifteen percent of the employers in the NBGH survey saw spouses or other dependents shifting to the online marketplaces next year; 12 percent saw full-time workers making the switch.  
Last week Kaiser Health News reported that United Parcel Service would drop about 15,000 working, white-collar spouses from its company plan next year but would continue to cover nonworking spouses. 
While large employers are barred from buying on state exchanges at least until 2017, their workers and dependents could buy plans as individuals. ...

U.S. Moves Toward Nationalization of Healthcare, Germany Moves Toward the Free Market

Sad But True

The German government abolished the three-year waiting period for an individual to move from state-regulated health insurance to private health insurance. This has lead to more Germans purchasing private coverage. ...

German citizens have started investing in private health insurance products to gain access to better medical treatment, without having to pay expensive medical costs. Increasing public awareness about the benefits of private health insurance products, and the flexibility of accessing private healthcare services supported the growth. The segment registered 20% more new business during the first half of 2011 than it registered in 2010.

Metallica - Sad But True

Thursday, August 29, 2013

ObamaCare Needs Amnesty for Illegals to Get Enough Bodies in Exchanges to Make Them Work

This is from Bob Vineyard writing at InsureBlog
If you ever wondered why the government is spending so much money and effort to SELL us on a plan that is law, this will make you scratch your head. 
Recent polls show that 2/3 of those here legally do not want Obamacare. So what is the plan now?

Recruit people from outside the country to come here so they can get government subsidized health insurance.
"Well, the (Obamacare) bill is crafted in such a way that those who are undocumented will not have access to the tax credits or shopping in the (health insurance) marketplace. That has been limited, which is, frankly, why -- another very keen reason why we need comprehensive immigration reform," Sebelius told a gathering of Latinos in Philadelphia. 
CNS News

Did you follow that logic?

Only with immigration reform, AKA amnesty, will they have enough people covered by Obamacare to make it popular.

Study: Obama's Affordable Care Act Looking Unaffordable, Premiums Higher for Most

This is part of a longer article written by Clara Ritger at the National Journal (link): 

Whether the quality of care in the new market is comparable to private offerings remains to be seen. But one thing is clear: The cost of care in the new market doesn't stack up. A single wage earner must make less than $20,000 to see his or her current premiums drop or stay the same under Obamacare, an independent review by National Journal found. That's equivalent to approximately 34 percent of all single workers in the U.S. seeing any benefit in the new system. For those seeking family-of-four coverage under the ACA, about 43 percent will see cost savings. Families must earn less than or equal to $62,300, or they, too, will be looking at a bigger bill.

Those numbers include the generous tax subsidies designed to make the new system more attractive to consumers.

"In 16 states that HHS studied, premiums were on average almost 20% lower than what the Congressional Budget Office projected," Peters wrote in an e-mail.

Premiums may be lower than predicted, but they're not competitive with what workers are now paying for employer-sponsored care.

On average, a worker paid between $862 and $1,065 per year for single coverage in 2013, according to Kaiser's numbers. For the average family plan, defined as a family of four, insurance cost between $4,226 and $5,284.

Fewer than half of all families and only a third of single workers would qualify for enough Obamacare tax subsidies to pay within or below those averages next year. ... 

In places where the median family income is higher, the number of people who benefit from cost savings will be even lower. It's a tough reality for California, which is home to the largest number of uninsured people in the country (6.7 million) and therefore viewed as the most important test for the success of the new federal health law. ...

The trap is that the exchanges also present a savings for some employers but a rate hike for their employees.

And shifting employees to the exchanges also is just logistically easier than trying to meet the law's employer mandate. ...

'I'm sorry I put you on a 1,200 calorie diet': Former Jenny Craig consultant publicly apologizes for 'wronging' her clients with 'unhealthy' advice

Apology: Iris Higgins, who has a master's degree in psychology from New York University, published a moving essay titled, An Open Apology to All of My Weight Loss Clients, on her blog Your Fairy Angel

... A former weight loss consultant for Jenny Craig has publicly apologized to hundreds of her clients for giving them, what she calls, bad health advice.

Iris Higgins, who has a master's degree in psychology from New York University and lives in Missouri published a moving essay titled, An Open Apology to All of My Weight Loss Clients, on her blog Your Fairy Angel.

'I am sorry because many of you walked in healthy and walked out with disordered eating, disordered body image, and the feeling that you were a "failure,"' she wrote earlier today.

Ms Higgins worked at Jenny Craig for three years, and in her letter, admits to a number of perceived mistakes: giving bad advice for thyroid issues, not addressing body dysmorphic disorders, designing diets with too few calories for both pregnant and non-pregnant women, as well as recommending yo-yo and fad diets.

Now a gluten-free health blogger, and author of The Essential Gluten-Free Baking Guides, Ms Higgins says she 'wronged' many of her clients.

'I'm sorry because when you were running 5x a week, I encouraged you to switch from a 1,200 calorie diet to a 1,500 calorie diet, instead of telling you that you should be eating a hell of a lot more than that,' she writes.

'I'm sorry because you were breastfeeding and there's no way eating those 1,700 calories a day could have been enough for both you and your baby.'

According to the United States Department of Agriculture, young women aged 14 to 18 years old should be on a 1,800 calorie diet, while females 19 to 30 years old should maintain a 2,000 calories diet. ...

Ms Higgins also criticized the food given to Jenny Craig clients, calling it 'chemically laden'.

'I'm sorry because many of you had thyroid issues and the LAST thing you should have been doing was eating a gluten-filled, chemically-laden starvation diet,' she explained.

'I'm sorry because by the time I stopped working there, I wouldn't touch that food, yet I still sold it to you.'

The weight-loss empire typically provides its clients with personal consultants, such as Ms Higgins, in order to get them to eat and live healthy. 

According to the website, 'Jenny teaches portion control and a balanced approach to living, with the freedom to live your life your way.' ...

But Ms Higgins now believes this is an unhealthy way to loose weight. ...

But Ms Higgins doesn't blame Jenny Craig, instead she blames the doctors, registered dietitians on the medical advisory board, the media and women's glossy magazines for reinforcing such ideas.

'I've been played for years, and so have you, and inadvertently, I fed into the lies you've been told your whole lifeThe lies that say that being healthy means nothing unless you are also thin.'

Wednesday, August 28, 2013

Full-replacement HSAs result in dramatic long-term savings for employers

... According to a recent report released by the Employee Benefit Research Institute, this type of consumer-directed healthcare plan may be the key to cutting back on overall expenses and increasing employee autonomy when it comes to managing wellness.

Conducted by Paul Fronstin, Ph.D., of the EBRI, and M. Christopher Roebuck, Ph.D., of RxEconomics, the study examined employer experiences with full-replacement HSAs over a period of five years – the longest observation period for this type of coverage option.

Used in conjunction with high-deductible health plans, HSAs are a tax-advantaged and convenient option for individuals and families to get the most out of their medical care plans and learn how to make decisions about their health with quality and cost in mind.

Fronstin and Roebuck discovered that within the first year of implementing a full-replacement HSA, employers substantially decreased their medical expenses.

"In the first year of the HSA, the employer's aggregate healthcare spending was reduced by $527 per person," wrote the study's authors. "Results show that spending was reduced significantly in the inaugural year of the HSA plan in medical, pharmacy and total-claims categories. Further, the magnitude of the cost savings was greatest in this first year but the cost savings continued over the succeeding three years albeit at a slower pace."

According to researchers, laboratory services spending was reduced by 36 percent, while expenses for prescription drugs declined by 32 percent. For four years after the full-replacement HSA was adopted, pharmacy spending decreases were the most substantial at between 40 to 47 percent for individuals.

The market for HSAs has grown substantially in recent years, with 8.2 million Americans in HSA-eligible health plans opening their own HSAs in 2012, according to Devenir, an investment firm. This figure is expected to increase by 73 percent by the end of 2015.

While HSAs can lead to significant savings for employers, a recent survey by Fidelity Investments has demonstrated that many Americans responsible for making decisions about family health services may be unsure about how HSAs actually work.

According to researchers, about two-thirds of participants in the survey noted that they do not understand how HSAs work or how they can benefit them.

"Health savings accounts provide a tremendous opportunity for American employees to take better control of their healthcare spending while also benefiting from the tax advantages afforded by the accounts," said William Applegate, vice president of Fidelity Investments. "The special tax advantages of these accounts allow employees to accumulate funds over their working life and withdraw funds tax-free for qualified medical expenses in retirement. With many Americans uncertain of the savings feature of the HSA, employers are in an ideal position to provide educational guidance on the many benefits of the accounts."

Distributing educational materials could be crucial for eliminating confusion, as the survey revealed that 73 percent of respondents to the survey were unsure or believe an HSA is essentially the same thing as a flexible spending account (FSA), which require that contributions be spent by the end of the year otherwise they will be forfeited. 

Advanced HSA and FSA administrators are using innovative and creative means to educate people about account benefits. Read more about ConnectYourCare's consumer-directed healthcare plans and tax savings videos.

'Wellness' that Works: Don't Hire Smokers

This is Skyler Swisher writing for the Daytona Beach News Journal (link):

Starting Jan. 1, Bert Fish Medical Center will no longer hire tobacco users, joining two other local hospitals in telling smokers not to apply.

Applicants will be tested for a nicotine byproduct and sign an agreement to remain tobacco-free during their employment with the New Smyrna Beach public hospital. The prohibition doesn’t apply to volunteers, medical staff or Bert Fish’s roughly 700 employees who were hired before the implementation date.

“We are in the health care business, and we should be a role model,” said Nancy Evolga, executive director of human resources for the 112-bed hospital. “There is 50 years of data that says tobacco use is bad.”

The hospital’s decision is its latest move in a series of steps to restrict smoking. In 2009, Bert Fish declared itself a smoke-free campus and banned lighting up on the property.

In January 2012, it began a $25 charge per paycheck for smokers who elect to take health insurance. At first, employees were on the honor system to report their smoking, but, starting this year, the hospital began testing employees for a nicotine byproduct with a mouth swab, Evolga said. Employees hired after Jan. 1 who test positive will be subject to disciplinary action up to termination.

A health-risk assessment survey found that about 22 percent of Bert Fish employees use tobacco, Evolga said. To help them quit, Bert Fish offers free tobacco-cessation counseling and nicotine-replacement therapy to employees and their families.

Money collected from tobacco users who work at Bert Fish is pooled together to fund a wellness initiative called Fit for Life. Employees can take yoga classes at the hospital, grab healthy take-home meals and join walking clubs. ...

In 29 states, legislation prevents employers from discriminating based on a person’s smoking during the hiring process, but Florida is not one of those states.

Bert Fish officials cite high health care costs and lost productivity associated with smoking, the toll tobacco use takes on the community’s health, disruptive smoke breaks and the unpleasant smell on smokers’ clothes that colleagues and patients must endure as reasons why they decided to stop hiring tobacco users. ...

Florida Hospital Flagler in Palm Coast and Florida Hospital Fish Memorial in Orange City don’t hire smokers. All hospital campuses in Volusia and Flagler are smoke free.

Tuesday, August 27, 2013

Armstrong and Getty Discuss The 'Cult' of Multiculturalism in the Univ. of California System

This was their best clip of the week, by far.  It is astounding how far the gulf in reality is amongst the citizenry.

Joe reads a letter he received from a listener who, as an employee in the University of California system had to undergo multiculturalism training which taught them that being "too logical" was simply another form of oppression of the majority and other similarly disturbing, paste-eating drivel.  Listen as Jack and Joe lambaste this garbage coaching attendees to turn off their brains and turn on their hearts.

ObamaCare's Poster Child, California, May Delay Online Enrollment

During a June trip to California, President Obama stopped in San Jose to talk about the state's health exchange. Golden State officials were among the most aggressive and enthusiastic in the nation when it came to implementing the law, and Obama touted their work on the health care overhaul as a model for the nation. 

Opponents of Obamacare, the president said, "had all kind of sky-is-falling, doom-and-gloom predictions" about how the law might fail. California was proving them wrong. “It turns out that what we are seeing in the states that have committed themselves to implementing this law correctly, we’re seeing some good news.”

But the latest news from California's exchange is not so good for the president's health law. State officials warned yesterday that they might delay the opening of the exchange's online enrollment system—the core feature of the exchange.The Wall Street Journal reports:

California's new health-insurance exchange, the biggest of the state marketplaces emerging under the federal health-care overhaul law, said there was a possibility consumers won't initially be able to enroll in coverage online when it is launched on Oct. 1.

Peter V. Lee, executive director of Covered California, the state agency creating the exchange, said Thursday in a meeting of its board that the agency potentially would "phase in support" for the exchange, starting with allowing offline means of sign-up and later adding the ability to fully enroll online.

Lee said that the decision to delay hasn't officially been made yet, and that the announcement was made in order to help manage expectations. And enrollment, he said, would still be possible over the telephone. 

Even still, this is a worrying sign for the law's implementation. And it suggests that criticisms aimed at the law's complex technical challenges were, at the very least, not too far off base.

It also threatens to undermines the president's promises about how the law will work. When Obama stopped in San Jose in June, he said that one of the key things to know about the law was that uninsured individuals in California would be able to buy quality, affordable health coverage under the law beginning in October. "And here’s how," he said. "States like California are setting up new, online marketplaces where, beginning on October 1st of this year, you can comparison shop an array of private health insurance plans side-by-side, just like you were going online to compare cars or airline tickets." Maybe not? 

If California goes through with the delay, it won't be the only state to have missed the deadline for online enrollment. Oregon, another eager implementer of the health law, has already officially confirmed that its online enrollment won't be ready on October 1. 

Obama Wants More Lawyers: Argues We Should Shorten Law School by 33%

  • We already have too many lawyers - not too few.   
  • More importantly we have too many stupid lawyers.  (List of dumbest questions lawyers ask in court). 
  • So Obama wants to make more lawyers by lowering the bar?  
This is like California's idea of having more unqualified folks treat more and more advanced conditions to ameliorate the physician shortage. See Nurses Play Doctor by Katy Grimes.

This is Peter Lattman writing at the New York Times:

President Obama urged law schools on Friday to consider cutting a year of classroom instruction, wading into a hotly debated issue inside the beleaguered legal academy.

“This is probably controversial to say, but what the heck. I am in my second term, so I can say it,” Mr. Obama said at a town hall-style meeting at Binghamton University in New York. “I believe that law schools would probably be wise to think about being two years instead of three years.”

The president’s surprising remarks, made while discussing how to make education more affordable, come at a time of crisis for law schools. With an increasing number of graduates struggling with soaring tuition costs, heavy student debt and a difficult job market, a growing number of professors and administrators are pushing for broad reforms in legal education. ...

Monday, August 26, 2013

What the Bible Says About Big Government

I'm always amused when Statists argue that it is our responsibility to pass laws so that we can compel "kindness" and "charity" at the point of a gun.  Compulsion by force is the opposite of a charitable heart.  Next time you hear a power grabbing, grandstanding, charlatan politician tell you that we need to raise taxes for the children or the most vulnerable amongst us, re-read this passage. 

This is: 1 Samuel 8:16 via  at the NCPA.  

Samuel told all the words of the Lord to the people who were asking him for a king. 11 He said, “This is what the king who will reign over you will claim as his rights: He will take your sons and make them serve with his chariots and horses, and they will run in front of his chariots. 12 Some he will assign to be commanders of thousands and commanders of fifties, and others to plow his ground and reap his harvest, and still others to make weapons of war and equipment for his chariots. 13 He will take your daughters to be perfumers and cooks and bakers. 14 He will take the best of your fields and vineyards and olive groves and give them to his attendants. 15 He will take a tenth of your grain and of your vintage and give it to his officials and attendants. 16 Your male and female servants and the best of your cattle and donkeys he will take for his own use. 17 He will take a tenth of your flocks, and you yourselves will become his slaves. 18 When that day comes, you will cry out for relief from the king you have chosen, but the Lord will not answer you in that day.” 

Doctor Goodman then points out that this "king" will only take 10%. 

Even Samuel could not foresee the plundering capabilities of modern American government.  

The New Mini-Med: Why Health Law's 'Essential' Coverage Might Mean 'Bare Bones'

It came as a surprise to some that the Affordable Care Act seems to allow large employers to offer health insurance that pays for preventive care and not much else. Check out our story on "skinny" plans quoting a consultant saying that for employers with 50 or more workers, “the feds imposed no minimum standard on how skimpy that coverage can be other than to say, in essence, it’s got to be more robust than a dental plan or a vision plan." (The Wall Street Journal broke the story here in May. Subscription required.)
Retailers, restaurant chains and temporary staffing companies are said to be interested.
But how can a law praised for expanding coverage -- one that includes an "employer mandate" to offer "minimum essential coverage" -- allow companies to offer insurance that might not even cover hospitalization?
Take a walk through the ACA weeds to see why.
First of all, there is no outright ban on skinny plans -- even after the employer mandate kicks in in 2015. Instead, large employers -- those with 50 or more full-time employees -- run the risk of fines only if the coverage doesn't conform to ACA rules. The regulations published so far, however, seem to allow skinny plans with a penalty that many employers may choose to pay because it is less costly than offering fuller coverage.
There are two fines in the health law for large employers failing to offer adequate coverage. First, any company that does not offer "minimum essential coverage" is liable for a $2,000-per-worker penalty (minus the first 30 workers), triggered when at least one employee enrolls in subsidized coverage in the online marketplaces known as exchanges.
But what is minimum essential coverage? Not as robust as you might think. To start, don't confuse it with "essential health benefits," including maternity benefits and prescription drugs, that must be included in plans sold to individuals or small employers.
If health insurance is merely sponsored by an employer, it passes one test for minimum essential coverage.
Now how good does that employer insurance have to be? The regulations are obscure, defining minimum essential coverage largely in terms of what it is not. For example, "limited-scope dental or vision benefits" are not minimum essential coverage. Nor is "coverage only for a specified disease or illness."
Neither the law, nor the regulations say much about what minimum essential coverage offered by a large employer is. As a result, many experts believe large employers can shield themselves from the $2,000 penalty by offering a plan that covers the health law's required preventive care, but still leaves workers vulnerable to thousands in bills if they're hospitalized. If employees sign up for such plans, which may cost as little as $50 a month, they would also be protected from health-law penalties levied on individuals without coverage.
The health law also fines employers that don't offer "minimum value" in their health plans, says Alden Bianchi, a Boston-based benefits and compensation lawyer. Skinny coverage flunks that test, based on regulations that measure minimum value against "benchmark plans" in each state, Bianchi said. But the employer penalty is only $3,000 for each worker enrolling in subsidized exchange coverage. That's likely to be much less than the fine for not offering minimum essential coverage, which is $2,000 for nearly every employee in the company, even if most don't buy policies in the exchanges.
But what about other rules governing health benefits? What about the part of the health law that bans insurers from cutting off benefits at a certain dollar level? Not a problem for skinny plans. Unlike the "mini-med" plans in common use before the law was passed, they don't impose a dollar cap; they merely exclude large categories of care, which also keeps down costs.
What about new rules limiting out-of-pocket expenses for consumers? For 2014, your plan can't make you pay more in co-pays and deductibles than $6,350 for individuals and $12,700 for families. (That may temporarily be higher if your employer has separate administrators for drug benefits and doctors and hospitals.) Skinny plans pass the test again. Out-of-pocket caps are for covered care only, and skinny plans don't cover much care.
What about restrictions on self-insured employers (the large majority of large companies are self-insured) offering a rich-benefit plan to managers and a limited-benefit plan to hourly workers? Skinny plans survive this one, too, says Ed Fensholt, a senior vice president at Lockton Cos., a large insurance broker. These non-discrimination rules contain exceptions for high-turnover workers, he said. And they require employers only to offer the management plan to hourly workers, not for the workers to enroll.
"That plan would be priced at a place where relatively few rank and file employees would want it," Fensholt says. "And then they'd offer the skinny plan to the rank and file."
When asked about the situation, the Obama administration said consumers lacking good coverage "can enter into the marketplaces and choose a health insurance option that works for them."
Bianchi, who represents large employers, says the people who wrote the law intended to give companies a bare-bones option.
"The ability to offer such plans is a result of conscious policy decisions by Congress, as implemented by the regulators," he wrote in an industry brief.
The Cato Institute's Michael Cannon, on the other hand, suspects the administration "had no idea what they were doing," as he wrote on the libertarian think tank's blog.

Michael Berry Show: Discussion of Employers Dropping Employees Below 30 Hours, Unions' Responses and Free Market Realities

Michael Berry discusses the businesses making the rational economic response to ObamaCare’s Employer Mandate and cutting employee hours down below 30 per week. Finally, unions have begun to realize that PPACA is horrible for their members. When Statists try to control markets the workers are always the ones to pay.

Michael expounds on this as well as the subsequent Obama supporters whining as only he can in the 8/14/13 show in the 9AM hour.

Part 1:

Part 2:  

In the second part of this segment, Michael compiles a string of audio clips from Statist bureaucrats about ObamaCare, Nancy Pelosi, Howard Dean (this is a form of redistribution) , John Dingell (this is what we need to do to 'control' the people), Tom Harkin (some folks not having healthcare is 'segregation'), Dick Durbin, and Harry Reid (eventually we'll have single payor).