MHA Health Care Aide

Welcome to MHA's Health Care Aide

The health care environment is constantly changing and business leaders need to stay informed about these changes. The Mississippi Hospital Association (MHA) recognizes that you need resources to help you make the critical decisions required to ensure affordable, quality health care for your employees, and we hope that MHA's Health Care Aide will be an invaluable resource to our state's businesses.

We will keep the Web site updated with timely, pertinent information. Feel free to suggest resources to share with others too. (Email suggestions to Shawn Rossi at srossi@mhanet.org.)

Tell us what you think and what you'd like to see on this site in the future. Together, we can make a difference.

Sam W. Cameron
President/CEO
Mississippi Hospital Association

Small Businesses Pay More For Health Care Coverage

In a 2009 study by the White House, small businesses pay 18% more in premiums for health coverage than their big box competitors per employee. As a small business owner are you surprised by this statistic?

Of course not.

Report: Millions of employers fail to claim healthcare tax credit

Millions of small businesses failed to claim tax credits they could have received under President Obama’s healthcare law, according to a new report from the advocacy group Families USA. Read more from The Hill's health care blog here.

HHS: Nearly 50,000 people enrolled in Pre-existing Condition Insurance Plan

Nearly 50,000 people are enrolled in the Pre-existing Condition Insurance Plan, according to a report released Feb. 23 by the Department of Health and Human Services. The Patient Protection and Affordable Care Act created the program as a bridge to 2014, when the ACA prohibits denying coverage to people with pre-existing conditions. Twenty-seven states have elected to administer their own programs, often in coordination with existing high-risk pools, while HHS operates the program in the remaining states.

Many PCIP participants have serious health conditions, which has contributed to higher per-member claims costs in state-based PCIPs than traditional state high-risk pools, HHS said.

[ via AHA News Now ]

CMS issues FAQs on intended approach to essential health benefits

The Centers for Medicare & Medicaid Services on Feb. 17 issued answers to Frequently Asked Questions on the agency’s intended approach to defining “essential health benefits” for individual and small group health insurance plans under the Patient Protection and Affordable Care Act. In December, CMS issued a bulletin outlining proposed EHB policies the agency plans to define in future rulemaking.

The FAQs are intended to provide additional guidance to states and others working to establish health insurance exchanges. For more information, e-mail CMS at EssentialHealthBenefits@cms.hhs.gov.

The agency also plans to release future guidance on Medicaid benchmarks and essential health benefits.

Administration highlights business healthcare tax credits in Obama budget

President Obama's proposed budget would expand the health law's healthcare tax credits by about $14 billion over a decade, the administration highlighted Feb. 16. Under the law, companies with 25 or fewer workers that pay for at least half of employees' healthcare coverage can claim progressively higher tax credits (up to 50 percent starting in 2014). The president's budget would increase the size of eligible companies to those with 50 or fewer workers, make it more generous and make it easier to claim.

Read more here.

Small Business Health Insurance Exchanges: Potential And Pitfalls

The Affordable Care Act’s state health insurance exchanges for small businesses present a host of opportunities for states now creating them, but they also present design and regulatory challenges that could make or break the success of the program, according to a cluster of articles in the February issue of Health Affairs, released Feb. 8.

Read more here.

 

How will the Affordable Care Act affect small businesses and their employees?

A new Kaiser Family Foundation fact sheet summarizes key provisions in the Affordable Care Act that may affect small businesses and their employees. The fact sheet explains the law’s small business tax credits and the Small Business Health Options Program exchanges to be established in each state by 2014, both of which are designed to make it easier for small businesses to purchase insurance for their workers.

The fact sheet also describes the penalties employers who employ more than 50 full-time workers would face if they do not offer affordable coverage starting in 2014; smaller employers are exempt from that requirement and would not face any penalties. The fact sheet is available online.

Law won't lead most employers to drop health coverage, study finds

A study by the Urban Institute found that even after enactment of the federal health care law, most employers will still offer coverage to workers rather than pay fines and leave employees to get insurance from state health exchanges. The study found that employers' desire to keep highly skilled workers will prompt them to continue offering health insurance, but employers with many low-wage workers are likely to drop coverage.

Read more here.

Study looks at competition in state insurance markets

The health insurance market for individuals and small groups is highly concentrated in many states, according to a new study by the Kaiser Family Foundation. The study found a single health insurer dominates at least half of the individual market in 30 states and at least half of the small group market in 26 states.

The market share for a state's largest insurer in the individual market ranged from 86% in Alabama to 21% in Wisconsin, while the market share for the largest insurer in the small group market ranged from 96% in Alabama to 24% in Oregon and Pennsylvania. "As state policymakers consider their options as implementation of the [Patient Protection and Affordable Care Act] proceeds, they may want to examine the level of competitiveness in their insurance markets as a factor in the choices they make with respect to insurance market rules, exchanges and rate review," the authors state.

IOM issues guidelines for ACA essential benefits package

A new Institute of Medicine report recommends criteria and methods to guide the Department of Health and Human Services in developing a package of essential benefits for qualified health plans under the Patient Protection and Affordable Care Act. The ACA requires HHS to define the minimum package of benefits that certain health plans must cover, including those participating in health insurance exchanges.

The report recommends that the cost of the average premium for the initial package not exceed the national average premium for the typical small employer plan. It says HHS should gauge potential services and products against a set of criteria, including medical effectiveness, safety and relative value compared with alternative options, and evaluate whether the package as a whole protects the most vulnerable individuals, promotes services that have proved effective, and addresses the medical concerns of greatest importance to the public.

The report also recommends creating an independent National Benefits Advisory Council to advise the HHS secretary on annual updates to the benefits package.

HHS begins posting premium rate review information

The Department of Health and Human Services on Oct. 7 began posting information submitted by health insurers requesting premium increases of 10% or more. On Sept. 1, the Patient Protection and Affordable Care Act began requiring health insurers to publicly disclose and justify such premium increases.

To access the rate review information, visit http://companyprofiles.healthcare.gov.

Insurance Exchanges: Trouble At The SHOP?

A feature of the Affordable Care Act that’s received relatively little attention is the requirement for each state to have a Small Business Health Options Program (or SHOP) exchange, intended to assist small group employees’ enrollment in health plans. The ACA gives states the choice of creating separate individual and SHOP exchanges or including both functions within a single entity.

It’s an attractive concept. Small employers face higher premiums and more administrative problems than their larger competitors in providing for their workers’ coverage.  SHOP exchanges could simplify health plan selection and payment and give small businesses some of the advantages of scale enjoyed by bigger firms.

Unfortunately, the experience so far of small employer exchanges is not encouraging. Of five exchanges examined in a recent report from the Small Business Majority and the Center for American Progress, the largest closed its doors five years ago, while none of the others has succeeded in making major inroads into the small employer insurance market.

Read more from the Health Affairs blog here.

Group announces small business insurance exchange

The Independent Association of Businesses on Aug. 17 announced the creation of a national private health care exchange, which it said will offer small business owners and the self employed greater options to obtain affordable health care and medical benefits. “The exposure through a national collective exchange will offer even greater assistance to the over 35 million small business professionals who effectively can utilize this service,” the organization said.

It said the exchange “offers multiple providers and additional health care and medical solutions that are not designed with the [Patient Protection and Affordable Care Act] state and federal based exchanges.” An IAB committee recommended forming the exchange “based on participating state by state licensed insurance companies.”

Agencies issue rule, template for health plan benefit summaries

The departments of Health and Human Services, Labor and the Treasury on Aug. 17 proposed standards for health plans disclosing a summary of their benefits and coverage under the Patient Protection and Affordable Care Act, and a proposed template and instructions for disclosing the information. All health plans would provide a summary of benefits and coverage, along with a uniform glossary of terms, to shoppers and enrollees on request and before they buy coverage.

They also must give enrollees at least 60 days notice of any significant change in their plan or coverage during the plan or policy year. To help consumers compare plans, the summary would include “coverage examples” showing the proportion of care expenses covered for having a baby, treating breast cancer, and managing diabetes.

The proposed rule and template will be published in the Aug. 22 Federal Register, with comments accepted for 60 days. A proposed rule establishing minimum essential benefits for health plans under the ACA is not expected to be published any time soon.

 

The Effects of Health Reform on Small Businesses and Their Employees

Some critics have raised concerns about the effects of the Patient Protection and Affordable Care Act (ACA) on the health insurance landscape for small firms. Here, the Robert Wood Johnson Foundation consolidates the results of several Urban Institute studies that address the likely effects of the ACA on small firms. 

Report estimates ACA impact on employer-sponsored health coverage

In yet another recent entrant into the collection of studies on the potential impact of health reform, Avalere Health on June 20 issued an analysis that the employer-sponsored health insurance market is likely to remain fairly stable after 2014, when a number of key provisions of the Patient Protection and Affordable Care Act go into effect. Those provisions include the Medicaid expansion, new subsidies to purchase coverage through state-based health insurance exchanges, small business tax credits, penalties on certain employers who do not offer coverage or offer unaffordable coverage, the individual mandate, and the high-cost plan excise tax.

Certain segments of the market, such as firms employing low-wage workers and early retirees, "are likely to obtain coverage through the new health insurance exchanges in either 2014 or soon after because the ACA provides alternatives or new economies of scale for these segments that do not currently exist," the report concludes. "On the other hand, large employers are unlikely to stop offering coverage in the near-term as the benefit to dropping coverage may not outweigh the costs for both the employer and their employees."

While near-term changes in aggregate employer-sponsored insurance rates are unlikely, "longer term erosion - over 10 to 20 years - is possible under certain circumstances," the report adds.

Raising the Age of Medicare Eligibility: A Fresh Look Following Implementation of Health Reform

One of the policy options for reducing the federal deficit is to increase the eligibility age for Medicare to 67 from 65. The Kaiser Family Foundation has a new study out looking at the savings and the costs.

Read more here.

How US healthcare reform will affect employee benefits

The Congressional Budget Office has estimated that only about 7 percent of employees currently covered by employer-sponsored insurance (ESI) will have to switch to subsidized-exchange policies in 2014. However, our early-2011 survey of more than 1,300 employers across industries, geographies, and employer sizes, as well as other proprietary research, found that reform will provoke a much greater response. Overall, 30 percent of employers will definitely or probably stop offering ESI in the years after 2014.
 
Read the full article from the McKinsey Quarterly (free registration required).

Series to Explore Health Reform and the Private Insurance

The Kaiser Family Foundation on June 13 launched a new series of short notes that will dissect and help explain the implementation of the Affordable Care Act and the private health insurance market. The series, Notes on Health Insurance and Reform, will feature timely posts that clarify complex regulatory and insurance topics, provide context for ongoing policy debates, and foreshadow significant implementation challenges.

The series is part of the new Kaiser Initiative on Health Reform and Private Insurance, which will examine the implications of changes in the private insurance market under the Affordable Care Act and inform federal and state policymakers as they implement provisions of the health reform law. The initiative focuses on such topics as new rules that make insurance more accessible to people with pre-existing health conditions and require a minimum level of coverage; the creation of insurance purchasing exchanges by states; state review of proposed premium increases; and the design of tax credits to subsidize coverage for modest-income families. 

HHS requires insurers to justify premium hikes of at least 10%

The HHS has issued a final rule, effective in September, requiring insurers to explain annual premium hikes of at least 10% to state regulators and post the reasons online. However, the rule does not allow regulators to void increases. The Obama administration in September 2012 also will create state-by-state thresholds for reporting premium hikes to account for regional insurance trends and health costs.

Read more from the New York Times here.