Reasons Behind the ACA Employer Mandate Delay

The Affordable Care Act employer mandate has been delayed by a year to 2015, announced the U.S. Treasury Department on July 2. The reprieve will give businesses some breathing room as they are now able to postpone offering worker health insurance for another year. Though the official reasoning behind the delay was to help businesses begging for more time, left unstated was the fact that the federal government hadn’t written key guidelines for employers, according to current and former administration officials, and computer systems that were supposed to run the program were not yet operational.

“The administration’s decision… to delay the implementation of the employer mandate is welcomed by the business community and will help avoid some serious near-term economic consequences of this law,” said U.S. Chamber of Commerce President and CEO Thomas Donohue in a statement.

The Affordable Care Act (ACA) passed in 2010, and was set to go into effect on January 1, 2014. It required businesses with over 50 full time workers to offer affordable healthcare to them. The ACA demanded employer coverage just for those who work over 30 hours per week for a period of a month. Depending on the size of the company and the state in which it’s located, a business may be able to buy a less expensive small group policy through a standardized insurance exchange. If a company has fewer than 25 employees but they choose to offer insurance anyway, the ACA will provide a tax credit to balance the price. Smaller companies also have more incentive to self-insure, in which the businesses take on the financial risk of offering health benefits to its workers. Rather than paying premiums to insurers, they pay claims filed by workers and health care suppliers. Larger corporations with hundreds of employees or more often self-insure as well because they have the cash on hand to pay the majority of the claims filed right away.

The government’s computer systems are being tested now, but experts say there’s no way to tell how well they will work before the launch October 1.

According to an official in Obama’s administration, the Treasury Department realized they couldn’t address concerns and questions raised by employers in time for the employer mandate to go into effect, so they had to push the date back. He said the postponement was caused partially by the limited staffing and the wait for the Supreme Court’s review results.

“They were so late putting out regulations, and even as of today they have not produced proposed regulations, they knew it was not realistic to expect employers and insurers to implement their system changes,” said Catherine Livingston, a former health care counsel at the IRS.

According to the Treasury, the latest change won’t affect the individual mandate which demands most taxpayers buy insurance or pay a government fine. The timeline hasn’t changed for the application of the individual and small businesses exchanges – which are marketplaces where people and business owners can shop for insurance at the state level. The Department of Health and Human Services insists they’re prepared to open the exchanges as planned.

How Will DOMA Ruling Impact Employee Health Care Benefits?

Last month, the U.S. Supreme Court ruled that the 1996 Defense of Marriage Act (DOMA), which defined marriage as being between a man and a woman, was unconstitutional. This decision will affect the economy as it will impact things like employee benefit packages. The ruling ensures that same-sex couples will have the same federal benefits as heterosexual couples, because it requires same-sex couples wed under state law to be recognized by the federal government as legal.

“People who are married will be treated as married for the 1,100 federal rights and benefits that apply to all married couples,” said Hunter Carter, a partner at the law firm Arent Fox in New York. “The most important are social security, taxes, federal pensions, federal worker benefits for federal employees and, of course, immigration.”

Same-sex couples living anywhere in the U.S. will now qualify for federal-employee benefits if they have a marriage license from any of the 13 states that recognize same-sex marriage, as well as Washington, D.C. For employers, the decision means that any federal benefits and laws that would apply to an employee’s spouse now extends to same-sex spouses in legally recognized marriages. The big ones that employers need to know are health and retirement benefits, taxes, and family leave.

Employers who have, even before the ruling, offered same-sex couples health insurance benefits were obligated to consider those as income to the employee, since “technically they were giving something of value to someone who wasn’t related to them” said Boston attorney Scott Squillace, who advises same-sex couples. From now on, federal tax law will think of those benefits as the same as an employee’s own health insurance, which means they’re tax-free for the employee.

“The rulings take effect immediately (possibly even retroactively). If marital status affects the delivery of benefits to an employee’s same-sex spouse or that spouse’s child, employers may need to amend the plan’s ‘spouse’ definition; reprogram tax reporting systems; and update enrollment forms, distribution election packages, tax notices, beneficiary designation forms, SPDs [summary plan descriptions], and the like,” according to Mercer.

Before the Supreme Court’s decision, DOMA guaranteed that benefits were limited for lawfully married same-sex couples. Now, the right to file joint federal taxes can save same-sex couples thousands of dollars, social security benefits will be available to same-sex spouses, and same-sex spouses won’t be taxed on the inheritance of their spouse’s estates.

Health Care Reform May Lower Insurance Costs for Some Businesses

Numerous small business employers and owners are worried about their insurance costs rising under the health law next year. However, for some businesses, especially those with older workers or those who have employees who have been ill, the Wall Street Journal reports that costs may actually decrease according to business owners and insurance brokers.

Under a stipulation of the Affordable Care Act (ACA), which goes into effect in January, insurers will be forbidden from setting rates for healthcare coverage based on the health status of employers or their employees are at businesses with less than 50 or 100 workers, depending on the state. Rather, the rates will be announced on government-run health insurance marketplaces, or online exchanges, which are meant to extend the additional costs of insuring higher-risk policyholders, like those with prior sicknesses or pre-existing medical conditions.

A survey conducted in April by The Wall Street Journal and San Diego-based executive mentoring group Vistage International Inc., found that 12% of 783 businesses with less than $20 in yearly revenue believe their insurance premiums will be cheaper or stay roughly the same under the ACA. Similarly, a survey by eHealthInc. done in February found that 11%of 259 small business employers, most with less than 10 workers employed at their businesses, said they think their rates will go down next year.

Some business owners say costs could go down if the exchanges produce cheaper rates on individual plans, which would lead some employees to drop their employer-sponsored plans completely.

“If I insure fewer people, my benefit costs go down,” says Kurt Gabrick, who runs a software-consulting firm in Tucson, Ariz., with eight full-time employees. Right now, Gabrick says he pays half of his employees’ health-insurance costs—a total of around $4,000 a month—as part of a small group plan.

Both early renewals and self-funded plans will end up keeping more groups off the exchanges, which will reduce the savings for high-risk policyholders. Besides that, any savings from the exchanges will be contingent on whether they’re up and running by Oct. 1, the deadline for offering coverage that will be effective come January.

The federal government’s own health-insurance exchange for small businesses, called the Small Business Health Options Program, or SHOP, which it will supervise in 33 states, isn’t expected to be fully operational and available until 2015.

US Government Launches New Health Care Website

Recently, the Obama administration revealed plans to expand coverage under the federal health care law after the Government Accountability Office, a nonpartisan investigative division of Congress, discovered that the federal government and many states were “behind schedule” in implementing marketplaces where Americans are meant to be able to buy insurance.

The plans include creating a website and a telephone call center to provide information to consumers are to help prepare for the expected masses who will flock to buy insurance starting October 1.

Secretary of health and human services Kathleen Sebelius says the call center will be operational 24 hours a day and reachable at 800-318-2596. The website, www.healthcare.gov, offers information that promotes the 2010 health care law and explains new insurance choices. Both currently only have general information about coverage which will begin January 1.

“The new Web site and the toll-free number have a simple mission: to make sure every American who needs health coverage has the information they need to make choices that are right for themselves and their families or their businesses,” said Sebelius in a statement.

The Congressional Budget Office expects around seven million people to buy private insurance next year through marketplaces, or exchanges, while nine million people will get coverage through Medicaid. By 2016, the number of uninsured Americans will be reduced by approximately 25 million from the current estimation of 56 million.

The health care website will ask consumers for information about their household incomes in order to figure out if they are eligible for federal subsidies, in the form of tax credits, to help pay premiums.

Sebelius expressed concern about the ability of low-income people in some states to access either Medicaid or subsidies to buy private insurance. However, there is no set timetable for states to expand Medicaid, and states that vetoed the expansion of eligibility this year could reassess next year.

The federal website does recognize that some states aren’t expanding Medicaid and it says that “under the health care law, states have the choice to cover more people.”

More than half of all people without health insurance reside in states that are not intending to expand Medicaid.

Administration representatives said the call center would ultimately have 9,000 customer service representatives handling calls. Consumers can also find information in live Web chats.

Congress Considers Revisions to ACA to Help Small Businesses

Attempts to repeal a tax on insurance companies in the new healthcare reform law are picking up steam in Congress, driven by worries that the fee would affect small businesses especially hard.

The legislation would get rid of the fee on health insurance companies set to go into effect when the law does in January 2014. Referred to as the health insurance tax (HIT tax), the fee will be calculated based on the plans insurers sell right to individuals and companies, known as the fully insured market, but doesn’t include plans established and managed by companies themselves, known as the self-insured market.

The majority of big companies self-insure their workers; as a result, experts forewarn that insurance companies will pass the added costs of collecting the fee to small businesses, which are inclined to buy coverage in the fully insured market.

“It’s pretty straightforward, what’s going to happen, that the tax is going to be passed along,” Rep. Jim Matheson (D-Utah) said in an interview, observing that insurance agents and underwriters have told him as much. “It isn’t really taxing the insurance companies, it’s taxing the people paying the premiums, and in this case, that’s small business owners.”

Matheson is one of several democrats who have pledged their support to the legislation repealing the HIT tax, uniting with almost every Republican in the House. Recently, the bill, H.R. 763, hit the 218-cosponsor mark, which is enough to guarantee its passage in the lower chamber; the tally has since increased to 221.

Sam Graves (R-Mo.) attributed the bill’s momentum to trepidations expressed by small business owners, including many who have testified during hearings before the House Small Business Committee, over which he officiates.

“We keep hearing that from small businesses; that they’re premiums keep going up, keep going up, and now this thing’s coming along, and they’re going to go up even more,” said Graves. “That’s the reason you’re hearing so much about this tax and why you’re seeing such bipartisan efforts to repeal it.”

Those efforts, however, are fighting against the political current on the Hill, where lawmakers have been reluctant to consider proposals to modify the health care law.

This hasn’t discouraged small business advocates from pursuing small fixes, and their efforts are starting to yield signs of progress. Recently, Sens. Susan Collins (R-Maine) and Joe Donnelly (D-Ind.) introduced legislation that would change the health care law’s definition of full-time employee from 30-hour workers to 40-hour workers, a shift meant to keep labor laws more steady for businesses.

Quitting Caffeine: Kicking the Habit Isn’t That Simple

While caffeine may seem like a harmless but necessary drug to get you through the day, the Wall Street Journal reports that it’s now the basis of two official diagnoses in the mental-health bible released in May, with a third under consideration. The most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, frequently called DSM-5, includes both caffeine intoxication and withdrawal. Both of these conditions are counted as mental disorders when they harm an individual’s ability to function in daily life.

Caffeine intoxication had been included in the previous version of the manual, known as DSM-IV, as a diagnosis. However, caffeine withdrawal was upgraded in DSM-5 from a “research diagnosis” to a diagnosis. Also, caffeine use disorder, which is when a person suffers disconcerting side effects and isn’t able to quit, was added to DSM-5 as a research diagnosis, meaning it needs more analysis to be included.

However, the new mental health diagnoses come with debate.

“Caffeine intoxication and withdrawal both occur fairly frequently but only rarely cause enough clinically significant impairment to be considered a mental disorder,” said Allen Frances, who chaired the task force that established the previous version of the DSM and has been an outspoken critic of the latest version. “We shouldn’t medicalize every aspect of life and turn everyone into a patient,” he added.

“The symptoms [of caffeine withdrawal] overlap with a lot of other disorders and medical problems,” said American University psychology professor Laura Juliano, who guided the DSM-5 Substance-Related Disorders Work Group. “We’ve heard many times people went to the doctor for chronic headaches or because they thought that they had the flu and it turns out it was caffeine withdrawal and they didn’t even know it.”

While caffeine is addictive, studies have shown that it is actually related to some health benefits. Nevertheless, various experts say that some individuals should avoid caffeinated goods, like those with anxiety, high blood pressure, insomnia, and diabetes.

In order to be diagnosed with caffeine withdrawal, a person has to experience at last three of five symptoms within 24 hours of stopping or decreasing caffeine intake: headache, fatigue or drowsiness, depressed mood or petulance, difficulty focusing, and flulike symptoms like nausea or muscle pain. Withdrawal symptoms often begin 12 hours after consumption and reach their peak at 24 hours.

For the majority of people, the symptoms will disappear in around a week and that may be preferable to spending a few weeks decreasing your caffeine intake only to find that the last step in quitting still leads to withdrawal symptoms.

Among routine caffeine drinkers who go without caffeine, headache is reported about 50% of the time and functional impairment about 13%, said Dr. Roland Griffiths, a professor at Johns Hopkins University School of Medicine in psychiatry and neuroscience who advised the DSM-5 work group.

Most Common Complaint in Hospitals? Noise.

A stay in the hospital is a noisy experience; between monitors, alarms, TVs, hospital personnel, pagers, and cellphones, a patient staying overnight is bombarded with sounds from all sides. According to the Wall Street Journal, hospitals are becoming increasingly creative in finding ways to lower the noise level, mask invasive sounds, and distract patients from the din.

Facing possible Medicare financial penalties has prompted hospitals to alter practices and habits that add to the hubbub. Some are changing the overhead pager system, others permitting patients to shut the doors to their rooms and hang a “Do Not Disturb” sign, while some are designating sleep hours which mean in some wings unless absolutely necessary, there’ll be no routine checks of vital signs. Other changes some hospitals are making include installing white-noise machines, sound-absorbing ceiling tiles and carpets in rooms and hallways, providing closed-circuit “relaxation programming” of calming music and pictures of nature, and “quiet kits” consisting of sleep masks and earplugs.

Studies show that hospital noise is more than just irritating; by disturbing patients’ sleep, it can actually stimulate increases in blood pressure, delay wound healing, and interfere with pain management.

Last year, after Medicare started basing part of hospital reimbursement on quality measurements like patient ratings on quality of care, hospitals really focused on increasing their noise-reduction efforts. The most recent figures from the federal program for the year ended in June 2012 and showed that just 60% of patients said the area outside of their rooms was quiet at night, the lowest satisfaction score given from the 27 questions about the hospital experience.

The Beryl Institute, a nonprofit that helps hospitals increase patient satisfaction, released a 2013 State of Patient Experience report in April that indicated hospital administrators ranked noise reduction as the most important priority for the second time since the last report conducted in 2011. Beryl mentioned changing behavior and culture as the biggest obstacles.

“There is a constant tension in hospitals between the need to create a place where patents can rest and heal and the realities of an active and almost chaotic work environment,” says Beryl president Jason Wolf. Noise can never be totally eliminated, he adds, but “we can counteract it.”
While many hospitals now have only private rooms, a factor that makes quietness more difficult is hospitals’ growing openness in their visiting hours and cellphone policies. Also, numerous hospitals are asking personnel to use “library” voice because soft whispers can be more soothing than normal speaking tones.

HCA Subsidiary Parallon Buys The Outsource Group

Parallon, the Franklin, TN-based subsidiary of HCA Holdings Inc., will purchase The Outsource Group. Based in St. Louis, The Outsource Group is a healthcare revenue cycle management company that brought in $116 million in 2012 revenue.

Parallon employs over 22,000 workers and serves more than 1,400 hospitals and close to 11,000 non-acute care providers. The company works to improve the business performance of hospitals, health care systems and non-acute care providers. The new purchase enables Parallon to expand its outsourced business offerings to hospitals and health care practices and other related businesses.

Though terms were not disclosed, the deal is expected to be final in the third quarter of 2013. Read the full article on Tennessean.com.

Prepare for Affordable Care Act: Tips for Employers

With the Affordable Care Act (ACA) set to go into effect in January 2014, many employers supporting group health care plans are rushing to get ready for the impending changes. Here are some tips on how to prepare for the upcoming implementation of the ACA:

1. Figure out how the ACA will affect your business. According to Forbes, when the ACA is ratified, it will oblige businesses with over 50 full time workers to offer affordable healthcare to them. The ACA is demanding employer coverage just for those who work over 30 hours per week for a period of a month. Corporations who wish to avoid providing this medical insurance for their workers and who are on the verge of having 50 employees may then look to temps and staffing agencies in order to evade being forced to obey the law or create more part-time jobs as another way to shirk the ACA’s policies. Companies doing this will undermine the legislation and its intentions of increasing coverage to more American employees.

2. Choose whether to “pay” or “play” and make decisions about your insurance. To “pay” is to pay employer-shared-responsibility penalties of around $2,000 per employee per year. To “play” is to offer employer-sponsored coverage to fulltime employees.

3. Think about adding wellness program incentives. According to a recent survey by the Midwest Business Group on Health, more than 80% of the country’s biggest employers are looking to implement a penalty and reward system to encourage their workers to get healthy.

4. Organize and give out obligatory employee communications like a summary of benefits and coverage, plan descriptions, etc.

5. Amend your Health Insurance Portability and Accountability Act privacy and security rules and processes before the Sept. 23, 2013, deadline for acquiescence with final regulations.

6. Pay the first comparative effectiveness research fees by July 31, 2013, and plan for future reinsurance charges.

The Affordable Care Act: 5 Changes Healthcare Organizations Must Know

Recently, the U.S Department of Health and Human Services (HHS) has issued final rules applying some crucial consumer protections from the Affordable Care Act (ACA). The intention of lawmakers and government bureaucrats when drafting the Affordable Care Act legislation was to enrich health care benefits. Under the final rule, all individuals and employers will have the ability to buy health insurance coverage no matter what their health status may be.

Insurers will also be stopped from charging discriminatory rates to people and small employers based on reasons like health status or gender. The HHS is now demanding that most health plans include the following requirements by 2014:

1. Reasonable Health Insurance Premiums
Coverage offered to individuals by health insurance companies will only be allowed to vary their premiums based on age, tobacco use, family size, and geography; to base the premium on factors other than those will be illegal.

2. Availability
Almost all health insurers that offer coverage to individuals and employers will have to sell health insurance policies to all consumers; no one can be deprived of health insurance because of a current or past sickness.

3. Renewability
Under the new rules, health insurers will not be able to refuse to renew coverage due to a person becoming sick. Consumers hold the power to choose to renew coverage.

4. Single Risk Pool
Health insurance companies won’t be able to charge higher premiums to higher cost consumers by placing them into separate risk pools. The insurers will need to have a single statewide risk pool for the individual market and one for the small group market.

5. Catastrophic Plans
Consumers will have the right to a catastrophic plan in the individual market. The plan will typically have lower premiums, protection against high out-of-pocket costs, and include recommended preventive services without cost sharing.

When these ACA requirements go into effect in 2014, expect a substantial increase in patient volume. Whether you view healthcare reform as positive or negative, it could prove beneficial to nurse staffing and other forms of healthcare staffing.

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