Obamacare: Coverage Costs Widely Vary by State

How much will individuals pay for health insurance through Obamacare? Although Obamacare is a nationwide healthcare initiative, the coverage costs will vary depending on each state.

According to data recently released by the Department of Health and Human Services, Americans under the age of 65 who purchase coverage through the new healthcare act will end up paying the highest rates in Wyoming, while those who opt into the program in Minnesota will end up spending the least. Meanwhile, the states of Kentucky and Massachusetts have not yet released their coverage rates.

When it comes to unsubsidized costs, Minnesota comes in with the lowest rates, and is the sole state offering middle-tier “silver” plans for less than $200 a month. Furthermore, the lowest tier of ACA coverage, also called the “bronze” plan, calls for average monthly premiums of $144. In comparison, the state of Wyoming offers the bronze plan at an average of $425, while its silver plans begin at $489.

Meanwhile, in all other states across the U.S., bronze plans are offered at an average of $249, while silver plans begin at $310. Aside from the fact that silver plans, on average, are priced at 16 percent less than the projected $392 per month, government officials report that 56 percent of uninsured participants will be able to pay $100 or less each month. Nevertheless, the monthly cost exceeds the prior projected price tag of $392 in seven states.

Another influential factor for determining coverage rates under Obamacare is age. The Department of Health and Human Services reports that the average cost for younger Americans will likely be lower than what older people will be required to pay. As a general rule of thumb, states with more competing insurers will be charged lower rates than those states with fewer participating insurers.

With the help of an online subsidy calculator, individuals can get a better idea as to how much they can afford to spend on health insurance. By inputting various factors such as income level, age, and family size, an estimate will be calculated to help determine an individual’s eligibility for subsidies.

ACA: Updates, Delays, and Deadlines You Should Know

A number of delays have plagued the implementation of the Affordable Care Act, and new deadlines have been established. Following is a brief rundown of delays and deadlines to keep your understanding of the ACA up to date.

Deadlines

Reporting employee status: Employers must begin to collect information about their employees’ status over a 12-month period of their choosing in order to estimate their tax liability when the employer mandate takes effect next year (see Delays, below). Beginning in 2015, employers subject to the mandate will be required to offer coverage to employees who work full-time or pay the corresponding penalty.

Marketplace notification: Employers subject to the FLSA should have notified their employees of available health care options on the health insurance exchanges by October 1, the enrollment start date. If you haven’t yet notified your employees, do so ASAP.

Summary of Benefits: Employees must receive a summary of their provided benefits no later than 30 days before the beginning of the plan year. The summary must indicate whether coverage meets the minimum essential standard established by the ACA.

Delays

Small Business Health Options Program (SHOP) marketplaces: Originally slated to roll out with the individual marketplaces on October 1, the federal government delayed the launch of the SHOP marketplaces to November 1. Plans purchased on the exchange will still begin January 1, and small businesses that purchase their plans through brokers or other means will not be affected.

In addition, the marketplaces will have an additional year to offer a la carte plan options, in which businesses may choose individual coverage for their employees within an overall package.

Employer Mandate: Companies employing more than 50 full-time employees now have until 2015 to provide minimum essential coverage before they are subject to the $2,000-$3,000 per employee tax penalty for noncompliance.

Out-of-Pocket Limits: Some insurance plans will not be subject to consumer out-of-pocket limits ($6,350 for an individual/$12,700 for a family) until 2015. During the delay period, employers who offer separate plans for care and pharmacy benefits will be allowed to maintain separate limits for each plan, and plans that do not have a limit will not be required to implement one.

Update on the Individual Marketplaces

Technological issues that crippled several state exchanges soon after their launch have been resolved, leading to tens of thousands of new enrollments during the first week of operations nationwide. In the meantime, federal officials have acknowledged the need for design and server updates to the federal exchange at healthcare.gov to handle the high levels of traffic and make the experience more user-friendly.

PRN Funding’s healthcare factoring programs can provide the cash flow for your company to effectively fulfill its healthcare responsibilities under the ACA. Contact us to learn more.

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Medicare Penalizing Hospitals for Readmission Rates Under ACA

In an effort to emphasize quality of hospital care over quantity, the Centers for Medicare & Medicaid Services (CMS) have reported their second round of reimbursement reductions under the Hospital Readmissions Reduction Program. This key provision of the Affordable Care Act went into effect October 1, 2012; this year, CMS will reduce Medicare and Medicaid reimbursements to more than two thousand hospitals nationwide.

The CMS’*Hospital IQR program has established a national average for readmissions for heart attacks, heart failure, and pneumonia, and has monitored hospitals’ performance on each, since 2009. Hospitals have been required to participate in the program for reporting purposes, but were not penalized for their actual performance prior to the Hospital Readmissions Reduction Program.

Readmission applies to any patient who visits any hospital within 30 days of their initial discharge the same complaint, unless it is a planned readmission. Hospitals reporting excessive reimbursements will face reimbursement reductions calculated by algorithms available on the CMS Web site. CMS’ goal in implementing the HRRP is eliminate the “double dipping” incentive for hospitals to readmit patients by providing incomplete care during their initial admission.

Hospitals facing higher penalties are disproportionately located in underprivileged communities. Patients in these facilities are more susceptible to “preventable” causes of readmission, including the inability to purchase costly medication or to follow necessary but untenable discharge instructions. Slightly more than half of the hospitals facing reduction, however, have lowered their penalty amount due to procedural changes such as improved technology and discharge planning for patients.

One of the most important discharge instructions is follow-up with a physician. Some hospitals have begun locating a primary care provider for patients without one; others have opened their own clinics to provide post-discharge care to patients who cannot otherwise access a PCP.

Proposed rules for fiscal years 2014 and 2015 will include COPD, elective total hip arthroplasty, and total knee arthroplasty in future readmission calculations.

If you do work for a hospital facing reduction, PRN Funding’s healthcare factoring program can help you maintain a steady cash flow despite reimbursement reductions at the hospitals you serve.

Learn more about healthcare factoring and apply today.

Online Health Insurance Marketplaces Face Tech Hurdles

The rollout of online health marketplaces was marked with technological difficulties at various stages of the process.

Users attempting to access the federal marketplace via healthcare.gov experienced glitches when signing up for an account, which the Center for Medicare and Medicaid Services attributes to overwhelming visitor traffic during the first several hours the exchange was live. While the CMS claims they addressed initial issues right away, the marketplace was still fraught with issues well into the afternoon and eventually shut down.

State-run marketplaces in 17 different states also reported high traffic and sporadic glitches. Users may seek assistance via the live chat function or call centers, or they may contact a local healthcare representative. Unfortunately, these avenues will not allow customers to compare plans or view more detailed information regarding each plan’s deductibles and coverage. Some states are still experiencing issues today.

While not unexpected, these issues have frustrated and dismayed many consumers who are eager to realize the promise of affordable healthcare. Still, a number of people have successfully used the marketplace to purchase insurance, and consumers still have plenty of time to sign up for insurance – the deadline for coverage beginning January 1 is December 15, and the open enrollment period will continue until March 31, 2014. Officials maintain that glitches are normal for any large-scale tech rollout (see: Apple); for the moment, consumers may be better off just waiting it out.

Currently, approximately 15 percent of the population is expected to use the marketplace to purchase insurance in the absence of employer-provided health plans or benefits from the VA, Medicare, and Medicaid.

Learn how factoring can provide the cash flow to provide insurance to your employees.

Insurance Companies Helping to Delay Nurse Practitioners Role in Primary Care

While demand for primary care providers is projected to increase dramatically following implementation of the Affordable Care Act, insurance companies and physician groups remain opposed to the credentialing of nurse practitioners to provide primary care services.

Advanced practice registered nurses hold a master’s degree and have an additional 700 hours of supervised clinical experience, allowing them to diagnose and treat many common illnesses as well as to administer anesthesia or deliver babies with the proper specialization. Despite their licensing, however, many states do not allow nurse practitioners to operate without physician oversight and many insurance providers will not credential them as primary care providers in their plans.

Physicians argue that the clinical role of nurse practitioners is different from that of doctors and that ensuing confusion could affect the quality of patient care; however, there is also a financial element regarding the current requirement that nurse practitioners bill through a physician’s office for service.

The American Nurses Associate submitted comments on the federal rules governing the national healthcare marketplace, set to open enrollment tomorrow, in which they encourage the Obama administration to include provisions requiring insurance providers to credential a certain number of nurse practitioners for independent practice. For their part, insurers are more focused on increasing access to primary care through other, “team-based” means.

At present, roughly half of the 250,000 advanced practice nurses in the United States work in physicians’ practices; many of them, it seems, would open their own practices if they were able to bill patients directly and insurers would include them in provider listings.

Learn more about funding options for nurse practitioners and other primary care providers.

Some Employers Cut Back Health Insurance to Contain Costs

In an effort to offset rising insurance costs, and in part as a response to the Affordable Care Act going into effect, some employers will begin requiring their employees to pay an additional fee for their spouses’ healthcare coverage, or will eliminate that coverage entirely.

Some companies, such as UPS, have decided to exclude spouses from their employer-sponsored health plans beginning in 2014 if those spouses have access to health insurance through their employers. Experts suggest this as a reasonable cost-cutting measure for a couple of reasons: one, covered spouses are more likely to be women, who use the health system more through middle age and therefore cost more; and two, the employer mandate will shift those costs by requiring the spouses’ employers to offer affordable coverage.

Another factor for companies’ consideration is the pending “Cadillac tax”, which will add a further 40 percent tax to premiums above established ceilings for individual and family coverage. While the tax does not take effect until 2018, large companies are working to lower their spending now in preparation. Important to note is that restricted coverage will not affect spouses who do not have coverage through an employer, nor will it impact minor dependents on employees’ plans.

The percentage of companies who plan to eliminate or charge for spousal support is in the single digits, and several studies cited by the Department of Health and Human Services suggest that it will remain a minority plan of action. In addition, the NY Times cites Mercer senior health consultant Barry Schilmeister as claiming this type of action would “not…be a popular move among employees.”

PRN Funding can help healthcare companies seeking a cash flow alternative to scaling back their health coverage. Healthcare factoring is available for vendors filling a variety of healthcare roles, including temporary nurse staffing, medical billing, and home health care. By purchasing invoices for service and advancing immediate cash, PRN’s factoring program provides the flexibility your company needs to provide the right kind of health coverage for your employees.

Contact us to learn more about healthcare factoring and to get started today.

Is Obamacare Responsible for Hospital Staff Layoffs?

Hospital systems nationwide have been in the news lately for projected staff layoffs and other budget cuts. Just this week Cleveland Clinic, Cleveland’s largest employer, announced a $330 million annual budget cut without specifying how much of those cuts would come from staff reduction. Other systems have specifically announced layoffs and staff voluntary buyouts.

A scan of the headlines suggests that the Affordable Care Act is the culprit behind these healthcare staffing changes. But is that really the case?

Some recent headlines:
• Ohio Clinic touted by Obama slashes budget due to ObamaCare (Fox News)
• Citing Obamacare, Cleveland Clinic to cut $300M, Warns of Layoff (US News & World Report)
• Hospital Finds Obamacare Harmful to Its Health (Heritage.org)
• Atlantic General Hospital Hires During ‘Obamacare’ Scare (WBOC TV 16)
• Emory Healthcare to cut 100 jobs party because of Obamacare (WSB-TV)

Quotes regarding the Cleveland Clinic’s budget reduction came from both an unnamed spokeswoman and the Executive Director of Corporate Communications for the Cleveland Clinic Foundation, though the article does not specifically attribute the ACA connection to either source. In the Emory news report, however, an Emory spokesman does acknowledge that the ACA “played a role in the layoffs”.

While most of the mainstream media is running with the ACA-layoff connection, others are digging deeper to discover ongoing root causes that have little or nothing to do with the ACA. Dan Diamond of California Healthline’s Road to Reform reports that the ACA is merely one factor in hospital staffing decisions, and makes the argument that the ACA is actually poised to increase job growth.

Other factors involved in hospital layoffs and hiring freezes include changes in Medicare reimbursement policy; budget reallocation decisions that affect specific departments (as cited in the Emory reduction of inpatient psychiatric staff); and continuing financial challenges.

The ACA’s effect, meanwhile, appears to be more complex than headlines may imply. There is a great deal of uncertainty surrounding implementation of the ACA’s key provisions, and concern that expanded Medicaid coverage will mean lower reimbursements for care. Some hospitals are actually reporting an increase in hiring to provide care for a higher number of patients who are expected to utilize the system once health plans are made available to them.

Another issue reported in Huffington Post is that hospitals in some states are being forced to close because the state is not implementing ACA provisions, namely Medicaid expansion. The ACA reduces funding to hospitals serving large populations of uninsured patients, expanding Medicaid with the savings; however, if state government does not accept the resulting federal Medicaid funding then those hospitals will not be able to recoup the lost dollars.

While the debate over the Affordable Care Act continues to rage in Congress, there will undoubtedly be more headlines attributing hospital cuts to the law. There is certainly a degree of truth to many of these claims, but given the contentious nature of the ACA it is especially important to look beyond the headlines and carefully consider all the facts involved.

As the full effects of the Affordable Care Act remain to be seen, make sure your healthcare staffing agency is prepared. PRN Funding’s healthcare staffing factoring program can provide you immediate cash to expand your workforce or weather staffing gaps in your area. Learn more and contact us today to get started.

Physician Pay Gap: Female Doctors Earn 25% Less Than Male Doctors

Female doctors, who account for a third of all doctors in the United States, are still not earning as much as their male counterparts earned 20 years ago.

Researchers posted their findings in JAMA Internal Medicine earlier this month. Their data indicated a pay gap of more than $50,000 per year between female and male doctors’ incomes in 2010 – a difference of 25 percent. Female physicians’ median income was $165,278 between 2006 and 2010, which is still two percent lower than male physicians’ median income ($168,795) in 1990.

However, the data were insufficient to draw more specific conclusions based on physician specialty. This leaves the findings open to greater interpretation based on the question of opportunity versus preference: are female physicians choosing specialties with lower pay scales, or are they being turned away from preferred higher-pay specialties in favor of male physicians?

The research team has indicated that there is considerable room for further study into the reasons for the income disparity between genders. Based on their findings, there could be interesting implications for physician pay models in the future.

A survey by WebMD-affiliated Medscape, meanwhile, indicates an income disparity of 30 percent between male and female physicians (17 percent in primary care) and illustrates the difference in pay between several different specialties. They ascribe much of the gap to choice of specialty, though they acknowledge that set, regular schedules do a great deal to close that gap in large health systems. Last year’s report suggested a difference in the number of hours worked contributed to income disparity.

Of course, the reality of the income gap has a very important implication for private practitioners in the present: the cost of doing business is not adjusted for a provider’s gender, meaning that rising costs pose a greater threat to the success of a female physician’s practice than to a male physician’s practice. Private practice medical factoring can offset that pay gap and allow doctors of both genders to continue providing top-quality care to their patients.

Final Obamacare Regulations are in Place

Of the many provisions found in the Affordable Care Act, none is as contentious as the individual mandate. This provision, which requires that affected American purchase health insurance or pay a fine, goes into effect January 1, 2014. The Obama administration released the final regulations for the healthcare reform mandate earlier this week; however, these regulations indicate that the individual mandate will not be the healthcare enforcer that both proponents and opponents claim it to be.

The individual mandate will require taxpayers to cover their dependents (as reported on annual tax returns) or assume the fine for not doing so. The employer mandate, meanwhile, does not require employers to offer insurance for dependents. This could potentially force many individuals to seek supplemental health coverage for their spouses and children in the healthcare marketplace.

In addition, any employer-sponsored coverage will largely meet the mandate’s threshold of “minimum essential coverage”. This has already led to employers offering low-cost plans that cover very few services, and will be a strong incentive to other employers to follow suit.

Both of these are troubling characteristics of a hugely unpopular mandate. Other regulations, though, exempt as much as 40 percent of the population from the individual mandate; people exempt from the individual mandate include:

• The elderly, whose higher premiums and lower income may drive the cost of their coverage over the established limit of eight percent of household income (though a much lower income will qualify individuals for tax subsidies, in which case the mandate applies);
• Those who don’t file IRS tax returns;
• “Members of recognized religious sects” – these protected populations belong to groups such as the Amish that have existed since the end of 1950 and whose tenets are opposed to taking advantage of benefits such as Social Security, Medicare, and Medicaid in addition to health and life insurance plans;
• American Indians – members of recognized Indian tribes already receive government health care through the Indian Health Service.

The prescribed fine (the loftily-titled “Shared Responsibility Payment for Not Maintaining Minimum Essential Coverage”) for failing to purchase health care is itself minimal compared to the potential costs of purchasing outside health coverage. Each taxpayer is responsible for their individual fine as well as the fines for up to two dependents. The fine will increase parallel with cost-of-living adjustments, from the greater of $95/1% of income to the greater $695/2.5% of income per person from 2014-2016.

Even so, the fine’s increase is still smaller than annual insurance premium increases historically. It may be a better financial decision for some people to pay the fine and continue without coverage. Furthermore, the IRS is specifically prohibited from penalizing non-exempt taxpayers who fail to purchase health care or pay the fine; the only thing they are able to do is withhold the fine from your tax return (if you don’t file, see above).

The effectiveness of the individual mandate remains to be seen for consumers, facilities, and vendors, but combined with the employer mandate we will see a large number of new enrollments in healthcare plans around the country.

To ease the transition, and offset the added cost of exempt or non-compliant patients, consider healthcare factoring to keep your cash flow sound.

Employers Shift Health Care Cost Increases to Employees

Kaiser Family Foundation released their 2013 Employer Health Benefits Survey last week. One of their primary findings, according to Bloomberg Businessweek, is that small business owners are providing healthcare benefits to their employees at close to the same rate as they were last year, belying the contention by ACA opponents that benefits would decrease.

However, they are doing so in what Kaiser Family Foundation CEO Drew Altman calls it “a quiet revolution in health insurance from more comprehensive to less comprehensive with higher deductibles.” Higher out-of-pocket costs for employees are seen to offset the rising costs on the employers’ end of providing the healthcare.

Though premiums for family plans only increased by four percent since last year, they have still increased at a higher rate than employees’ take-home pay. Higher premiums, higher deductibles, and comparably lower paychecks are likely to cause concern among families facing a difficult time paying for medical care.

While it isn’t yet clear if these higher-deductible plans will meet the ACA’s requirements for affordable care, in the short run the added financial strain may very well extend beyond the policyholders to their healthcare providers. Hospitals and other medical facilities may delay or withhold payment of invoices as they wait for their patients to pay, creating a gap in cash flow that will be difficult for many small businesses to overcome.

Get ahead of the problem with medical receivables factoring. Same-day cash advances will allow you to continue providing excellent service to medical providers and stop rising healthcare costs from sinking your small business.

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