Archive for the ‘Health Care Reform’ Category

Next year your health insurance carrier will be taxed to find out which drugs, medical procedures, tests and treatments work best, but those costs are going to be passed onto you.

This little-known provision of the present administration’s health care reform law, was created to answer basic medical questions such as whether a new prescription drug advertised on TV really works better than an old generic costing much less.

But in the politically charged environment surrounding health care, medical effectiveness research is eyed with suspicion. Even former Vice Presidential candidate Sarah Palin labeled this effort “death panels”, expecting the findings to result in rationing of medical care for sick people.

Beginning in 2012, every health insurance policy will be taxed $1 to fund the agency, that fee doubles in 2013, then increases will be tied to inflation in subsequent years.

The federal government will change these fees directly to the insurance carriers who need little reason to increase policy premiums and will use this as more fuel for that fire.

The research is to be compiled by a new quasi-governmental agency created by Congress called the Patient-Centered Outcomes Research Institute.

However, concerns abound, and Kathryn Nix, a policy analyst for the conservative Heritage Foundation is just one of the voices speaking out.

“The more concerning thing is not the institute itself, but how the findings will be used in other areas,” Nix said. “Will they be used to make coverage determinations?”

But Dr. Joe Selby, a primary care doctor, medical researcher and director of the PCORI expects patients and doctors to make the decisions, not his organization,
“We are not a policy-making body. Our role is to make the evidence available.”

To whom, how and under what privacy protections are questions yet to be answered, but there is hope that some good will come of the data they compile.

Much of the medical research that doctors and consumers rely on now is financed by pharmaceutical companies and device manufacturers, who have a large stake in the outcome. Presently, a drug maker only has to show that their new medicine is more effective than a placebo, usually a sugar pill, and not a competitors product, to win government approval for marketing.

And Insurance companies say they expect to use the research and work with employers to fine-tune workplace health plans. But will this be a good thing or a bad thing for employees and their families, especially ones seeking regular care.

Health Plan Members could be steered to hospitals and doctors who follow the most effective treatment methods, but if they decide to use another facility or provider, they could face higher co-payments, similar to added charges they now pay for “non-preferred” drugs on their insurance plans.

And you though Health Care reform was supposed to make medical care cheaper and more readily available.

With this one of many taxes to come, is that eve really possible?

As you pour over your medical coverage options, call us at Small Business Benefit Solutions, LLC.  Let us examine what you have, what your using and how you’re using it to see if you have the right plan or if a better plan exists for you.

HHS issued new rules adding more preventive care requirements in the Patient Protection and Affordable Care Act (PPACA), targeting women.

These rules expand preventive care policies that were already in force as part of the Health Care Reform legislation, but many of these will also further expand the costs of medical care as well as costs associated with a health insurance policy.

Insurance companies are told, through these rules, that they will be picking up the tab for contraceptives of any kind, some of which can cost upwards of $100 per fill, with no way to recoup these costs from the individual filling that prescription.  The costs will then be passed on to everyone who holds a group health insurance policy or an individual medical plan.

This controversial Contraceptive coverage also includes “Plan B”, the so-called ‘morning-after pill’, but not “RU-486″, a more controversial pill that induces abortion. While some contraceptives are available over the counter, a woman would have to show a prescription from her health care provider to be guaranteed them free of charge.

The sad part of this ruling is that Health and Human Services failed to define contraceptive coverage. What kind of contraceptives, how much and how often were not specified so the door is open to everything and anything, and at any cost.  HHS could have limited the coverage to generic birth control pills only to keep the costs low, but instead issued blanket rules with no regard for cost controls. Health and Human Services is accepting public comment for the next 60 days and we plan to file our concerns formally.

As part of these rules, the following additional preventive services must also be covered without charging a co-payment, co-insurance or a deductible:

• Well-woman visits
• Screening for gestational diabetes
• Human papillomavirus (HPV) DNA testing for women 30 years and older
• Sexually-transmitted infection counseling
• Human immunodeficiency virus (HIV) screening and counseling
• FDA-approved contraceptives and contraceptive counseling
• Breastfeeding support, supplies, and counseling
• Domestic violence screening and counseling

New health plans will need to include these services without cost sharing for insurance policies with plan years beginning on or after August 1, 2012. Grandfathered plans do not need to comply with the preventive care requirements.

Religious institutions that offer insurance to their employees will be able to choose whether or not to cover contraception services.

Small Business Benefit Solutions, LLC is women owned and operated and we see the value in much of this ruling, but the entire health care reform picture has been painted with such broad strokes that are oblivious to cost controls, and this is just another glaring example.

Slightly more than a year after health reform legislation was rammed through Congress, a new industry report revealed that consumers may be paying billions of dollars more in out-of-pocket health care expenses than was previously thought.

It’s the “hidden” costs of health care that really add up, such as:

• ambulance services
• alternative medicines
• nutritional products
• vitamins
• weight-loss centers
• and most dramatically, supervisory care of elderly family members

According to a report from the Deloitte Center for Health Solutions, these expenses are racking up bills of more than $360 billion, ore $1,355 per consumer, on top of the $8,000 the government says people spend on doctor fees and hospital care.

This far exceeds typical household expenses for the average American family.

“We’re surprised that this number came in so high. It’s significant,” said Paul Keckley, executive director at Deloitte.

The out-of-pocket costs that the government tallies usually include only insurance-related costs like premiums, deductibles, and co-payments.

Keckley said the study is the first to estimate how much consumers dish out on health care related goods and services not covered by private or government insurance.

As health reform rolls out over the next few years, Keckley expects consumers will be dishing out much more from their own pockets than promised. Health care costs continue to rise faster than household incomes and insurers, doctors and hospitals are passing along more costs to their customers.

The average household income fell 1.9% last year while health care costs rose 6%, he said.

Now may be the right time to review your policy and see if we can find you a more affordable health insurance plan – sometimes major changes can pay off greatly.

Experts like those at Small Business Benefit Solutions, LLC really take the time to crunch the numbers with you, figure out what your medical expenses have been, compare then to prevailing rates for all available plans, and find a balance that protects your small business and your budget.

Small business health insurance is a huge expense to an employer and only some agents are equipped to handle the conversation in this way.

If you think you’re paying to much for your group medical insurance plan, and we all do, then talk to us; we can help.

But last year, the IRS waived that requirement for 2011 and said the health insurance reporting mandate would be pushed back and additional year and apply to 2012 W-2s, which are issued in 2013.

Under IRS Notice 2011-28, released on the 29th or April, 2011, employers that issue fewer than 250 Form W-2s in tax year 2011 will not be required to report health coverage costs on their 2012 W-2s.

Those employers “will not be required to report the cost of health coverage…prior to January 2014. This transition relief will continue until the issuance of further guidance,” the IRS said.

In addition, the IRS also clarified that the reporting requirement does not apply to retirees receiving health care coverage but no longer receive wages or salary.

Small Business Benefit Solutions, LLC was assuming that this reporting requirement would later lead to taxation of health insurance benefits.

As employers were going to be required to pay for 75% of their employees coverage in 2014 under the present Health care reform plan, the tax implications of health insurance benefits were going to spike in 2015, leading to a possible boom in taxable income.

With present budget shortfalls, this could be a large untapped source of income for the government, as well as the push towards a single payer system that is highly touted by the present Democratic caucus.

“Unpopularity numbers are as high as 60% across the country,” said the incoming chairman of the House Energy and Commerce Committee,  “I don’t think we’re going to be that far off from having the votes to actually override a veto”.

Democrats contend that because they still control the Senate, Republicans are wasting time.

But Rep. Upton said a big House vote for repeal could sway votes in the Senate “to perhaps do the same thing. But then, after that, we’re going to go after this bill piece by piece,” he said, by trying to block various parts of the law including an individual mandate for insurance coverage.

“We will look at these individual pieces to see if we can’t have the thing crumble,” Rep. Upton said.

Florida Democrat Debbie Wasserman Schultz told’ “Face the Nation” that she thinks people are learning more about benefits of the health care law, diminishing chances it will be defeated.

“A constituent in my district came up to me a few weeks ago and thanked me for saving her $3,000 a year because she could put her two adult children back on her insurance. That’s what the Republicans are going to be proposing to repeal this week. It’s not going to happen,” she said.

South Carolina Republican Sen. Lindsey Graham said he thinks that the fight to defund the bill will go through and that he would work “to allow states to opt out of the individual mandate, employer mandate and expansion of Medicaid.”

Either way, 2011 will shape up as a contentious year on Capitol Hill and this fight is just the beginning.

UPDATE:

This measure was voted down and will not be passed onto Congress in it’s present form.

Medical malpractice liability reforms, health care benefit taxation up for vote

The National Commission on Fiscal Responsibility and Reform  is expected to vote Friday on a series of wide-ranging recommendations—including medical malpractice reforms and phasing out the tax-favored status of employer-provided health care benefits—as part of comprehensive plan to reduce the federal budget deficit.

On a positive note, finally a government agency is seeing the need for and benefit of reforming the highly abused medical malpractice arena where millions of dollars can be awarded for minor medical infractions.

But coupled with positive legislative recommendations comes a blow to employers and employees alike in a recommendation to begin taxing medical benefits employers offer to their employees.

The report proposes that, starting in 2014, employees should be taxed on employer health care plan contributions and that by 2038, all employer health care plan contributions would be added to employees’ taxable income.

Under current law, employer contributions—regardless of the amount—are excluded from employees’ taxable income.

Back to the good news: the NCFRR panel claims that medical malpractice reform could save $17 billion through 2020 and they recommend modifying the collateral source rule to allow outside sources of income, such as workers compensation, collected as a result of an injury to be considered in determining awards and imposing a statute of limitations on medical malpractice lawsuits.

The report also calls for the creation of special “health courts” that would hold malpractice hearings rather than traditional courtrooms.

Although the commission does not specifically endorse statutory caps on punitive and noneconomic damage awards in medical malpractice cases, the report notes that many commission members support caps and that “we recommend that Congress consider this approach and evaluate its impact.”

The question now is, which Congress will act on these proposals, if any.  Despite Republican or Democratic control, taxing health care benefits is extremely controversial, and with Washington full of lawyers, lawsuit reforms are also likely to stall.

In 2011, tax-free spending accounts for medical expenses will have additional restrictions further minimizing the tax advantages of thee plans.

Thanks to the new health care reform laws, you’ll have to go to your doctor and get a prescription if you want to get an over-the-counter fix for your medical problem, rather than a more costly pharmacy fix, but only if you plan to file for reimbursement from your flexible spending program or if you plan to pay for the medicine with your Health Savings Account dollars.

This includes aspirin, allergy medicines, heartburn blockers, and other remedies easily purchased at your local drug or grocery store.

Physicians are getting themselves  and their staff ready for patient confusion and office annoyances as they now have to handle requests for prescriptions for things that people normally didn’t need a prescription for in the past.

Flexible spending accounts and health savings bank accounts are used so that employees can set aside pretax money to pay for out of pocket medical carecosts, which includes non prescription medicines, medical insurance deductibles, copays, eyeglasses, medical treatments or care that their insurance plan may not provide coverage for, and dental work.

The new healthcare reform law states that the only way an over the counter medication will qualify for reimbursement is if the patient has a prescription from their doctor for it.

Then, the law will change yet again in 2013 when there will be a cap of $2,500 to be set-aside in a flexible savings account.  Many employers currently let up to $5,000 to be set aside into employees’ accounts, because they’re often used for more expensive medical costs, other than over the counter drugs.

The estimated 35 million users of flexible savings accounts have a “use-it-or-lose-it” provision, meaning that they must spend their entire set aside funds each year or surrender the funds to their employer.  People commonly use their leftover money by purchasing a stock of cold remedies, pills or other drugstore staples at the end of the year.  The new prescription rule may hinder that shopping spree next year at this time.

The Internal Revenue Service says that this new requirement for a prescription is only required for over the counter medicines, and not for things like contact lens solutions, crutches, bandages, blood sugar testing kits, and other non-drug medical supplies.  These items will continue to require a receipt in order to get reimbursed.

The people that will most be affected are those that take daily over the counter drugs such as Tylenol or Motrin to treat arthritis, Zyrtec or Claritan to treat hay fever, and Zantac or Prilosec to treat acid reflux.

While it may not seem like a big deal at first, if your doctor is unaware that you are using over-the-counter remedies, she or he may want you to come into the office (and pay a co-payment) before writing up that prescription for you.

Health Care Reform, otherwise known as the Patient Protection and Affordable Care Act requires that all new health plans issued on September 23, 2010 or later must offer coverage for in-network preventative care for free, or in insurance terms, with no cost sharing, co-payments or deductibles.

But the list of these “FREE Services” is a long one and when a doctor has to perform these services, someone has to pay for them.

That someone is, you guessed it, YOU and I.

While you won’t have a co-payment to pay for these services anymore, you are getting socked with higher insurance premiums becasue your insurance carrier is the one who will have to write out a bigger check to your doctor for all of these extra tests and screenings.

Below is just an example of what  the U.S. Preventative Services Task Force, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration have clarified as preventive.

Preventative services that are covered for adults:

• A preventative medical exam that is age-appropriate
• Discussions with primary care physicians regarding alcohol misuse
• Discussions with primary care physicians regarding obesity and weight management
• One time screening for men aged 65-75 who have smoked in their past, for abdominal aortic aneurysm
• Blood pressure screenings
• Cholesterol screenings for those adults that have a higher risk of cardiovascular disease
• Screenings for colorectal cancer for adults between 50 and 75 years of age
• Screenings for prostate cancer for men between 50 and 75 years of age
• Screenings for depression
• Screening for type 2 diabetes for adults that have high blood pressure
• Discussions with primary care physicians regarding the usage of aspirin for those adults that have a higher risk of cardiovascular disease
• Discussions with primary care physicians regarding diet counseling for adults who also have a high risk for chronic diseases
• Immunizations for adults (however, recommended ages, populations, and doses vary)
  • Diphtheria
  • Hepatitis A & B
  • Herpes zoster
  • Human papillomavirus
  • Influenza
  • Measles, mumps and rubella
  • Meningococcal
  • Pertussis
  • Pneumococcal
  • Tatanus
  • Varicella

Counseling, screening and prevention of sexually transmitted infections such as:

• Chlamydia
• Gonorrhea
• HIV
• Syphilis
• Tobacco Cessation discussion with a primary care physician

Additional preventative services for women and pregnant women:

• Preventative medical exam, which is age-appropriate
• Chemo prevention discussion with a primary care physician for women that have a higher risk of breast cancer
• Discussion with a primary care physician about ovarian and/or breast cancer susceptibility due to family history
• Mammogram screening for breast cancer for women between the ages of 50 and 74
• Mammogram screening for breast cancer in other age groups, as determined jointly by physician and patient
• Cervical cancer screening for women between the ages of 21 and 65
• Osteoporosis screening for women 65 years old or older, and for women who are at a higher risk
• Tobacco cessation discussion with a primary care physician
• Screening for chlamydia infection for sexually active men and women who are at higher risk
• Screening for gonorrhea for all women who are at higher risk
• Scheduled prenatal office visits and first postpartum visit
• Screening for syphilis in all pregnant women, and those women that are at a higher risk
• Screening for anemia for pregnant women
• Screening for urinary tract infections or other infections for pregnant women
• Screening for Hepatitis B for pregnant women at their first prenatal visit
• Breast feeding discussion with a primary care physician about interventions to support and promote breast-feeding
• Folic acid supplements discussion with a primary care physician for women who may plan on becoming pregnant
• Screening for prescription incompatibility for pregnant women, and follow up testing for those women that may be at a higher risk

Children’s covered preventative services:

• Preventative medical exam that’s appropriate for the child’s age
• Medical history records for all children through the years of their development
• Body mass index, height & weight measurements
• Behavioral assessments by a primary care physician for children of all ages.
• Developmental screening and surveillance by a primary care physician for all children less than 3 years old
• For adolescents, a discussion with a primary care physician about drug and alcohol use assessments
• Screening for autism for children at 18 months of age, and 24 months of age, performed by a primary care physician
• Screening for cervical dysplasia for females that are sexually active
• Screening for congenital hypothyroidism for newborns
• Screening for phenylketonuria (PKU) for newborns
• Screening for dyslipidemia for children that may be at a higher risk of lipid disorders
• For young children, a risk assessment for oral health performed by a primary care physician
• A screening for lead amongst children that may be at risk of exposure
• A discussion with a primary care physician about screening for obesity and obesity counseling
• Medication to prevent gonorrhea for all newborns’ eyes
• Screening for hearing for newborns
• Screening for vision for all children
• Screening for hemoglobin or hematocrit
• Screening for sickle cell or hemoglobinopathies for newborns
• Testing for tuberculin amongst children who have a higher risk of tuberculosis
• Screening for HIV amongst adolescents that may be at higher risk
• Counseling for the prevention of sexually transmitted infections amongst adolescents that may be at higher risk
• A discussion with a primary care physician about fluoride supplements for those children that don’t have any fluoride in their water
• A discussion with a primary care physician about iron supplements for 6-12 month old babies that may be at risk for anemia
• Immunizations from birth to 18 years old (recommended populations, recommended ages and doses vary):
  • Diphtheria
  • Haemophilus influenza type B
  • Hepatitis A
  • Hepatitis B
  • Human papillomavirus
  • Inactivated poliovirus
  • Influenza
  • Measles
  • Meningococcal
  • Mumps
  • Pertussis
  • Pneumococcal
  • Rotavirus
  • Rubella
  • Tetanus

So don’t shoot the messenger when your agent shows up with another annual premium increase.  Better yet, call your senator, congressman or woman.  The ball is in their court now to really look at health care and reform it in a way that benefits more than just the special interest groups.