Transcript MASI’s World

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Jim Williams, Benefit Specialist,
Lockard and Williams Ins. Svcs.
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Jim Williams, Benefit Specialist,
Lockard and Williams Ins. Svcs.
Steve Dickson, Registered Lobbyist,
Strategem, Inc.
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Jim Williams, Benefit Specialist,
Lockard and Williams Ins. Svcs.
Steve Dickson, Registered Lobbyist,
Strategem, Inc.
Donnie Smith, VP of HR & PR,
Rush Health Systems
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Jim Williams, Benefit Specialist,
Lockard and Williams Ins. Svcs.
Steve Dickson, Registered Lobbyist,
Strategem, Inc.
Donnie Smith, VP of HR & PR,
Rush Health Systems
Pam Gregory, Agent,
Bottrell Insurance Agency, Inc.
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Jim Williams, Benefit Specialist,
Lockard and Williams Ins. Svcs.
Steve Dickson, Registered Lobbyist,
Strategem, Inc.
Donnie Smith, VP of HR & PR,
Rush Health Systems
Pam Gregory, Agent,
Bottrell Insurance Agency, Inc.
Dan Risher, Dir. of HR & Safety,
Marshall Durbin Companies
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All new health plans must provide certain
preventive services, with no copay or deductible.
Many people will get government subsidies to buy
insurance they could not otherwise afford.
If you have a pre-existing condition, you will be
able to buy insurance for the same premium people
in good health pay.
No lifetime limits on health insurance coverage if
you have an expensive, chronic health problem.
As many as 34 million people will become newly
insured.
Source, National Center for Policy Analysis
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Yes Access is the real issue, not health care
coverage, but access. Only 5% of Medical Students
are going into Family Practice. Currently, we are
175,000 doctors short of our need—
Nationwide. The rural communities will hurt the
most. The majority of Medical Students usually
stay within a 50 mile radius of where they went to
med school.
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FNP’s can help out greatly.
But you may not be able to see a doctor when you
need help.
In Massachusetts, with a similar reform:
New patients in Boston wait an average of 63 days to
see a family doctor.
More people than ever are seeking care at hospital
emergency rooms.
Source, National Center for Policy Analysis
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Some insurers are already restricting which
doctors you can see.
The new law encourages doctors to join
Accountable Care Organizations (ACOs).
In an Accountable Care Organization (ACO):
You will not necessarily see the same doctor or
nurse on each visit.
You will not be allowed to get care from doctors
outside of the ACO, and
The ACO will get to keep any money they save by
giving you fewer tests and services.
Source, National Center for Policy Analysis
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Pre-PPACA, consumers have the choice to go
directly to the carrier for coverage or shop the
market place under the counsel of a independent
licensed insurance agent.
After 2014, health insurance exchanges will be
developed and up-and-running as a new source
for obtaining coverage. Currently the Mississippi
exchange legislation is dead. If the legislature can
not pass authorizing legislation by next year’s
session, the federal government will establish the
exchange in our state.
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The Exchange will be the only source for
uninsureds to obtain subsidized coverage. They
will also have Navigators whose role is to do
outreach to uninsured populations and enroll them
into coverage through the exchange.
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Agents and brokers have worked in the health
insurance market place to assist individuals and
business owners to obtain insurance.
They counsel consumers through their decision
making process and insure that their clients obtain
the best product to meet their needs.
The State licenses insurance producers to assist in
the enrollment process of health products and it is
a role they will continue to have in the new health
insurance market place.
In 2011:
 The Department of Health and Human Services
will issue standards for plans (including selffunded plans) to follow when describing coverage
to enrollees.
 The Department of Labor will begin annual studies
on self-funded plans using data from 5500s.
 Costs for over-the-counter drugs not prescribed by
a doctor can no longer be reimbursed through an
HRA or health FSA or on a tax-free basis through
an HSA or MSA.
In 2011:
 The tax on distributions from an HSA or MSA not
used for qualified medical expenses is increased to
20 percent.
 CLASS program (voluntary long term care) takes
effect; employers may facilitate payroll deductions
but participation is not mandatory.
In 2012 (or within 24 months from date of
enactment):
 Plans must begin to report value of employersponsored health insurance coverage on W-2s.
 Plans must provide a summary of benefits to
enrollees using format described earlier.
 Plans must provide a 60-day prospective notice of
plan changes.
In 2012 (or within 24 months from date of
enactment):
 Plans must pay $1 per plan participant for the first
plan year ending after September 30, 2012 to
support comparative effectiveness research. This
fee increases to $2 per participant in the following
plan year, and then the fee is indexed by the cost of
“national health expenditures” after.
In 2013:
 Subsidies to employers who maintain prescription
drug plans for Medicare Part D eligible retirees will
cease to be deductible, which has an immediate
impact on employers’ FAS 106 accounting.
 Employee salary reduction contributions to FSAs
will be limited to $2,500, indexed by the Consumer
Price Index.
In 2013:
 Employers must provide a notice to employees
about the availability of the exchange and how to
obtain assistance, and their potential eligibility for
premium credits if the employer’s share of costs is
less than 60 percent of the allowed total cost of
benefits.
 Medicare payroll tax increases by 0.9 percent for
high income earners (employee portion only). High
income earners are joint filers with incomes above
$250,000 or others with incomes above $200,000. A
new 3.8 percent tax on unearned income for the
same filers will also go into effect.
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Make voluntary changes to increase benefits.
Conform to required legal changes.
Adopt voluntarily consumer protections.
Change third-party administrators.
Lose grandfathered status in one benefit package
but keep it in another.
Implement amendments to a plan that were
adopted prior to March 23, 2010 but not effective
until after.
Enroll new family members of individuals already
enrolled, enroll new employees (whether newly
hired or newly enrolled) and their families.
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Increase fixed-amount cost-sharing requirements
such as deductibles and out-of-pocket limits by no
more than medical inflation (CPI-U Medical) plus
fifteen percentage points.
Increase copayments by no more than:
Medical inflation plus 15 percentage points,
or $5 increased by medical inflation.
Decrease its portion of the premium or other fixed
cost of coverage relative to the portion of such cost
paid by employees.
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Enter a new contract of insurance as long as the
change becomes effective on or after November 15,
2010.
Contracts that took effect before November 15,
2010, but after March 23, 2010, will cause the plan
to lose grandfathered status.
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Increase a percentage cost-sharing requirement
(such as coinsurance) above the level at which it
was on March 23, 2010.
Decrease its contribution rate toward the cost of
any tier of coverage by more than 5 percentage
points below the contribution rate for the coverage
on March 23, 2010.
For this purpose, contribution rate is defined as the
amount of contributions made by an employer
compared to the total cost of coverage, expressed
as a percentage.
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In the case of a self-insured plan, contributions by
an employer are calculated by subtracting the
employee contributions towards the total cost of
coverage from the total cost of coverage.
Eliminate all or substantially all benefits to
diagnose or treat a particular condition, or
eliminate an essential component for treating a
particular condition.
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Increase a fixed-amount cost-sharing requirement
other than copayments, such as a $500 deductible
or a $2,500 out-of-pocket limit, by a total
percentage measured from March 23, 2010 that is
more than the sum of medical inflation and 15
percentage points.
Increase fixed-amount copayments by an amount
that exceeds the greater of:
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A total percentage measured from March 23, 2010
that is more than the sum of medical inflation plus
15 percentage points,
or $5 increased by medical inflation.
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Move enrollees from one plan to another that has
fewer benefits or higher cost sharing.
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Yes. Since you are limited on the costs you can
share with your participants you must effectively
manage your plan costs. You must make sure that
all the components of your plan (eligibility,
wellness, pre-cert/case management, disease
management, Rx, reporting, communication, etc)
are designed aggressively and working in concert
to effectively control your health plan costs.
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Probably not. Employers can drop your coverage
altogether and pay a fine that costs less than
insuring you and your family.
14 million employees will lose their employer plan.
80% of small businesses won’t be able to keep their
current plan.
More than 100 million people will be forced into a
more costly, more regulated health plan.
Source, National Center for Policy Analysis
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More. You can avoid more costly state mandated
benefits in favor of benefits specifically designed
for your participants and their needs.
The tailored plan design and data capture abilities
of self-funded administration should allow your
plan to be agile in dealing with the challenges that
today’s health care environment presents.
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Yes, because of the flexibility that it gives a plan
sponsor in dealing with all the pressures faced by a
health plan today.
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The cost of health care. It doesn’t matter whether
you are looking at the costs paid by the plan or the
participant, the cost of health care is high. Cost
transparency would be a great first step in address
this issue.
If EVERYONE, Plan and participant alike,
understood the total cost of health care and shared
in those cost decisions would be made that would
begin to drive health care costs down.
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Informing consumers of the costs of their medical
services creates a more educated public who makes
more responsible cost/benefit choices when
choosing their care.
As for carriers, their rates will have to be disclosed
and reported to the states in a more transparent
process. The argument is there that states will have
the opportunity to review rates and approve or
disapprove them, forcing carriers to become
compliant and competitive with others who wish to
do business in that insurance market.
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$5,800 for an individual (in 2016)
$15,200 for a family of four (in 2016)
In the government exchange, the out-of-pocket
premium will be limited to a percent of your
income up to about $43,000 ($88,000 for a family).
Source, National Center for Policy Analysis
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The government will require you to show them
your most recent tax return, revealing your total
family income — including any nonwage income
as well as your spouse’s income.
Source, National Center for Policy Analysis
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More than half of the cost of reform will be paid for by
reduced spending on the elderly and disabled on Medicare.
New taxes on drugs and medical devices, such as
wheelchairs, pacemakers, artificial joints, etc.
40% tax on “Cadillac” plans.
Scores of other items will be taxed, ranging from tanning
salons to the sale of your home, in some cases.
Source, National Center for Policy Analysis
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Health insurers will have to raise premiums for
everyone.
Employers will have to reduce wages and other
benefits.
As many as 700,000 jobs could be lost by 2019.
Source, National Center for Policy Analysis
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Medicare Advantage (MA) members will lose $1,267 in
Medicare payments in 2014.
One of every two MA members (7.4 million) will lose
their plan entirely.
One in seven hospitals may go out of business, and
doctors may not take new patients
Medicare will pay for an annual checkup.
Deductibles and copayments will be eliminated for many
preventive services.
If you are in the prescription drug “doughnut hole,” you
may qualify for a $250 rebate.
Eventually (in 2019), the doughnut hole will be
eliminated.
Source, National Center for Policy Analysis
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Penalties for employers with more than 50 full-time employees
that DO NOT offer coverage to employees:
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If an employer does not offer its full-time employees (and their
dependents) group health coverage, and one or more full-time
employees enrolls for coverage in an exchange and qualifies for a
premium tax credit or cost-sharing reduction,
Then the employer would pay a $2,000 annual penalty per full-time
employee, except that the first 30 full-time employees are exempt
from the calculation. The penalty is assessed monthly and is indexed
for inflation.
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Penalties for employers with more than 50 full-time employees
that DO offer coverage:
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If the employer offers its full-time employees (and their dependents) the
opportunity to enroll in group health coverage,
And one or more full-time employees enrolls in coverage in an exchange and
qualifies for a premium tax credit or cost-sharing reduction because the
employee’s family income is less than 400 percent of the federal poverty limit,
And the employee’s share of the premium exceeds 9.5 percent of his or her
income,
Or the employer covers less than 60 percent of the allowable costs under the
plan,
Then the employer would pay a $3,000 annual penalty (assessed monthly) for
each full-time employee who receives a tax credit or cost-sharing reduction.
The total penalty is capped at the amount the employer would otherwise have
to pay for providing “no coverage” as described above and would be indexed
annually.