Are Many States Creating Health Exchanges? Study Finds Interesting Input ...

Interesting article found in California Healthline, Daily Digest of News, Policy and Opinion - Friday, Dec. 14th...

"Federal Government To Operate Most Health Exchanges, Study Finds ...

The federal government will operate health insurance exchanges under the Affordable Care Act in a majority of states, according to an analysis by Avalere Health, The Hill's "Healthwatch" reports.

As of Thursday -- one day before the federal deadline for states to declare whether they intend to run their own exchange -- 14 states and the District of Columbia had submitted plans, while three more states publicly have committed to operate their own exchange (Viebeck, "Healthwatch," The Hill, 12/13).

Background

Under the ACA, states can operate their own exchange, partner with the federal government or let the government run an exchange for them (Lengell, Washington Times, 12/13).

In a letter sent to governors in November, HHS Secretary Kathleen Sebelius said the administration was extending the deadline for states to submit detailed applications -- or blueprints -- required by federal officials to Dec. 14, but the Nov. 16 deadline to notify HHS of their decisions would stand.

Meanwhile, states that intend to partner with the government will have until Feb. 15 to submit their declaration letter and blueprint. Sebelius noted that the extended deadlines would not affect the anticipated launch of the exchanges in January 2014.

Details of Analysis

Because a large number of states are defaulting to federally run exchanges, Avalere estimated that two-thirds of U.S. residents who obtain coverage through an exchange under the ACA will do so in either a federally run exchange or a partnership exchange ("Healthwatch," The Hill, 12/13). Some experts predict that the federal government ultimately could be responsible for running exchanges in more than 30 states.

GOP Lawmakers Point to Compliance Costs, Lack of Guidelines as Reasons for States' Choices

At a House Energy and Commerce Subcommittee on Health hearing on Thursday, Republican lawmakers pointed to compliance costs and a lack of federal guidelines on the exchanges for many states' reluctance to run their own insurance marketplace, Reuters reports. Rep. Michael Burgess (R-Texas) said, "The uncertain regulatory environment and the overall lack of response from HHS are not encouraging the states or the health plans to move forward."

However, Rep. Frank Pallone (D-N.J.) countered that Republicans who oppose the law for political reasons are simply trying "to delay implementation under the guise of lack of information" (Morgan, Reuters, 12/13). Rep. Henry Waxman (D-Calif.) added, "For some states, no amount of information will ever be enough. And that's the tragedy of politicizing the law" (Sanger-Katz, National Journal, 12/13).

Experts Doubt Federal Government's Ability To Operate Exchanges

Meanwhile, some experts raised questions about the federal government's ability to successfully operate exchanges for so many states. Experts say the largest challenges for HHS will be the creation of a health IT system that can exchange data with multiple states, as well as providing adequate customer service to handle enrollment (Reuters, 12/13).

CMS Refuses To Delay Insurance Exchange Rules

In related news, Gary Cohen -- director of CMS' Center for Consumer Information and Insurance Oversight -- denied Republican senators' request to extend the comment period and delay the finalization of rules governing the health insurance exchanges, Modern Healthcare reports.

"There's not a lot of time between now and October, and people are saying that we need to get these rules; the [insurance] industry in particular is saying 'We need to get these rules finalized in order to know how to develop plans and get them into states,'" Cohen said (Daly, Modern Healthcare, 12/13)."

How Healthy "IS" Living In California?

How healthy is living in California?  A little bit more healthy than in 2010! 

Here is a recent study as published at healthinsurance.org/california 

California climbed two spots from its #26 ranking in 2010, and is now ranked as the 24th healthiest state to live in, according to the 2011 America's Health Rankings® by the United Health Foundation.

The good news:

Smoking has been on the decline in California, falling by 20 percent over the past decade (though nearly 3.4 million adults still smoke).

The bad news:

• The number of obese Californians has risen by 2 million over the past decade. More than 6.9 million California adults are now obese.
• Diabetes among adults has also risen over the past decade, from 6.8 percent to 8.6 percent of adults.
• The percentage of children in poverty has increased from 18.5 percent to 23 percent over the past five years.

California's best and worst category rankings:

Smoking – 2nd

Early Prenatal Care – 3rd

Occupational Fatalities – 4th

Infant Mortality – 5th

Lack of Health Insurance – 45th

Air Pollution – 50th

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http://www.healthbroker.com

Who Is A Full Time Employee Under The New Healthcare Act

If  you've been listening to the news the last couple of days, you've probably heard that the owners of Lobster House and the Olive Garden are changing some employees to part time workers vs. full time to save costs on the reformed healthcare laws.  Think we will see more of this as the days go forward and businesses need to see how adaptations can affect their bottom lines both positively and negatively.     

If you are in a position of reviewing who is full time and/or part time you may benefit from this article written and posted by Tina Bull on October 9th, 2012 in the PSA Perspective, by  PSA  Insurance and Financial Services.  

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"The Affordable Care Act (ACA) requires employers with 50 or more full-time equivalent employees to offer affordable, valuable minimal essential coverage to all full-time employees or pay a penalty. This requirement is referred to as the employer shared responsibility requirement and is effective January 1, 2014.

ACA defines a full-time employee as one who has an average of at least 30 hours of service per week. Proposed regulations are expected to provide that 130 hours of service in a calendar month will be treated as the monthly equivalent of 30 hours of service per week.

The IRS has issued Notice 2012-58 to describe safe harbor methods an employer may use to determine if current employees and new “variable hour” employees must be treated as full-time employees for purposes of the shared responsibility requirement. An employee may be considered a “variable hour” employee if, based on facts and circumstances, it cannot be determined that the employee is reasonably expected to work on average at least 30 hours per week.

Ongoing Employees

For an ongoing employee (i.e. an employee who has been employed at least one standard measurement period as described below), full-time status may be determined under the safe harbor by calculating the employee’s actual average weekly hours of service during a specified look back period. This specified period is referred to as the standard measurement period and is a defined length of time between three and 12 consecutive calendar months.

If the employee averaged 30 or more hours of service per week during the standard measurement period, then health coverage must be offered to that employee during a subsequent stability period (of at least six months and no shorter than the standard measurement period). This coverage is provided to the employee for the entire stability period without regard to the number of hours of service the employee has during the stability period. However, another measurement period will commence for purposes of determining whether health coverage must be offered during the next stability period.

Between the measurement period and the stability period, an employer may use an administrative period of up to 90 days to notify and enroll eligible employees.

Employers will likely establish a standard measurement period immediately preceding annual open enrollment, an administrative period that coincides with open enrollment, and a stability period that matches the plan year. This means that the first standard measurement period may start as early as October 2012.

New Employees

For new variable hour and seasonal employees, the safe harbor method is similar. However, the initial measurement period and the administrative period combined cannot extend beyond the last day of the thirteenth full calendar month of employment. The initial stability period must be the same length as the stability period for ongoing employees.

In addition, certain hours of service during the initial measurement period will also be counted toward the next standard measurement period that begins after the new employee’s date of hire. A variable hour employee who is determined to be full-time during the initial measurement period must be offered coverage during the full initial stability period, regardless of the average number of hours of service during the first standard measurement period.

If a new employee is reasonably expected to work full-time at the date of hire, then the safe harbor method for variable hour and seasonal employees does not apply. The employee must be initially classified as full-time and coverage must be offered to the employee at or before the conclusion of the employee’s initial three calendar months of employment.

Reliance and Comments

Employers may rely on the safe harbors for measurement periods that begin through 2014 and related stability periods that may extend into 2016. The IRS has asked for comments on the following: other safe harbors for categories of employees that present special issues, other guidance that may be needed to determine full-time status, measurement/stability period issues during a merger or acquisition and how seasonal worker should be defined.

While the safe harbor methods are optional and may be administratively challenging for employers, use of them will provide certainty that an employer will not be subject to the ACA penalty for failing to offer coverage to all or substantially all full-time employees."
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New CA Laws Preparing State for New Healthcare Insurance

It is all rolling along at a fast clip!!  CA is getting ready for Obama Care!  Gov Brown just signed into CA law the following items ... probably just the first of many??  

Here is the list as published in the LA Times and written by Scott J. Wilson

October 7, 2012

"Gov. Jerry Brown signed into law last week a set of measures aimed at preparing California for coming changes in how consumers get healthcare insurance. Some of the laws:

• To head off deceptive marketing attempts, AB 1761 bans unauthorized individuals and businesses from claiming to represent the California Health Benefit Exchange, the new central marketplace for buying insurance that goes into effect in 2014.

• Beginning in 2014, under AB 792, Californians who lose their health insurance because of job loss, divorce or legal separation will receive information about reduced-cost plans available through the health exchange and no-cost coverage from Medi-Cal.

• Self-employed people will be covered, under AB 1083, by California's law governing small business health insurance. Previously, businesses had to have at least two employees to qualify. Backers argued that the change, effective in 2014, will expand the availability of affordable coverage to entrepreneurs.

• Insurers hoping to sell policies through the state exchange will have to meet minimum coverage standards as established by AB 1453 and SB 951. The new laws, supported by Consumers Union and other groups, designate two Kaiser HMO plans as the state's "benchmarks" for benefits and services.

• The state's Managed Risk Medical Insurance Board, which oversees plans that help those who cannot get health insurance elsewhere, will get increased subsidies under AB 1526 to lower rates consumers pay. Legislative analysts estimated the bill will cost the state $16 million in 2013."

Privacy Rights .... When On Parent's Health Insurance Policy!

Thought this article written by Michelle Andrews and provided by Kaiser Health News was especially interesting.  Generally the ability for young adults up to the age of 26 to remain on their parents health insurance has been received as an excellent enhancement. BUT ... what about the privacy rights of the young adults??  Hmm... read on!  Here is some input from Michellel Andrews.

Elizabeth Nash was 21 and just finishing her junior year at the College of William & Mary when she had a miscarriage. She planned to tell her parents about it in person, but her insurer beat her to it when, as a matter of routine, it mailed them a form that described the medical treatment she'd received.

Nash says the experience "caused a rift that took a while to repair."

Nash, now 38, recently co-authored an analysis of state laws on health-care confidentiality for insured dependents for the Guttmacher Institute, a reproductive health organization, and was surprised to find that state laws in this area are "so lacking and vague and mushy."

Under the Affordable Care Act, which allows adult children to stay on their parents' plans until they reach age 26, breaches of privacy such as the one Nash experienced may become a growing problem. Since the law passed, more than 3 million young adults have gained coverage, according to the Department of Health and Human Services.

Although parents must give consent for most care provided to children younger than 18, many states allow minors to consent on their own to such potentially sensitive services as testing and treatment for sexually transmitted infections, prenatal care and delivery, contraception and outpatient treatment for mental health and substance abuse.

The privacy rule of the federal Health Insurance Portability and Accountability Act (HIPAA), which took effect a decade ago, generally prohibits the unauthorized disclosure of individuals' medical records and other health information. But there's a catch. Health-care providers and insurers can generally use such information when trying to secure payment for treatment or other services.

And that can be problematic. Providers submit bills to insurers, which process them and generate a document, often an Explanation of Benefits (EOB) form, that tells the insured or the policyholder how much the insurer paid and what, if anything, is owed on the bill.

These communiques are important to combat fraud and identity theft, and many states require that they be sent, according to Nash.

But the documents do not always go to the person who was treated. "The notice could go to your parents or to you, depending on state law, insurance contracts and insurance policy," says Abigail English, director of the Center for Adolescent Health and the Law, and lead author of the analysis published by the Guttmacher Institute.

English says it's "extremely common" for insurers to send EOBs to the policyholder rather than the patient.

Under federal privacy regulations, patients can request that insurers not disclose confidential information or ask that they send it to an address of their choosing. Insurers are required to comply if not doing so would endanger the patient, says English, for example, if it posed a threat of domestic violence.

"Plans typically do have procedures in place to deal with the disclosure of sensitive information," says Susan Pisano, a spokeswoman for America's Health Insurance Plans, a trade group.

Some insurers have made strides in addressing confidentiality issues related to billing and other communications. Cigna, for example, redesigned its EOB forms to strip out specifics about the treatment or services provided, says Joe Mondy, a spokesman for the company. The form, which typically goes to the policyholder, does name the facility and the provider, however.

In addition, unless the law requires it, the insurer sends an EOB only if there's a balance due.

Policy experts say strategies such as Cigna's make sense. That's especially true given the expansion in free preventive services under the Affordable Care Act. Starting in January, for example, many women in new health plans or in those that have changed their benefits enough to lose grandfathered status will be eligible for such services, including contraceptives, counseling and screening for sexually transmitted infections, and screening and counseling for domestic violence.

"With more insurance coverage of contraception, there will be more issues of whether insurers are protecting confidentiality," says Tina Raine-Bennett, an obstetrician-gynecologist at Kaiser Permanente Medical Center in Oakland, Calif., who is chair of the Committee on Adolescent Health for the American College of Obstetricians and Gynecologists.

Although protecting young women's privacy poses a challenge for insurers, "I do believe there will be a net gain in having those services," she says."

So now, what do you think??  See the actual article here, http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2012/under-26-insurance-privacy-michelle-andrews-100212.aspx

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

To Buy Health Insurance Or Pay The Penalty??

Which are you planning on doing?  The time will soon be here where there will be a tax penalty to pay if you do not have health insurance.   You may purchase health insurance directly from a provider, through a state created insurance exchange ( with or without qualifying for credits, i.e.discounts), or through a company group plan!  

It looks like, from the following article that the penalty is going up!  So do do your homework.

Here is info written by Ricardo Alonso-Zaldivar on September 24, 2012 in the Insurance Journal: 

"Nearly 6 million Americans — significantly more than first estimated— will face a tax penalty under President Barack Obama’s health overhaul for not getting insurance, congressional analysts said. Most would be in the middle class.

The new estimate amounts to an inconvenient fact for the administration, a reminder of what critics see as broken promises.

The numbers from the nonpartisan Congressional Budget Office are 50 percent higher than a previous projection by the same office in 2010, shortly after the law passed. The earlier estimate found 4 million people would be affected in 2016, when the penalty is fully in effect.

That’s still only a sliver of the population, given that more than 150 million people currently are covered by employer plans. Nonetheless, in his first campaign for the White House, Obama pledged not to raise taxes on individuals making less than $200,000 a year and couples making less than $250,000.

And the budget office analysis found that nearly 80 percent of those who’ll face the penalty would be making up to or less than five times the federal poverty level. Currently that would work out to $55,850 or less for an individual and $115,250 or less for a family of four.

Average penalty: about $1,200 in 2016."

You may read the entire article here:

http://www.insurancejournal.com/news/national/2012/09/24/264067.htm