Category Archives: Health Care Reform

Broke, ObamaCare, Pre-existing insurance plans closing

The State Pre-existing Insurance Plans were set up by ObamaCare to cover those that could not get coverage otherwise, until the advent of the final regulations this January.  I have reported previously that it is completely broke.  If you call their offices they have a message that says e- even if you are covered, they may not be able to pay your claims.

HHS recently asked states to accept lower funding for the rest of the year, or shut down the State Programs and forward those covered to the Federal Government PCIP.  Conspiracy theorists will undoubtedly point to this as one more way the Obama administration is moving people to nationalized coverage.  In any event… it occurred, even though enrollment was far lower than expected, the claims of those covered was far more than expected.  If they had just asked a broker how this would work out…

The anticipated response from the States is now arriving.  Broker, and with reduced funding, 18 states are closing the plans down, leaving only 9 states with PCIP plans .  The National Association of State Comprehensive Health Insurance Plans said in a letter that it fears “catastrophic disruption of coverage” for the PCIP enrollees.  The big problem, as I see it, is that the Federal Program only has one benefit plan.  The North Carolina PCIP offers 4 plans, so with the shift, participants will also get new premiums, and different benefits – and perhaps increased out of pocket costs.

New York Paid Time Off Regulation update

Beginning in 2014, employers with full time or part-time employees that work in New York City will be required to provide minimum sick time.  Depending on the number of employees qualified, it may be paid or unpaid.


Here are the rules:

# employees            When it starts                                         Annual Maximum PTO

20 employees          Paid leave beginning April 1, 2014               40 hours per year

15-19 employees     Unpaid leave beginning April 1, 2014          40 hours per year

Paid leave beginning October 1, 2015

Fewer than 15          Unpaid beginning April 1, 2014                    40 hours per year


Part Time Employees will accumulate at a rate of 1 hour per 30 worked, so a 20 hour/week employee would get 4.33 days per year.

Sick time MUST be carried over to the following year UNLESS 2 conditions are met.  These conditions are

1)  You pay the employee for any unused sick time at the end of the year, AND

2)  You provide the employee with the minimum requirement (above) on January 1.

You may use existing time you provide the employees already if you allow them to use any time off as sick time.  The simplest approach to this is to combine all days off (vacation, religious, sick, and personal) into one category called Paid Time Off (PTO), and allow them to carry at least the minimum of 5 days over.

You are not required to pay out unused time on termination, but you must reinstate time off for anyone rehired within 6 months.

GOING FORWARD: Similar regulations exist for the entire state of Connecticut, Portland OR, San Francisco, Seattle and Washington D.C.  Similar regulations are on the legislative docket in numerous states, so this would be a good time, as you make changes to comply with Health Care Reform at the end of the year, to include these types of regulations in your employee policies and manual.

Nurses slam PPACA for doing little to control health costs

The nation’s largest organization of registered nurses is fighting
back against the Patient Protection and Affordable Care Act, slamming
the law for doing nothing to control skyrocketing health care costs.

National Nurses United, a union representing about 185,000 nurses,
says that exorbitant hospital charges have become a major factor in
driving up overall health care costs, exaggerating a national health
care crisis as “increasing numbers of Americans are priced out of access
to needed medical care or pushed into financial ruin or bankruptcy.”

New data released by National Nurses United finds that hospital charges jumped 22 percent in 2011 alone.

Though the government earned praise when it recently released what individual hospitals charge Medicare
— and what they actually get paid — for the most common diagnoses and
treatments, National Nurses United said that does nothing.

“Sure, they released some numbers, but what does that do really?”
Charles Idelson, a spokesman for National Nurses United said, noting
that Medicare’s released information was for individual medical
procedures, not the “totality of charges.”

“Transparency is nice but it’s not enough. One of the biggest holes
in PPACA — and there’s a lot — is how little is does to address the
issue of cost and what nurses see on a daily basis — that high hospital
and health costs are constantly hurting families,” Idelson said.

The nurses’ research found what appear to be staggering statistics:
U.S. hospitals charge on average $331 dollars for every $100 of their
total costs, a 331 percent charge-to-cost ratio. From 2009 to 2011 (the
most recent year for which the data is available), hospital charges
lunged upward by 16 percent, while hospital costs only increased by 2

“There is no other word for this than price gouging,” said Deborah
Burger, co-president of NNU whose research arm, the Institute of Health
and Socio Economic Policy produced the findings based on an analysis of
publicly available Medicare Cost Reports.

Burger says the consequences of hospital price gouging for patients
and families is “immediate and severe.” High hospital charges get passed
along by insurance companies to employers and individuals. And
employers either drop health coverage or shift the cost to workers, she

“Hospitals should be providers of care, not loan sharks,” Burger
said. “But we also know that price gouging is widespread throughout the
health care industry, and that is a symbol of what is wrong with our
profit-focused health care system, and why we need real reform.”

Idelson said that any diminishment of cost in the last two years is
only because the recession hurt so many people’s finances, and caused
them to forgo medical treatment because they couldn’t afford it.

“Effective reforms would include a crackdown on inflated charges as
well as greater public oversight and protection generally,” Burger
said. “Ultimately, the only long-term solution is still the
transformation of our broken healthcare system to a more humane system,
such as in expanding and improving Medicare to cover everyone.”

Why we can’t get answers from the DOL

A head Labor Department official said Monday that the department
cannot provide as much clarity or answer questions about the Affordable
Care Act as people are seeking due to elements of the law.

Speaking at the International Foundation for Employee Benefit Plans Washington
Legislative Update at the Capital Hilton, Phyllis Borzi, assistant
secretary for employee benefits security, acknowledged that those in the
audience — mostly multi-plan trustees — are struggling with how to
implement the ACA and although the DOL is working with them “these are
very, very difficult issues because the statute is so unforgiving in a
number of areas.”

Borzi, who is in charge of the Employee Benefits
Security Administration, said that many times people come into the
department’s offices to talk about the law and want to put aside the
statute during the conversation. “We can’t do that,” Borzi said. “It’s
only when the statute gives us some wiggle room and often it does not.”

Further, she said often when the U.S. Government is sued about the law, many of
the cases accuse the government of exceeding its legal authority so “we
are very cautious about not exceeding our legal authority,” Borzi said.

However she said the department remains committed to helping people as they
figure out how the law will impact their plans. “We are not there yet,”
she explained, “any of you wondering what will happen, I wish I could
give you some clarity … but we do understand how important your plans


This article was posted by Brian Kalish on 5/21/13 on Employee Benefit Advisor

First Peak – Oregon posts 2014 rate requests

The Oregon Insurance Division has posted individual and small-group rate proposals for 2014.

The division has posted rate proposals from a total of 16
conventional carriers and two new CO-OP plans for the exchange and
non-exchange markets. The division marked proposals from carriers that
plan to participate in the state’s Cover Oregon health insurance exchange program with asterisks.

Officials expect 12 of the 15 carriers in the individual market and
eight of the 14 carriers in the small-group market to sell coverage
through Cover Oregon.

The Patient Protection and Affordable Care Act (PPACA) requires the
U.S. Department of Health and Human Services (HHS) and state agencies to
set up exchanges, or health insurance supermarkets, for individuals and
small groups in all 50 states and the District of Columbia by Oct. 1.

Oregon is setting up its own exchange.

A look at individual exchange plan rates for the Eugene, Ore., area,
for example, shows that proposed rates for a mid-tier silver plan for a
21-year-old single non-tobacco user could range from $176 at Moda to
$394 at Trillium.

For a single 60-year-old non-tobacco user, silver plan rates could
range from $519 per month at PacificSource to $1,070 at Trillium.

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA. - SIPC - Brokercheck