Category Archives: Health Care Reform

Insurers say Medicare Advantage cuts are too risky

By February 21, 2013 • BeneftisPro

America’s Health Insurance Plans is pushing back against proposed
cuts to Medicare Advantage payments, saying it will put those patients
at risk.

The Obama administration proposed the 2 percent cut late last week.

AHIP said Thursday payment changes will especially hurt low-income
and minority seniors. The organization also slammed the timing, saying
an additional cut to Medicare Advantage payments next year is especially
harmful when the program is already facing “significant payment cuts
and a new health insurance tax included in the health care reform

Medicare Advantage is the part of Medicare through which private
health plans provide comprehensive medical coverage to seniors and other
Medicare beneficiaries. More than 14 million Americans—or roughly 28
percent of all Medicare beneficiaries—are enrolled in a Medicare
Advantage plan because of the good services, high-quality care and
additional benefits these plans provide, AHIP says.

AHIP researchers say that that Medicare Advantage plans are more
effective than the fee-for-service part of Medicare at addressing
crucial patient care issues, including reducing preventable hospital
readmissions, increasing primary care visits and managing chronic

“Medicare Advantage is a lifeline for millions of low-income and
minority Medicare beneficiaries who rely on the high-quality coverage
and innovative programs and services these plans provide,” AHIP
President and CEO Karen Ignagni said in a statement.

AHIP’s research also notes that Medicare Advantage plans are most
popular among black and Hispanic seniors. About 41 percent of Medicare
beneficiaries with Medicare Advantage coverage had incomes of $20,000 or
less. By comparison, 37 percent of all Medicare beneficiaries had
incomes of $20,000 or less.

Employer-sponsored health insurance hits new low

By | February 22, 2013 • Benefitspro

The number of Americans getting employer-sponsored health insurance
is at the lowest point since President Obama took office, a new Gallup
poll released Friday reveals.

At 44.5 percent, the percentage of people getting health care through
an employer is just slightly lower than in 2011, but 5 percentage
points lower than in 2008. The latest figures come despite the fact that
the economy added roughly 1.8 million jobs last year.

Opponents of President Obama’s Patient Protection and Affordable Care
Act have argued dropping health coverage is an unintended consequence
of the law that will negatively affect employees who want to stick with
the coverage they know and like.

Estimates have widely varied on just what reform will do to employer-based health coverage. A Deloitte report last summer estimated that one in 10 employers will drop coverage for their employees, while consulting firm McKinsey & Co. drew fire
when they stated 30 percent of respondents will “definitely” or
“probably” stop offering employer-sponsored health insurance after 2014.

At the same time, Gallup finds more Americans continue to report
having a government-based health plan—Medicare, Medicaid, or military or
veterans’ benefits—with the 25.6 percent who did so in 2012 up from
23.4 percent in 2008.

Gallup predicts that number will also continue to increase, as reform
expands the Medicaid program in 2014 to cover more people, which will
likely affect the total percentage of all adults who get their coverage
through a government plan.

“Fewer Americans continue to have employer-based insurance than did
so in 2008. This appears to be due to two factors: higher unemployment
and fewer workers getting insurance through an employer, either because
that employer no longer offers it or because the cost is prohibitive for
the employee,” Gallup researchers note. “Americans are now more likely
to be uninsured or to get their coverage through a government-based

Though the decline in employer-based coverage is apparent for those
workers employed full time for an employer or for themselves, the
percentage of part-time workers who have employer-based insurance rose
in 2012. Gallup notes this group of workers skews young, and young
adults—many of whom are either likely still in college and thus can only
work part time or are just entering the workforce and struggling to
find a job—have become more likely to be insured since PPACA provision
allowing those up to age 26 to stay on their parents’ plans went into

Employer-based health insurance coverage rates have dropped among all
major subgroups since 2008, declining the most for middle-income
Americans and the least for seniors. Rates have been steadily trending
down every year since 2008, Gallup says.

Extended Tax Relief Deadline for Hurricane Sandy Victims

The Internal Revenue Service (IRS) has announced that the February 1, 2013, deadline for Hurricane Sandy tax relief has been extended to April 1, 2013, for affected taxpayers whose principal residence is, or who work in certain areas of, New Jersey and New York.

Watchdogs: States short on PPACA info

By | February 21, 2013 • Reprints
State agencies have more information about implementing the Patient
Protection and Affordable Care of 2010 (PPACA) than they had a year
ago, but they still need more details from Washington.

Stuart Wright, a deputy inspector general at the Office of Inspector
General at the U.S. Department of Health and Human Services (HHS), has
come to that conclusion in a report on state PPACA implementation efforts.

PPACA calls for state and federal agencies to work together to expand
enrollment in Medicaid and the Children’s Health Insurance Program
(CHIP), and to set up a new system of “exchanges” that will serve as
health insurance supermarkets.

PPACA Section 1413 requires HHS to help the states with the PPACA
“health subsidy” program efforts by developing a streamlined health
program application form.

Section 1413 requires each state to develop a “secure electronic
interface for exchange of information among program,” and to
“participate in data-matching agreements for obtaining eligibility
information from various sources,” Wright wrote in his report.

In March 2012 and April 2012, inspector general’s office
investigators surveyed the states to get their views on how
implementation was going and what kinds of additional help they needed from the Centers for Medicare & Medicaid Services (CMS), the HHS arm in charge of PPACA implementation efforts.

At that time — about a year ago — 35 of the 45 states that
responded said they expected to be able to meet the PPACA requirements
by Jan. 1, 2014, Wright said.

“States also reported needing information and guidance, particularly
on the secretary’s application form, the planned federal data services
hub, and the calculation of modified adjusted gross income,” Wright

Since then, HHS has posted details about the exchange individual and group coverage application forms.

HHS also has posted technical information on how states can shift to using PPACA modified adjusted gross income (MAGI) in place of ordinary taxable income or other income measures when deciding which applicants qualify for which programs.

Regulators in 24 states that have been requiring asset tests for enrollees
Medicaid or CHIP plans are still wondering whether CMS and HHS will
really require them to open up their government health programs to
lottery winners.

State regulators are also still asking questions about the HHS data services hub.

Earlier this month, for example, Don Hughes, an Arizona health care
policy advisor, said uncertainty about the status of the federal data
services hub project was one reason the state decided not to try to set
up a state-based exchange or a state-federal “partnership exchange” in

Marilyn Tavenner, the CMS acting administrator, said in a response to
the inspector general’s report that CMS has “shared a significant
amount of key Hub documentation and technical specifications since
September 2012.”

States now have business service descriptions for multiple hub services in final formats, Tavenner said.

CMS also has held one-on-one conversations with states about the hub
and what the state-hub connection testing process will require, and it
has been holding calls with states on topics such as Internal Revenue
Service safeguards and remote identity proofing, Tavenner said.

Final HIPAA Regs require employer changes

This was published at – go there fore additional information. – Reeve
The HIPAA privacy rules restrict the use or disclosure of
protected health information by covered entities – including employer
group health plans – without express authorization, except when
necessary for treatment, payment or health care operations, or certain
other permitted purposes. The privacy rules include standards for
individuals’ privacy rights to understand and control how their health
information is used. The HIPAA security rules set standards to protect
the confidentiality, integrity, and availability of electronic protected
health information. Employers with self-insured group health plans,
including medical, dental, vision, health flexible spending accounts or
health reimbursement arrangements and certain employee assistance
programs, as well as those sponsoring on-site medical clinics or using
data warehousing in conjunction with their group health plans, will have
HIPAA obligations. In general, employers with insured group health
plans that don’t have access to protected health information will have
only limited HIPAA obligations. The final regulations implement the
amendments to HIPAA made by the Health Information Technology for
Economic and Clinical Health Act (the HITECH Act) and the Genetic
Information Nondiscrimination Act (GINA).

Generally, the final regulations:

  • Modify the HIPAA privacy, security, and enforcement rules, to:
    • incorporate increased and tiered monetary penalties and expanded enforcement structure of the HITECH Act
    • make business associates directly liable for compliance with certain privacy and security rules
    • modify the rules for breach notification
    • require modifications to notices of privacy practices
    • strengthen limits on use and sale of protected health information
    • expand rights to electronic copies of health information and
      restrict disclosures to health plans where the individual has paid for
      the treatment
    • adopt additional HITECH Act provisions.
  • Modify the HIPAA privacy rule to strengthen and implement the
    privacy protections for genetic information under GINA There are
    numerous changes in the final rules from earlier interim and proposed
    rules; however, employers will find that the general compliance
    framework for satisfying their HIPAA privacy and security obligations
    was not significantly altered by this recent round of regulatory
    guidance. HHS did not finalize other proposed regulations (published in
    May 2011) affecting accounting for disclosures and access reports.

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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