Category Archives: Health Care Reform

Exchange deadline passes, 26 states opt in with feds

By Tom Howell Jr. The Washington Times

Saturday, February 16, 2013

The backbone of President Obama’s health care law is taking shape, with 26 states choosing to let the federal government
run the online insurance markets mandated by his signature reforms
instead of keeping the job in-house or partnering with the feds.

The Department of Health and Human Services
had encouraged states to run their own markets, or “exchanges,” that
help the uninsured find coverage. Only 17 states and the District took
on the task while seven states decided to split the duties, according to
a breakdown by the Kaiser Family Foundation.

The exchanges, which are designed to let those without employer-based insurance compare
and buy plans with the help of tax credits, are a crucial part of the
Patient Protection and Affordable Care Act that passed in 2010 and was
largely upheld by the Supreme Court in June. States that wanted to run a partnership exchange with the federal government had to let HHS know by late Friday, ending months or even years of debate among governors and state lawmakers.

Their discussions marked one of two major decisions under “Obamacare.”
Whether or not to expand Medicaid within their borders is the other, and
it remains a source of contention in state capitals across the country.

The Obama administration says it will be ready to run exchanges in more than half of the states,
even though a bevy of Republican governors and lawmakers flouted their
intentions by saddling them with the task.

“It’s not what the drafters of the bill had hoped would happen,” Timothy S. Jost, a professor at Washington and Lee University School of Law who specializes in health care, said of the outcome on Friday.

State leaders who deferred to the federal government
cited numerous reasons for their choices; among them, they wanted to
distance themselves from Mr. Obama’s first-term achievement, could not
obtain enough information to make an informed decision or ran out of
time after Mitt Romney lost the presidential election. That loss effectively ended Republicans’ hopes of repealing the health care law.

New Jersey Gov. Chris Christie sent a letter to HHS Secretary Kathleen
Sebelius on Friday to confirm his previously stated preference for a
federally run exchange.

West Virginia, meanwhile, applied for a partnership exchange “to retain our ability to
assist consumers and maintain our traditional authority to regulate
health insurance” in the state, said Jeremiah Samples, an official at
the West Virginia Insurance Commission. He said that after months of
analysis, officials decided that a state-run exchange would not be worth
it because of the state’s relatively small market and the hefty
information-technology costs associated with the exchange.

From the start, HHS advised states to run the exchanges so they could tailor
them to their residents’ needs. But the majority said no.

Mr. Jost said the tilt toward federally run exchanges may help officials in
Washington stay on the same page during the early stages of
implementation because the marketplaces rely on computer networks that
will share data among several federal agencies.

“It’s not a particularly bad thing at this point to be doing it this way,” Mr. Jost said.

Federal health officials declined to comment on the states’ decisions before
midnight Friday, making it unlikely they will weigh in on the spectrum
of exchanges until this week.

The Obama administration is striking an optimistic tone less than eight months before enrollment begins, despite the burden of implementation.

“We are making great progress, we are on track, and we will be ready for
people all across the country to obtain high-quality affordable health
care coverage beginning on Oct. 1,” Gary Cohen, director of the Center
for Consumer Information and Insurance Oversight, told the Senate
Finance Committee on Thursday.



Retirement, Health Care and ObamaCare…Changes coming

Congratulations – you retired, and you are not yet age 65, so not eligible for Medicare.  In the past this has been a big challenge from the health insurance perspective – how do you get affordable coverage until Medicare kicks in?  Or perhaps your spouse has retired, and is over age 65 (covered by Medicare) but you are younger- say age 61.  How do you get affordable coverage until Medicare kicks in for you?

This has been a big problem in the past.  Some mix of COBRA rights, purchasing a catastrophic high-deductible plan, and prayer.  Beginning January 1, however, “ObamaCare” will bring new options.  Heres a  (very) simple and short primer…

  • IF your income is below 133% of the federal poverty level (you are retired, remember? under @ $15,282) you will be covered by an expanded Medicaid Program.
  • IF you are between 133% and 400% (@ $45,960) you will have access to a number of health plans, with standardized benefits, in “the marketplace” also called the Exchange.  You will receive a subsidy from the federal government which will keep your premiums at about 9.5% of your gross income.
  • IF you earn more than 400% then you will be able to go to the Exchange, or go outside, and purchase any available product (at full price, no subsidy).

Once you turn 65 you will have access to Medicare and at that time will purchase a supplemental product, or a Medciare Advantge Plan (PPO).  But thats another article.

Changes to Military Leave and FMLA

This information comes from Michael Best & Freidrich LLP. – Reeve


In our experience, the military leave provisions of the FMLA have not been a problem for employers. However, the changes do impact employer policies and forms. Of significant note:

  • The regulations address FMLA leave taken by an employee
    to care for the serious illness or injury of a veteran of the Armed
    Forces. The regulations: (i) define who constitutes a “covered
    veteran”; and (ii) incorporate four different alternative standards
    by which the veteran’s serious illness or injury may be determined. The
    regulations also announce the DOL’s stance that leave granted to veterans
    pursuant to the 2009 statutory changes to the FMLA, but prior to the
    effective date of the final regulations would not “count” as
    leave for a covered service member’s illness or injury (even though
    employers may have fully complied with the statutory requirements at the
    time). Thus, the DOL has created in the new regulations an eligibility
    “amnesty” period for an employee seeking leave to care for a
    seriously ill or injured veteran who achieved such status after, or had
    such status on, the date of the 2009 adoption of the change in the law.
  • The regulations permit eligible employees to obtain
    certification of a service member’s serious injury or illness from any
    health care provider, not only those affiliated with the Department of
    Defense, Veterans Administration, or TRICARE Networks (as was previously
    the requirement).
  • The regulations extend qualifying exigency leave to
    eligible employees who are family members of members of the regular Armed
    Forces and adding the requirement for all military members to be deployed
    to a foreign country in order to be on “active duty” under the
  • The regulations increase the amount of time an employee
    may take for qualifying exigency leave related to the military member’s
    Rest and Recuperation leave from five days to up to fifteen days.
  • The regulations create an additional qualifying
    exigency leave category permitting employees to take FMLA to care for the
    military member’s parent who is incapable of self-care while the military
    member is on covered active duty.

In addition, concurrent with the new
regulations, the DOL has issued a model certification form to address leave to
care for the serious illness or injury of a veteran.

Part Time workers rarely elect benefits

Benefit News, By Andrea Davis February 4, 2013

A new study sheds light on the health care benefit participation rates of part-time workers and how they might shift in 2014 when the Patient Protection and Affordable Care Act mandates affordable coverage for employees who work more than 30 hours a week.

Part-time workers at large U.S. companies that are eligible for health care benefits elect coverage at a significantly lower rate than full time employees, according to the 2012 Study of Large Employer Health Benefits from the ADP Research Institute.

While 77% of eligible full-time workers select health coverage, only 15% of part-time workers who are eligible for coverage do so. As a result, part-time employees represent less than 5% of the total population participating in their employer’s health coverage.

“The big question for employers is what happens in 2014 if the part time eligible population grows from 15% to 25% or 30% or more?” says Chris Ryan, chief strategy officer at ADP Strategic Advisory Services. “What happens if they start to respond more like a full-time workforce, which we know has much higher participation rates? There are some industries that are highly dependent on part-time and hourly workers for whom this could have a material financial impact on their company.”

The average employer in the study contributed roughly $7,225 per year in health premiums for each employee enrolled in the employer’s group health plans for the 2012 benefit year.

“There will be some employers for whom it makes sense to convert part-time workers to full-time or to change the composition of their workforce,” says Ryan. “For others it may mean having very tight control over time and labor reporting to ensure that, under the shared responsibility rules [of PPACA], people stay under the 30-hour rule.”

The study also suggests that employers that have a higher proportion of older workers may be at a higher risk of triggering PPACA’s excise tax in 2018. Known as the Cadillac tax, it imposes a 40% excise tax on the value of coverage exceeding certain limits.

While it’s well-known that there’s a relationship between the age of a population and total health premiums, the ADP study “established that a significant proportion of the variance of the cost of health care between different industries can be explained by the average age of participants alone,” says Ryan.

“While we might expect that [the] manufacturing [industry] might have more generous benefits and thus higher total premiums than [the] accommodation and food services [industry], the flip side is that the average age in accommodation and food services is substantially less so a significant portion of that cost is different,” he continues. “A challenge for employers is that, clearly, your workforce population — under certain circumstances — could put you at higher risk of triggering the excise tax and that’s something companies are going to want to think about.”

The study looked at 2012 data for health and welfare benefits from approximately 300 U.S.-based ADP clients, all with more than 1,000 employees.

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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