Analysis of proposed health reform policies

Health reform has remained a hot topic throughout the recent months leading up to the presidential election. Here is a breakdown and analysis of a few proposals put forth during the 2016 presidential campaign.

Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.

Regardless of your political affiliation, I think we can agree there are many aspects of The Affordable Care Act (Obamacare) that have mitigated the current health care crisis. The law has mandated more comprehensive coverage of health plans, for example, dependents must be eligible up to age 26, there are no more lifetime limits

Growth in renewable jobs in Massachusetts

According to a recent report from the Massachusetts Clean Energy Center (MassCEC), the state has seen an increase in jobs and performance in the energy sector over the past two years. The double-digit growth has been consistent for the past four years with the state now employing 98,985 workers at 6,439 clean tech and renewable energy companies across the state. Massachusetts clean energy is now an $11 billion dollar industry, making it a stand out on the map for global leadership in clean energy.

The innovation and investing in the field has allowed Massachusetts to grow the industry into a model of what other states want to accomplish. “Private sector innovation and investment combined with public sector leadership on forward thinking clean energy policies are continuing to prove to be a strong formula to drive the flourishing of this industry,” commented Northeast Clean Energy Council President Peter Rothstein.

IRS extends 1094-C, 1095-C filing deadlines

As employers anxiously prepared for the upcoming deadlines for the 1094-C and 1095-C filings, the IRS dropped another holiday week surprise. They extended the due dates for the filing of these 2015 forms (Notice 2016-4). This extension of time was also granted to health insurers who will be providing coverage information to individuals who are covered by fully insured plans.

Applicable large employers will have almost two additional months to issue Forms 1095-C to individuals. 1095-Cs must now be distributed by March 31, 2016 (the original due date was February 1). The deadline for filing the forms with the IRS, including the 1094-C, has been extended by three months. The new IRS deadline is now May 31, 2016 (via mail) and June 30, 2016 (electronically). 

Insurance unicorn cut in half

Unicorns, private, VC-backed firms with valuations over $1 billion had been growing by leaps and bounds this year.  But, now those valuations are under pressure.  The most dramatic of these in insurance is Zenefits, an online health insurance broker.  Press reports today say that Fidelity cut its valuation for Zenefits by 48% from its May round, still a unicorn but a much smaller one at a reported $2.34 billion.  That cannot be making shareholders happy.

The report also says that turnover is high and telephone sales representatives in Arizona are being paid $30,000 per year. No surprise at those low wage levels.

Insurer steps into drug pricing controversy

Insurance will play a huge role in the developing drug pricing controversy.  Healthcare commentator, Ezekial Emanual, opined in yesterday’s New York Times that new drugs, particularly PCSK9 inhibitors for cholesterol control, are entering the market at prices well above their utility as measured by the extremely clinical, but widely used,  “Quality-adjusted Life Years” measure.  Now, of course, Amgen (a PCSK9 maker) may not agree with Emanuel’s calculations and that represents just one of the problems.

Emanuel fairly raises the question of whether the drug/healthcare industry will self-regulate the issue.  The alternative, “death panels” from the government, are highly unlikely based on prior debates. 

The Affordable Care Act’s provisions on expatriate health insurance

​On June 30, 2015, the Internal Revenue Service (IRS) and Treasury Department issued Notice 2015-43. The notice provides transition relief and interim guidance based on the application of particular provisions of the Affordable Care Act (ACA) to expatriate health insurance issuers, expatriate health plans, and employers in their capacity as plan sponsors of expatriate health plans, as defined in the Expatriate Health Coverage Clarification Act of 2014 (EHCCA).

The Departments of the Treasury, Labor, and Health and Human Services aim to publish proposed regulations on the requirements for expatriate health plans, plan sponsors, and health insurance issuers. The departments are welcoming comments on defining the terms “expatriate health plan” and “qualified expatriate,” in addition to the interaction of the EHCCA with existing relief for expatriate health plans.

July 1st signaled the beginning of paid sick leave for MA and CA employees

Employees in California and Massachusetts who previously did not receive paid sick leave are now eligible for this benefit.  In Massachusetts, employers must now provide all employees with five days of sick leave per year, paid or unpaid depending on the employer’s size. California employers, on the other hand, must now provide employees at least three paid sick days per year. Employers that already provide paid time off, vacation, or other leave benefits can potentially use existing policies to meet their new compliance obligations as long as its meets the minimum requirements of the new law. Below is a high-level overview of some of the major provisions of each state’s sick leave law.

Employee benefits for same-sex couples changing as states legalize marriage

As the number of states with legal same-sex marriage climbs to 37 plus the District of Columbia, some employers are informing their staff that they must wed in order to continue providing health-care coverage for their partners. According to a federal tally, approximately one-third of public- and private-sector employees in the U.S. have access to benefits for unmarried same-sex partners. However, a Supreme Court ruling that legalizes same-sex marriage in all 50 states will likely cause more employers to drop same-sex partner benefits in favor of spousal benefits.

Over the past decade, more and more companies offered coverage for employees and their partners as a way to provide equal benefits for couples who could not wed legally. However, some employers who offer benefit coverage for same-sex partners are now saying it is only fair to require these couples to marry, where legal, in order to extend coverage.

The Cadillac Tax and its implications for employers

The Affordable Care Act (ACA) includes an excise tax, called the Cadillac tax, scheduled to take effect in 2018. It was created in response to Congress’s notion that the unlimited, tax-free nature of healthcare causes inefficiencies and increased healthcare costs. The tax will be levied against employers who offer benefits programs that are deemed too excessive.  Its intended purpose is to slow the growth of healthcare costs, and generate revenue to balance out the ACA’s hefty $1 trillion price tag.

The IRS has been in a comment period regarding the Cadillac tax and is currently in a review process of the copious amounts of comments it has received.  Among the comments, the Council of Insurance Agents and Brokers (CIAB) “urges the IRS to keep in mind the overarching policy goals of the ACA, the potential adverse consequences of the tax for employees and their families, and the potential financial and administrative challenges for employers that seek to comply with the various (and sometimes competing) pieces of the ACA.”

Is Telehealth becoming the new norm in patient care?

The traditional trip to the doctor’s office may quickly become a thing of the past, as front-line employees struggle to find time to fit it into their schedules. Some think that they have to scramble for an urgent care center or spend an inordinate amount of time in a hospital ER waiting room when a situation requiring medical attention occurs on a weekend or in the late hours of the night.

Employees at Cleveland Metroparks, a park district in Ohio, have been offered an alternative solution via their employer’s telehealth benefit. One call to Teladoc, Metroparks’ telehealth provider, can diagnose urgent yet treatable ailments, or issue a prescription to a local pharmacy. Rather than being stuck in a waiting room for an extensive period of time, employees can get