January 26th, 2012 § 0 comments § permalink
Here is a hat tip to my friend Greg Scandlen for summarizing information found in Paul Fronstin’s EBRI Issue Brief entitled “Health Savings Accounts and Health Reimbursement Arrangements: Assets, Account Balances, and Rollovers, 2006–2011“.
Be sure to read Greg Scandlen’s summary.
January 26th, 2012 § 0 comments § permalink
Here is a hat tip to my friend Greg Scandlen for summarizing information found in Paul Fronstin’s EBRI Issue Brief entitled “Health Savings Accounts and Health Reimbursement Arrangements: Assets, Account Balances, and Rollovers, 2006–2011“.
Be sure to read Greg Scandlen’s summary.
January 25th, 2012 § 0 comments § permalink
In new regulations released by the U.S. Department of Health and Human Services (HHS) at the end of 2011, the federal government established new guidelines for how rebates related to medical loss ratio (MLR) results will be handled.
Previous HHS interim regulations required that group policy subscribers receive premium rebates if health insurers failed to meet or exceed MLR percentage thresholds established by group size.
Under the provisions of the Affordable Care Act, health insurance companies are required to spend a certain percentage of premium dollars on medical claims and activities that improve health care quality.
MRL Calculations
The MLR is calculated by insurance legal entity, state of group contract issuance and group size (individual, small group, large group) for each state in which an insurer writes fully insured business. Based on those criteria, employers will be placed in an aggregation set to determine eligibility for rebates.
MLR percentages are calculated on a calendar year basis. For 2011, which is the first rebate period, UnitedHealthcare conducted an employer survey of group size to assist in the placement of groups in the correct aggregation sets. Calculations utilizing 2011 financial data will identify which aggregation sets qualify for rebates.
Rules Now Vary on Plan Type
Rules regarding the issuance of rebates now vary, depending upon whether a group is a plan governed by ERISA, a government plan or neither. In most circumstances, an issuer must provide a rebate to each applicable group policyholder if the issuer’s relevant MLR does not meet or exceed the minimum MLR percentage required during the MLR reporting year.
Rebate Conditions
In very limited circumstances, rebates will be required to be sent to group policy subscribers instead of the group policyholder. For policies in the individual market, rebates will be paid directly to individual policyholders. All group and individual policyholder rebates must be paid prior to Aug. 1, 2012.
Most group policyholders have the obligation to use a portion of the rebate to benefit their subscribers. For example, plans governed by ERISA must follow U.S. Department of Labor requirements for handling rebates that qualify as a “plan asset.”
For more information about MLR here is a flyer on this subject published by UnitedHealthcare – http://bit.ly/x4IjBa.
January 24th, 2012 § 0 comments § permalink
The federal government as of today has been operating WITHOUT a budget for 1,000 days. To prevent shutting the government down the Congress has passed a number of CRs (continuing resolutions) and raised the debt ceiling along the way. Also, the president recently asked Congress for additional borrowing power of $1.2 trillion, and last week the House passed a resolution disapproving of President Obama’s request to once again increase the nation’s borrowing limit.
According to theobamadebt.com, the federal government’s debt of $15,236,245,309,870 has increased by $4,609,368,260,957 since President Obama’s inauguration. If the president’s request to raise the debt ceiling by yet another $1.2 trillion gets passed, this will bring our national debt to $16.4 trillion. Doing the math, the national debt is projected to increase by $5.8 trillion or nearly 60% in just four years, from $10.6 trillion to $16.4 trillion.
I attended a Cato Institute event, “The Libertarian State of the Union” (http://www.cato.org/event.php?eventid=8807) this afternoon in Washington, DC. Of course, the POTUS is delivering the SOTU this evening, so the name of the Cato event was obviously a play on the SOTU this evening. Here are some of factoids I found fascinating:
The problem with this post is that I am using facts. The shame of this is I am willing to bet that if I were to do a “Jay-walk” (like what Jay Leno does when he interview folks on the street), the vast majority of folks I would speak with don’t even understand the fact that our federal government has been unconscionably operating without a budget for these 1,000 days and has added more than $4.6 trillion to our debt. Of course, this says NOTHING of the $117 trillion in unfunded liability related to entitlements that we face given the current value of future promises that have been made (i.e., Medicare, Social Security, and Medicaid) – http://www.usdebtclock.org/.
I don’t mean to depress my readers, but regardless of one’s political worldview, the truth which most voters really don’t want to face is that the current spending trajectory is simply not sustainable. I hope it does not come down to a situation where civil unrest, food shortages, etc. takes over. At some point there will be a day of reckoning unless there is a sharp correction in the fiscal course we are following. For the sake of our children and grandchildren I sure hope that we all wake up before it is simply too late.
January 18th, 2012 § 0 comments § permalink
Yesterday I blogged about “Tebowing”.
Today I came across a very insightful article in last Friday’s WSJ entited “Tim Tebow’s Role Model”. It is a compelling read that I would like to recommend to my blog’s readers – http://on.wsj.com/yE2sMM.
January 18th, 2012 § 0 comments § permalink
Kudos to my friend and colleague Greg Scandlen for “Myth Busters #17: ERISA, Part I” (http://bit.ly/ySwY0V), a very worthy read for anyone who cares about how and why federal laws like ERISA get enacted.
January 18th, 2012 § 0 comments § permalink
A number of new interesting reports and studies were issued last week.
Concerning the last bullet point, the decline in healthcare spending is not attributable to PPACA, since the data collected is for 2010, and few of the laws provisions were in effect then, and none were in effect for the entire year. Also, it is important to note that in 2010, the federal government’s share of national health spending increased to 29 percent. As PPACA’s subsidy provisions take effect in 2014, the amount of national health spending incurred by the federal government is only expected to grow further.
January 18th, 2012 § 0 comments § permalink
HHS has sent two new important PPACA regulations over to the Office of Management and Budget (OMB) for review in the last week. The regulation detailing how state-level PPACA waivers will be carried out was submitted last week, and today the final rule on PPACA’s summary of benefits requirements was referred there, too.
The OMB is the last stop for administration review before a regulation is published in the Federal Register, and it is generally the place where White House officials weigh in with any concerns or proposed changes. Sometimes OMB review can take days and other times regulations linger there for months.
It’s notable that both of these rules are billed as “final” rules, which means that they will have the full force of law upon issuance. The summary of coverage regulation has already gone through the proposed rule process, and NAHU and many other organizations have already submitted public comment. However, the rule of state-level waivers to PPACA has not been previously issued. Normally rules that are issued as “final” or “interim final” right away, without a proposed rule being issued first, have to do with matters that require immediate implementation. But the state-level waivers do not take effect until 2017, so it’s curious that the Obama administration has filed them as final from the get-go.
January 18th, 2012 § 0 comments § permalink
The Supreme Court ruled yesterday that the National Federation of Independent Business (NFIB) may add two plaintiffs to its lawsuit challenging the constitutionality of PPACA. The original business owner that was the primary subject of NFIB v. Sebelius filed for bankruptcy last year, so there was some concern that without the addition of new plaintiffs, the NFIB’s grounds for filing suit could be questioned. The federal government did not oppose the addition of new plaintiffs in the case.
Meanwhile, the American Center for Law and Justice and Susan Seven-Sky, plaintiffs in other suits challenging the constitutionality of the individual mandate on religious grounds, submitted a brief to the Court last Wednesday, asking to join the 26 states and the NFIB in their case against PPACA. The Court has not yet responded to their request.
In other news concerning the case, last Friday was the first deadline for the submission of amicus, or friends of the court, briefs. Twenty-two groups that either agree with the federal government on the constitutionality of the individual mandate or with the NFIB and the states on the point that since the law does not contain a severability clause then the entire law must be stricken if certain portions are declared unconstitutional, submitted supporting briefs to the Court. Additional deadlines are forthcoming for the submission of amicus briefs on other key points and positions, so many more briefs will be filed between now and the start of oral arguments in March.
January 18th, 2012 § 0 comments § permalink
To say that Tim Tebow is a fan sensation is clearly an understatement. “Tebowing” has become a cultural phenomenon, witness the Tebowing website at http://tebowing.com/.
Just for fun, earlier today when we were posing for staff pictures for our website Chris Saundle and I struck the now familiar “Tebowing” pose:
All kidding aside, I have closely followed Tim Tebow’s collegiate career at the University of Florida and the first 2 years of his professional career with the Denver Broncos. This kid is nothing short of amazing as in selfless. To wit, be sure to read the ESPN article published last Friday entitled “I believe in Tim Tebow” – http://es.pn/xPDTpk. Of particular note is the following excerpt from that article:
“Who among us is this selfless?
Every week, Tebow picks out someone who is suffering, or who is dying, or who is injured. He flies these people and their families to the Broncos game, rents them a car, puts them up in a nice hotel, buys them dinner (usually at a Dave & Buster’s), gets them and their families pregame passes, visits with them just before kickoff (!), gets them 30-yard-line tickets down low, visits with them after the game (sometimes for an hour), has them walk him to his car, and sends them off with a basket of gifts.
Home or road, win or lose, hero or goat.
Remember last week, when the world was pulling its hair out in the hour after Tebow had stunned the Pittsburgh Steelers with an 80-yard OT touchdown pass to Demaryius Thomas in the playoffs? And Twitter was exploding with 9,420 tweets about Tebow per second? When an ESPN poll was naming him the most popular athlete in America?
Tebow was spending that hour talking to 16-year-old Bailey Knaub about her 73 surgeries so far and what TV shows she likes.
“Here he’d just played the game of his life,” recalls Bailey’s mother, Kathy, of Loveland, Colo., “and the first thing he does after his press conference is come find Bailey and ask, ‘Did you get anything to eat?’ He acted like what he’d just done wasn’t anything, like it was all about Bailey.”
More than that, Tebow kept corralling people into the room for Bailey to meet. Hey, Demaryius, come in here a minute. Hey, Mr. Elway. Hey, Coach Fox.
Even though sometimes-fatal Wegener’s granulomatosis has left Bailey with only one lung, the attention took her breath away.
“It was the best day of my life,” she emailed. “It was a bright star among very gloomy and difficult days. Tim Tebow gave me the greatest gift I could ever imagine. He gave me the strength for the future. I know now that I can face any obstacle placed in front of me. Tim taught me to never give up because at the end of the day, today might seem bleak but it can’t rain forever and tomorrow is a new day, with new promises.”
It is frankly refreshing to see a professional athlete emerge on the scene who is the “real deal”. If only we had more professional athletes and celebrities in our culture who accept responsibility for being role models!
January 16th, 2012 § 0 comments § permalink
The US News & World Report article found at http://bit.ly/z1bikd, entitled “What to Do About Retiree Healthcare Costs”, points out issues that are best addressed by purchasing private long term care insurance and setting up an HSA (health savings account) as part of one’s pre-retirement planning. (Note: With an HSA one is able to withdraw money tax-free to pay long term care insurance premiums and / or actual LTC services.). There really is no “mystery” here. Simply put, there are plenty of opportunities to address healthcare costs in retirement if one takes the adequate steps BEFORE retirement to plan for them.
January 11th, 2012 § 0 comments § permalink
Those who know me well know that my favorite animal is the penguin (of which there are different species – http://www.penguins.cl/penguins-species.htm).
One of my employees pointed out this MSNBC post this morning about a very rare leucistic Chinstrap penguin spotted in Antarctica a couple days ago – http://on.msnbc.com/Amrg5O.
January 10th, 2012 § 0 comments § permalink
Last week, the Internal Revenue Service issued new guidance for employers detailing how PPACA’s requirement that employer provide employees with informational reporting to their employees about the cost of their group health insurance coverage on W-2 statements must be fulfilled. The new guidance supersedes and expands upon guidance issued by the IRS on this topic earlier this year.
Significantly, the notice adds new seven new questions and answers for employers, which may be helpful to group plan sponsors implementing the reporting requirements for 2012. In addition, the notice clarifies several of the old questions and answers for employers and republishes the questions and answers that remain unchanged from the old guidance.
The new notice requirements will apply until additional guidance is issued. Many of the new rules are characterized as “transitional relief” and may change in the future as final regulations are developed. However, the guidance specifies that any future changes will be prospective, meaning that they will not be in force right away, and that any new requirements will not be retroactively enforced.
January 10th, 2012 § 0 comments § permalink
Last week, HHS told two more state insurance departments, those in Kansas and Oklahoma, that their requests for adjustments to PPACA’s medical loss ratio (MLR) standards for individual market insurers were denied. Ten states or jurisdictions have now had their MLR adjustment requests turned down by the federal government. Waiver petitions by insurance commissioners from Delaware, Florida, Guam, Indiana, Louisiana, Michigan and North Dakota were all turned down by HHS in 2011.
The only state to receive the exact adjustment it requested to date is Maine, which was the first state to apply for one in 2010.HHS also approved modified adjustment requests for Georgia, Iowa, Kentucky and Nevada earlier in 2011. However, the federal government has not approved any state adjustment requests since the National Association of Insurance Commissioner voted on November 22 to formally ask both HHS and Congress to modify PPACA’s MLR requirements to accommodate producer compensation arrangements. HHS has yet to make a determination on adjustment requests submitted by North Carolina, Texas and Wisconsin earlier last year. The states of Florida and Louisiana are both currently in the process of appealing their adverse waiver determination decisions.
January 10th, 2012 § 0 comments § permalink
The Supreme Court is gearing up for opening arguments in the case of NFIB v. Sebelius, the court case challenging the constitutionality of the Patient Protection and Affordable Care Act being brought against the federal government by the National Federation of Independent Business and 26 states. The deadline to submit opening briefs on issues was last Friday, so a host of briefs were filed, including the Obama administration arguing the individual mandate is constitutional, and a variety of individuals and groups arguing that the whole law should be struck down if the individual mandate portion is found unconstitutional. In addition, court-appointed counsel submitted a brief arguing that the Anti-Injunction Act should prevent a ruling on the mandate until it goes into effect.
The next major deadline is today, when the states will be required to file their briefs on Medicaid challenge in the case. In addition, the court is expected to rule soon on a request by the NFIB to add two additional lead plaintiffs to the case. This move was based on the fact that the original lead plaintiff, small business owner Mary Brown, filed for bankruptcy earlier this year. The concern was the PPACA concerns she had might not be valid if she was no longer in business and that the federal government could argue that Brown had no “standing” to challenge the law. The Obama administration has not objected to the NFIB’s request.
