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Thursday, June 28, 2012

Here is a detailed analysis of today’s Supreme Court ruling from NAHU, courtesy of our retained counsel, Ernst & Young:

US Supreme Court Upholds Affordable Care Act
The US Supreme Court today (June 28, 2012) upheld the Affordable Care Act (ACA), ruling that the law’s individual mandate is a constitutional exercise of Congress’s power to impose taxes. With the Court’s decision, compliance efforts likely will move ahead at full speed with major provisions of the ACA becoming effective in 2013 and 2014.
In a 5-4 decision, Chief Justice Roberts, joined by Justices Ginsberg, Breyer, Sotomayor and Kagan, concluded, “The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax. Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.”
In the Court’s analysis of the ACA’s Medicaid provisions, it held that it would be unconstitutional for the federal government to withhold all Medicaid funding in order to force states to comply with the Medicaid expansion. Chief Justice Roberts wrote, “Nothing … precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.”
The Court ruled that the Anti-Injunction Act, which limits lawsuits challenging a tax before it is assessed, does not apply because Congress specifically provided that the penalty payment enforcing the individual mandate would not be treated as a “tax.” Notwithstanding acceptance of Congress’s penalty label for purposes of application of the Anti-Injunction Act, the Court ruled that for purposes of determining whether the individual mandate is constitutional, the penalty payment falls within Congress’s general power to tax and, therefore, is upheld.
The decision arises from cases brought by the state of Florida (and joined by 25 other states), the National Federation of Independent Business, and several individuals challenging the constitutionality of the individual mandate and the Medicaid expansion. The cases were later consolidated.
In their dissent, Justices Kennedy, Scalia, Thomas and Alito wrote that the law should have been struck down in its entirety.
With the exception of the limitation on the federal government’s authority to withhold Medicaid funding, all provisions of the ACA stand and compliance efforts likely will move ahead at full speed. In preparation for the major coverage expansion to occur under the ACA in 2014, the Administration is expected to release a host of regulations dealing with the definition of minimum essential coverage, employer coverage and reporting requirements, and an array of new taxes and fees. Clients should be aware of provisions of the law set to take effect in 2013 and 2014, including those listed in the table below.
Provisions of the Affordable Care Act That Take Effect in 2012, 2013 and 2014
2012
• Medicare hospital value-based purchasing program
• Increase in physician quality reporting requirements in Medicare
• Additional Medicare pilot programs on alternative payment methodologies, e.g., accountable care organizations
• Increased requirements for hospitals to maintain not-for-profit status
• Fees from insured (including self-insured) plans transferred to the Patient-Centered Outcomes Research Trust Fund

2013
• Increase Medicare payroll tax by 0.9% on high-income earners
• Impose a 3.8% tax on net investment income of high-income individuals
• $500,000 cap on health insurers’ deduction for executive compensation  
• Eliminate employer deduction for Medicare Part D subsidy
• FSA limitations
• Excise tax on medical device manufacturers and importers
• Medical expense deduction floor increases to 10%  
• Nationwide bundled payment pilot begins in Medicare
• Increased Medicaid reimbursement for primary care
• Medicare physician comparison data available to the public
• Reductions in Medicare payments for select hospital readmissions
• Expanded coverage of preventive services by Medicaid

2014
• Employer mandate and individual mandate
• Employer and insurer reporting requirements
• New health insurance market reforms take effect
• State health insurance Exchanges established
• Premium tax credits and cost-sharing subsidies available to certain individuals in Exchange insurance products
• Medicaid expansion to new populations (100% federal match to states for newly-eligible populations through 2016)
• Annual fee on health insurers
• Medicare/Medicaid DSH payment cuts begin
• Independent Payment Advisory Board (IPAB) issues first report to Congress if Medicare spending exceeds growth target

Post-2014
• Excise tax on high-cost employer-sponsored coverage (2018) 
Political reactions
The Court’s ruling will not end the political debate over health care, which will remain a central issue in the 2012 elections and beyond. The law stands as the centerpiece of the domestic record  of President Obama, who today said, "Whatever the politics, today's decision was a victory for people all over this country whose lives will be more secure because of this law and the Supreme Court's decision to uphold it." The President added, "With today's announcement it is time for us to move forward to implement and, where necessary, to improve this law."
In comments in response to the ruling, presumed Republican presidential nominee Gov. Mitt Romney said, "What the Supreme Court did not do on its last day in session, I will do in my first day in office. I will act to repeal Obamacare."
Following the release of the decision, House Majority Leader Eric Cantor (R-VA) announced that the House on July 11 will hold a vote on legislation to repeal the ACA in its entirety. The measure likely will pass the Republican-controlled House, but it is unlikely to advance in the Democratic-controlled Senate.
Repeal of the ACA has been a primary focus of congressional Republicans and remains a central objective of many Republicans’ campaigns in the November elections. Efforts to repeal all or part of the law will remain difficult unless Republicans maintain control of the House, win the presidency, and win at least a majority in the Senate in the November 2012 elections.
Republicans to date have not coalesced around a proposal to replace the ACA. Further efforts to control rising health care costs, including reforms to federal health entitlement programs and health-related tax expenditures, will be at the center of budget and deficit-reduction debates that are expected to dominate Washington after the November elections.
Background on the law
The Affordable Care Act was enacted in March 2010; it comprises the Patient Protection and Affordable Care Act of 2010 (which President Obama signed on March 23, 2010) and the Health Care and Education Reconciliation Act of 2010 (which the President signed on March 30, 2010).
The primary goals of the ACA are to: (i) expand coverage to an estimated 32 million Americans without health insurance; (ii) reform the delivery system to improve quality and drive efficiency; and (iii) lower the overall costs of providing health care.
To accomplish the goal of expanding coverage, the ACA mandates that all Americans maintain a minimum level of health coverage (the so-called individual mandate) or face a tax penalty. The law expands Medicaid coverage and provides federal premium tax credits and cost-sharing subsidies to assist low and moderate income individuals without affordable employer-sponsored insurance in obtaining health insurance through state-based insurance Exchanges. The ACA mandates, for the first time, that employers with 50 or more full-time employees provide certain minimum benefits or pay penalty fees.
The law also implemented insurance market reforms, including a ban on exclusions for pre-existing conditions, premium rate restrictions, extension of dependent coverage through age 26, and mandatory coverage of preventive services.
A mix of Medicare and Medicaid reimbursement cuts; provisions to reduce fraud, waste, and abuse in those public programs; other delivery system reforms; and a series of tax increases on individuals, corporations and the health industry are used to offset the cost of the law.

Wednesday, June 27, 2012

Lack of Insurance Proves Fatal

Lack of health coverage lead to the premature death of 26,100 people in 2010, according to a study by Families USA. From 2005 to 2010, the number of people who died prematurely due to a lack of health coverage rose from 20,350 to 26,100 a year.
 States with the most premature deaths due to uninsurance in 2010 were
 California with 3,164 deaths, Texas with 2,955 deaths, Florida with 2,272 deaths, New York with 1,247 deaths, and Georgia with 1,161 deaths. The survey compared the uninsured to the insured:
  • Uninsured adults are five times less likely to have a regular source of care than the insured (55% versus 11%).
  • 51% of uninsured adults who tried to find a new primary care doctor in the past three years said it was somewhat difficult or very difficult, with 20% saying it was very difficult.
  • 41% of the uninsured said that a doctor’s office or clinic would not accept them as a new patient.
  • Uninsured adults are nearly four times as likely to delay or forgo a preventive care screening due to cost (36% versus 10%).
  • Uninsured women over 50 are about half as likely to have gotten a mammogram in the past two years (42% versus 79%).
  • Uninsured 50- to 64-year olds with incomes below 250% of the federal poverty level are five times less likely than insured people in the same age group to have gotten a colon cancer screening in the past five years (10% versus 50%.)
  • Uninsured adults are more than six times as likely to go without needed care due to cost (26% versus 4%).
  • Uninsured Cancer patients are more than five times as likely to delay or forgo cancer-related care because of medical costs (27% versus 5%).
  • Uninsured adults are more likely to be diagnosed with a disease in an advanced stage. For example, uninsured women are substantially more likely to be diagnosed with advanced stage breast cancer than women with private insurance, as are uninsured people with colorectal cancer.
  • Uninsured adults are at least 25% as likely to die prematurely.
  • Uninsured patients can’t get the same discounts on hospital and doctor charges that the insurance companies get. As a result, uninsured patients are often charged more than 2.5 times what insured patients are charged for hospital services. Three out of five uninsured adults report having problems with medical bills or medical debt.
For more information, visit http://www.familiesusa.org/.

Tuesday, June 26, 2012

How to get discounts on your companies Workers Compensation!

Did you know that your Employers WC and Anthem BC can get up to 35% in credits??? That’s right! Not only will Employers give you 10% off of the premium for being on the Integrated Medicomp product but you can also receive an additional 25% in credits for having the following:

1.       Being members of the NFIB or CRA
2.       Industry experience
3.       Having a  formal work and safety program
4.       Employee Benefits (401k, IRA, vacation & sick policy, Employee Assistance Program, medical plan, dental plan, vision plan, life plan)

In addition Anthem BC will give you further discounts as this is an integrated product. Therefore,  you will get 6% off of the life, 6% off the dental (DentalBlue or DentalNet) and 1% off the medical but they may also be considered for an additional RAF reduction and they will get OVER 10% off of their workers comp premium on the Integrated Medicomp program!

NOTE: this is subject to being in a classification acceptable to Employers WC programs.

Wednesday, June 20, 2012

How Consumer Driven Health Care Plans Reduce Costs

Consumers who moved from a traditional health plan to consumer driven health plan (CDHP) were able to reduce their health care spending significantly. They also increased their use of preventive care, according to a study by Health Care Service Corp. (HCSC).  HCSC operates Blue Cross and Blue Shield Plans in Il, Texas, Okla. and N.M.

The CDHP program, BlueEdge, is offered through the four Blue Cross and Blue Shield Plans and includes health savings account (HSA) and health reimbursement account (HRA) options. The study reveals the following about members who went from a traditional plan to a CDHP:

• They were 4% more likely to get preventive services.
• They reduced health care utilization more than 12%.
• They were 10% more likely to fill prescriptions with generics.
• They spent 24% less on in-patient hospital services and 8% less on out-patient services.
• They had a 12% decrease in emergency room visits.
• They reduced combined medical and pharmacy spending by 11%

Employers that offered only a CDHP saw even greater spending reductions up to 14.4% over the three years after moving from a traditional plan to a CDHP

Tuesday, June 19, 2012

Saving Tips for Young Adults

Today, younger adults face a variety of challenges in their pursuit of financial independence. Some of these challenges are similar to those faced by previous generations, while others are unique to the times. Here are five financial tips to help you manage your personal finances and prepare for your future:
  1. Invest in your future. Rapidly changing technology used in various fields may require continuing education. You may wish to make ongoing education a priority to enhance your skills and increase your professional potential. The more varied and flexible your skills, the more you will have to offer to prospective employers.
  2. Open an emergency savings account. The uncertainty of the workplace may mean that your professional life will be interrupted by career changes. If you need to return to school to change career paths, you may experience periods of time without steady income. Creating an emergency fund to cover at least six months' worth of living expenses can help you manage work-related transitions. This savings fund may also be used for other endeavors, such as starting your own business.
  3. Save early and continuously for retirement. Saving for retirement is your responsibility. The more disciplined and diligent you are, the better off you may be. Social Security provides only a base level of income, and many employers no longer offer traditional pension plans. With employer-sponsored 401(k) plans, the responsibility of saving rests on your shoulders. Although you may be years away from retirement, the key is to make time and compound interest your allies.
  4. Let retirement funds accumulate. If you change jobs early or often, consider rolling over your employer-sponsored retirement plan funds into an Individual Retirement Account (IRA) or new company retirement plan. It may be tempting to cash in the account, especially if you have accumulated only a small amount, but doing so would make it immediately taxable, and you may also incur an early withdrawal tax penalty. Perhaps a greater concern, however, is that you may be unable to make up for time already spent to accrue these savings.
  5. Use credit wisely. Credit card companies frequently target young adults with the lure of "easy money." While credit cards offer convenience (it is virtually impossible to conduct some transactions, such as reserving airline tickets, without one), they also have the potential to create debt problems. Because payments can be extended far into the future, overspending on credit can create an illusion of wealth. Paying off the full balance each month is the best way to manage your use of credit.
Plan Now for the Future
Remember, the funds you accumulate during your working years may be your primary source of retirement income. Although inflation can erode your savings over time, a little discipline and common sense may help you better manage your current and future personal finances.

Tuesday, June 12, 2012

1. An Individual Disability Policy is a piece of valuable property.
It is a contract. Even though it is underwritten for the current occupation and income - it will cover you the insured in any job you may do through your career; for the benefit amount of the contract.
2. Retirement Savings Disability Income
What happens when your you go on disability? Usually cannot contribute to your retirement plan (IRA, 401(k), etc). This product will do that for you.  So - if they are disabled through age 65/67 they will actually have a 'retirement' fund to use.
3. LTC - Calendar or Service Day Elimination? This is a huge difference at claim time.
When your client's doctor says they need care - on a Calendar Day contract - that starts the elimination period and each day counts. The Service Day contract says that only the days on which the client gets service counts toward the elimination period. This is important because in the beginning - they may only get service 3 times a week or so.
4. MET - Catastrophic Rider - this is different from other carriers!!!
Standard, Principal and Ameritas all use the '2 of 6 ADL's' in conjunction with their CAT rider. If a client's disability is such - they pay the CAT rider benefit in addition to the base benefit. MET - their definition of Catastrophic is the loss of both hands, feet, speech etc!

Friday, June 01, 2012

About Social Security / Get The Biggest Check


Patience Pays Off.
waiting, that larger first check becomes the basis for future cost-of-living adjustments. 

reaches his retirement age, he can ‘file and suspend’, meaning she can collect her share while he waits to collect until later.

The longer you wait, the bigger the check. You can start collecting at age 62. ByMarriage Has Its Perks. Say she’s ready to start collecting benefits but he is not ready to retire. The solution: Once he
Collect If You Decouple.

Bide Your Time. If you wait until age 70 you can collect even more, thanks to the delayed-retirement credit. With life expectancies at an all-time high, chances are good you’ll be around to enjoy the higher benefits.
 
Ask For A Do-Over.
 
Have a Financial Advisor review the best options for you.
If you started collecting Social Security and wish you had waited in order to get a higher benefit, you can press the ‘reset button’. You’ll need to pay back what you’ve received and request a tax refund.
You may be able to collect on your former spouse’s benefits, as long as you were married for at least ten years and are 62 or older.