PPACA could price smokers out of health insurance

Millions of smokers could be priced out of health insurance because of tobacco penalties in the Patient Protection and Affordable Care Act (PPACA), according to experts who are just now teasing out the potential impact of a little-noted provision in the massive legislation.

  • PPACA — “Obamacare” to its detractors — allows health insurers to charge smokers buying individual policies up to 50 percent higher premiums starting next Jan. 1.
  • For a 55-year-old smoker, the penalty could reach nearly $4,250 a year. A 60-year-old could wind up paying nearly $5,100 on top of premiums.

Younger smokers could be charged lower penalties under rules proposed last fall by the Obama administration. But older smokers could face a heavy hit on their household budgets at a time in life when smoking-related illnesses tend to emerge.

Workers covered on the job would be able to avoid tobacco penalties by joining smoking cessation programs, because employer plans operate under different rules. But experts say that option is not guaranteed to smokers trying to purchase coverage individually.

Nearly one of every five U.S. adults smokes. That share is higher among lower-income people, who also are more likely to work in jobs that don’t come with health insurance and would therefore depend on the new federal health care law. Smoking increases the risk of developing heart disease, lung problems and cancer, contributing to nearly 450,000 deaths a year.

Insurers won’t be allowed to charge more under the overhaul for people who are overweight, or have a health condition like a bad back or a heart that skips beats — but they can charge more if a person smokes.

Starting next Jan. 1, the federal health care law will make it possible for people who can’t get coverage now to buy private policies, providing tax credits to keep the premiums affordable. Although the law prohibits insurance companies from turning away the sick, the penalties for smokers could have the same effect in many cases, keeping out potentially costly patients.

“We don’t want to create barriers for people to get health care coverage,” said California state Assemblyman Richard Pan, who is working on a law in his state that would limit insurers’ ability to charge smokers more. The federal law allows states to limit or change the smoking penalty.

“We want people who are smoking to get smoking cessation treatment,” added Pan, a pediatrician who represents the Sacramento area.

Obama administration officials declined to be interviewed for this article, but a former consumer protection regulator for the government is raising questions.

“If you are an insurer and there is a group of smokers you don’t want in your pool, the ones you really don’t want are the ones who have been smoking for 20 or 30 years,” said Karen Pollitz, an expert on individual health insurance markets with the nonpartisan Kaiser Family Foundation. “You would have the flexibility to discourage them.”

Several provisions in the federal health care law work together to leave older smokers with a bleak set of financial options, said Pollitz, formerly deputy director of the Office of Consumer Support in the federal Health and Human Services Department.

First, the law allows insurers to charge older adults up to three times as much as their youngest customers.

Second, the law allows insurers to levy the full 50 percent penalty on older smokers while charging less to younger ones.

And finally, government tax credits that will be available to help pay premiums cannot be used to offset the cost of penalties for smokers.

Here’s how the math would work:

Take a hypothetical 60-year-old smoker making $35,000 a year. Estimated premiums for coverage in the new private health insurance markets under Obama’s law would total $10,172. That person would be eligible for a tax credit that brings the cost down to $3,325.

But the smoking penalty could add $5,086 to the cost. And since federal tax credits can’t be used to offset the penalty, the smoker’s total cost for health insurance would be $8,411, or 24 percent of income. That’s considered unaffordable under the federal law. The numbers were estimated using the online Kaiser Health Reform Subsidy Calculator.

“The effect of the smoking (penalty) allowed under the law would be that lower-income smokers could not afford health insurance,” said Richard Curtis, president of the Institute for Health Policy Solutions, a nonpartisan research group that called attention to the issue with a study about the potential impact in California.

In today’s world, insurers can simply turn down a smoker. Under Obama’s overhaul, would they actually charge the full 50 percent? After all, workplace anti-smoking programs that use penalties usually charge far less, maybe $75 or $100 a month.

Robert Laszewski, a consultant who previously worked in the insurance industry, says there’s a good reason to charge the maximum.

“If you don’t charge the 50 percent, your competitor is going to do it, and you are going to get a disproportionate share of the less-healthy older smokers,” said Laszewski. “They are going to have to play defense.”

*Modified from a LifeHealthPro.com article

0

CBO: PPACA tax credit could be big

By 2021, federal health insurance purchase tax subsidies could amount to about 13 percent of the insurer’s total 2011 premium revenue.

Analysts at the Congressional Budget Office (CBO) have analyzed the premium assistance tax credit, a component of the Patient Protection and Affordable Care Act of 2010 (PPACA), in a general report on refundable tax credits.

An ordinary tax credit is an amount that a taxpayer can subtract directly from the amount a taxpayer owes the government Traditionally, if using a tax credit would make the taxpayer’s tax bill a negative number, the taxpayer simply got out of paying taxes, or possibly could apply the amount to the next year’s tax bill. When using a refundable tax credit produces a tax obligation amount that happens to be a negative number, the government pays that amount to the taxpayer, CBO analysts wrote in their report.

The topic is of special interest this year, because the drafters of PPACA used refundable tax credits as the vehicle for helping low-income and moderate-income pay for health insurance.

When Congress created the first refundable tax credit — the Earned Income Tax Credit (EITC) program — in 1975, the goal of that program and later, similar programs was mainly to help low-income people increase their income, the analysts said.

In the past, Congress usually used spending programs such as the Food Stamp program, Medicaid and Pell Grants to help people pay for specific goods and services, such as food, health care or education, the analysts said.

Today, because tax credit programs tend to be more palatable to members of Congress and to the credit users than “government handouts,” Congress has structured more aid programs as refundable tax credit programs.

The EITC program and the child tax credit program will be by far the biggest refundable tax credit programs this year, and they are on track to generate about $125 billion of the $149 billion in refundable tax credits that taxpayers will report, the analyst said.

The new PPACA premium assistance tax credit could lead to about $35 billion in credit costs in 2014, and $110 billion of the $213 billion in total refundable credit costs in 2021, the analysts said.

U.S. health insurers took in about $864 billion in premium revenue in 2011, according to government estimates.

Tax credit recipients are supposed to use the premium assistance tax credit to pay health insurance premiums, and most will then have to use some of their own cash to cover the rest of the cost of the premiums.

Private health insurers are expected to generate much higher premium revenue in 2021 than in 2011, but, if consumers had spent an additional $110 billion in health insurance in 2011, that would have increased their revenue by about 13 percent.

Distributing benefits through refundable tax credits rather than through direct spending programs may effect the fairness of the tax system, the complexity of the tax system, and the efficiency of how resources are allocated in the economy, the analysts said.

In some cases, the analysts said, researchers have suggested that well-designed refundable tax credits might increase fairness and resource allocation efficiency.

Studies have suggested that the EITC has helped lead to a big increase the employment and earnings of single mothers that took place in the 1990s, the analysts said.

In the past few years, as the result of the weak economy, older tax credits, and new, stimulus-related tax credits, the average individual income tax rate for households in the bottom 40 percent of the income distribution has been negative, the analysts said.

The analysts also talk about questions about the complexity of administering the premium assistance tax credit.

PPACA lets individuals ask to get an advance on the premium assistance tax credit that they expect to collect, so that they can use the amount to pay for health coverage in 2014.

The government is supposed to pay the advance payments directly to the health insurers, and PPACA will limit how much individuals have to pay back if the government pays an advance premium assistance tax credit amount that happens to be bigger than what an individual actually qualifies for.

The amount the individual ends up qualifying for will depend on how much the individual earns, who else is in the individual’s family, and how much others in the individual’s family earn, and the initial, preliminary credit determination will depend on what those factors look like two years before the individual officially gets the credit, the analysts said.

“The amount of the credit will later be recomputed on the basis of the taxpayer’s characteristics in the year that the subsidy is paid,” the analysts said. “As a result, some recipients may have to repay part or all of any overpayment if changes in their family’s composition and income affect their eligibility for the credit or its amount.”

*Modified from LifeHealthPro.com article

 

0

New regulations shed light on looming health-care reform costs for businesses

January 16, 2013

The ramifications of health care reform for business owners are coming into focus as regulators float new rules to govern employer-sponsored coverage.

  • Lost in the political fervor over the fiscal cliff, the Internal Revenue Service recently proposed new regulations to govern what has been dubbed the “employer mandate” section of the Affordable Care Act. The provision, which takes effect next year, requires companies with 50 or more employees to either provide adequate and affordable coverage to their workers or pay tax penalties.

But just how are those 50 to be counted?

Business owners have been waiting to find out how part-time and seasonal employees will count toward staff totals, how owners of more than one business are supposed to tally their workers, and of course, exactly how steep the penalties will be for failing to provide coverage.

The IRS addresses several of those issues with its newly proposed regulations. Here’s a look at what we now know about the employer health care requirements, as well as three key questions that remain unanswered.

Included in the proposed rules

A formula for calculating full-time equivalents: The health care law set the threshold for large-employer penalties at 50 full-time employees and full-time equivalents, but left the definition of those terms up to the IRS.

  • The agency has proposed counting all employees who work an average of 30 hours per week as full-time workers and calculating full-time equivalents by adding up the total number of hours worked by part-time employees each month and dividing by 120. Thus, a company with 45 full-time employees and eight part-timers who each work 85 hours per month (about 20 hours each per week) would be subject the large-employer coverage mandate (5.66 full-time equivalents + 45 full-time employees = 50.66 employees).

A slim margin-of-error for no-coverage penalty: The law states that a no-coverage penalty shall apply to any eligible large company that “fails to offer [coverage] to its full-time employees,” and the penalty has been pegged at $166.67 per month multiplied by the number of full-time employees, excluding the first 30. By that formula, a firm with 51 full-timers that doesn’t provide coverage would generally pay $3,500 per month (21 X $166.67).

But while that language granted regulators permission to penalize large firms that do not immediately provide benefits to each and every full-time employee, the IRS has granted some leniency. The new regulations would only enforce the non-coverage penalty for employers who fail to offer coverage to more than 5 percent of their employees (or five workers, whichever is larger).

  • The inclusion of paid-leave hours: But what about paid vacation, holidays or extended leaves—do those hours count toward monthly totals for each employee?

This was a pressing question for many business owners, and most of them won’t like the answer. Regulators have suggested that hours used to determine full-time status will include hours worked and hours for which employees are entitled to compensation even if no work is performed. That means time spent away for paid vacation, illness, maternity leave and even jury duty can push workers over the threshold for full-time benefits.

  • A transition rule for determining employer-size status: Business owners must make their own large- or small-employer determination on an annual basis by counting the number of full-time employees and equivalents they had during each month of the past calendar year.

But for the first year, to ease the transition, regulators have included a provision that allows them to count their employees for any six-month period in 2013 to determine their size status for 2014. The rules also delay the penalty for failing to provide coverage to employees’ dependents until 2015 so long as large employers that don’t yet offer those benefits take steps toward implementing them by 2015.

  • A delayed start for non-calendar year plans: The law states that the employer mandate provisions will take effect on January 1, 2014, which left business owners with fiscal-year (rather than calendar-year) health care plans wondering whether they would be held to that start date (which may fall right in the middle of their current plan) or permitted to wait until the start of their 2014 fiscal year. The proposed regulations grant them that break, noting that large businesses will not be subject to penalties until the start of their plan year for 2014.

Still up in the air

What constitutes a controlling interest in a business? The language in these latest proposals remains vague for owners of multiple businesses and part-owners of a single business. For example, if a pair of business partners share ownership of two companies, each taking a two-thirds majority stake in one firm and one-third ownership of the other, the regulations do not specify whether they will each be forced to count only one entity’s employees toward their respective totals or whether they will both count all workers.

What constitutes a seasonal employee?

The regulations leave the term “seasonal employee” open to interpretation when calculating their contribution to a company’s size status and their eligibility for health benefits. In one case, the regulations refer to definitions of “seasonal employee” set by the Labor Department, but later, regulators state that through at least the end of 2014, employers will be responsible for using a “reasonable good faith interpretation” of the term to determine which of their workers should be considered seasonal.

What constitutes adequate and affordable care? While the IRS has started to clarify the tax penalty side of the health reform equation, plenty of large employers are still waiting for the Department of Health and Human Services to define the law’s essential health benefits package — in other words, they haven’t yet been told what type of medical and health-related expenses their plans must cover for full-time employees. Until then, projecting future health costs for many businesses remains difficult.

*Modified from a Washington Post article

0

ObamaCare’s Health-Insurance Sticker Shock

Thanks to mandates that take effect in 2014, premiums in individual markets will shoot up. Some may double.

By MERRILL MATTHEWS AND MARK E. LITOW

Health-insurance premiums have been rising—and consumers will experience another series of price shocks later this year when some see their premiums skyrocket thanks to the Affordable Care Act, aka ObamaCare.

The reason: The congressional Democrats who crafted the legislation ignored virtually every actuarial principle governing rational insurance pricing. Premiums will soon reflect that disregard—indeed, premiums are already reflecting it.

Central to ObamaCare are requirements that health insurers (1) accept everyone who applies (guaranteed issue), (2) cannot charge more based on serious medical conditions (modified community rating), and (3) include numerous coverage mandates that force insurance to pay for many often uncovered medical conditions.

Guaranteed issue incentivizes people to forgo buying a policy until they get sick and need coverage (and then drop the policy after they get well). While ObamaCare imposes a financial penalty—or is it a tax?—to discourage people from gaming the system, it is too low to be a real disincentive. The result will be insurance pools that are smaller and sicker, and therefore more expensive.

How do we know these requirements will have such a negative impact on premiums? Eight states—New Jersey, New York, Maine, New Hampshire, Washington, Kentucky, Vermont and Massachusetts—enacted guaranteed issue and community rating in the mid-1990s and wrecked their individual (i.e., non-group) health-insurance markets. Premiums increased so much that Kentucky largely repealed its law in 2000 and some of the other states eventually modified their community-rating provisions.

States won’t experience equal increases in their premiums under ObamaCare. Ironically, citizens in states that have acted responsibly over the years by adhering to standard actuarial principles and limiting the (often politically motivated) mandates will see the biggest increases, because their premiums have typically been the lowest.

Many actuaries, such as those in the international consulting firm Oliver Wyman, are now predicting an average increase of roughly 50% in premiums for some in the individual market for the same coverage. But that is an average. Large employer groups will be less affected, at least initially, because the law grandfathers in employers that self-insure. Small employers will likely see a significant increase, though not as large as the individual market, which will be the hardest hit.

We compared the average premiums in states that already have ObamaCare-like provisions in their laws and found that consumers in New Jersey, New York and Vermont already pay well over twice what citizens in many other states pay. Consumers in Maine and Massachusetts aren’t far behind. Those states will likely see a small increase.

By contrast, Arizona, Arkansas, Georgia, Idaho, Iowa, Kentucky, Missouri, Ohio, Oklahoma, Tennessee, Utah, Wyoming and Virginia will likely see the largest increases—somewhere between 65% and 100%. Another 18 states, including Texas and Michigan, could see their rates rise between 35% and 65%.

While ObamaCare won’t take full effect until 2014, health-insurance premiums in the individual market are already rising, and not just because of routine increases in medical costs. Insurers are adjusting premiums now in anticipation of the guaranteed-issue and community-rating mandates starting next year. There are newly imposed mandates, such as the coverage for children up to age 26, and what qualifies as coverage is much more comprehensive and expensive. Consolidation in the hospital system has been accelerated by ObamaCare and its push for Accountable Care Organizations. This means insurers must negotiate in a less competitive hospital market.

Although President Obama repeatedly claimed that health-insurance premiums for a family would be $2,500 lower by the end of his first term, they are actually about $3,000 higher—a spread of about $5,500 per family.

Health insurers have been understandably reluctant to discuss the coming price hikes that are driven by the Affordable Care Act. Mark Bertolini, CEO of Aetna, the country’s third-largest health insurer, broke the silence on Dec. 12. “We’re going to see some markets go up by as much as 100%,” he told the company’s annual investor conference in New York City.

Insurers know that the Obama administration will denounce the premium increases as the result of greedy health insurers, greedy doctors, greedy somebody. The Department of Health and Human Services will likely begin to threaten, arm-twist or investigate health insurers in an effort to force them into keeping their premiums more in line with Democratic promises—just as HHS bureaucrats have already started doing when insurers want premium increases larger than 10%.

And that may work for a while. It certainly has in Massachusetts, where politicians, including then-Gov. Mitt Romney, made all the same cost-lowering promises about the state’s 2006 prequel to ObamaCare that have yet to come true.

But unlike the federal government, health insurers can’t run perpetual deficits. Something will have to give, which will likely open the door to making health insurance a public utility completely regulated by the government, or the left’s real goal: a single-payer system.

Mr. Matthews is a resident scholar with the Institute for Policy Innovation in Dallas, Texas. Mr. Litow is a retired actuary and past chairman of the Social Insurance Public Finance Section of the Society of Actuaries.

0

Insurers’ 2014 hikes already taking toll

If you work for a small business, your next health insurance premium may give you sticker shock.

Many of the small-business and individual insurance policies are working the health reform law’s 2014 fees into their 2013 bills, contributing to double-digit premium increases for some people.

All those new consumer benefits packed into the health reform law — birth control without a co-pay, free preventive care and limits on when insurers can turn down a customer — had to be paid for somehow.

So the law’s drafters included a new tax on health insurers, starting at $8 billion in 2014 and increasing to $14 billion within four years, to help meet the new expenses. And insurers in 2014 will also have to pay a “reinsurance contribution” to cushion health plans that end up with a lot of sick customers under new rules requiring them to cover people with pre-existing conditions.

Some health insurance companies are getting a jump-start, passing on those 2014 fees to consumers in policies that start in 2013. While insurance rates have been going up for years — and not all of the new increases can be pinned to the health law — the hikes will certainly give more fuel to Obamacare critics.

  • Insurers say they have no choice but to increase premiums to cover those costs. But it’s hitting pocketbooks sooner than some people expected, and that’s causing controversy.

Everyone, even many of the law’s supporters, admit premiums are going to go up under the health law — although many people will get subsidies to help pay for coverage. Many of the costs — and the priciest benefits — were pushed beyond the 2012 election to 2014. But if the public revolts when they see 10 percent,15 percent or 20 percent rate hikes, already shaky support for the health law could suffer.

That means there’s a lot at stake for insurance companies and the law’s supporters when consumers see their health insurance bills. The law’s backers have a history of using steep rate increases to garner public support for health reform — and against insurers. One turning point that helped the law’s passage was when Democrats blasted a 39 percent rate increase requested by Anthem Blue Cross in California in early 2010.

Now, insurers are being proactive, arguing the health law is driving the increase in prices.

  • “There’s a massive new health insurance tax that starts in 2014,” said Robert Zirkelbach, a spokesman for industry group America’s Health Insurance Plans. “For policies that are sold in 2013 and extend into next year, there’s going to be taxes imposed. … As a result, like all taxes, they will be reflected in premiums charged.”

But insurers are already getting in trouble with at least one state insurance commissioner. California Insurance Commissioner Dave Jones said this week that Anthem Blue Cross is “unlawfully” including the 2014 fees in its 2013 rates.

“California state law requires that premiums bear a relationship to the insurance sold to a particular customer,” Jones told POLITICO. “In this case, what’s happening is that Anthem Blue Cross is collecting from customers … a fee that Anthem Blue Cross doesn’t have to pay until 2014.”

Anthem spokeswoman Kristin Binns said the company has to collect the fees in yearlong policies that start in 2013 because they’ll extend into 2014. And the fee is prorated in a customer’s premium so they’re paying for only the 2014 part of the policy.

Jones said that doesn’t make it right. “They should wait until 2014 to do it.” Anthem’s not alone. A review of rate filings posted on a website managed by the Department of Health and Human Services shows many insurers are charging 2014 fees in new policies and renewals issued in 2013.

Premiums for small group policies from CareFirst BlueChoice in the District will rise an average of 11.8 percent after April 1.

The price of an Aetna small group plan in Illinois will jump 13 percent in 2013 and 16.5 percent in Pennsylvania. A small group policy from Anthem in Connecticut will increase 13.8 percent this year, too. All of those plans said in their filings that the 2014 health reform law fees account for at least a portion of the price spikes .

The health insurance tax is going to have the largest impact. It is expected to increase premiums by about 1.9 percent to 2.3 percent in 2014, according to a study by Oliver Wyman that has been touted by the insurance industry.

Insurance giant Aetna said in its rate filings that the tax on health insurers accounts for 1 percent of its proposed premium increase, and the reinsurance fee accounts for 0.5 percent. Several insurers also said the new preventive care requirements, such as birth control coverage without a co-pay, contribute to their new rates. And they point to medical costs, which are increasing more slowly than they used to but still faster than the overall economy is growing.

CareFirst BlueCross BlueShield spokesman Michael Sullivan said the fee increases in its policies will be prorated for the portion of the yearlong policy that extends into 2014. He called it a “fairly common industry practice.” “The approach that we’re taking here is making sure that the share of those things we have to pay in 2014 is reflected in the premiums,” Sullivan said.

* Modified from an article by By JENNIFER HABERKORN | 1/11/13

 

0

OBAMACARE LAYOFFS, HIRING FREEZES BEGIN

Obamacare opponents warned that forcing companies employing 50 or more full-time workers to buy healthcare would prompt employers to slash jobs and worker hours. And that’s exactly what’s happening, says one of President Barack Obama’s favorite economists, Mark Zandi of Moody’s Analytics. “It will have a negative impact on job creation” this year, says Mr. Zandi.

The Obamacare employer mandate doesn’t go into effect until January 1, 2014, but the government requires businesses to track worker schedules for three to 12 months in advance. That means many employers plan to get a jump start on avoiding Obamacare’s $2,000 per-worker fine by firing workers now, reducing employee hours, or replacing full-time employees with part-time workers.

A survey by the International Franchise Association finds that 31% of franchisees say they plan to cut staff to duck under Obamacare’s 50-employer mandate. And another study by Mercer consulting firm found that half of businesses who don’t presently offer health insurance plan to reduce employee hours to avert triggering Obamacare’s penalties.

As Breitbart News has reported, Pennsylvania Community College of Allegheny County has already slashed the hours of 400 adjunct instructors, support staff, and part-time teachers to sidestep the Obamacare fines. Doing so will save the already cash-strapped college an estimated $6 million.

Other Obamacare provisions, like the medical devise excise tax, have forced Stryker medical supply to cut 1,170 positions, despite the fact that the founder of the company’s grandson was among Mr. Obama’s biggest campaign donors. Other medical device makers like Boston Scientific, Dana Holding Corp., Welch Allyn, Medtronic, Kinetic Concepts, and Smith & Nephew have similarly forecast the needs to cut hundreds of jobs each as the result of Obamcare.

The day after Mr. Obama’s reelection, a Las Vegas employer fired 22 of his 114 employees citing Obamacare regulations as the culprit. Christine Ippolito of Compass Workforce Solutions says companies just under the 50 employee threshold now plan to hold off on hiring to avoid triggering the $2,000-per worker penalty. Ernie Canadeo, the president of EGC Group advertising agency, agrees. Mr. Canadeo says he had planned to hire 10 workers this year, but may wait so as not to cross the 50-worker mark.

The looming Obamacare layoffs and hiring freezes come as a Labor Department report announced today that the unemployment rate remains at 7.8% (revised up from the originally reported 7.7%). Presently, 22.6 million Americans are either unemployed, underemployed, or marginally attached to the work force.

*Modified from an article by Wynton Hall published January 5, 2013

0

Health Insurers Raise Some Rates by Double Digits

Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.

Dave Jones, the California insurance commissioner, said some insurance companies could raise rates as much as they did before the law was enacted. Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own.

In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders, according to the insurers’ filings with the state for 2013. These rate requests are all the more striking after a 39 percent rise sought by Anthem Blue Cross in 2010 helped give impetus to the law, known as the Affordable Care Act, which was passed the same year and will not be fully in effect until 2014.

In other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders. The rate increases can amount to several hundred dollars a month. The proposed increases compare with about 4 percent for families with employer-based policies.

Under the health care law, regulators are now required to review any request for a rate increase of 10 percent or more; the requests are posted on a federal Web site, healthcare.gov, along with regulators’ evaluations.

The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability. New York, for example, recently used its sweeping powers to hold rate increases for 2013 in the individual and small group markets to under 10 percent. California can review rate requests for technical errors but cannot deny rate increases.

The double-digit requests in some states are being made despite evidence that overall health care costs appear to have slowed in recent years, increasing in the single digits annually as many people put off treatment because of the weak economy. PricewaterhouseCoopers estimates that costs may increase just 7.5 percent next year, well below the rate increases being sought by some insurers. But the companies counter that medical costs for some policy holders are rising much faster than the average, suggesting they are in a sicker population. Federal regulators contend that premiums would be higher still without the law, which also sets limits on profits and administrative costs and provides for rebates if insurers exceed those limits.

Critics, like Dave Jones, the California insurance commissioner and one of two health plan regulators in that state, said that without a federal provision giving all regulators the ability to deny excessive rate increases, some insurance companies can raise rates as much as they did before the law was enacted.

“This is business as usual,” Mr. Jones said. “It’s a huge loophole in the Affordable Care Act,” he said. While Mr. Jones has not yet weighed in on the insurers’ most recent requests, he is pushing for a state law that will give him that authority. Without legislative action, the state can only question the basis for the high rates, sometimes resulting in the insurer withdrawing or modifying the proposed rate increase.

The California insurers say they have no choice but to raise premiums if their underlying medical costs have increased. “We need these rates to even come reasonably close to covering the expenses of this population,” said Tom Epstein, a spokesman for Blue Shield of California. The insurer is requesting a range of increases, which average about 12 percent for 2013.

Although rates paid by employers are more closely tracked than rates for individuals and small businesses, policy experts say the law has probably kept at least some rates lower than they otherwise would have been.

“There’s no question that review of rates makes a difference, that it results in lower rates paid by consumers and small businesses,” said Larry Levitt, an executive at the Kaiser Family Foundation, which estimated in an October report that rate review was responsible for lowering premiums for one out of every five filings.

Federal officials say the law has resulted in significant savings. “The health care law includes new tools to hold insurers accountable for premium hikes and give rebates to consumers,” said Brian Cook, a spokesman for Medicare, which is helping to oversee the insurance reforms.

“Insurers have already paid $1.1 billion in rebates, and rate review programs have helped save consumers an additional $1 billion in lower premiums,” he said. If insurers collect premiums and do not spend at least 80 cents out of every dollar on care for their customers, the law requires them to refund the excess.

As a result of the review process, federal officials say, rates were reduced, on average, by nearly three percentage points, according to a report issued last September. In New York, for example, state regulators recently approved increases that were much lower than insurers initially requested for 2013, taking into account the insurers’ medical costs, how much money went to administrative expenses and profit and how exactly the companies were allocating costs among offerings. “This is critical to holding down health care costs and holding insurance companies accountable,” Gov. Andrew M. Cuomo said.

While insurers in New York, on average, requested a 9.5 percent increase for individual policies, they were granted an increase of just 4.5 percent, according to the latest state averages, which have not yet been made public. In the small group market, insurers asked for an increase of 15.8 percent but received approvals averaging only 9.6 percent.

But many people elsewhere have experienced significant jumps in the premiums they pay. According to the federal analysis, 36 percent of the requests to raise rates by 10 percent or more were found to be reasonable. Insurers withdrew 12 percent of those requests, 26 percent were modified and another 26 percent were found to be unreasonable.

And, in some cases, consumer advocates say insurers have gone ahead and charged what regulators described as unreasonable rates because the state had no ability to deny the increases.

Two insurers cited by federal officials last year for raising rates excessively in nine states appear to have proceeded with their plans, said Carmen Balber, the Washington director for Consumer Watchdog, an advocacy group. While the publicity surrounding the rate requests may have drawn more attention to what the insurers were doing, regulators “weren’t getting any results by doing that,” she said.

Some consumer advocates and policy experts say the insurers may be increasing rates for fear of charging too little, and they may be less afraid of having to refund some of the money than risk losing money.

Many insurance regulators say the high rates are caused by rising health care costs. In Iowa, for example, Wellmark Blue Cross Blue Shield, a nonprofit insurer, has requested a 12 to 13 percent increase for some customers. Susan E. Voss, the state’s insurance commissioner, said there might not be any reason for regulators to deny the increase as unjustified. Last year, after looking at actuarial reviews, Ms. Voss approved a 9 percent increase requested by the same insurer.

“There’s a four-letter word called math,” Ms. Voss said, referring to the underlying medical costs that help determine what an insurer should charge in premiums. Health costs are rising, especially in Iowa, she said, where hospital mergers allow the larger systems to use their size to negotiate higher prices. “It’s justified.”

Some consumer advocates say the continued double-digit increases are a sign that the insurance industry needs to operate under new rules. Often, rates soar because insurers are operating plans that are closed to new customers, creating a pool of people with expensive medical conditions that become increasingly costly to insure.

While employers may be able to raise deductibles or co-payments as a way of reducing the cost of premiums, the insurer typically does not have that flexibility. And because insurers now take into account someone’s health, age and sex in deciding how much to charge, and whether to offer coverage at all, people with existing medical conditions are frequently unable to shop for better policies.

In many of these cases, the costs are increasing significantly, and the rates therefore cannot be determined to be unreasonable. “When you’re allowed medical underwriting and to close blocks of business, rate review will not affect this,” said Lynn Quincy, senior health policy analyst for Consumers Union.

The practice of medical underwriting — being able to consider the health of a prospective policy holder before deciding whether to offer coverage and what rate to charge — will no longer be permitted after 2014 under the health care law.

*Modified from a New York Times article dated January 5, 2013

 

 

0

PPACA taxes and fees: Coming to a return near you

The Patient Protection and Affordable Care Act (PPACA) is supposed to provide health insurance subsidy tax credits for about 20 million low-income and moderate-income Americans in 2014, but it also could impose a significant increase in federal income tax payments for some high-income Americans.

Here’s a look at some of the major PPACA taxes and fees that are supposed to take effect in 2014.

  • Health care industries. Insurers, drug companies and medical device manufacturers face new fees and taxes.
  • The insurance industry faces an annual fee that starts at $8 billion in its first year, 2014.
  • Companies that make medical equipment sold chiefly through doctors and hospitals, such as pacemakers, artificial hips and coronary stents, will pay a 2.3 percent excise tax on their sales, expected to total $1.7 billion in its first year, 2013. They’re trying to get it repealed.
  • Pharmaceutical companies that make or import brand-name drugs are already paying fees; they totaled $2.5 billion in 2011, the first year.
  • Employer penalties. Starting in 2014, companies with 50 or more employees that do not offer coverage will face penalties if at least one of their employees receives government-subsidized coverage. The penalty is $2,000 per employee, but a company’s first 30 workers don’t count toward the total.
  • The intentionally uninsured. Nearly 6 million people who don’t get health insurance will face tax penalties starting in 2014. The fines are estimated to raise $6.9 billion in 2016. Average penalty in that year: about $1,200. The penalty provision is supposed to exempt people with conscientious reasons for refusing to buy health coverage and those who cannot find affordable coverage.
  • Upper-income households. Starting Jan. 1, individuals making more than $200,000 per year, and couples making more than $250,000, will face a 0.9 percent Medicare tax increase on wages above those threshold amounts. They’ll also face an additional 3.8 percent tax on investment income. Together these are the biggest tax increase in the health care law.
  • Indoor tanning devotees. The 10 percent sales tax on indoor tanning sessions took effect in 2010. It’s expected to raise $1.5 billion over 10 years. The 28 million people who visit tanning booths and beds each year — mostly women under 30, according to the Journal of the American Academy of Dermatology — are already paying. Tanning salons were singled out because of strong medical evidence that exposure to ultraviolet lights increases the risk of skin cancer.

*Modified from a LifeHealthPro.com article

0

Health Costs on His Mind Small Factory Owner Looks for Ways to Cope With New Law

Sales at Automation Systems LLC, a parts-assembly factory in the Chicago suburbs, dropped 60% following the 2008 financial collapse. Owner Carl Schanstra was able to get the firm back on its feet by breaking into new markets, such as the auto industry. Sales are up 12% this year, and are likely to rise again next year, too.

But for the 34-year-old, the expected growth in sales brings a new concern. He is worried that as Automation Systems continues to expand, it will be subject to a provision in the health-care overhaul that could damage its bottom line.

Mr. Schanstra is contemplating various strategies he can take next year in order to sidestep what he believes are significant burdens of complying with the law. In fact, he’s considering whether he should split his manufacturing firm in two.

That is because his plant, with sales of about $1.6 million for 2012, currently employs 40 full-time workers, mostly low-paid employees who monitor the factory equipment. If sales were to continue to rise, the plant could, conceivably, employ 50 full-time workers in 2014. Under the new health-care law, the Affordable Care Act, businesses with 50 or more full-time equivalent employees will be required, starting in that year, to offer workers health insurance or potentially pay a penalty.

The expense, he says, would drive up the cost of his labor. So he doesn’t want to let employment at the factory reach that number. “I’ll be hammered for having more people at work,” says Mr. Schanstra, who took over the firm when his father died in 2003.

Splitting the business into two would be a “headache,” he acknowledges. But with fewer than 50 full-time equivalent employees in each half of this business, he hopes to avoid paying the penalties that otherwise could amount to at least $40,000 a year. His firm hasn’t offered health-insurance benefits since 2003, when premiums jumped 50%, bringing his yearly outlay for coverage for his staff of 20 people to about $40,000 total.

The Checkup

Automation Systems LLC weighs whether to add workers as Affordable Care Act nears

  • Sales of $1.6 million for 2012, up 12% this year and expected to rise next year
  • 40 full-time employees, 10 shy of the 50 that would trigger health-care requirement
  • Penalty for not offering 50 or more full-time workers health insurance: At least $40,000

Source: The company

Legal and tax experts say breaking up a firm—as Mr. Schanstra is contemplating—generally won’t allow a business owner to stay outside the parameters of the law. According to the Internal Revenue Code, all workers who are employed by a common group of corporations or business partners must be treated as being employed by a single owner.

But an owner could potentially create a spinoff entity if his or her business has more than one revenue stream, and if there are different owners for each entity, says Peter Fleming, a partner with Carnegie, Pa.-based accounting firm Wilke & Associates LLP. He recommends exploring other options first. “The spinoff move is a big step,” he says, because it requires surrendering a portion of the company over to someone else.

Small-business experts say it isn’t surprising that some business owners are thinking of splitting their firms or taking other steps to eschew the health-care overhaul due to the associated costs and regulatory burdens. “It’s a very legitimate question to ask, should I try to find a way to get under the 50-employee threshold,” says Alden Bianchi, a partner with law firm Mintz, Levin, Cohn, Ferris, Glovsky and Popeo PC in Boston. Providing health insurance is “a compensation cost and it’s the job of the business owner to minimize costs,” he adds.

Exploring far-reaching strategies to dodge the employer mandate isn’t uncommon, adds Katie Mahoney, executive director of health-care policy at the U.S. Chamber of Commerce, because, for some business owners, “it’s a matter of dollars and cents and they don’t have it. They find a way around it or they close their business.”

Average premiums for family health-insurance plans have increased 97% since 2002, according to a September study conducted by nonprofits Kaiser Family Foundation and Health Research & Educational Trust.

Business owners have other less-radical options for maneuvering around the law’s provisions.

Some say they’re likely to reduce their workers’ hours or even lay off staff in order to remain below the thresholds established under the act. Under the law, firms with 50 or more full-time-equivalent employees will have to provide “minimum essential” and “affordable” coverage, or pay a penalty for each employee in excess of 30 full-time employees.

Sidney Brodsky, chief executive officer of James Gerard Foods, a gourmet food business in Phoenix with roughly 50 employees, says he is considering “weeding out” his weakest performers to reduce his firm’s head count to below 50 full-time equivalents. He would then bring on contract workers, should he need more help.

Mr. Brodsky has offered health-care benefits to his employees for the past 12 years, though he only contributes 50% toward their premiums. By hovering under the law’s employee threshold, he can continue to offer health benefits to his employees without having to worry about meeting the “minimum essential” mandate. In order to avoid penalties, employers must offer a plan that covers at least 60% of the of the actuarial value of the cost of the benefits. In addition, employers must not charge the employee more than 9.5% of his or her household income toward the cost of health-insurance premiums.

Others plan to shift to part-time workers, because there are no penalties if part-time employees aren’t offered coverage.

Mr. Schanstra says he is thinking of bringing in a partner to take over one half of the business, should he divide it. He is also considering opening a factory in South America—and focus his growth there—catering to industries in that region. “I want to see where the cards fall,” he says. “Splitting the company is not off the table.”

Mr. Schanstra is aware that dividing his business into two may not help him dodge the law’s requirements. His backup plan, if he can’t split his firm, is to keep his head count low or to invest in machinery that would replace workers. He also plans to raise prices as much as 20% starting in January to buffer any health-care related costs he may incur in 2014.

Getting part-time staff is “not a really good functional way for us to operate our business,” he says, because of how employees’ shifts, which rotate 24 hours a day, are scheduled for optimal productivity.

“The unknown makes everyone stop spending and start saving,” he says. “We will be more cautious and leaner and tighten up.”

Corrections & Amplifications
Under the Affordable Care Act, employers with 50 or more full-time equivalent employees more must offer a health plan that covers at least 60% of the of the actuarial value of the cost of the benefits. In addition, employers must not charge the employee more than 9.5% of his or her household income toward the cost of health-insurance premiums. A previous version of this article stated that employers are required to pay 60% of the total cost of the plan’s benefits.

*Modified from a Wall Street Journal Article by Emily Maltby and Sarah Needleman

0

Are 2013 health care tax hikes just the start?

BY 

DECEMBER 26, 2012

WASHINGTON (AP) — New taxes are coming Jan. 1 to help finance the Patient Protection and Affordable Care Act (PPACA). Most people may not notice. But they will pay attention if Congress decides to start taxing employer-sponsored health insurance, one option in play if lawmakers can ever agree on a budget deal to reduce federal deficits.

The tax hikes already on the books, taking effect in 2013, fall mainly on people who make lots of money and on the health care industry. But about half of Americans benefit from the tax-free status of employer health insurance. Workers pay no income or payroll taxes on what their employer contributes for health insurance, and in most cases on their own share of premiums as well.

It’s the single biggest tax break the government allows, outstripping the mortgage interest deduction, the deduction for charitable giving and other better-known benefits. If the value of job-based health insurance were taxed like regular income, it would raise nearly $150 billion in 2013, according to congressional estimates. By comparison, wiping away the mortgage interest deduction would bring in only about $90 billion.

“If you are looking to raise revenue to pay for tax reform, that is the biggest pot of money of all,” said Martin Sullivan, chief economist with Tax Analysts, a nonpartisan publisher of tax information.

It’s hard to see how lawmakers can avoid touching health insurance if they want to eliminate loopholes and curtail deductions so as to raise revenue and lower tax rates. Congress probably wouldn’t do away with the health care tax break, but limit it in some form. Such limits could be keyed to the cost of a particular health insurance plan, the income level of taxpayers or a combination.

Many economists think some kind of limit would be a good thing because it would force consumers to watch costs, and that could help keep health care spending in check. PPACA took a tentative step toward limits by imposing a tax on high-value health insurance plans. But that doesn’t start until 2018.

Next spring will be three years since Congress passed the health care overhaul but, because of a long phase-in, many of the taxes to finance the plan are only now coming into effect. Medicare spending cuts that help pay for covering the uninsured have started to take effect, but they also are staggered. The law’s main benefit, coverage for 30 million uninsured people, will take a little longer. It doesn’t start until Jan. 1, 2014.

 

0