Health Reform Insights from SPBA Active Past President Fred Hunt
MyHealthGuide Source: Fred Hunt, Active Past President, Society of Professional Benefits Administrators, 4/18/2011, www.SPBATPA.org
CAPITOL HILL is a ghost town for their recess until April 29th.
So, Congressmen and exhausted staff were bailing out as soon as the votes were completed Friday. The good news is that the health related parts reported to you a week ago (such repealing the vouchers based on finding the total household income of employees) in the Continuing Resolution (CR) agreement for the rest of 2011 have been formally voted into law.Also, as predicted, 59 Republican Representatives voted against the CR as too little, but that was made up with 81 Democrats who voted in favor. Statistics mania is now going on, and you will hear reports of all sorts of numbers thrown out as the predicted effects of the same issues. This just reflects that Uncle Sam has all sorts of ways to describe money (such as “appropriated” versus “dispensed”). It is a political game now. The main point is that it is at least a step in the direction of budget discipline.
The Republican-led House also passed the Ryan Budget proposal for 2012, and this will become the political punching bag for the next several months. The vote was strictly along party lines. There is no chance it will be accepted by the Democrat-led Senate, and the President’s speech last week already attacked it.
As an example (but also to avoid confusion), Democrats are saying that the Ryan proposal has a “death tax” since they assume the elderly would spend more of their estates for their end of life care. (Of course, if someone has an estate big enough to be drawn down, they are presumably among the “wealthy” whose taxes other Democrats want to raise for health care.)
However, the “death tax” is different from the Republican accusations that PPACA has a “death panel” in the form of a board that will decide what Medicare services are cost-effective. So, just brace yourself for all kinds of emotional disastrous-sounding rhetoric from now until the 2012 elections.
1099 Repeal is finally passed and signed by President Obama
So 13 months after passage, the only PPACA repeal to go through the traditional formal repealand one that had extremely wide bi-partisan supportis only now done.
Coverage Description Transparency Reg is expected to be issued very soon.
This reg is the attempt to create a uniform explanation of coverage in health plans (the 4-page format). Looking to SPBA for answers, the reg writer questions asked question, were informed and sincere.
Our main point is that ERISA plans already have very strict comprehensive rules about summary plan descriptions and letting plan participants know what very customized (to that group of workers) benefits are offered, and that trying to squish that into a one-size-fits-all format is apt to provide less information and thus not fulfill our ERISA duty. We don’t know how much flexibility the reg writers can find in the law to give ERISA and self-funded plans some slack or exception, but the DOL is telling the same message as emphatically as SPBA. Stay tuned.
Supreme Court Remains Mum On PPACA Constitutionality Case
The Supreme Court took no action on last Monday (4/18) on the PPACA constitutionality case. The Court may announce Monday (4/26) at the earliest and certainly no guarantee for then, either. My prediction continues to be that the Supremes will not take the case early, and this unannounced non-inclusion of that issue today reinforces my view.
Broker Medical Loss Ratio (MLR)
The Broker Medical Loss Raito (MLR) bill is slowly gaining momentum to remove brokers from the MLR formula and thus preserve the traditional commission process. (Insurers, triggered by the NAIC MLR formula, may have already migrated in their thinking, and the days of inclusive commissions and bonuses may already be fading.) However, the big factor will be when CBO and then others issue their cost-impact estimates. Congressional support will waiver if the numbers make it seem like taxpayers would be “subsidizing” brokers (taking a revenue loss). (Like the other issues, don’t forget that this is the never-never land of political slash-and-burn wild accusations, with inconvenient reality unmentioned).
HRA, HSA, FSA Billing Gaining Sponsors
The HRA, HSA, FSA bill is gaining Republican co-sponsors (27) in the House to repeal the PPACA restrictions on those plans. The key will be whether this gets associated with one party or the other, because then it becomes a political punching bag. Also, like the broker bill, what cost estimates will be stuck on it? However, if this is your market, this is a positive issue you and your clients can raise with your Congressmen (including Senators) while they are home with you until April 29th. This latest bill is led by Rep. Erik Paulson (R-MN) at (202) 225-2871.
HR Consulting Firms Move Into Broker Space
HR consulting firms have been looking for new profit centers in recent years, and they are now looking to move in on the broker role, to match their services with the new PPACA compliance requirements and advising employers on the “easy” selection of standardized plans under PPACA. This is just an FYI heads-up of an emerging marketplace factor, that HR consulting firms will be positioning themselves as the one-stop experts for employer health benefits needs (but I hear no talk of them taking on any of the fiduciary or licensed functions or actual administration).
Medical Home Demo Projects Cancelled Due to ACOs?
CMS has quietly cancelled the eight state Medical Home demonstration projects. No reasons given, but I am curious, because of the similarity between the Medical Home concept and the ACO concept which PPACA hopes/assumes will be the new dominant form of health provider. Is this an omen?
About SPBA
SPBA’s specialty has always been employee benefits regulations, since TPAs are expected to handle where the rubber meets the road. So we on the SPBA staff want to especially thank you for being the best and brightest and earning tremendous respect from the government officials for your expertise and professionalism in this arena. Visit www.SPBATPA.org.
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