Health Care Bill Update

On October 13, 2009, the Senate Finance Committee approved Senator Max Baucus’s (D-Montana) health care bill, the America’s Healthy Future Act, by a vote of 14 to 9. Senator Olympia Snowe (R-Maine) was the only Republican to vote with the committee’s 13 Democrats in favor of the bill. The Congressional Budget Office (CBO) estimated the cost of the bill at $829 billion over 10 years.

The bill will now be fully merged with Sen. Kennedy’s HELP bill with hands-on participation from Senate Majority Leader Harry Reid and key Administration officials. Some of the most contentious issues to be resolved in the merger include the fate of the HELP bill’s government option, the Finance Committee’s weak individual mandate penalties and new taxes and fees on the insurance industry.  

The stated aims of the legislation are to lower costs, provide quality, affordable health care coverage, make purchasing health insurance easier, prohibit discrimination due to health factors and improve the way the health care system delivers care. However, many in Congress are divided on whether the bill can meet these objectives. Opponents of the bill have argued that it will increase costs for many Americans, rather than making health care more affordable.  

Stayed tuned for MANY updates as this bill is vollyed about  the Senate and House.

BREAKING NEWS: AP Story on Increased Costs Caused by Senate Finance Proposal

The Associated Press is out with another story on the new PricewaterhouseCoopers’ report highlighting the increased costs for individuals and families as a result of proposals from the Senate Finance Committee.  Here are some key excerpts:

• “…a new accounting firm study that projects the legislation would add $1,700 a year to the cost of family coverage in 2013, when most of the major provisions in the bill would be in effect.  Premiums for a single person would go up by $600 more than would be the case without the legislation, the PriceWaterhouseCoopers analysis concluded.”
• The study projected that in 2019, family premiums could be $4,000 higher and individual premiums could be $1,500 higher.”
• It concluded that a combination of factors in the bill — and decisions by lawmakers as they amended it — would raise costs.”
• “Other factors leading to higher costs include a new tax on high-cost health insurance plans, cuts in Medicare payments to hospitals and doctors, and a series of new taxes on insurers and other health care industries, the report said.”
• ‘Health reform could have a significant impact on the cost of private health insurance coverage,’ it concluded.”
• the industry stopped short of signaling all-out opposition.  ’We will continue to work with policymakers in support of workable bipartisan reform,’ Ignagni said in her memo.”

Full AP Article

NYS Health Coverage Expansion Through Age 29

Effective September 1, 2009  the “Age 29” law, permits eligible young adults through the age of 29 to continue or obtain coverage through a parent’s group policy. Insurers will notify employees of this benefit. Employees or their eligible dependents may then elect the benefit and pay the premium, which cannot be more than 100% of the single premium rate. This benefit, referred to here as the “young adult option,” is separate and distinct from the “make-available” requirement. It is called the young adult option benefit because it permits eligible young adults to continue their coverage through a parent’s health insurance coverage once they reach the maximum age of dependency under the policy. Young adults may also elect this coverage when they newly meet the eligibility criteria, such as if they lose eligibility for group health insurance coverage.

“Age 29″  Frequently asked questions

Is your Company Prepared for the H1N1 Virus

The Harvard School of Public Health study released several weeks ago found that two out of three U.S. businesses are unprepared to deal with the effects of a flu pandemic, when employee absences can be a major disruption.

The Kineo Group’s Crisis Practice has created a H1N1 Readiness Check List that leverages its principals’ expertise from work at the American Red Cross and other global organizations to help leaders manage their workforce effectively.

• Don’t be taken off guard. Those companies with no crisis plan will be surprised by the extent of employee absences and other disruptions, forcing them to be reactive and accept higher losses;
• Review your existing plan, if you have one. Firms with existing crisis communications plans should review and update their plans for H1N1 flu, referencing the latest government guidance, including visiting www.flu.gov. This effort should start immediately and be reviewed monthly;
• Develop a plan now if you don’t. Organizations without existing crisis plans should immediately formulate a basic H1N1 response plan relying heavily upon published guidance from government agencies and medical associations;
• Form an assessment team. Firms should form a team to quickly assess those recommendations, identify issues unique to their industry and develop an action plan;
• Communicate regularly. All companies should communicate regularly to key stakeholders, particularly employees, about what the company is doing, and provide them clear information on what they need to do to sustain the enterprise.
• H1N1  douments:  H1N1 Legislative Brief, H1N1 Employee Awareness Poster, H1N1 Flu Vaccine Poster. For more detailed flu pandemic planning guides please contact me at jsbradley@chhins.com or 631-329-7268.

New Jersey Prepares to Launch Accountable Care Organization

New Jersey is one of the first states to experiment with accountable care organizations, or ACOs, a relatively new health care model that is similar to the patient-centered medical home, or PCMH, and that links primary care and subspecialist practices with area hospitals to create an integrated delivery system. Providers are accountable for costs and the quality of care delivered, and bonuses and penalties are tied to overall spending and quality measures. Learn more

Money Saving Tips on Brand Name Medications

The next time your doctor prescribes a name brand medication it may be worth checking online or with your local pharmacy to see if there is any special money saving offers available.  Many of these brand name drugs have their own dedicated websites that will provide  specific information to obtain savings.  

Provided below is a SAMPLE of medications that have special money saving offers.  This is not an all inclusive listing, so if you do not see a particular medication listed you may want to research the medication online.

Check here to see the sample Brand Name money savings list.

Stores Offering Free Antibiotics and Updated $4 Generic Drug Deals

Stop & Shop: $9.99 90 Day supply

Walmart: $4 30 Day supply, $10 90 Day supply

Kmart: $5/$10/$15  Generic List

Hannaford: $4 30 Day supply, $9.99 90 Day supply

Target: $4 30 Day supply, $10 90 Day Supply

Giant: $9.99 90 Day supply

Free Antibotics

Publix

Wegmans

Schnucks

Giant  

Three New Federal Healthcare Mandates Will Impact Healthcare Costs

American’s with Disabilities Act (ADA) Amendments

• • Effective October 3, 2009 for all large and small groups.
  • Hearing Aids:
    • Coverage of hearing aids will be standard.
    • Dollar limits mirror Durable Medical Equipment (DME) and Prosthetics and vary by state and plan
    • Limited to one device as follows:
      • Connecticut every 12 months
      • New Jersey every 24 months
      • New York every 3 years 

 Mental Health/Substance Use Parity

• • Effective October 3, 2009 for large (51+ lives) groups.
  • The new law does not allow more restrictive financial requirements for mental health and substance use disorder coverage than for any other medical expense.
  • It specifically states that deductibles, copayments, coinsurance, and out-of-pocket expenses must be in parity.
  • A plan may still have an aggregate lifetime limit and an aggregate annual limit that is applied to both medical and mental health/substance use disorder benefits.
  • The law also prohibits treatment limits on mental health and substance use disorder benefits that are more restrictive than those of medical/surgical benefits. The law specifically requires the following limitations to be in parity:
    • Limits on frequency of treatment
    • Limits on number of visits
    • Limits on number of days of coverage
    • Other similar limits on the scope or duration of coverage.

 Michelle’s Law

• • Effective October 9, 2009 for individual plans, large, and small groups.
  • Prevents dependent children covered under a group health plan from losing coverage if they are forced to take a medically necessary leave of absence from school

Governor Paterson Signs Legislation to Make Health Insurance More Affordable and Improve Access to Health Care

Governor David A. Paterson signed into law three Governor’s Program bills that will make health insurance more affordable and improve access to health care for New Yorkers. The first extends the period of time for COBRA coverage from 18 to 36 months; the second permits families to cover their young adult dependents through age 29 under their job-based insurance; and the third enacts a series of managed care reforms to make health insurance work better for consumers and permit timely access to necessary health services. The effective date of these changes is September 1, 2009.

Summary of New York Dependent Extension to Age 29

Swine Flu Employee Education

Below are links to a variety of swine flu educational resources that will help you stay on top of the situation. They include:

• General information about swine flu from the Centers for Disease Control. The CDC is updating this page several times a day.
• Information about workplace planning for a pandemic such as swine flu from the U.S. Department of Health and Human Services and OSHA.
• Additionally, we encourage you to contact your state and local health departments for additional guidance on this topic.

The CDC has offered recommendations for everyday actions people can take to protect themselves from this new strain of flu.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread that way.
• Try to avoid close contact with sick people.
  • Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
  • If you get sick, the CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.