Viewing posts from: April 2013

Popular Employee Benefits & Healthcare Legislation Blogs

Posted April 24, 2013 by Megan DiMartino

PPACA has been everywhere lately. Few businesses and individuals are left untouched. For better or worse, it represents one of the largest healthcare policy initiatives in our nation’s history. Here are some of the latest blogs on the matter:

Return to the AP Benefit Advisors blog soon for more on these and other important issues central to the healthcare and benefits industry.

Roofers union calls for Obamacare’s repeal

Posted April 17, 2013 by Megan DiMartino

United Union of Roofers, Waterproofers and Allied Workers International President Kinsey M. Robinson issued the following statement today calling for a repeal or complete reform of President Obama’s Affordable Care Act (ACA):

“Our Union and its members have supported President Obama and his Administration for both of his terms in office. But regrettably, our concerns over certain provisions in the ACA have not been addressed, or in some instances, totally ignored. In the rush to achieve its passage, many of the Act’s provisions were not fully conceived, resulting in unintended consequences that are inconsistent with the promise that those who were satisfied with their employer sponsored coverage could keep it.”

Obama Sees Insurers; Health Law Is Subject

Posted April 16, 2013 by Megan DiMartino

Source: The New York Times

WASHINGTON – President Obama met with insurance industry executives at the White House on Friday to coordinate the introduction this fall of the insurance marketplaces at the heart of the national health care law, and to discuss so-called rate shock if the industry sharply raises premiums.

“We’re all in this together,” Mr. Obama told the executives, according to people with knowledge of the meeting, who spoke on the condition that they not be identified discussing it.

Government and industry, which battled while forging the law, are now “joined at the hip,” the president said at one point. “We’re going to make it work.”

For weeks, news reports have conveyed industry warnings that the new law could lead to higher premiums for many people, because the policies to be sold under the law’s requirements will be more comprehensive than those many Americans have now. Republicans in Congress, who remain united in opposition three years after the law’s enactment, have held hearings to underscore such warnings.

But the administration says such talk is overblown. Consumers can move from expensive health plans to more efficient, lower-cost policies, officials say, and critics who focus on premiums do not take account of other provisions of the law that limit how much consumers will spend out of pocket for health care.

The administration predicts that those who get coverage after being uninsured are generally going to be younger and healthier than those who have insurance. That will hold down total costs of coverage for insurers and the government, officials say, and tend to hold down premiums in turn. If premiums do increase, they argue, lower-income people can get federal help.

Either way, both sides face a colossal challenge in planning for one of the most complicated and far-reaching social undertakings ever. On Oct. 1, enrollment starts nationwide for the emerging marketplaces where many millions of Americans can shop for coverage. Mr. Obama’s signature Affordable Care Act of 2010 requires most Americans to have health insurance, and provides subsidies for the needy, to expand coverage to an estimated 27 million uninsured Americans – including seven million through the exchanges in the first year.

Mr. Obama had not been scheduled to attend the meeting, but he presided over the entire hour long session, which included his chief of staff, Denis R.

McDonough, and his health and human services secretary, Kathleen Sebelius.

One official called it “productive,” adding that “the president discussed our shared goal of educating Americans about the value of health insurance and the new health insurance marketplaces.”

Among attendees from the industry, which stands to get millions more customers, were Karen M. Ignagni, the head of a trade association for the insurance industry; Chet Burrell of CareFirst BlueCross BlueShield; David M.

Cordani of the Cigna Corporation; Scott P. Serota of the BlueCross BlueShield Association, a federation of local Blue Cross and Blue Shield companies; and Joseph R. Swedish of WellPoint.

Officials said that each side shared information about how it was planning to spread the word about the insurance exchanges and enrollment centers, especially among young people.

Before the meeting, Ms. Sebelius told the House Ways and Means Committee, “There are costs going up and down, but what we know is that they are rising at a much slower rate right now than they did three years ago, before this law was passed. We have insurance departments, many for the first time, with aggressive rate review strategies in place.”

The marketplaces would intensify competition, she said, adding, “When plans have to compete side by side and it’s very transparent, that in and of itself drives prices down.”

Robert Pear contributed reporting.

HHS Delays SHOP (Smallgroup Health Options Program) Exchange until 2015

Posted April 3, 2013 by PHaynes

The Obama administration, through the Department of Health and Human Services (HHS/CMS), announced that it will delay, until 2015, the offer of a choice of plans with health insurance marketplaces specifically for small businesses (defined in most states as employers with less than 50 full-time employees).  The transition policy, outlined in HHS’ latest guidance, would delay implementation of the employee choice model as a requirement for all SHOPs until 2015 plan years.

Many news outlets are already reporting groups that are pressuring HHS/The Administration to reverse their position.  While anything is possible, most industry pundits have little faith that the required IT-infrastructure will be ready, up, running and functional within the next 4-5 months.

Why delay employee choice?

HHS is proposing that employers only be allowed to enroll in one QHP (Qualified Health Plan) in 2014. In addition, state SHOPs would not have to offer employee choice next year.  This policy is intended to provide health plan issuers with additional time to prepare for an employee choice model and to stabilize the small group market in 2014.

Here are a few of the highlights of those seeking reversals.

Modern Healthcare: Reversal Sought For Delay To Small-Business Exchanges
Small business groups and some lawmakers are urging the Obama administration to reverse course on plans to wait one year to give employees of small businesses a choice among health plans obtained through new exchanges. HHS in March proposed delaying the requirement in the 33 states where the federal government will operate insurance marketplaces either alone or in partnership with state officials next year. The comment period on the draft regulations for the small business health options program, known as SHOP, ended April 1 (Block, 4/2, subscription required).

Georgia Health News: Feds Take Slow Approach To Small Firms’ Exchange
Georgia’s small businesses will be limited to offering their employees just a single health plan – instead of several – in an insurance exchange next year. States will get insurance exchanges — online marketplaces offering comparison shopping on coverage — starting Jan. 1, as a result of the Affordable Care Act. Georgia and most other states have opted to have their exchanges run by the federal government. And in those states, the Obama administration has decided to delay offering a choice of health plans in the exchange for small employers until 2015 (Miller, 4/2).

MPR News: MNSURE’s Small Business Options Will be Ahead Of Other States Workers at small businesses that buy health insurance on MNSURE — Minnesota’s new online marketplace — will have access to features that will be delayed in many other states. The federal health care law calls for a system that allows small businesses to buy employee health coverage on a so-called exchange that lets workers choose from a variety of health plans … allowing more choice than the employer picking one plan for all (Stawicki, 4/2).

What are the special enrollment period proposed changes?
HHS/CMS previously established that a special enrollment period is 60 days from the date of the triggering event for the Marketplace and SHOP.

They now propose to amend the special enrollment period for the SHOP to 30 days for most applicable triggering events, so that it aligns with the special enrollment periods for the group market established by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

To further align the SHOP provisions with HIPAA, they also propose that if an employee or dependent becomes eligible for premium assistance under Medicaid or the Children’s Health Insurance Program (CHIP) or loses eligibility for Medicaid or CHIP, this would be a triggering event, and the employee or dependent would have a 60-day special enrollment period to select a QHP. This triggering event had previously been inadvertently omitted from the regulations.

HHS/CMS is also proposing to change special enrollment periods to clarify that a dependent of a qualified employee is not eligible for a special election period if the employer does not offer coverage to dependents.

Where can I find more information?

More information will be available following the comment period.


Related News:

  • Tens of thousands Obamacare ‘navigators’ to be hired.  Expected to average $20 per hour, they are to provide unbiased direction and advice and free translators (regardless of native language).   See CMS’ 63-page rule on this.
  • Of note, Joe Klein (Time Magazine) is citing this as flat out incompetence.  “The key incentive for small businesses to support Obamacare was that they would be able to shop for the best deals in health care super-stores—called exchanges. The Administration has had 3 years to set up these exchanges. It has failed to do so.”

PPACA SHOP – Small Business Insurance Market Delayed a Year

Posted April 3, 2013 by Megan DiMartino

Bloomberg – Small business employees will have to wait a year before they can choose their own medical plans after the Obama administration delayed a part of the Patient Protection and Affordable Care Act intended to provide them with coverage options.

Starting in 2014, workers at companies with fewer than 100 employees were supposed to have been able to choose from a variety of health plans through new small-business insurance marketplaces. They’ll instead wait until at least 2015, according to regulations released by the Department of Health and Human Services. To learn more, read the article on

2013 Revised Healthcare Reform Timelines, Version 9.0

Posted April 1, 2013 by PHaynes

If you want to see 10 pages of health reform in a 1 page timeline (well, 1 page for Employers and 1 page for Employees) then please visit our website (

But, if you are looking for details specific to just a certain year or plan, then you can’t do better than this implementation timeline from The Kaiser Family Foundation.

AP Benefit Advisors’ Timelines

Kaiser Family Foundation Implementation Timeline

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