S&S Benefits.....Opinion, Hearsay & News Review

In Illinois, a new law passed for fully insured plans that has “ologists” covered as in-network as of June 1^st. The person who sees an “ologist” while using an in-network facility can have no higher out of pocket expenses than if the person were in-network. The patient cannot be subject to balance billing if they have assigned benefits in writing to the provider. The benefits are for radiologists, pathologists, anesthesiologists, neonatologists and ER department services.  Will we see providers asking for assignment of benefits, once they figure it out? They do now.

Try to define the typical health plan and what is covered. Mercer conducted a survey attempt to do this. Results were somewhat predictable in that most major services are covered by employer plans. However, some items of interest were: Nicotine addiction was covered by 64% and TMJ by 55% of all respondents. Limits were placed on physical therapy (58% had limits), DME (41%) and organ transplants (22%). Mercer surveyed 800 employers.

HHS has announced that health insurers seeking rate increases of 10% or more will face increased scrutiny starting in September. The Feds don’t have the authority to do anything about it, but the implication will be there. Queen Sebelius is again trying to insert control that belongs to state regulators.

Meanwhile the feds have approved one year waivers for 1,372 employers that have annual plan limits below those set by PPACA. The waivers cover nearly 3.1 million enrollees, reportedly mostly union plans or for companies with large union employee populations.  Until we see a list of waiver denials, we will not have any idea of how political this provision has become.

A PwC survey indicates  that 22% of employers have in-network deductibles of at least $1,000, up from 16% in 2010 and 8% in 2009. Double that percentage imposed deductibles of at least $1,000 for out of network services. Sixty-nine percent of employers require employees to  pay more than 20% of premium as contributions for their health plans. This year, 17% of employers reported the greatest percentage of their employees were enrolled in high deductible plans, up from 13% in 2010 and 8% in 2009. Not noting that high deductible plans can be PPO, the survey said 57% of employers reported the highest enrollment in their traditional PPO plans.

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A relatively new interpretation of PPACA is out. A report in Business Insurance says that lawyers reading the bill have noted that employers who have employees join the exchanges with a premium subsidy must pay the $2,000 fine on all full-time employees working over 30 hours a week, not just those joining the exchanges!

Romneycare anyone? Today the wait time to see an internist is 48 days and family doc is 36 days in MA. Pediatricians are better at 24 days and 53% of family docs are not accepting new patients. Only 56% of family docs accept Romneycare while 87% of the same group accept Medicare. The number of ER visits has risen. Looking forward to the consequences of Obamacare?

The Milliman Medical Index measures the total cost of healthcare for a family of 4 covered by a PPO. The 2011 cost is $19,393 per year, an increase of 7.3% over 2010. Included are costs paid by the employer and employee. The employee paid portion of costs now stands at $8,008. Fortune Magazine did a profit margin survey by sector. Pharmaceuticals were 15.9%, medical products and equipment were 11.6%, pharmacy services were 5.8% and medical facilities were 5.3%.

Support for Obamacare has reached a new low. We’d like to think that we are part of the reason (Ha!). An AP-GfK poll shows that support has slipped to 35% while 45% oppose and 17% are neutral. Seniors had less than 30% support for the law, despite the fact that AARP lobbied heavily for the law.

Two Republican congressmen have written to the IRS Commissioner Doug Shulman seeking details on how the IRS intends to spend over 1 billion in funds from the Health Reform Implementation Fund above and beyond the IRS FY 2012 request of $473.3 million for healthcare related funding.  Could that be a salary of $62,500 for each of the 16,000 new IRS agents being hired to enforce the provisions of Obamacare?