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

S&S Benefits Consulting, Inc.  219 Darien , Dundee , IL 60118   Phone: 847-428-5353, Fax:847-428-9876

Email :jseiler@ssbenefits.net                                              http://www.ssbenefits.net/    May 2014 Issue


The American Health Policy Institute conducted a confidential survey of over 100 large employers. The total cost of Obamacare for all employers of 10,000 or more employees is estimated at $151 to $186 billion from 2014 to 2023. That breaks down to $4,800 to $5,900 per employee. The percentage increase in costs due to PPACA is estimated at 4.3%  in 2016, rising to 5.1% in 2018 and 8.4% in 2023.


The National Federation of Independent Businesses estimated the cost of a family policy with employer provided insurance will rise by $6,800 in the next decade just due to the health insurance tax on fully insured policies. They estimate that the tax will cause GDP to be $23 to $35 billion smaller.


Another consequence of the Obamacare law is that almost all insurance companies have stopped selling individual plans until open enrollment next November, since the law bans insurers from rejecting customers in poor health. Companies have figured out that mostly those in bad health would be applying outside of open enrollment periods.


UHC is making a concerted attempt to limit retail purchases of medications that patients repeatedly use. Starting May 1st, patients will be allowed to have two fills at a retail pharmacy. After that, the patient must order Rx through mail order or the script will cost the full out of network charge.


The taxes under PPACA will cost the average exchange plan $354 per person in 2014. However, that cost is reduced to $196 for an insured plan and reduced even further to $94 for a self-funded plan. By 2016, the per person cost of the taxes will be $361 for the exchange, $203 for a commercial fully insured plan and $59 for a self-funded plan. No wonder so many more small employers are considering self-funding.


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Analysis from Express Scripts shows that based on their medication usage, PPACA enrollees on the exchanges are more sick than non-exchange patients. They say six in 10 of the costliest medications used by exchange enrollees have been specialty drugs, a 47% difference from non-exchange enrollees.


According to a report by IMS Health Holdings, spending on Rx rose 3.2% in 2013 to $329.2 billion, a rebound from a decline in spending of 1% in 2012. Ironically, spending for less expensive generic drugs rose from 84% to 86% of all prescriptions issued.


HighRoads, a health compliance plan leader, released a survey which shows that employers are adjusting their plan designs to avoid the “Cadillac tax” in 2018 under Obamacare. Two-thirds of 2014 plans have in-network out of pocket maximums of $2,500 or more, up from 58% in 2013 and 49% in 2012. Currently 25% of all plans have a high deductible.


After spending over $300 million of taxpayer money, the Oregon Obamacare exchange has failed and they are turning things over to the federal exchange. That should make things especially interesting in Oregon if the courts ever rule that the law as written cannot be violated. Technically, those enrolled in the federal exchange are not allowed a subsidy, but in state exchanges a subsidy is allowed.


Data provided to the House Oversight and Investigations Subcommittee shows that as of April 15th, 2014, only 67% of people enrolled in the federal exchanges had paid their premium. Meanwhile, the White House is claiming that 8 million people have enrolled. We are not sure if the administration knows the difference between being enrolled and being covered.