Is More ACA Confusion Possible? You Bet.

Is More ACA Confusion Possible You Bet

As if the ACA debate couldn’t get more complex – the U.S. Department of Justice (DOJ) has declined to defend an ACA challenge filed by Texas and several other Republican states, seeking to invalidate the pre-existing coverage mandate – and therefore the entire law.  The suit alleges that since the individual mandate was reduced to… [Read More]

“Right to Try” Is Compassionate Legislation, but Does It Make Sense?

research drug at science lab

President Trump signed the Right to Try Act yesterday, which cleared the House in late May, having been approved by the Senate in 2017. This legislation gives terminally ill patients the ability to access experimental drugs which have passed Phase 1 of the FDA approval process but are not yet officially approved. It is interesting to… [Read More]

Anthem’s Entry Signals Further Stop Loss Market Growth

Arrows up isolated, many different styles, illustration vector

The tectonic plates continue to shift underneath the health insurance market. Ten years ago, most medical carriers were predominantly “risk-bearing” entities – taking in premium dollars and in return, paying claims. But as those claim dollars rose and the Affordable Care Act (ACA) introduced additional fees to the insurance market more employers moved towards self-funding,… [Read More]

Warning – The Healthcare Status Quo Is at Risk

5-2-16 An Exciting Day in Washington

Whether the Affordable Care Act (ACA) was ever an effective way to combat the issues facing our healthcare system is arguable – but it is clear that our political process has not helped. The Commonwealth Fund recently reported that the uninsured rate for working-aged Americans (between 19 and 64) has increased from 12.7% in 2016 to… [Read More]

Emergency Room Claims – Self-Diagnose or Pay the Price?

An emergency department sign.

While most of us know that emergency room (ER) care is more expensive that non-emergent care, you may not have realized just how much more. In some cases, you could be responsible for the entire cost of your hospital ER visit. We’re hearing an increasing number of stories from patients who are being billed for the… [Read More]

ACA Penalties for Failure to Provide or Have Coverage Are Still Around

finance business calculation with calculator and pen on chart

There is a lot of confusion out there concerning ACA penalties. The 2018 tax act did not eliminate any employer penalties for not offering health insurance coverage. The only change was reducing the individual coverage penalty to zero – however, this change does not go into effect until 1/1/2019. Applicable large employers (ALEs) with more… [Read More]

Participation: Is It a Good Thing or a Bad Thing?

prepare filling item form, business background

One of the central tenets of underwriting medical plans is to avoid adverse selection at all cost. Adverse selection results when a plan is designed or priced in such a way that it only adequately incentivizes sicker employees to enroll; failing to attract good risk to offset the bad. For this reason, most insurers historically… [Read More]

Chipping Away at the Affordable Care Act Isn’t Getting to the Real Issue

Health Care Reform sign

So, the Affordable Care Act’s (ACA’s) individual mandate penalty has been reduced to zero, the Cadillac Tax has been delayed for two more years (and may likely never be implemented) and the Children’s Health Insurance Program (CHIP) has been funded for six years. Now more than 1.75 million children in 20 states, who were at risk of losing their healthcare, can breathe… [Read More]

A Look at 2018 Healthcare Issues

Illustration of 2018 greeting for new year celebration with heartbeat design

Price Waterhouse’s Health Research Institute released their 2018 Top Health Industry Issues report. 2017 was quite a year for healthcare as the industry tried to address controlling healthcare costs in light of the failure of legislative reform along with natural disasters, opioid abuse and cyber security – and all of those issues continue. With the inability… [Read More]

Wellness Incentive Rules – and the Saga Continues…

Close-up hand businessman give the small gift box

Yep, the Equal Employment Opportunity Commission (EEOC) is back to the drawing board, reworking and finalizing new wellness regulations for 2019. We know that all wellness programs must be deemed “voluntary” for employees to participate in; but employees can be penalized thousands of dollars for not doing a screening or answering personal health questions through… [Read More]