Debate over Mandates in “Essential Benefits Package” Continues

As the Institute of Medicine continues to struggle to complete the “Essential Benefits Package,” they are now calling on the Department of Health and Human Services (HHS) to seek public input. This week, the HSS began gathering feedback from a wide variety of coalitions and interest groups in order to establish the specific mandates that will be included in the mandatory coverage guidelines under federal healthcare law. Once established, private insurers will be required to follow all included mandates to gain access to federally subsidized insurance exchanges by 2014.

As stated by Dan Daly, executive director of the essential health benefits coalition, the Essential Benefits Package and all mandates within are being established “in order to ensure workers can get the health coverage they need,” but not all parties remain optimistic about the initiative. The debate over what should be included in the package is expected to remain heated throughout the upcoming years, putting interest groups at odds with each other as they each struggle to be heard and the question of what will become of current mandates from individual states remains.

Groups like the End Obesity Action Fund, the National Health Council (which advocates for people with chronic diseases and disabilities), and the Habilitations Benefits coalition have already begun to petition the HSS to include representative mandates. Orrin Hatch, a republican member of the senate finance committee’s subcommittee on health care urged HHS secretary Sebelius to “examine these mandates with care and to understand that these mandates are a lead weight around the necks of families and businesses at a time of economic uncertainty and high unemployment” in a recent statement.

While the HHS has stated that it believes flexibility and affordability should remain paramount, it remains unclear how either will be established. Last week, the IOM issued recommendations involving the methodology for establishing the specific mandates but has not yet issued any specifics. Many expect health insurance premiums to rise until all issues with the Essential Benefits Package are resolved.

Report by Melissa Cenker

Any opinions expressed within this and all posts are the opinions of the third parties quoted and do not necessarily represent the opinions of Princeton HR Solutions, Melissa Cenker, or Melissa Cenker Consulting

Healthcare Premiums Continue to Rise in Era of Increasing Mandates

“This year, the average premium for a family hit $15,073,” reported Forbes contributor Sally Pipes in her most recent article for the magazine. Pipes, who is also president, CEO, and Taube Fellow in Health Care Studies at the Pacific Research Institute, wants the public to bear in mind that the new number represents a $1,303, or 9%, increase from that of 2010.

The Kaiser Family Foundation, who is responsible for the research behind the 2011 average, also noted that health insurance rates were up 5% in 2009 and up 3% in 2010. What’s worse? The Pipes article suggests that there really is no relief in sight.

According to a recent study by the National Business Group on health, employers expect premiums to rise 7.2% by 2012, and Kaiser Family Foundation says that we can expect to see health insurance premiums double within the next decade. To offset costs, according to Kaiser, 50% of employers will need to shift greater shares of health insurance costs to employees.

Pipes believes that ObamaCare is to blame for the continuing rise in health benefit costs to both employers and their employees. “ObamaCare drives up the cost of insurance by piling mandates and required coverage benefits onto every single policy,” she notes.

Whether for or against the new healthcare mandates, with premiums on the rise and an ever changing industry, employers will have to continue to do a great deal of homework when it comes to shopping for business health insurance coverage and managing employee benefits.

Report by Melissa Cenker
Any opinions expressed within this and all posts are the opinions of the third parties quoted and do not necessarily represent the opinions of Princeton HR Solutions, Melissa Cenker, or Melissa Cenker Consulting

Medicare Slow to Recognize and Act on Prescription Drug Abuse by Beneficiaries

According to last week’s New York Times report, Medicare may be “subsidizing drug abuse” by several of its beneficiaries. Investigators from the Government Accountability Office have reported that Medicare has been slow to act on and recognize recent findings that show thousands of Medicare beneficiaries are shopping around for doctors who fill prescriptions for large quantities of painkillers and other narcotics far exceeding what any patient can safely use.

The GAO is recommending that Centers for Medicare and Medicaid Services Administrator Dr. Donald M. Berwick “consider limiting patients who abuse prescription drugs to one prescriber per pharmacy.” The new regulation has been proposed in order to lessen the burden on working tax payers and business owners, many of which are already overburdened by the cost of their own health benefits.

Jonathan D. Blum, deputy administrator of the Centers for Medicare and Medicaid Services responded to the GAO’s request by stating that “greater use of electronic health records and the electronic transmission of prescriptions to drugstores could reduce fraud and abuse by making it easier to keep track of patients’ medication history.” Still, Medicare officials are reluctant to impose the requested regulation due to the fact that it “could jeopardize patients’ access to healthcare. The GAO presented their findings and evidence of abuse to the senate last Tuesday and is awaiting resolution.

Report by Melissa Cenker
Any opinions expressed within this and all posts are the opinions of the third parties quoted and do not necessarily represent the opinions of Princeton HR Solutions, Melissa Cenker, or Melissa Cenker Consulting

Rising Health Care Costs Burdening Families in New Jersey as well as Nationwide

Findings from a recent study conducted by Rand Corp show that rising health care costs are hitting families much harder than many people realize. According to the research firm, although monthly household income was up $1,910 from 1999 in 2009, the average American family was left with just $95 more per month to spend by the end of the same ten year period. With costs of living on the rise, the discrepancy between household income and net dollars available for spending continues to alarm researchers. “These sobering facts provide further evidence that lowering health care costs is one of the most important challenges of our time,” concluded Rand Corp researchers upon the study’s release.

Despite these alarming findings, health care costs for families and business owners continue to rise in New Jersey, Pennsylvania, and across the country. Another study, conducted by consulting firm Aon Hewitt on families in Houston Texas, found that the average employee in Houston will pay $2,516 for health-insurance premiums next year, up from $2,277 in 2011. The firm also expects that families will see a spike in co-payments and deductible expenses as businesses are forced to share more of the costs of health benefits with employees.

Now more than ever, both large and small business owners need to choose wisely when it comes to health benefits for employees. Finding the most cost-effective quality plan options is important. Consulting a New Jersey benefits consultant can help keep business expenses at a minimum and improve employee retention and quality of life.

Report by Melissa Cenker
Any opinions expressed within this and all posts are the opinions of the third parties quoted and do not necessarily represent the opinions of Princeton HR Solutions, Melissa Cenker, or Melissa Cenker Consulting