Income tax credit guidelines for state-run insurance exchanges, released earlier this month by the IRS for eligible individuals, may also have a bearing on their employers. As the Benefit Blog notes, “any full-time employee who obtains such a credit may cause a ‘large employer’ (one with 50 or more full-time employees) to owe a penalty under the [Affordable Care Act]’s ‘play-or-pay’ provisions".

The proposed guidelines apply to contributions employers make to health savings accounts (HSAs) or health reimbursement arrangements (HRAs) as well as financial incentives given to employees who satisfy the requirements of a wellness program. Specifically, they spell out whether such plan-related payments fall under the pay-or-play rules.

For an employee to qualify for the tax credit, the health plan offered by the employer must either not be “affordable” (because the employee’s share of the premium for employee-only coverage would exceed 9.5% of his or her income) or fail to provide at least “minimum value” (by covering the cost of at least 60% of “essential health benefits”).

The Benefit Blog summarizes the IRS guidance:

MedBen clients with questions regarding this or any ACA provisions regarding employer-sponsored plans may contact Vice President of Compliance Caroline Fraker at cfraker@medben.com.

Drug marketing has come a long way from the days of plying doctors for details about their prescribing habits over lunch, The New York Times reports. Now, much of the insider information pharmaceutical companies crave is available through electronic patient and physician databases.

As the Times notes, “The information allows drug makers to know which drugs a doctor is prescribing and how that compares to a colleague across town. They know whether patients are filling their prescriptions – and refilling them on time. They know details of patients’ medical conditions and lab tests, and sometimes even their age, income and ethnic backgrounds.”

Drug makers put a positive spin on this higher level of access, saying that the information allows them to help doctors encourage to take their medicine as prescribed, or make sure they are prescribing the right drug to the right patients. Some doctors, however, are wary of the practice even though personal information is deidentified.

Doctors who object to the use of their prescribing data by pharmaceutical companies can opt out through a program set up by the American Medical Association in 2006, though only about 4% of the nation’s practicing physicians have done so. Much of the information in these databases comes directly from the AMA, for a fee.

From The Newark Advocate – “MedBen celebrates 75 years of growing big in small markets“:

“Chairman and CEO Doug Freeman, who has headed MedBen for 25 years, said the company found many of its 427 clients in markets about the size of Newark, focusing on employers in the manufacturing, local government and hospital industries.

“’We decided we had to find a niche, and as a small company we had to do something different than the big guys,’ Freeman said. ‘In small markets, we rely on relationships and partnerships to help us compete very effectively in those markets.’

“Its local clients include the City of Newark, Licking County government, Licking Memorial Hospital, Park National Bank and the Energy Cooperative.

“’I guess you could say, only our clients are older than us,’ Freeman said.”

Read the complete article at newarkadvocate.com.

The U.S. Food and Drug Administration has approved Xofigo, a drug for men in the advanced stages of prostate cancer, HealthDay News reports (via WebMD).

Targeted to patients with late-stage, metastatic disease that has spread to the bones but not to other organs, Xofigo was shown in clinical trials to extend survival rates about three months longer than men who took a placebo.

“Xofigo binds with minerals in the bone to deliver radiation directly to bone tumors, limiting the damage to the surrounding normal tissues,” Dr. Richard Pazdur, director of the Office of Hematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research, explained in the news release.

According to the American Cancer Society, prostate cancer remains the leading cancer type among men outside of skin cancer, and about one man in every six will develop the illness during his lifetime. Caught early, it is often curable. About 239,000 new cases of prostate cancer are diagnosed among American men each year, and nearly 30,000 men die from the disease annually.

MedBen follows ACS prostate cancer screening guidelines, which recommend that men at age 50 who are at average risk of the disease and are expected to live at least 10 more years consult with their primary care physician about getting tested.

Older women who are hysterectomy candidates but are reluctant to proceed due to fears of increased cardiovascular disease risk shouldn’t be overly concerned, a new study suggests.

According to HealthDay News (via MedicineNet.com), researchers compared cardiovascular risk factors before and after premenopausal women had their uterus electively removed with women who had a natural menopause. Risk factors included cholesterol, blood pressure, inflammation, blood sugar and insulin resistance.

The research team concluded that while there were changes in cardiovascular risk factors after a hysterectomy, they were more attributable to weight gain following the procedure. These effects were similar in all ethnic groups.

“If women are contemplating hysterectomy, they don’t need to be worried about increased cardiovascular risk,” said study author Karen Matthews, a professor of epidemiology and psychology at the University of Pittsburgh.

Previous studies found an increased risk for conditions such as coronary heart disease, stroke and heart failure in women who underwent a hysterectomy. But unlike earlier research, this study focused specifically on women who underwent the procedure in midlife.

“Small businesses are not on board with the Patient Protection and Affordable Care Act, according to a Gallup survey released last week. The survey of more than 600 small businesses, commissioned by law firm Littler Mendelson, finds that 48% of small businesses say the ACA is bad for their business, while 9% say the legislation is good. Fifty-five percent, meanwhile, fear it will increase costs, while only 5% believe the ACA will lower costs.”

“Forty-one percent of those surveyed said they have held off on hiring new employees as a result of the ACA. ‘One of the most concerning unintended consequences of the Affordable Care Act is that we see employers looking to stay under the 50-employee threshold, if at all possible,’ says Steve Friedman, co-chair of the employee benefits group at Littler Mendelson. ‘Which means they often won’t be expanding their businesses when that’s generally the direction they’ve always wanted to go in. We also see a lot of employers that are refraining from hiring people on a full-time basis because of the Affordable Care Act. And that’s also something that’s not favorable, one would think, to the overall economy.’”

Read more at Employee Benefit News. You can also see more survey results at Gallup.com.

Body mass index (BMI) is a commonly used way to gauge an individual’s risk of an early death, in spite of the fact that many medical professionals question its accuracy. Now, the results of a British study suggest an alternate measure may be more effective.

According to MedPage Today, at the European Congress on Obesity in Liverpool, England, researchers reported that waist-to-height ratio (WHtR) may be a better predictor of mortality risk than BMI. Comparing the effect of central obesity (measured by WHtR) and total obesity (measured by BMI) on life expectancy, they found that mortality risk was associated with BMI, but WHtR estimates were higher and appeared to be a more accurate indicator of mortality risk.

“The use of WHtR in public health screening, with appropriate action, could help add years to life,” Margaret Ashwell, PhD, of Oxford Brookes University said in a statement. “If health professionals included this simple measurement in their screening procedures, then many years of productive life could be saved.”

Ashwell and her colleagues added that the results support the message, “Keep your waist circumference to less than half your height.” Also, they wrote, the use of WHtR in public health screening could help add years to life.

Last year witnessed a number of popular brand name prescription drugs losing their patent protection – a circumstance that led to a decrease in U.S. pharmaceutical spending for the first time since 1957, a new report concludes.

According to The Los Angeles Times, the availability of generic versions of such top-selling drugs as Lipitor and Plavix cut the nation’s tab for prescription medications 1% in 2012 to $325.8 billion. Adjusted for inflation and population growth, the decline was 3.5%. That means average spending per person was $898 last year, down $33 from 2011.

The report by the IMS Institute for Healthcare Informatics, a pharmaceutical research group, says that the rise of generics in 2012 offered greater savings to patients – a trend that will continue this year as more drug patents are set to expire.

“The largest driver of this slowdown,” said IMS research director Michael Kleinrock, was the “unprecedented cluster of very popular and effective medicines losing patent protections and facing generic competition at the same time.”

A weaker-than-usual cough, cold and flu season also contributed to the decline, the report says.

Following a refusal by Congress to provide extra funding to set up the Affordable Care Act, the Obama administration has turned to the private sector for help.

The Washington Post reports that Health and Human Services Secretary Kathleen Sebelius has contacted health industry executives, community organizations and church groups to ask that they contribute financing to nonprofit groups that are working to enroll uninsured Americans and increase awareness of the law.

While an HHS spokesperson said it is perfectly legal to solicit donations in this manner, some Senate Republican feel differently: “I will be seeking more information from the Administration about these actions to help better understand whether there are conflicts of interest and if it violated federal law,” Sen. Orrin G. Hatch (R-Utah) said in a statement.

A New York Times article on the funding requests notes that the Robert Wood Johnson Foundation is expected to contribute as much as $10 million, while tax preparation service H&R Block is expected to make a donation of about $500,000, according to administration officials.

May 8th marks the 75th anniversary of health care benefits management company MedBen. Initially specializing in group hospitalization plans, the Newark, Ohio-based business has greatly expanded its operations to provide a variety of benefits services to employer groups of all sizes throughout the Midwest.

Chairman and CEO Doug Freeman, who has headed MedBen for the past 25 years, said that credit for company’s decades of success goes first and foremost to its employees. “The stability we’ve demonstrated begins and ends with the talented group of people who’ve worked here – both those that I’ve been fortunate to work with and those who served here before us,” Freeman said.

“Likewise, we attribute our continued success to an incredible list of clients – organizations who have challenged and pushed and worked with us over the years to make us a better company,” he added.

Also important to MedBen’s endurance, Freeman believes, is its proactive approach to health care benefits management: “We’ve established a corporate culture that builds on its history by continually looking ahead.”

One recent way MedBen has strived to stay ahead of the curve was through its introduction of Partners Community Health Plan. This unique benefits package, currently available in selected areas throughout Ohio and Kentucky, partners with local hospitals and doctors to help employers save money on health care costs. “By getting providers involved in the success of the plan, we’ve found that members get better care and employers see bigger savings,” Freeman observed.

Finding innovative methods to control claims costs is another key to the company’s longevity, Freeman added. “Saving clients money requires a proper balance of the latest technology and some really smart people. So we’ve put in place a claims surveillance system that integrates advanced software with physicians to identify every opportunity for client savings.”

Read more »

Health care reform and its impact of self-funded group health coverage were among the topics at the latest MedBen University (MBU), held today at the Morrow Conference Center in Newark, Ohio.

Caroline Fraker, MedBen Vice President of Compliance, has covered a lot of miles this year to help groups navigate the twists and turns of the Affordable Care Act. In this presentation – her 15th of 2013 – she broke down two new fees that businesses will soon face under the law:

1. PCORI Comparative Effectiveness Fee: For plan years on or after October 1, 2012, all group health plans must pay a fee to cover the costs of the Patient-Centered Outcomes Research Institute. The fee is based on average number of covered lives. For the 2013 plan year, the fee equals $1.00 per covered person (employees and dependents) per year; for 2014, the fee equals $2.00 per covered person per year.
2. Transitional Reinsurance Fee: From 2014 to 2016, health plans must pay a fee per covered individual (employee and dependent) to state-based programs established to provide reinsurance for health insurance carriers issuing individual policies (for policies both in and out of the Exchanges). For 2014, the fee equals $5.25 per individual per month or $63.00 per individual per year.

Following Fraker was MedBen Vice President of Sales and Marketing Brian Fargus, who explained the mechanics of self-funding. In his presentation, Fargus outlined the employer advantages of partially funding group health coverage, such as plan design flexibility, improved cash flow and lower administrative costs.

Fargus also gave a detailed breakdown of what to look for in a third party administrator. Among the most important qualities in a TPA, he said, is “service capabilities", including the ability to provide custom reporting, an advanced claim processing system, and strong compliance support.

MedBen will continue to offer MBUs throughout 2013. Be sure to check this blog for future opportunities to attend a session!

The economic downturn of recent years is not the overriding factor for the slower growth in health care spending, two new studies suggest. The findings contradict earlier speculation that the slowdown was due primarily to the latest recession, which lasted 18 months and ended in June 2009.

According to Modern Healthcare, one of the studies found that the economy accounted for about 37%, of the slowdown, while cuts to Medicare and a decline in privately insured patients accounted for another 8%. “The evidence is at least as strong that it’s structural as it is cyclical,” said David Cutler, a health care economist and professor at Harvard University who co-authored the paper.

The second paper, which analyzed spending by 150 large employers from 2007 to 2010, concluded that larger deductibles, more coinsurance and higher copayments accounted for about 20% of the slowdown. Co-author Michael Chernew, a Harvard health policy professor, added that the results appear to underscore a shift in culture among hospital officials and physicians who have grown more focused on greater efficiency in the last five years.

While neither paper went so far as to say that improvements in the payment and delivery of health care have had a definitive effect on spending, the authors say they believe as the economy improves, growth will continue to be slower than it was prior to the downturn.

National health spending grew at a record-slow pace of 3.9% in 2009 and the same pace in 2010 and 2011, the most recent year for which federal estimates are available.

Lest Thursday, the IRS released the cost-of-living adjustments affecting health savings accounts (HSAs) for calendar year 2014. The HSA contribution limits and high-deductible health plan (HDHP) out-of-pocket maximums will both increase. The HDHP minimum required deductibles, which went up in 2013, will reamin unchanged next year.

• HSA Contribution Limits – The 2014 annual HSA contribution limit for individuals with self-only HDHP coverage is $3,300, and the limit for individuals with family HDHP coverage is $6,550.
• HDHP Minimum Required Deductibles – The 2014 minimum annual deductible for self-only HDHP coverage increases to $1,250; for family HDHP coverage, $2,500.
• HDHP Out-of-Pocket Maximum – The 2014 maximum limit on out-of-pocket expenses for self-only HDHP coverage is $6,350, and the limit for family HDHP coverage is $12,700.

MedBen clients with questions regarding these adjustments are welcome to contact Director of Administrative Services Sharon A. Mills at (800) 423-3151, Ext. 438 or smills@medben.com.

Avik Roy on an Oregon study to determine whether people on Medicaid have better health outcomes than those with no insurance at all, and how the finding impact nationwide health care reform:

“Piles of studies have shown that people on Medicaid have health outcomes that are no better, and often worse, than those with no insurance at all. But supporters of Obamacare were cheered in 2011 when a lone study, out of Oregon, purported to show that Medicaid was better than being uninsured. Yesterday, however, the authors of the Oregon study published their updated, two-year results, finding that Medicaid ‘generated no significant improvement in measured physical health outcomes.’ The result calls into question the $450 billion a year we spend on Medicaid, and the fact that Obamacare throws 11 million more Americans into this broken program. […]

“I want to make clear that I’m not opposed to spending that sum of money on health care for the poor. What I’m opposed to is wasting that sum of money on health care for the poor. There are so many market-based alternatives to Medicaid, alternatives that would offer uninsured, low-income Americans the opportunity to see the doctor of their choice, and gain access to high-quality, private-sector health care.”

Read more at Forbes.com.

In proposed federal rules announced earlier this week, the Internal Revenue Service announced that worksite wellness programs offered by employer-sponsored health care plans don’t count toward minimum coverage requirements, Reuters reports. Only programs designed to prevent smoking will qualify under the Affordable Care Act.

The health care reform law requires larger employers to meet minimum coverage standards established by the federal government. Those who fail to do so must pay an excise tax penalty, and any employees affected will receive a tax credit to buy health coverage through a state health insurance exchange beginning in 2014.

Tax lawyers who have reviewed the proposed rules called them a victory to labor unions and consumer groups. Business representatives had hoped the IRS would include wellness programs as part of health coverage.

“It is a setback for employers,” Greta Cowart, a partner at Haynes and Boone LLP, said of the IRS ruling. Employers now “lose part of the bang for the buck in terms of the penalty.”

The IRS rules are open to revisions before the law goes into effect, and the public has until July 2 to submit comments to the IRS for changes.

We’re a bit late in noticing this ad (and thanks to the KevinMD.com blog for posting it) but it certainly drives its point home effectively. Part of a 2011 British campaign by the National Health Service, the ad highlights various alternatives to going to the emergency room, such as visiting a general practitioner (or primary care physician), talking to a pharmacist or treating oneself at home.

In her blog post, internal medicine resident Ishani Ganguli says that one factor driving more Americans to ER care is a shortage of primary care doctors. But there’s more to the story, she adds:

“When I shared the NHS ad on Facebook, my economist friend Willa Friedman emailed me with her analysis: ‘So there are at least two explanations: (1) People think they’re special and then under-appreciate/under-change their behavior in response to the impact their actions have on others OR (2) People really have no idea about the options.’ What I realized I liked about the ad is that it uses information and a touch of drama to address both factors and in doing so, puts some of the responsibility on patients.

“We talk a lot about patient or consumer-driven health care and, separately, about doctors’ roles as stewards of health care resources without allying the two causes and recognizing the important role patients play in this stewardship […] Instead, we have to ask and enable patients to work with doctors to use the health care system judiciously. That’s why I think this ad is so powerful, and why we in the United States could stand to learn something from it.”

You probably already suspected this, but the statistic is still somewhat dispiriting: A new study reveals that nearly 4 out of 5 Americans don’t get enough exercise.

According to USA Today, the U.S. Centers for Disease Control and Prevention says that about 79% of adults in this country don’t meet the minimum recommended guidelines for physical activity – 2.5 hours a week of moderate-intensity aerobic activity such as brisk walking (or one hour and 15 minutes a week of vigorous-intensity aerobic activity, such as jogging) plus strength training activities (sit-ups, push-ups, etc.) at least two days a week.

“It amazes me that given all the well-known benefits of physical activity that so few Americans choose to be regularly active,” says Tim Church, director of preventive medicine research at the Pennington Biomedical Research Center in Baton Rouge. “The most powerful thing you can do for your health is become active.”

As the article notes, regular exercise can lower the risk of early death, help control weight and reduce the odds of developing some forms of cancer, as well as heart disease, type 2 diabetes and many other conditions.

In addition to the 21% of adults that said they met both the aerobic and muscle-strengthening activity guidelines, 52% said they are meeting the aerobic guideline, while 29% said they are meeting the muscle-strengthening recommendation.

It seems that a good number of people aren’t too concerned about the effects of the health care reform law – namely, because they don’t even know it’s really a law, NBC News reports.

According to a Kaiser Family Foundation health tracking poll, 42% of Americans are unaware that the Affordable Care Act is currently a law. Of that group, 12% believe it has been repealed by Congress, 7% think the U.S. Supreme Court overturned it, and 23% are unsure of its status.

(Incidentally, we can report with confidence that the law is very much alive… however, we can’t say that it’s well.)

The poll also found that for those who know the ACA exists, most have a negative impression of it – 40% compared to 35% who have a favorable view. Since the presidential election, public support of the law has dropped 7%.

The findings come at a period in which the Obama Administration is scrambling to educate Americans about upcoming ACA provisions, in particular the health insurance exchanges from which individuals and small groups can buy converage starting in 2014. Meanwhile, 49% of poll respondents say they still do not have enough information about the law and how it will impact their families.

Yesterday, President Obama defended of the implementation of his signature legislative achievement: “Despite all the hue and cry and ‘sky is falling’ predictions about this stuff, if you’ve already got health insurance, then that part of ‘Obamacare’ that affects you, it’s pretty much already in place.”

Women and girls 15 years and older with a valid ID will be able to buy Plan B One-Step over the counter, MedPage Today reports. Previously, girls under the age of 17 required a prescription to purchase the emergency contraceptive.

In its announcement of the new age guidelines, the Food and Drug Administration said it based its decision on actual use studies and label-comprehension data showing that girls and women 15 and older understood that the product was not for routine use and wouldn’t prevent sexually transmitted diseases.

The change follows a recent ruling by federal judge Edward Korman that women and girls should have access to over-the-counter emergency contraceptives regardless of age, reversing the earlier Department of Health and Human Services restrcitions. The FDA didn’t address the judge’s ruling, instead acting on an application by Plan B manufacturer Teva Women’s Health that requested the OTC age be reduced to 15 years old.

Protections to limit Plan B’s sale to those 15 and older will include a label specifying age eligibility and stating that proof of age is required for purchase. Cashiers will be prompted by product code to verify the customer’s age.

“Research has shown that access to emergency contraceptive products has the potential to further decrease the rate of unintended pregnancies in the United States,” FDA Commissioner Margaret A. Hamburg, MD, said in a statement. About one-half of pregnancies are unintended, studies have found.

MedBen University (MBU) is in session! Members of the MedBen team as well as other health care benefits professionals are traveling the Midwest this spring to share timely information about health care issues that are of importance to employers like you.

While some of these events are invitation-only, the MBU on Tuesday, May 7 is open to all employer representatives (including non-MedBen groups). This session will run from 8:30 a.m. to 12:00 p.m. and will be held at the C. Arthur Morrow Conference Center, 1821 W. Main Street, Newark, OH 43055 (next to MedBen’s Home Office). A continental breakfast will be served.

The curriculum for this FREE seminar includes:

• The Affordable Care Act – Employer Shared Responsibility: Caroline Fraker, MedBen Vice President of Compliance and Chief Privacy Officer, will take an in-depth look at employer responsibilities under the health care reform law, and provide guidance to clients and prospects attending. Her presentation will include the time lines for upcoming changes, the impact of health care exchanges, and penalty implications for employers of all sizes.
• Self-funding – The Next Step: Brian Fargus, Vice President of Sales and Marketing for MedBen, will explain why an increasing number of larger, and even mid-sized, employers are looking at self-funding their health care plans. Even if you already self-insure your employees, this presentation will offer valuable insights as to how self-funding can be part of your health care reform solution. It’s useful information for groups with 30 to 150 employees.

If you’re interested in attending this special MBU, please contact Sales Analyst Sally Wood at swood@medben.com or (800) 423-3151, ext. 502 no later than Monday, May 5. We hope to see you in class!