Three premier US based companies (including Amazon) announced they are going to join forces to tackle heath care. They plan to engage this partnership to cut costs and improve services for their estimated one million combined employee base. The announcement stated that this initiative will be an independent company that “is free from profit-making incentives and constraints” (Jeff Bezos, Amazon). This announcement caused a drop in the stock price of many of the big players in the market (Anthem, CVS, UnitedHealth Group) by at least 4%.
There were not many details offered in the announcement, but many analysts feel that the healthcare industry is ripe for a disruption. The combined group is planning on targeting technology and data solutions to help simplify healthcare delivery and want to leverage their combined best talent to solve this problem over time. There are still quite a few skeptics feeling that these three can make a big difference. However, Amazon has disrupted many industries on their astronomical rise. The fact that there was an announcement at all recognizes that there is room for more players in an industry that has not had any new players in many years.
This move is not completely new to the three companies
- Amazon – has been expected to move into health care selling prescription drugs
- Berkshire – owns MedPro Group (liability insurer)
- JPMorgan Chase – their institute studies health care costs.
For more details on the people being asked to spearhead this venture, follow this link
Both employers and employees want improved health care. There have been many Government based attempts and some States are working better than others. It may be time for business to step in and take strides to better an industry that many agree is ready for some big changes.
As exciting as this news may be, HRB Solutions has Health Insurance Options you don’t have to wait for that are proprietary and designed to make the difference employers have been waiting for. For more information or if you want to discuss what this means for your business going forward, please contact us.
For more details on this announcement:
One of biggest pharmacy players in the marketplace, CVS Health, announced that it has agreed to buy Aetna for $69 Billion. This works out to be approximately $207/share with $145 in cash and the rest in stock. The deal is expected to close, with regulatory approval in the second half of 2018. Today there was a call for congressional hearings to see if this is merger will lead to a better landscape or do more harm. So, more news to come.
What does this CVS acquisition of Aetna mean?
In the short term, CVS could provide a very wide range of services to the 22 million Aetna medical members. This could include expansions in the walk-in clinics, efficiencies in pharmaceutical sales and provide CVS with something other than just retail sales. We may see a better use of health data from both Aetna and CVS (stores and minute clinics) to create a better experience for all consumers. This could also lead to lower costs for care at Minute Clinics and in health care premiums.
Early reports indicate that CVS is considering transforming its locations into some sort of community health hub where pharmacists and nurses can provide services to individuals recently released from hospitals to help them stay out of the hospital. There also some signs that this combination could be a place where individuals go rather than to the emergency room. This could also extend into general wellness, nutrition, vision and hearing screening services. CVS could be positioning themselves in front of health issues to support a healthier person and thereby saving health care costs across the board. Health insurance providers want to get closer to the consumer so that they are better able to manage the aspects of a person’s health better, this could be that way fro Aetna. Many people agree that in the future you will see much less retail (where items can be purchased easily online) and more emphasis on health care from within the CVS stores. The combination CVS/Aetna group will have to take steps to convert customer perceptions that include a feeling that CVS sells eye make-up and toys so why would it be the place to go for health care?
Large companies that employ many have traditionally kept their prescription drug benefits separate from medical coverage. These companies feel they can get a better, lower cost deal by shopping these benefits around separately. This merger could change that thinking as CVS and Aetna argue that this deal will lower costs and give them the ability to negotiate drug prices down and the management in the use of these drugs up. We feel that this will lead to more companies when they look to negotiate their health contracts next year, to look to see if it is better to pull these services together or will overall savings occur by keeping health and pharmacy separate.
This may be the first in other health services mergers as this industry attempts to insulate themselves from competition from Amazon that is expanding into the sale of prescription drugs and from health insurers that have brought drug price negotiations in-house rather than using a middle man as CVS now becomes that middleman for Aetna.
We continue to monitor all aspects of the health care industry and will help guide you through the changing landscape. Our goal is to provide you with the maximum amount of savings in health care costs while still providing the right set of services to your employees.
Please contact us for more details.
Contributing sources as well as additional information on this merger can be found here:
CNBC / CNBC
New York Times
The Kaiser Family Foundation in conjunction with the Health Research and Educational Trust (HRET) recently announced their 2017 Employer Health Benefits Survey. This survey covers over 150 million people. It helps to provide fresh information about employer-sponsored health benefits. The 2017 report is the nineteenth survey of this type.
Quoted abstract from the Health Benefits Survey
“This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage including premiums, employee contributions, cost-sharing provisions, and employer practices. The 2017 survey included more than 2,100 interviews with non-federal public and private firms. Annual premiums for employer-sponsored family health coverage reached $18,764 this year, up 3% from last year, with workers on average paying $5,714 towards the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Education Trust 2017 Employer Health Benefits Survey. The 2017 survey includes information on the use of incentives for employer wellness programs, plan cost sharing, and firm offer rates. Survey results are released in a variety of ways, including a full report with downloadable tables on a variety of topics, summary of findings, and an article published in the journal Health Affairs”
The survey is very comprehensive and contains many pages of tables and charts that describe the current condition of the employer marketplace today.
Please contact us if you have any questions or check out the survey.
Here are a few 2017 Health Benefits Survey highlights
• The average premium for single coverage through an employer-sponsored plan is $6,690 up 4% over last year.
• The average premium for family coverage through an employer-sponsored plan is $18,764 up 3% over last year.
• Worker’s wages increased 2.2% and inflation increased 2.2%
• On average covered workers contribute 18% for single and 31% for family towards premium payments. With workers in small firms contributing a larger percentage than those workers in larger firms.
• Dwindling its share over the last 8 years by 8%, the PPO continues to be the most common plan type followed by High-deductible plan, HMO, POS and less than 1% in a conventional/indemnity plan.
• 15% of the workers in small firms and 79% of the workers in large firms are enrolled in plans that self-fund in some capacity. This is very similar to the numbers from last year.
• Most workers have some type of deductible such as a general annual deductible, cost-sharing, copayments or coinsurance for office visits and hospital stays.
• 53% of firms offer health benefits to some of their workers and 89% of the people surveyed work in firms that offers health benefits.
• A clear majority (over 94%) of all firms offer coverage to spouses of those eligible. Over 92% of all firms offer health benefits coverage to non-spouse dependents.
• Many firms that offer health benefits also offer supplemental benefits as well. These include dental, vision, critical illness insurance, hospital indemnity insurance and long-term care insurance. With firms more likely to contribute towards dental and vision than the others.
• A small number of firms (minimally 8%) collect health information from workers through wearable devices such as a Fitbit.
• 4% of firms with at least 50 workers offer health benefits through a private exchange. Many more are considering it going forward.
Conclusion highlights from the 2017 Health Benefits Survey:
• Employer-sponsored health benefits market displays no big changes over 2016
• Premium increases are modest and not much change in cost sharing or enrollments.
• Employers continue to invest in promotion of wellness and build incentives around programs that collect information about their employees.
• No signs that long term declines in the offer and coverage rates are reversing with the percentage of workers covered at work remains at 62%
• There continues to be a significant variation around premiums and contribution amounts. Large number of workers in small firms pay a substantial share of the cost of family coverage. This calls into question whether this is a viable source of coverage for the dependents.
• Even with the uncertainty of the ACA (Obamacare), employers seem to have adapted to the provisions without significant disruption. Even if repeal and replace efforts succeed the impacts on the group market will be relatively small. There may be some small changes made, but the costs and coverages will most likely not change in any meaningful way.
• One to watch – The Cadillac tax could affect the market over the next couple of years. Because this law has been pushed out to 2020 and with Congressional support for pushing it out further, the pressure on employers has been alleviated to some extent. This could change dramatically if the tax is not further delayed.
For more information on the survey methodology, please visit the Methodology section at http://ehbs.kff.org/.
For more information on how this information will impact your business contact us here at HRB Solutions Inc
The Internal Revenue Service (IRS) recently released Revenue Procedure 2017-36 which provides indexing adjustments for certain provisions under the Patient Protection and Affordable Care Act (ACA/Obamacare). Of interest to employers is the index adjustment of the contribution percentage used for purposes of determining affordability under the employer shared responsibility (pay or play) mandate. Employers looking to avoid pay or play penalties will need this information to assist in the decision-making process relative to plan designs and employer funding.
Background on Indexing Adjustments
In order to avoid pay or play penalties, applicable large employer (ALE) members must offer full-time employees minimum essential coverage (MEC) that is both affordable and provides minimum value (i.e., actuarial value of at least 60%). Under applicable rules, health care coverage is affordable if the employee’s required contribution for the lowest cost self-only option offered by the employer is 9.5% (as adjusted annually) or less of the employee’s household income. The statute defines “household income” as the modified adjusted gross income of the taxpayer and the members of the taxpayer’s family, and modified adjusted gross income is defined as adjusted gross income plus certain types of income that would otherwise be excluded from the taxpayer’s income (i.e., foreign earned income and housing costs, tax exempt interest, and the excludable portion of the taxpayer’s social security income).
The IRS did not address the household income standard in its employer shared responsibility regulations.
The IRS did not address the household income standard in its employer shared responsibility regulations. Instead, the IRS established a choice of three safe harbors that employers could use to demonstrate compliance with the affordability standard, all of which limit the determination of affordability to employee self-only coverage. Those safe harbor affordability standards include the Form W-2 Safe Harbor (based on the employee’s W-2, Box 1 reported wages for that year), the Rate of Pay Safe Harbor (based on an employee’s hourly rate times 130 hours per calendar month), and the Federal Poverty Line Safe Harbor (based on the annual federal poverty line for a single individual divided by 12).
The provision in the ACA/Obamacare statute that established 9.5% of an employee’s household income as the general affordability standard also provided for indexing (adjustments) of that standard beginning in 2015. The annual adjustments, prior to 2018, are as follows:
- 2015 – 9.56%
- 2016 – 9.66%
- 2017 – 9.69%
- 2018 – 9.56% (decreased)
Affordability percentage for 2018
For purposes of the employer shared responsibility mandate, the required contribution percentage has decreased for 2018 to 9.56% (from 9.69% in 2017). This means that if an employee’s share of the premium (in 2018) for the lowest cost self-only option offered by the employer is more than 9.56% of his or her household income (or the applicable standard if using one of the affordability safe harbors), the coverage is not considered affordable for that employee and the ALE member may be liable for a penalty if that employee obtains a premium tax credit for health coverage purchased through the public exchange.
So, unless the employer shared responsibility mandate (or at least the related penalties) is repealed, employers may need to reduce employee contributions (or the relative share of plan cost reflected in employee contributions) in 2018 to maintain “affordable” coverage under the ACA/Obamacare.
Contact us for more details
On October 12th, President Trump signed a health care executive order that requests his administration to develop policies to increase health care industry competition and consumer choice while improving quality and lowering prices. However, it could also shatter The Affordable Care Act (Obamacare) by providing a means for younger, healthier individuals to opt out from the exchanges.
The President is asking the Department of Labor to find ways to make it easier for small businesses and perhaps individuals to form nationwide associations to buy health insurance.
Trump’s Health Care Executive Order potentially could:
- allow employers in the same industry to offer group coverage across state lines.
- provide a much a wider range of policies.
- lower costs to consumers (employers and employees).
- offer consumers the ability to purchase short-term policies that do not need to comply with pre-existing condition protection.
- broaden health reimbursement arrangements (aka HRA’s) allowing employers. to give workers money to buy their own coverage.
- free the association health plans from several Obamacare regulations so that they can operate more like large corporations. These could include:
- requirement to provide comprehensive policies that cover prescription drugs, mental health and substance abuse
- deny coverage to the group
- set rates based on the medical history of those in the group
- exclude employees or develop premiums based on health conditions
- expand the use of short-term insurance plans
- exclude those with pre-existing conditions
- base rates on consumers’ health background
- offer plans with lower premiums with less benefits.
- offer less comprehensive coverage
- create plans that reduce and/or eliminate state oversight.
- pull younger and healthier customers away from Obamacare.
- increase premiums for sicker people left in the exchanges.
May take 6 months or more to implement Trump’s health care Executive Order
The order could leverage the buying power of millions of Americans to form big health care pools. However, there are many who feel it is not going to solve the problem as it only effects a tiny number of people and will not do anything for workers that are currently part of the exchanges and are not members of a franchise or trade association.
It is not known how the agencies within the Trump administration will change the current regulations at this time. Health care plans sponsored by trade organizations already exist. We will continue to watch as this new executive order begins to take shape and let you know what you need to know to keep competitive and stay ahead of the regulations. Please contact us with any questions or concerns you may have.
Our Proprietary Programs have been helping Employers achieve what Trump is proposing. HRB Solutions Inc. has been helping employers participate in large pools with economies of scale discounts for over 5 years!
Here are a few other resources that will help you understand more about this news of the day.
Wall Street Journal
Every year, employers must provide their Medicare-eligible employees covered under their group health plan a written notice regarding Medicare Part D.
This notice must be received by the employee by October 14th
This notice must contain details about coverage status of the prescription drug benefit. The notice must inform the employee if the prescription drug benefit on their group healthcare plan is as good as the standard Medicare Part D Plan.
There are two types of Medicare Part D notices that need to be sent by October 14th:
- A creditable coverage notice should be provided when the drug benefit is at least as good as the standard Medicare Part D plan.
- A non-creditable coverage notice should be provided when the drug benefit isn’t as good as the standard Part D plan.
Other times when the Medicare Part D notice needs to be sent:
- When creditable coverage status changes
- When a Medicare-eligible employee first joins the plan.
Who should receive the Medicare Part D notice:
- Any covered dependents who are eligible for Medicare,
- Employees who become eligible for Medicare due to a disability.
- COBRA beneficiaries
- Covered retirees who are eligible for Medicare
As a best practice, employers may want to provide this notice to everyone covered under their group health plan.
Please note, anyone who is eligible for Medicare but is late to enroll is subject to a late enrollment penalty unless they have suitable coverage elsewhere. This penalty is calculated at 1% of the base beneficiary premium for every month the person is without creditable coverage.
In August, 217 the Centers for Medicare and Medicaid Services (CMS) announced the average basic premium for Medicare Part D prescription drug plan was projected to decline $1.20 from the 2017 rates to a new level of $33.50. Open enrollment for Medicare begins on October 15th and ends on December 7th.
Sample notices can be found on the CMS website or contact us to discuss what documents are needed for your organization and to see if we can save you some money.
Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) have been spearheading efforts (aka Graham-Cassidy Bill) to repeal and replace substantial parts of the Affordable Care Act (ACA). While there are many changes that the so-called “Graham-Cassidy” bill would make to the ACA, there are really three main themes that stand out:
1. Block Grants to States: The bill would end funding for Exchange subsidies and Medicaid expansion as it exists under the ACA today. Instead, states would be provided block grants from the federal government, and states would decide how those funds are used. States could opt out of certain ACA provisions, such as those that apply to pre-existing conditions and essential health benefits, but only if there was a program in place to provide adequate and affordable coverage to lower income and/or high-risk individuals.
2. The End of Mandates: The bill would make penalties under the Individual and Employer Mandates $0 retroactively to 2016. Although this is not a direct repeal of the mandates, it essentially has the same effect as a repeal.
3. Enhancements to HSAs: Contribution limits for Health Savings Accounts (HSAs) would increase and would be equal to the maximum out-of-pocket limit for an HSA-eligible health plan ($6,650/single, $13,300/family in 2018). Several other HSA enhancements were also included in the bill.
The Senate had planned to vote on the Graham-Cassidy bill this week, but that’s not going to happen anymore. This is a bill that was only going to pass if all Senate Republicans but two voted in support of it, and as of Tuesday, at least three opposed the bill. Senators John McCain (R-AZ), Rand Paul (R-KY) and Susan Collins (R-ME) all publicly indicated their opposition to the bill. This essentially puts Republican efforts to repeal and replace the ACA in a standstill.
For more information, please check out these links from these great sources or contact us to discuss the details:
The article by Katie Kuehner-Herbert linked below highlights several elements from the Large Employers’ 2018 Health Care Strategy and Plan Design Survey.
The health care industry is rapidly changing. Daily we hear of something new. We see changes in Washington, at the State levels and even some changes locally. The costs of supplying health care to employees for the average business is growing well beyond the rest of the business. To help combat this trend, we are starting to see businesses leverage new means for controlling costs and steer away from the traditional ways of the past. It is a fine line to walk down. As a business, cost containment is paramount. With employee acquisition and retention, having a quality health care plan in place is crucial. We need to find a way to keep costs and care in balance so that neither have a negative impact on the business.
Key Highlights from the 2018 Heath Care Strategy Survey include:
- Implementation of consumer-directed health plans.
- Exploring new ways to guide employees through the systems.
- Offering consumer-directed health plans.
- Raising awareness and management of pharmaceutical costs.
- Engaging telehealth services when state law allows.
- Promoting accountable care organizations.
- Supporting on/near site health centers.
- Utilizing centers of excellence for certain procedures.
This is a focused article that gets to the heart of what many businesses need to consider as we move together towards a very uncertain and potentially very costly future. For more ways to control rising health care costs, please contact us.