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Employers look for new ways to cut costs

Posted on August 28, 2012 | No Comments

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Key Developments
Implementation Briefs

The 2012 Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care offers insights into the actions and plans of leading U.S. employers and views of what the future of employer-provided health care in the U.S. may look like this year and in the coming three years. According to the study, as health care costs continue to rise, employers are looking for ways to cut costs. While the total cost of health care is predicted to rise 5.3%, to $11,507 per employee in 2013, the growth is slowing. Many companies will keep premium increases in line with the health care cost increases. The study found that 13% of companies would increase premiums by 5% in 2013, for example.

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A report issued by S&P Capital IQ found that if publicly traded companies drop employer-sponsored insurance (ESI) benefits by 2020, they could save more than $700 billion by 2025. The report, released earlier today, said that these companies would save substantially by paying the Affordable Care Act's (ACA's) penalty rather than paying premium contributions and other costs associated with offering ESI. The authors postulate that once several notable companies elect to no longer offer ESI, many others will follow suit, leading to potentially 90% of major corporation employees receiving ACA Marketplace coverage by 2020.
According to a new report released by the Commonwealth Fund, a new set of proposed policies designed to accelerate innovation in care delivery could slow health spending growth by $2 trillion over the next decade. The report outlines a comprehensive set of policies to modify the way public and private purchasers pay for care, improve the accessibility of high-value care options, and address forces driving skyrocketing health care expenditures. Commonwealth estimates indicate that if the policies are implemented soon, with public and private payers acting in concert, federal spending could be reduced by $1.04 trillion, state and local government spending by $242 billion, and employer spending by $189 billion over the next decade. The proposed policies would also realize significant savings for families ($537 billion over a decade) as a result of lower future health insurance premiums and out-of-pocket costs. Click here for an executive summary of the report.
According to a new study for the National Institute for Health Care Reform (NIHCR), offering employer-sponsored health insurance will continue to make fiscal sense for businesses employing most workers (81%) now offered insurance. The study found that the economic incentives to offer coverage will remain strong under the Affordable Care Act (ACA) for most larger, higher-wage firms,  but will weaken for small and low-wage employers. These smaller firms are the companies already more likely to drop coverage to due rising costs. Pre-ACA, all businesses had the option to offer health insurance coverage. After 2014, employer premium contributions remain tax exempt, and two new policies will take effect. First,  larger employers that do not offer affordable health insurance will be penalized and second, premium tax credits for lower-income people to purchase insurance in new state exchanges if they lack access to affordable employer coverage will be available. The economic incentive to cover employees is calculated by adding the dollar value of the employer-sponsored insurance tax subsidy and the value of avoiding the penalty for not offering insurance, and then subtracting the value of the premium tax credits that eligible workers could use in an exchange if their employer does not offer coverage. After 2014, the largest firms (500 or more workers) will continue to have a strong economic incentive, with an average incentive of $2,503 per employee. However, the smallest firms (fewer than 50 workers) will face lower economic incentives because they are exempt from the penalty. Certain industries, such as food service, entertainment, agriculture, forestry and fishing, will have less incentive to offer employer coverage, as their workers will be eligible for exchange subsidies. The study draws on data from the 2008-2010 Medical Expenditure Panel Survey.
In a report released yesterday, the Center for American Progress (CAP) introduced the Senior Protection Plan, a proposal to reduce federal spending on health care delivery. Instead of shifting costs and/or ultimately increasing costs, the Senior Protection Plan, according to CAP, would improve health care delivery efficiency, eliminate waste, and improve the quality of care. This approach, in theory, would ultimately reduce health care spending. The Senior Protection Plan serves as an alternate to the other proposals made in the past years with the goal of reducing health care spending. Such proposals include transforming Medicare into a premium support or voucher program, raising Medicare's eligibility age to 67, increasing cost-sharing, and slashing Medicaid and increasing long-term care costs for seniors. The Senior Protection Plan would enhance competition based on price and quality, increase transparency of price and quality information, reform health care delivery to provide better care at lower cost, repeal the Sustainable Growth Rate (SGR) mechanism, reform graduate medical education and the workforce, reform Medicare premiums and cost-sharing, reduce drug costs, bring Medicare payments into line with actual costs, cut administrative costs and improper payments, reduce the costs of defensive medicine, reform the tax treatment of health insurance, and promote better health. CAP's Senior Protection Plan yields substantial savings, as scored by the Congressional Budget Office, without harming beneficiaries. The plan would save over $385 billion in federal expenditures over 10 years. In addition, the tax policies related to health care would generate up to $100 billion over 10 years. The plan also includes an array of reforms that would bend the cost curve over the long term. For the report summary, click here.
The Affordable Care Act's provisions to increase federal revenue through taxes on high-income workers are among the many proposals that policymakers will face next year, according to a new report released by the Congressional Research Service (CRS). The report provides an overview of the tax and spending policy changes set forth by the Act. Collectively referred to as the "fiscal cliff," these policies would extend current revenue policies (e.g., extending the Bush tax cuts) and change current spending policies (e.g., not allowing the Budget Control Act sequester to take effect) to increase the projected budget deficit relative to current law. The Congressional Budget Office (CBO) estimates that if current law remains in place, the budget deficit will fall by $502 billion between FY2012 and FY2013. In making these fiscal policy choices, Congress will have to weigh the benefits of deficit reduction against the potential implications of fiscal policy choices for the ongoing economic recovery. Maintaining current revenue and spending policies will add to the deficit, while increasing revenues and reducing spending, as under current law, could slow economic growth. Thus, deficit reduction measures must be balanced against concerns that spending cuts or tax increases could dampen an already weak economic recovery. CBO has concluded that allowing current law fiscal policies to take effect will dampen short-term economic growth, but accelerate long-term economic growth. Conversely, CBO has concluded that postponing the fiscal restraint would accelerate short-term economic growth, but dampen long-term economic growth. In that context, several policy observers have recommended implementing a credible medium-term plan that balances economic considerations with deficit reduction.
New guidance released by the Internal Revenue Service (IRS) explains Affordable Care Act (ACA) market interactions on health reimbursement arrangements (HRA), flexible savings accounts (FSA), and other employer-related options. The guidance states that group health plans used to purchase coverage on the Marketplaces, such as HRA and FSA, will not be considered as integrated for the purposes of determining annual dollar limits or preventive service requirements. Moreover, the IRS guidance states that employers not offering insurance coverage may try to use "excepted only benefits" HRA plans to count toward employee compensation.
The Department of Treasury's Internal Revenue Service (IRS) published a final rule detailing the Affordable Care Act’s (ACA's) tax on certain medical devices. The rule will take effect in 2013. To help pay for the expansion of health coverage, the ACA imposes a 2.3-percent excise tax on the sale of any taxable medical device by the manufacturer or importer of the device starting in 2013. Although lawmakers initially considered a higher tax, the medical device industry ultimately succeeded in halving the amount of revenue that device taxes would raise. IRS also released a final rule that imposes fees on health insurers and plan sponsors to fund the Patient-Centered Outcomes Research Trust Fund. Insurers criticize the new fee, which they called a tax.
Final regulations published in the June 3rd Federal Register (at 78 Fed. Reg. 33158) implement the ACA amendments to pre-existing federal laws permitting employer-sponsored health plans and health insurers selling products in the group insurance market to include in those products “non-discriminatory wellness programs”. The regulations were released jointly by the federal Departments of Labor, Treasury, and Health and Human Services. An earlier Implementation Brief examined the rules in their proposed form. The final rule largely retains the elements of the proposed rule, while also making important clarifications regarding how a wellness program must be structured in order to be considered non-discriminatory based on health status. Because the final regulations revise previous rules issued in 2006, the wellness program standards apply to both grandfathered and non-grandfathered plans, since the revisions simply restructure older standards rather than creating new ones.
As described in a previous Implementation Brief, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) generally prohibits group health plans and group health insurance issuers operating in the group health market from discriminating against similarly situated individuals with regard to premiums, benefits or eligibility based on a health factor. HIPAA recognized an exception...