What’s Happening With The Exchange? Opines Are Abundant

The news forums are buzzing with commentary about the new health care exchange. You don’t have to look very hard to find a wide range of opinions. For your reading pleasure, here’s a small collection of industry experts opining about what’s happening with the new exchange…

Joe Paduda’s Managed Care Matters: Exchange enrollment – the big picture

An insurance industry veteran, Joe’s commentary is always witty, amusing and timely. The funny thing is, he’s really good at breaking down double speak language, regardless of the specific topic at hand. In this recent post, he discusses the current state of enrollment on the new exchange and offers four current stories of not-so-happy exchange customers.

Julie Rovner for Shots – Health News from NPR: State Insurance Exchanges Still a Mixed Bag

Rovner, according to her bio, is a health policy correspondent for NPR and specializes in the politics of health care. In this recent story, she breaks down what’s happening with exchange enrollment, state by state. Since it is NPR, you can listen to the story if you choose – there is a 4-minute audio recording.

Sam Stein on Huffington Post: Obamacare enrollment reaches 4 million

Stein, a political reporter for The Huffington Post, provides an overview of enrollment numbers in the exchange and what’s likely to happen over the next few weeks leading up to the enrollment deadline. A quick one-minute video summarizes the article.

Jenny Gold of Kaiser Health News: New ACA Insurance Causes Headaches in Some Doctor’s Offices

A regular KHN reporter, Jenny’s stories cover the health care industry, overhaul and disparities for radio and print. Her pieces for KHN have aired for NPR and have been printed in USA Today, the Washington Post, MSNBC and more. Her story sheds light on another emerging issue now that enrollment numbers are increasing.

Narrow Provider Networks Are Not All The Same. Know the Difference…Someone’s Life Could Depend Upon It.

With the official arrival of healthcare reform, a lot has been written lately about the topic of “narrow networks.” In fact, we’ve recently written about it here Keep Your Doctor? Your Preferred Hospital? Do Your Homework Before Selecting A Plan.

Employers and their employees should know this: There could be a huge difference between established narrow networks of healthcare providers (developed and offered prior to 2014) and some of the new networks created primarily to accommodate the new lower cost Obamacare plans offered on the exchange.

Many of the narrow networks offered prior to 2014, for example, placed a more discerning emphasis on contracting with high performing providers. These networks gave a nod toward the combination of higher quality and lower cost.

Many of the new narrow networks created for the exchanges are aimed primarily at low cost and bear a striking resemblance to Medicaid networks. They are comprised mainly of only those providers willing to accept Medicaid-like fee-schedules.

Describing how carriers built these new networks, one highly respected industry insider indicated that contracts containing these low fee-schedules were mailed out to the provider community. Carriers then waited to see which of the providers would accept this low rate of pay and sign-up. The new networks were then built accordingly.

So what’s the net for all of us?

Caveat emptor. If you or your employees know anyone considering plans utilizing a narrow network, especially one of the lower cost Obamacare plans on the exchange, it’s more important than ever before to review and understand what providers are in the network before selecting a plan. Ultimately, someone’s life could depend upon it.

Most Large Employers Are Keeping Coverage: Mandates, Rules and All

More on what large U.S. employers are choosing to do in the wake of added Obamacare mandates, rules and general confusion over what to do. A recent national survey shows one percent of employers have decided to stop providing health care this year while approximately five percent have decided they will exit the health care system completely. This information is from a survey of large employers conducted by Aon Hewitt, a large employee benefits consulting firm,

According to Jim Winkler, chief innovation officer for health and benefits at Aon Hewitt, “Employers remain committed to providing health benefits, but recognize the need for new approaches that fix those problems.”

The survey includes more than 1,230 employers who currently provide coverage to over 10 million employees and identifies that large employers intend to shift more costs to workers via a “house money / house rules” approach. About 40% of the employers who participated in the survey are shifting more responsibility on their workers by asking them to take a more active role in their health. This includes initiatives aimed at lowering costs and improving employee health by offering health screenings and more robust health care coverage along with lower premiums to those employees who maintain better health.

Another one third of the companies surveyed revealed their plans to move employees to a private health care exchange within three to five years. Employers who move to the private exchange approach plan to provide a subsidy or “credit” to each employee who will then take their “credit” to the exchange to purchase their own health care coverage. Employers will determine the amount they will provide as a subsidy and the amount will vary from employer to employer.

Aon Hewitt has developed it’s own exchange and claims more than 18 large employers with a combined 600,000 workers are already using it.

Winkler goes on to say that “Traditional cost management tactics do not address foundational issues in health care, including worsening population health and misaligned provider payment methodologies.”

This information is a summary of an article titled “Employers Keeping Coverage Despite Obamacare Mandates, Rules” that appeared recently on Forbes.com


More Changes / Delays to the Employer Mandate

3 Employer Take-a-ways

The administration announced late Monday yet another change-up to one of the major focal points embedded in the Affordable Care Act  –  the employer mandate. Here are the three biggest aspects of the announcement that employers of all sizes need to know:

Employers with 100+ Employees

Employers with 100 or more workers will only have to cover 70% (down from 95%) of eligible employees in 2015 to avoid fines. The original 95% benchmark now goes into effect in 2016 and beyond.

Employers with 50 – 100 Employees

Employers in this category get a reprieve of sorts through 2015 as the mandate is delayed altogether for another year. As things stand today, they must begin offering coverage to eligible employees in 2016 in order to avoid fines associated with the new law.

Employers with fewer than 50 Employees

Under 50 employers (already exempt from the employer mandate to provide coverage) will now be exempt in 2015 and each year going forward from the reporting requirements they were subject to as originally outlined in the new law.

Despite speculation by many, as of yet there have been no changes or reprieves to the individual mandate that went into effect on January 1 of this year. It remains unchanged.

For more detailed information on Monday’s announcement see articles that appeared in the Washington Post and Fiscal Times

For an expert analysis, read Bob Laszewski’s piece at Health Care Policy and Marketplace Review.

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