The House tries yet again to delay or gut Obama-Care mandates; And who is behind all these attempts

by LAS

The GOP-dominated House has yet again passed a bill to delay or gut key provisions of the PPACA (aka Obama-Care) law. This week they passed bills to delay implementation of two key provisions, the individual mandate and the employer mandate (for businesses with 50 or more workers).

First of all, even though the House has made several attempts to delay or gut provisions of the reform law, it is very unlikely that the Senate will even discuss comparable bills on the floor. In fact, the House has voted 37 times already to “repeal or defund at least part of the health-care law, including three times to annul the entire measure” since 2010.

The Obama administration said in a statement that the measure to delay the employer mandate is “unnecessary,” and legislation postponing the individual requirement “would raise health insurance premiums and increase the number of uninsured Americans.”

However, House members of the GOP ran on promises to delay or defund PPACA in 2010 or 2012, and so they wish to make a little political hay during the summer months by keeping the issue on the House floor.

But my question is more about who is behind all these attempts to gut the bill. The key is the the employer mandate applies to companies with 50 or more employees. Specifically, companies that may have thousands of employees.

What many Americans may not know is that the PPACA law includes something called the non-discrimination clause. This has nothing to do with the color of a policy-holder's skin or what religion he or she believes in.

As it is now, companies can design deluxe healthcare plans for executive employees,as long as the plan was fully insured. But the non-discrimination clause in Obama-Care applies to ALL group healthcare plans, in terms of eligibility or benefits. The fact is that current healthcare plans treat different groups of employees differently. Most people are aware that the top brass gets the best perks package in the company. But most people may not be aware that even their healthcare plans are different, and that the PPACA specifically bars this and penalizes this practice.

First let us define the term “highly compensated” employees. This group includes the five highest-paid officers of the company, the shareholders who own 10 percent or more of the company, and all employees among the top 25 percent of all the company's employees.

Violators of the non-discrimination rules will be subject to stiff fines. This starts at $100 per day, per “failure penalty” – which will likely apply to each NON-highly-compensated employee who is left out of the cushy coverage plans. The company is also vulnerable to a civil lawsuit to compel it to provide the same upscale coverage plan to the non-covered employees.

Multiply that $100 per day per non-covered employee for a large multinational corporation, and you are talking about a significant hit to the corporate pocketbook. For a company with say, 500 employees, this easily adds up to a fine of $37,500 PER DAY. This is where I believe the pressure is coming from on House members to keep trying to negate provisions of the PPACA law.

Corporate America really believes that the executive class has to be lured to work for a given company with the most extraordinary gold-plated perks of every kind. Not being able to offer a healthcare plan that has no deductibles and no copays seems like a small loss when they are offering a company car, country club and health club and golf club memberships, the proverbial key to the executive washroom, stock options, and much more.

The employer mandate is being delayed for one year with White House permission. And the government has stated that there will be a phasing-in period where employers will be given time to make adjustments before the government begins sanctioning those that do not comply. But still I would not be surprised if corporate America tries to get all current healthcare plans to be grandfathered under the law, thereby escaping all sanctions and fines entirely. 

Why health insurance premiums are tumbling in New York under Obama-Care

By LAS

The Washington Post of July 17 reports that health insurance premiums in New York state will plummet under PPACA (aka ObamaCare) provisions – some at least by half and some to as little as a third of the cost before controls take effect.

According to the Post, “Individuals in New York City who now pay $1,000 a month or more for coverage will be able to shop for health insurance for as little as $308 monthly,” Roni Caryn Rabin and Reed Abelson report. “With federal subsidies, the cost will be even lower.”

New York has had a law since 1993 that insurers have to accept anyone who applies for a health care insurance policy, no matter what kind of pre-existing condition they might have. That explains the highest premiums in the country. In fact, the Post explains it in scintillating simplicity thus: “New York has, for 20 years now, been a long-running experiment in what happens to universal coverage without an individual mandate. It’s the type of law the country would have if House Republicans succeeded in delaying the individual mandate, as they will vote to do this afternoon. The result: a small insurance market with very high insurance premiums.” (my bold)

However, now that some of the provisions of the PPACA law are taking effect, healthy individuals who had believed that they would always be healthy and never have to have medical care, will now be contributing to the pooled coverage, and bringing the average cost of healthcare (AND insurance premiums) down. Yes, DOWN.

That is why the House attempts to gut the individual mandate are very disturbing and will only serve to undermine the promised savings of the program. So far, the Senate has not caved in to Republicans or to the corporate pressure to delay or delete sensitive provisions of the PPACA program. Let's hope it stays that way!

[For original story in the Washington Post, you may go to http://www.washingtonpost.com/blogs/wonkblog/wp/2013/07/17/heres-why-health-insurance-premiums-are-tumbling-in-new-york/ ]

A Few Examples of Unusual, Humane Senior Care

by LAS

Here are a couple examples of humane senior care programs around the country. These are not the only ones out there, but we just wanted to let you know that you have choices when it comes to placing an aging parent in some kind of facility.

DAY CARE – at NIGHT

The Elder-Serve at Night program offered by The Hebrew Home in the Bronx, New York.

Similar to senior day care where adult children drop off a parent while they go to work, this one allows adult children to sleep when the senior is prone to wandering at night.

Patients can just socialize with the other patients, paint, do yoga, listen to live music. Therapies are offered – physical therapy, light therapy, and even aromatherapy.

Staffers are present at all times to provide services, and dispense medications if needed.

NO RULES for DEMENTIA PATIENTS

The Beatitudes Campus in Phoenix is flexible enough to accommodate patients who want a late dinner and a bath at 3 am. There are nurses who can play the piano, so that patients who remember little else can sing the lyrics to old songs. If a patient does better without medications, then he or she may be taken off the drugs.

The Campus provides a calming atmosphere that helps everyone to remain calm and engaged in things that they enjoy.

RURAL RETREAT for SENIORS

The Life Care Cneter of Nashoba Valley is a rural facility in the Littleton, MA area. A resident llama named Travis allows residents to pet him.

Staffers work at figuring out what triggers upsets and what kind of prop or activity will soothe them. For one person, music is soothing. For another, who was a former librarian, just holding a book is comforting.

Best wishes in finding the right place for a beloved but brain-damaged or senile parent.

Hospital “Merger Mania” Leading to Higher Bills for Patients

by LAS

Nationwide, we are seeing more and more concentration of medical care via mergers, acquisitions, joint operating agreements, and partnerships with doctors and other providers. However, these mergers rarely result in a cost savings for either the consumer or the hospitals themselves.

Over 100 hospital mergers took place in 2012, and the pace shows little sign of slackening. What advantage does this have for the hospitals? One effect is that by banding together, hospitals have greater bargaining power – but not, as you might hope, to negotiate lower prices with suppliers. Nope. The hospitals band together to bargain with the insurers for HIGHER payments.

This is partly due to less competition in a given city or county. With fewer providers or networks, the consumer cannot just go across the street for a knee replacement.

Less competition translates as higher costs to the consumer – a study published in 2011 showed that private insurers paid 13 to 25 percent more for procedures done in areas with less competition.

The increased cost is often paid by hapless consumers in the form of higher copays, higher insurance premiums, higher deductibles, and miscellaneous fees.

The real insult is that the quality of care has little relationship to the cost of care. Studies have not found any improvement in quality to match the increase in costs. 

A similar hospital merger boom in the 1990s resulted in increased patient costs of anywhere from 5 to 40 percent.

Another End-Run Around ObamaCare that Employers May Try: Cutting Hours Down to Part-Time

By LAS

It is well for workers to be aware that if ObamaCare does in fact become the law of the land for group plans as currently scheduled, employers may try yet another end-run to get out of having to comply – a risky end-run, but nevertheless, they could be tempted to try it.

That end-run is to cut affected employees' hours to less than the mandated 30 hours-per-week work schedule which triggers qualification for benefits.

I am told that “countless” employers and advisors are seriously considering this game-playing, this strategy to undercut the unpopular (among corporations) costs of ObamaCare.

However, employees who face loss of eligibility for any benefit should know that this may trigger legal ramifications that could prove costly to the employer if he should try this strategy. 

Employees are covered by provisions of the ERISA law – specifically, Section 510 (which in turn refers back to Section 502).

The pertinent paragraph of ERISA Section 510 states:

“It shall be unlawful for any person to discharge, fine, suspend, expel, discipline or discriminate against a participant or beneficiary for exercising any right to which he is entitled under the provisions of an employee benefit plan – or for the purpose of interfering with the attainment of any right to which such participant may become entitled under the plan.”

Aha! We gotcha now, you think. Well, maybe – depending on how much of a junkyard dog your attorney is.

Now, this is not affected by a short-term cut in hours due to a slow period. Many industries have slow periods in the spring or summer, and then ramp up sharply for the fall or winter. This is true of retail, for example, or of the tire business.

BUT if the SINGLE MOTIVE for cutting hours is to deprive employees of qualifying for any employment benefit – which includes ObamaCare – then the company faces legal shaky ground and fines for doing so.

The company stands to be assessed penalties for violating ERISA law. The Department of Labor can assess these fines if the company is found guilty of violating ERISA law, and these penalties are assessed FOR EACH INSTANCE of such violation of the law. Put into other words, the company will have to pay for each employee affected by their shenanigans.

How do you go about exercising your rights under the ERISA law? First you have to start a civil action against the company complaining of the loss of your ERISA rights, or complaining of their retaliation for exercising your rights under ERISA.

Keep a little diary or journal for each day from the moment that the company announces that some employees will have a cut in hours. Keep copies of any newsletters or memos related to this action. Note how many hours a day you worked. Keep this and other pertinent papers together in a little file or large envelope.

And good luck!

We Will Have to Watch Congress like Hawks to Keep Them from Repealing ObamaCare

by LAS

While the current political situation (i.e. – factional infighting) keeps any one party from being able to repeal the Affordable Care Act outright – that will not stop them from attempting the “death by a thousand cuts.” In other words, according to the National Association of Underwriters (an arm of the insurance industry), lobbyists will attempt to get individual provisions of the act repealed by inserting lines into other bills.

The insurance industry will be working with friendly members of Congress to insert language repealing just one given provision of the Affordable Care Act into bills that may about entirely unrelated matters. And they will do this for each provision of ObamaCare until it looks like Swiss cheese and totally useless for providing healthcare to those who need it. 

Supreme Court decisions on DOMA rules will affect gays' insurance, pensions, and more

by LAS

The recent Supreme Court decisions on the Defense of Marriage Act (DOMA) solidifies gays' rights in the 12 states that recognize same-sex marriage, but still leaves unclear areas in the other states. However, in those 12 states, gay couples will see personal benefits in healthcare coverage, pensions, annuities, 401(k)'s, and might possibly extend to COBRA and the Family Medical Leave Act.

It is pretty clear now that gay couples who live in those 12 states, who have for example, a pension plan in effect, will be able to draw survivors annuities rights. If the plan provides for a maximum benefit of $1500 per month, then the survivor could apply for a benefit check of at least $750 per month. Also, if a surviving spouse had already been receiving such survivor benefit checks, and those were taxed by the federal government, the survivor can now apply for a refund of that tax now that the benefit is not taxable.

Persons affected by these changes will still have to wait while employers prepare updated materials and forms related to these medical and pensions plans. So please, be patient, because this is not going to happen overnight – and typically employers have until the end of the year after such a ruling to get things in order. Again, be patient, because the employers have to make sure all the i's are dotted and t's crossed, and there are a lot of legal and tax implications to be thought through.

Still unclear are all the implications and applications when the couple was married in a state that recognizes gay marriage but no longer reside in a state that recognizes gay marriage. That could easily happen if a couple worked in New York, which does, and retires to Florida, which does not. Companies are still unclear on how a change in residence would affect coverage. Another area that needs clarification is in the case of companies that operate in several states – are they only bound by the laws in states where they have offices, or only the state where they are incorporated? In any case, it will be a tangled mess to prepare paperwork for employees in the several states where they have employees.

It is always a tangled mess that the courts weave, and employers and insurance companies will need some time to untangle it.