For ACA Enrollees, How Much Premiums Rise Next Year is Mostly up to Congress

For ACA Enrollees, How Much Premiums Rise Next Year is Mostly up to Congress  | KFF

Source: Kaiser Family Foundation, by Cynthia Cox and Krutika Amin

Health insurers are now submitting to state regulators proposed 2023 premiums for plans offered on the Affordable Care Act (ACA) Marketplaces. Changes in these unsubsidized premiums attract a lot of attention, but what really matters most to the people buying coverage is how much they pay out of their own pockets. And the amount ACA Marketplace enrollees pay is largely determined by the size of their premium tax credit. Generally speaking, when unsubsidized premiums rise, so do the premium tax credits, meaning out-of-pocket premium payments hold mostly steady for people getting financial assistance.

For just over a year, ACA Marketplace enrollees have benefited from enhanced tax credits under the American Rescue Plan Act (ARPA), which Congress passed as temporary pandemic relief. The enhanced assistance lowers out-of-pocket premiums substantially, and millions of enrollees saw their premium payments cut in half by these extra subsidies. ACA Marketplace signups reached a record high of 14.5 million people in 2022, including nearly 13 million people who received tax credits to lower their premiums.

Soon, the vast majority of these nearly 13 million people will see their premium payments rise if the ARPA subsidies expire, as they are set to at the end of this year.

The ARPA subsidies were enacted temporarily for 2021 and 2022 as pandemic relief, but congressional Democrats are considering extending or making the expanded subsidies permanent as a way of building on the ACA, as President Biden had proposed during his 2020 campaign. If Congress does not extend the subsidies, out-of-pocket premium payments will return to their pre-ARPA levels, which would be seen as a significant premium increase to millions of subsidized enrollees. In the 33 states using HealthCare.gov, premium payments in 2022 would have been 53% higher on average if not for the ARPA extra subsidies. The same is true in the states operating their own exchanges. In New York, for example, premiums for tax credit-eligible consumers would be 58% higher if not for the ARPA. Such an increase in out-of-pocket premium payments would be the largest ever seen by the millions receiving a subsidy. Exactly how much of a premium increase enrollees would see depends on their income, age, the premiums where they live, and how the premiums charged by insurers change for next year.

For states, the timing of Congressional action on ARPA subsidies matters both for rate review and state enrollment systems. State-based exchanges – as well as the federal government, which operates HealthCare.gov – will need to reprogram their enrollment websites and train consumer support staff on policy changes ahead of open enrollment in November. States will start making these changes as soon as this month. Additionally, as insurers submit premiums for review, state insurance commissioners and other regulators must assess the reasonableness of 2023 rates, and some of that determination will depend on the future of ARPA subsidies. The non-partisan National Association of Insurance Commissioners (NAIC) wrote to Congress asking for clarity on the future of ARPA subsidies by July.

For insurers, the timing matters because 2023 premiums get locked in later this summer. Last summer, when insurers were setting their 2022 premiums, some said the ARPA had a slight downward effect on their premiums, based on the risk profile of enrollees. Insurers are now in the process of setting 2023 premiums and some might factor in an upward effect on premiums if they expect ARPA subsidies to expire. Premiums for 2023 are locked in by this August, so if Congress does not act before its August recess, whatever assumptions insurers make about the future of ARPA subsidies will be locked in to their 2023 premiums. Additionally, although this is not necessarily at the same scale of the uncertainty seen in 2017 surrounding the ACA repeal and replace debates (when many insurers explicitly said that uncertainty was driving their premiums up), it is possible that some insurers will price 2023 plans a bit higher than they otherwise would, simply because of uncertainty around the future of the ARPA’s enhanced subsidies. The NAIC letter to Congress warned that “uncertainty may lead to higher than necessary premiums.”

For enrollees, the timing matters both for knowing how much they will pay and for maintaining continuous coverageNearly all of the 13 million subsidized enrollees will see their out-of-pocket premium payments rise if the ARPA subsidies expire. But if the subsidies are renewed by Congress, but not until the end of the year right before subsidies are set to expire, there could still be a disruption if states and the federal government do not have enough lead time to update their enrollment websites to reflect the enhanced subsidies. In this scenario, the millions of enrollees who currently have access to $0 premium Marketplace plans might have to pay a premium in January – putting them at risk of losing coverage due to non-payment. Similarly, middle-income enrollees might temporarily lose access to advanced payments of the tax credit in the month of January, making it unaffordable for them to maintain coverage.

Congress’s action or inaction on ARPA subsidies will have a much greater influence over how much subsidized ACA Marketplace enrollees pay for their premiums than will market-driven factors that affect the unsubsidized premium. Even if unsubsidized premiums hold steady going into 2023, the expiration of ARPA subsidies would result in the steepest increase in out-of-pocket premium payments that most enrollees in this market have seen. This would essentially be a return to pre-pandemic normal, but the millions of new enrollees and others who have received temporary premium relief may not see it that way.

Payers, Providers And States Likely Have More Time Until COVID-19 Health Emergency Ends

Payers, providers, states have more time until COVID emergency ends

Source: Fierce Healthcare, by Robert King

The healthcare industry likely has until this fall to face the end of the COVID-19 public health emergency (PHE) as a key deadline came and went with no notice Monday.

 

The Department of Health and Human Services (HHS) promised to give states a 60-day notice when the PHE will end, giving a vital heads-up for when a slew of regulatory flexibilities that have been in place for more than two years will go away. The current PHE will run until July 16, and HHS did not provide any notice that it won’t be extended again for another 90 days.

The decision to not give a 60-day notice comes after an intense lobbying effort from healthcare providers that are worried about the flexibilities of the PHE going away amid a potential new surge of COVID-19.

“The risk from COVID-19 variants remains, and case rates are currently rising across the country,” said the letter from 16 health groups to HHS leadership dated May 10. “Throughout the pandemic, we have painfully learned that the rapid global spread of new variants has resulted in significantly increased transmission rates and infections in the U.S.”

Some health groups and state Medicaid officials have asked HHS Secretary Xavier Becerra to give them more than a 60-day notice of the PHE going away. A key reason is that states agreed to get a 6.2% increase in federal Medicaid matching funds in exchange for not dropping anyone off Medicaid for the duration of the PHE. Once the PHE ends, states will have up to 14 months to fully redetermine whether Medicaid beneficiaries are still eligible.

Becerra has shot down giving more notice, previously saying the PHE can only be extended for 90 days at a time. Becerra has also said that any decision on the PHE will be made via the science.

 

The PHE brought a series of major regulatory flexibilities that could go away once it expires, chief among them in telehealth. The Centers for Medicare & Medicaid Services temporarily removed barriers that include originating site requirements and audio-only restrictions for telehealth services, enabling providers to get reimbursement from Medicare for the new technology.

The flexibilities, however, only last through the PHE. Several bills introduced this session aim to offer to extend the telehealth flexibilities for several months past the PHE to determine what should be made permanent.

Rising Google Searches For Procedures Suggest Recovering Demand, Analysts Say

Google Accused of Enabling Piracy With Images Search Feature | TimeSource: Healthcare Dive, by Nick Paul Taylor

Dive Brief:

  • * Searches on Google for 20 common, nonemergent procedures are above pre-pandemic levels, providing another data point that indicates demand is recovering, according to analysts at Needham.
  • * The analysts believe Google Trends data may indicate the level of consumer interest in certain procedures, leading them to track the resource to understand changes over time. U.S. searches for orthopaedic, general surgery and cardiovascular procedures were at 114%, 112% and 101% of their pre-pandemic levels, respectively, in the last analysis.
  • * Earlier analyses suggest the data may bode well for future sales at medical device companies. The data previously have correlated with medtech financial results, with slumps and rises in search numbers in step with drops and increases in revenue.

Dive Insight:

The most recent medtech industry earnings season was characterized by improving results. After struggling with the impact of omicron early in the year, many companies had a recovery in demand as the quarter progressed, leading some orthopaedic businesses to post sales that matched or topped pre-pandemic levels and businesses across the industry to report that the recovery continued into April.

Google search data potentially provides a window into what is coming next. The idea is that the search results show whether consumer interest is falling or rising and, in doing so, offer insights into future sales of medical devices.

The latest analysis found nonemergent procedure searches are up on both the pre-pandemic period, defined as the first seven weeks of 2020, and on a trailing 90-day basis. Over the 90 days through last week, Google searches for the 20 procedures tracked by the Needham analysts rose 8%, with hernia repair having the greatest improvement and nephrectomy faring the worst.

Searches related to orthopaedics, general surgery and cardiovascular procedures gained 12%, 6% and 9%, respectively, over the analyzed period. The figures are similar to the analysis covering the 90 days through the end of April, with orthopaedic searches decelerating by one percentage point and general surgery and cardiovascular gaining two percentage points and one percentage point, respectively.

The rise in orthopaedic searches over the past 90 days suggests the recovery in demand seen during the first three months of the year may have continued into the second quarter. Still, patient demand likely is just one of the forces that will shape results in the second quarter and after, company executives have said.

“We do expect that staffing pressure will continue to be a challenge throughout the year, just not as intense, I think, as what we thought when we started the year,” Zimmer Biomet CEO Bryan Hanson told analysts on a quarterly results conference call.

After the Pandemic Hit Nursing Homes Hard, California Lawmakers Push to Tighten Licensing Rules

Nursing home COVID copy 2_i.png

Source: Kaiser Health News, by Samantha Young

When Johanna Trenerry found a nursing home for her husband after his stroke, she expected his stay would be temporary.

He never came home.

Arthur Trenerry died at Windsor Redding Care Center in Northern California in October 2020. The 82-year-old great-grandfather is among more than 9,900 California nursing home residents who have died of covid-19.

The nursing home where Trenerry died is licensed by the state, but not under its current owner, Shlomo Rechnitz. The state denied Rechnitz a license, citing at least one death and multiple cases of “serious harm” at other nursing homes he owns or operates. To get around that, Rechnitz formed a business partnership with one of the home’s former owners, who continues to hold the facility’s license.

Some California lawmakers want to put an end to those types of business arrangements and ban people or entities from buying or operating nursing homes unless they have a license — which is the situation in most states. They’re also proposing an overhaul of the licensing process to reject applicants with poor performance and those without adequate experience or financial resources.

The ambitious effort, which the industry considers an overreach, could make California’s oversight the gold standard and a model for other states trying to improve nursing home care. Nationwide, more than 152,000 residents of nursing homes have died of covid during the pandemic, according to federal data.

“The public health emergency that we’ve experienced could be something that becomes a catalyst for making real change,” said Dr. Debra Saliba, a UCLA professor of medicine who served on a National Academies of Sciences, Engineering, and Medicine committee that released a comprehensive report on nursing homes in April. “One of the things that we have right now is the determination, the resources to make things happen.”

In his State of the Union address in March, President Joe Biden said the quality of care had declined in nursing homes taken over by investors — and vowed to set higher federal standards. In anticipation of the speech, the White House released a proposal calling on Congress to boost funding for nursing home inspections and to give federal regulators the authority to deny Medicare funds to underperforming facilities. The administration also directed the Centers for Medicare & Medicaid Services to propose minimum staffing standards within a year.

States are also taking steps to improve quality. New Jersey, for example, this year adopted a law that toughens penalties for health violations and requires nursing homes to disclose financial records.

In California, lawmakers are considering several proposals, including the changes to nursing home licensing rules.

Companies and individuals can buy or run nursing homes in California before they get a license, a process that even an industry lobbyist described at a legislative hearing this year as “backward” and unique to the state.

“In California, nursing home owners and operators can operate without a license even after they’ve been denied a license,” said state Assembly member Al Muratsuchi (D-Torrance), author of AB 1502. “Many of these owners and operators have, unfortunately, an extensive history of neglect and abuse.”

Muratsuchi’s bill would require an owner or company to apply for a license 120 days before buying or operating a nursing home and include financial records that contain the names of all owners and investors. The state would reject applicants who fail to meet standards for character, performance in other homes, and the financial ability to run the home. Homes operating without a license would lose Medicaid funding and couldn’t admit new residents.

The powerful California Association of Health Facilities, which represents more than 800 nursing homes, has blocked previous licensing legislation and has set its sights on Muratsuchi’s bill. The group is led by Craig Cornett, a veteran of the state Capitol who has worked for four Assembly speakers and two Senate leaders.

The organization has made just over $2 million in political contributions and spent $5.9 million lobbying lawmakers from Jan. 1, 2011, through March 31, 2022, according to records filed with the California secretary of state’s office.

The bill fails to consider the state’s “complex regulatory environments” and would create “extensive” disclosure requirements on ownership applications that “in many cases would fill an entire room with boxes and boxes of paper,” Jennifer Snyder, a lobbyist for the association, told lawmakers in January.

The measure would “eliminate the ability for most current owners in California to actually apply or even apply for a change of ownership,” she added.

But this year, the industry faces an altered political landscape.

Covid has pushed lawmakers to act — and Muratsuchi has gained a valuable co-sponsor for his bill, Democratic state Assembly member Jim Wood, head of the Assembly Health Committee. Wood has condemned nursing homes for not doing enough during the pandemic and has directed state regulators to conduct stricter oversight.

Muratsuchi’s measure has cleared the state Assembly and awaits a hearing in the Senate.

Investigations by news organizations CalMatters and LAist last year found that at least two California nursing home operators without licenses were running dozens of facilities even though officials at the state Department of Public Health had declared them unfit to do so.

The homes remain open, in large part because finding another nursing home for residents is incredibly difficult.

In July 2016, state regulators denied a license to Rechnitz — who had purchased the Windsor Redding Care Center, where Arthur Trenerry died — citing 265 health and safety code violations at his other facilities in the previous three years. Nevertheless, Rechnitz continues to operate the home in partnership with a former owner, Lee Samson, who is listed as a license holder in state records.

Mark Johnson, a lawyer who represents Rechnitz and his company, Brius Healthcare, said that Windsor Redding Care Center’s “license is in good standing” and that Rechnitz is managing the facility under an agreement “that is customary in the skilled nursing facility industry.” Rechnitz has filed a new and updated license application with the state, Johnson said.

Johanna Trenerry said she had no idea Rechnitz had been denied a license. Had she known, she said, she would never have placed her husband of 60 years at Windsor Redding.

Even before her husband caught covid, Trenerry and her children were trying to transfer him to another home because he seemed overly medicated, could no longer hold up his head, and fell numerous times trying to get out of bed, she said. Once, she recalled, the nursing home brought out the wrong person when the family visited.

They kept him “so drugged up,” said Nancy Hearden, one of the Trenerrys’ eight children. “And I think it was just because it was easier for them. He wasn’t getting to go to his rehab. I felt, ‘We’ve got to get him out of this place.’”

Then he got covid.

Sixty of the 84 residents at the facility came down with the disease in September 2020 — and at least two dozen of them died. According to a lawsuit filed by family members of 15 residents who died, including the Trenerrys, employees of the home were forced to work despite having covid symptoms. The lawsuit refers to state citations that found the home didn’t supply enough personal protective equipment to staffers, didn’t test staff, and placed covid patients and untested patients in the same rooms with residents who weren’t infected.

Johnson denied the allegations.

Leapfrog Group: Patients report worse hospital experiences during COVID-19 pandemic, raising safety concerns

Leapfrog sees 'significant' infection increases across its largest-to-date  release of hospital safety grades | Fierce HealthcareSource: Fierce Healthcare, by Dave Muoio

The latest batch of hospital patient safety ratings from the Leapfrog Group shows a general decline among “several” hospital safety measures concurrent with the onset of the COVID-19 pandemic, according to the healthcare safety watchdog.

 

Released Tuesday, the scores are accompanied by a report from Leapfrog that highlights a “significant” decline in the experiences of adult inpatients at acute care hospitals during the pandemic, with many areas “already in dire need” prior to the pandemic deteriorating even further.

“The healthcare workforce has faced unprecedented levels of pressure during the pandemic, and as a result, patients’ experience with their care appears to have suffered,” Leah Binder, president and CEO of the Leapfrog Group, said in a statement.

 
 

Leapfrog’s twice-annual reports assess more than 30 patient safety measures and component measures compiled from the Centers for Medicare & Medicaid Services (CMS) and Leapfrog’s hospital surveys between July 2018 and March 2021. The most recent release assigns letter grades to nearly 3,000 U.S. general hospitals and is the second collection of scores to incorporate safety and experience data from the COVID-19 pandemic.

This time around, Leapfrog assigned 33% of hospitals an “A,” 24% a “B,” 36% a “C,” 7% a “D” and less than 1% an “F”—a roughly equivalent distribution to those given in the fall.

Eight states had 50% or more of its hospitals receive an “A” grade, with North Carolina (59.8%) and Virginia (59.2%) leading the way.

 

On the other end of the spectrum, Wyoming, West Virginia, North Dakota and the District of Columbia had zero hospitals that received an “A” from the watchdog.

As before, Binder said that the “significant variation in safety performance” across different facilities underscores the need for public access to hospital assessment tools “so patients can make the best decision for themselves and their loved ones.”

Alongside the scores, Leapfrog placed a spotlight on patient experiences in a report comparing Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) scores across more than 3,500 U.S. hospitals before (2019) and during (mid-2020 to mid-2021) the COVID-19 pandemic.

The group found statistically significant declines between the survey periods in the average percentage of hospital patients who gave the most favorable responses for nine of the 10 HCAHPS measures.

 

The greatest decline was seen among patients’ experiences with hospital staff responsiveness (a 3.7 percentage point decrease), followed by communication about medicines (a 2.9 point decrease), and cleanliness of the hospital (a 2.9 point decrease).

Leapfrog noted that these patient experience areas and others—like understanding care transitions (which already claimed the least favorable responses)—are directly tied to patient safety events and likely took a hit due to pandemic strains on the healthcare workforce.

“We commend the workforce for their heroic efforts these past few years and now strongly urge hospital leadership to recommit to improved care—from communication to responsiveness—and get back on track with patient safety outcomes,” Binder said.

The inpatient experience report is the second in a series of three such analyses from Leapfrog focused on patient experience during the pandemic. The first report, released in early April, focused on a decline in favorable patient ratings for communications about procedures across ambulatory surgery centers and hospital outpatient departments alike.

Leapfrog’s broader Hospital Safety Grade rankings are available online as a free resource for patients and their families. The organization said its analyses are independently assessed and peer-reviewed, with the methodology of the scoring available online for review.

The prior round of ratings highlighted “significant” declines in hospitals’ performance on preventable hospital-acquired infections. Those findings echoed similar concerns from patient experience intelligence firm Press Ganey and the Centers for Disease Control and Prevention.

White House Warns Of COVID Surges In The Winter

White House warns of Covid surges in the winter - POLITICO

Source: Politico, by Hannah Farrow

Covid cases surged during the last two winters and are likely to again this year — unless the country can prepare and act, White House Covid-19 response coordinator Ashish Jha said Sunday morning.

“If we don’t get ahead of this thing, we’ll have a lot of waning immunity, this virus continues to evolve and we may see a pretty sizable wave of infections, hospitalizations and deaths this fall and winter,” Jha said on ABC’s “This Week.”

Congress needs to provide resources, Jha said, specifically $22.5 billion, a number that will help with a vaccine supply that’s dwindling. In March, White House Coronavirus Response Coordinator Jeff Zients said: “If the science shows that fourth doses are needed for the general population later this year, we will not have the supply necessary to ensure shots are available.”

The money, once allocated, would go toward Covid vaccine supply and coronavirus testing.

“If Congress doesn’t step up and fund these, I think, urgent and emergent priorities … they can’t wait until the fall, it will be too late,” Jha said.

And the proof is in the jab. With cases increasing in the Northeast, deaths remain low because of high vaccination rates.

“That’s not true for the whole country,” Jha said.

With enough resources to get more people vaccinated and more therapeutics in place, he said, “I do think we can get through this winter without a lot of suffering and death.”

5 Predictions For Employee Benefits In 2022 And Beyond

5 predictions for employee benefits in 2022 and beyond | BenefitsPRO

Source: BenefitsPRO, by Becky Seefeldt

The pandemic and the Great Resignation have created a perfect storm for employers. Employers need to be forward-thinking regarding employee benefits because this crucial feature can make or break a company. As people are less likely to stay at their current positions, they’re also much less interested in applying with any company that doesn’t offer them benefits such as health care or vacation time.

Related: 10 recruiting trends for the years ahead

The future of benefits is uncertain, but there are five predictions for where they’re headed in the next few years that could help employers adjust their current package.

1. A push to improve HSAs

There’s a chance that some common-sense changes could be made to health savings accounts (HSAs). These adjustments will allow those who are eligible for Medicare or Tricare benefits the ability to contribute towards their own HSAs. There’s also interest in revisiting how we define what a “qualified high-deductible plan” entails so as not only to accommodate more Americans but also do away with any unnecessary restrictions altogether.

The solution to this problem is not one-size-fits-all. Some would like the requirement taken away altogether, while others are open to compromise. This may include modifying how high-deductible plans should work so that anyone, even those with limited benefits, can contribute towards an HSA. With these changes, individuals will be able to prepare themselves better because they can use their HSA as needed now or put money away for the future.

2. A convergence of health plan options

For roughly the past 20 years, premiums have been increasing. The average premiums for family coverage have increased from $7,000 in 2001 to more than $22,000 by 2021. Deductibles have also risen, with the average deductible for a PPO rising from $201 in 2001 to nearly $1,700 in 2021. The average deductible is so high that it’s beginning to meet the criteria for a high-deductible health plan. PPOs (and all plans) have been increasing their deductibles, which may indicate convergence between health care and savings options.

The best option for employees can be to utilize these new and improved tools. Some people hesitate to move into a high-deductible health plan because of the name: “high-deductibles.” But, this is an excellent option for certain employees who want more control over their expenses and savings rates if something happens unexpectedly. The contribution and eligibility for an HSA can be adjusted by making a few changes to the PPO design. This way, employees will save more money since they’ll have access to managing their medical expenses, which benefits employers, too!

3. Increased or improved price transparency

Increased or improved price transparency has been on the table for about two decades; however, there is more reason than ever to expect forward progress in this area. First is the No Surprises Act, which protects consumers from being surprised by unexpectedly high bills. This includes air ambulance claims, emergency services, and even non-emergency medical treatments that are billed as out-of-network when performed at an in-network facility. This act establishes limits on what can reasonably be charged and provides dispute resolution between plans and out-of-network providers.

Next, the Transparency in Coverage Act requires plan providers, including employers with group coverage or individuals purchasing their own plan to be transparent about prices and out-of-pocket costs. The start date for this act has been pushed back to July 1, 2022.

4. A move to strengthen health and wellness

When it comes to health and wellness, there are several options available. Help employees identify and address health risks before they result in costly medical procedures. As an employer, you can provide them with more comprehensive management and assistance using digital programs, online counseling services, etc.

Another option is utilizing a “specialty account” that caters to unique needs. This type of pre-tax savings plan has been gaining traction with employers who want to help their employees save money on afterschool programs, fitness classes, or even scooters for commuting purposes.

5. An increase in targeted benefits communications

The final prediction is regarding an increase in targeted benefits communications. With targeted communications on the rise, this trend is just getting started. We live in a world where personalization is everything, and benefits should be no exception. Benefits have traditionally been a data dump that occurs every few weeks in which employees are overwhelmed by the sheer volume of information. As employees continue to demand more from their employers both digitally and physically, companies must find ways to elevate their offerings. Consumers want personalized everything — from meals at home or takeout to how much information is given about them when they buy something. Why should employee benefit plans be any different?

While the future of benefits is uncertain, employers should be proactive in preparing for changes. Employers need to be forward-thinking regarding employee benefits and stay up-to-date on the latest industry trends. These five predictions offer a glimpse into what could be ahead, so it’s essential to start thinking about how they may impact your organization and employees.

Becky Seefeldt is vice president of strategy at Benefit Resource LLC (BRI), a leading provider of dedicated pre-tax account administration and COBRA services nationwide.

WTW: A Look At Employers’ Strategies For Addressing Affordability

WTW surveys employers on healthcare costs

Source: Fierce Healthcare, by Paige Minemyer

Most employers are putting a focus on managing healthcare costs coming out of the pandemic, a new survey shows.

 

Analysts at WTW polled 636 employers representing 10 million workers and found that 94% are naming healthcare costs a top priority over the next two years. A close second was enhancing mental health benefits, with 87% calling it a key priority.

Nearly two-thirds of the surveyed employers (64%) said they will be taking steps to address affordability over the next two years. These efforts include enhanced low- or no-cost benefits, named by 41% of the employers, as well as addressing outcomes and care quality, named by 55%.

“Employers are really having to manage a lot of things at the same time,” Courtney Stubblefield, insights and solutions leader for health and benefits at WTW, told Fierce Healthcare. “It’s a lot of really substantial things that are durable. We’re in a challenging time for employers as they try to put together the best benefit package they can.”

Close to one-third of employers (32%) said they expect to make changes to employees’ out-of-pocket costs over the next two years, and 21% said they plan to make changes to the health plan payroll contributions.

Behavioral health is not a new source of focus for employers but has become an even more significant challenge coming out of COVID-19. By the end of 2023, most employers (95%) said they will offer virtual care for physical and behavioral health, and 61% said they expect to lower the out-of-pocket costs for virtual care.

 

More than half (55%) said they expect virtual care will drive down care costs in the long run.

Stubblefield said key challenges in addressing behavioral health include providing care to unique populations such as children and adolescents. They’re also looking at ways to integrate behavioral health coverage into other apps and member-facing tools to ensure workers are aware of the benefits they have access to, she said.

“All eyes are focused on this,” she said. “It’s a very concerted effort.”

Small Businesses Owe Billions In Unforgiven PPP Loans

Small Businesses Owe Billions in Unforgiven PPP Loans | Word & Brown

Source: Word & Brown, by Alex Strautman

The Paycheck Protection Program (PPP), launched as part of the federal government’s Coronavirus Aid, Relief, and Economic Security (CARES) Act to aid to small businesses coping with the impact of COVID-19, ended on May 31, 2021. However, nearly 350,000 small businesses that received a PPP loan have not had their loans forgiven. Another 380,000 loans have been only partially forgiven.

A recent analysis by Bloomberg News says total PPP debt amounts to $28 billion, with most loans for less than $25,000. During 2021, the Small Business Administration (SBA) reported distributing more than $400 billion to more than six million businesses through the PPP, Restaurant Revitalization Fund, Shuttered Venue Operators Grant, COVID Economic Injury Disaster Loan (EIDL), and targeted and supplemental advance programs.

Employers receiving a PPP loan during the first funding round had until August 30, 2021, to apply for loan forgiveness. However, advocacy groups, community leaders, and business owners say the process for seeking forgiveness is burdensome for businesses. Indeed, the loan forgiveness application, SBA Form 3508S (07/21), is seven pages and requires considerable documentation regarding how PPP funds were used.

The SBA boasted in 2021 that it had streamlined its forgiveness application processes. In a press release, the SBA said, “a borrower of a participating lender can now complete most or all of a forgiveness application using a computer or, for the first time, their smartphone. On average, users are able to complete and submit directly to the SBA their applications in just six minutes, and most receive their forgiveness decisions within a week from the date of submission.“

More than six months after the forgiveness application deadline, 50+ business and advocacy groups are still pushing the SBA, Treasury Department, and Congress to forgive automatically PPP loans of $25,000 and less. They argue that many sole proprietors face challenges with income, payroll, and expense documentation. They are also seeking rescission of a rule that denied forgiveness to businesses making a good-faith effort to comply with forgives rules.

In other PPP-related news, the Justice Department continues to go after individuals and businesses that have misused funds related to CARES assistance. In March, charges were filed in Louisiana against an Amtrak employee who sought approximately $89,000 in PPP funds, even while working full-time.

Sentencing also took place last month for two Michigan residents who obtained nearly $1.5 million in PPP funds. Authorities have recovered more than $1.123 million traced to the fraudulently obtained funds through a parallel civil asset forfeiture action. California convictions include seven individuals in Los Angeles sentenced in November for PPP and EIDL fraud in excess of $20 million, as well as a separate action last year against a Temecula business owner who sought and obtained $7.25 million in federal assistance.

Trump Era Rule That Expanded Duration Of Short-Term Health Plans In Democrats’ Crosshairs

Trump era rule that expanded duration of short-term health plans in  Democrats' crosshairs | Fierce Healthcare

Source: Fierce Healthcare, by Robert King

Democratic lawmakers and advocacy groups are making a push to convince the Biden administration to nix a controversial Trump-era rule that expanded the duration of short-term health plans.

 

A collection of more than 40 House Democrats wrote to Department Health and Human Services (HHS) Secretary Xavier Becerra earlier this week calling for the agency to pull the rule. The action comes after more than 20 advocacy groups wrote to Becerra back in January asking for the rule to be nixed or modified.

“Junk plans pose clear risks to consumers, undermine the strength of the Affordable Care Act and are incompatible with the goal of making affordable, high-quality health insurance accessible to all Americans,” the letter, led by Rep. Cindy Axne, D-Iowa, told Becerra.

Advocates say urgency has been rising to get the administration to reverse the rule, which was finalized in 2018 and lengthened the duration of short-term plans from three months to a year.

A major concern is the potential end of the COVID-19 public health emergency (PHE), which was extended until July. Once the PHE goes away, states will be able to disenroll ineligible Medicaid beneficiaries and extra COBRA subsidies will go away.

“The second that the PHE is allowed to end all of those people are suddenly uninsured and the worry is that if we don’t do something now a lot of those people continue to stay uninsured or will buy a short-term plan that doesn’t meet their needs,” said Caitlin Donovan, senior director of the National Patient Advocate Foundation, one of the groups pressing the administration to act.

 

Donovan said she was confident the rule will eventually be rescinded, as it has not been popular.

The Trump administration finalized the regulation in 2018 for short-term limited duration plans that can bypass requirements under the Affordable Care Act (ACA) to cover preexisting conditions and essential health benefits. The rule said that the 12-month plans can be renewed for up to 36 months.

HHS at the time said the plans were necessary to give consumers options as premiums on the ACA’s exchanges were too high. However, the insurance industry and consumer advocates charged the plans offer skimpy coverage and can deceive consumers that they are getting more robust benefits.

“Individuals that unwittingly purchase a short-term plan that are later diagnosed with a chronic or acute condition may find themselves seriously uninsured as short-term plans typically exclude coverage of key services such as prescription drugs and mental health services, among others,” the letter, led by the National Patient Advocate Foundation and more than 20 other groups, said.

 

The letter has proposed several changes to the initial 2018 rule, chief among them to restore the original three-month limit for the plans.

Other recommended changes include:

  • * Halting sales of short-term plans during the ACA open enrollment. Advocates pointed to studies that indicate the plans can be “aggressively and deceptively marketed to consumers.”
  • * Limit sales of plans via internet and phones to help clamp down on deceptive marketing tactics.
  • * Improve disclosure of the types of risks associated with short-term health plans, including by telling the consumer the plan is not comprehensive.

The Biden administration has been in favor of getting rid of the rule or making changes, referencing it in the latest Unified Agenda that outlines regulatory priorities for the coming year.

So far, HHS has not released any regulations on the issue, and the Centers for Medicare & Medicaid Services did not return a request for comment as of press time.

Last Updated 05/25/2022

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