How States Can Expand Volunteer Health Care

Millions of poor Americans are still uninsured or lack access to affordable health care options, but a simple local reform is already changing thousands of lives, and if enacted across the country, could help millions, says a report by the Foundation for Government Accountability (FGA). The report shows how every state can offer legal protections for health care professionals, like doctors, nurses, dentists, pharmacists, surgeons, and more, who provide free health care to low-income patients and their families.

Using Florida’s Volunteer Health Services program as a case study, the report shows how low-income residents in the Sunshine State benefitted from $1.3 billion in donated medical goods and services from 2010 to 2014. In 2014 the state netted a $614 to $1 return on its investment, spending just under $500,000 to administer the program, leading volunteers to provide nearly $300 million worth of care.

“There are so many charitable, caring people working in our health care system who want to help those in need, but feel constrained by frivolous liability concerns, which keeps them from donating valuable care to the poor,” said Tarren Bragdon, FGA CEO.

Volunteer care reforms are incredibly popular with the public, with 84% of voters supporting incentivizing and protecting health care professionals who provide free treatment. If volunteer care reforms are widely adopted, almost 4 million Americans could benefit from greater access to health care services each year. “We’ve already seen how transformative this program can be for people’s lives,” said Andrew Brown, a senior fellow with FGA. A Florida truck driver, who lost his job because of severe diabetes, got free treatment under the program, which helped him get back on the road. He now has a steady income and is able to provide stability for his family, and health insurance.

Federal Action Could Expand Private Retirement Coverage

About half of private sector workers in the United States have no access to a workplace retirement savings program, especially those who are low-income or employed by a small firm, according to a report by the General Accountability Office (GAO). This is an important issue for states because millions of workers who don’t have enough retirement savings could strain safety net programs.

About 45% of private sector workers participate in a workplace retirement savings program. Using tax data to correct for under-reporting raised the share of workers participating to 54%, but it still indicates that many workers lack coverage. Eighty-four percent of those who are not participating work for employers that don’t offer retirement savings programs or they are not eligible for the programs because they are new employees or in jobs that are excluded from participating. The majority of lower-income workers and those employed by smaller firms say they would participate in a workplace retirement program if is was offered.

Key strategies to expand private sector coverage include encouraging or requiring workplace access, having automatic enrollment, offering financial incentives, and simplifying the program. Pending implementation, California and Illinois would require certain employers to enroll workers automatically in a state-run program, though workers could choose to opt-out.

Combining workplace access with automatic enrollment and financial incentives has helped increase participation in the countries that GAO studied. States and countries have tried to simplify programs by reducing complexity, cost, and risk for workers. Some states intend to reduce burdens for employers by selecting and monitoring providers. They plan to reduce the complexity for workers by limiting investment options.

State and national stakeholders say that the Employee Retirement Income Security Act of 1974 (ERISA) creates challenges that could delay or deter state efforts to expand coverage. ERISA preempts any state law relating to employee benefit plans for private sector workers. Four of the six states that GAO reviewed intend to create payroll deduction IRA programs that would not be considered employee benefit plans. But under ERISA, it is unclear whether a state can offer such programs or certain program features. Regulations from the Departments of Labor (DOL) and the Treasury also create uncertainty.

In addition to federal efforts, a growing number of states have proposed efforts to expand coverage in private sector workplace retirement savings programs. Other countries have also implemented similar efforts. GAO suggests that Congress consider giving states limited flexibility to expand private sector coverage. Agencies generally agreed with GAO’s recommendation. DOL plans to issue a proposed rule on state programs by the end of 2015

Senate Bill Would Expand Access to Pharmacies

The National Community Pharmacists Association (NCPA) strongly endorses The Ensuring Seniors Access to Local Pharmacies Act, S. 1190. The legislation would expand the number of pharmacies that can offer discounted copays for Medicare Part D prescription drugs. It was introduced by Senators Shelly Moore Capito (R-W.Va.), Joe Manchin (D-W.Va.), Tom Cotton (R-Ark.) and Sherrod Brown (D-Ohio).

Medicare beneficiaries in medically under-served areas would be able to access lower copays at any pharmacy that agrees to accept a drug plan’s preferred pharmacy terms and conditions. S. 1190 is a companion bill to H.R. 793, The Ensuring Seniors Access to Local Pharmacies Act, which has been introduced by Reps. Morgan Griffin (R-Va.) and Peter Welch (D-Vt.). NCPA CEO Douglas Hoey, RPh, MBA said, “Medicare beneficiaries should not be confronted with the Hobson’s choice of continuing to patronize their pharmacy at a higher cost or making a long trip to another pharmacy.”

The bill has been endorsed by the Alliance for Retired Americans, the Center for Medicare Advocacy, Families USA, Justice in Aging, the Medicare Rights Center, the National Consumers League, the National Rural Health Association, and the U.S. Pain Foundation. “Today many Medicare beneficiaries are effectively told by drug plan middlemen which pharmacy to use based on exclusionary arrangements among the pharmacy benefit manager (PBM) middlemen and, in most instances, large publicly traded chain pharmacies,” Hoey added. According to a recent Medicare study, in urban areas 54% of preferred pharmacy drug plans failed to meet the government’s threshold for reasonable access to pharmacies. In rural America the closest preferred pharmacy can be 20 miles away or more.

Covered California Update

CoveredCAAnnouncementCOBRA Recipients Get Another Chance to Sign Up for the Exchange
At a recent board meeting,Covered California’s executive director, Peter Lee outlined what to expect with the state’s exchange over the next couple of years. He announced a special enrollment period for COBRA enrollees. On May 15, Covered California launched a limited-time special-enrollment period for people who have COBRA health insurance and would like to switch to an exchange plan. They will be eligible to buy coverage through Covered California until July 15.  “Since the passage of the Affordable Care Act, plans in the individual market could be preferable to COBRA coverage because of premium assistance and cost-sharing reductions…For some people who have COBRA coverage, purchasing a plan in the Covered California marketplace…could save thousands of dollars a year,” he said in a press release. At the board meeting, Lee explained that many people missed the open enrollment deadline because they found it difficult to compare the two types of coverage. Lee said that Covered California is telling COBRA recipients, “Don’t try to do this alone.” They are encouraged to get help from navigators and agents, whom Covered California has been busy training to help with COBRA issues.

Don’t Expect Major Changes to Covered California Until 2016
Lee said that Covered California is not expecting to make major changes in 2015. “We will continue to make sure that networks are adequate and that networks are not shrunk or changed…We need product consistency so renewal can be as smooth as possible. We expect minimal changes to our contracts with plans.” Lee said that Covered California will revisit model contract issues for 2016. “We think that there will be significant issues, such as how to look at benefit design and consumer understanding of coinsurance and copayments as well as issues of contract terms.”

Networks to Expand
Lee said that carriers are greatly expanding their networks in Covered California. Blue Shield has expanded its network significantly over past 12 months. He said that 65% of doctors in the company’s global broad PPO network are now serving enrollees in Covered California as well as individual enrollees outside of Covered California. Health Net has expanded its doctor network by 58% since Jan. Brad Johnson of the California Medical Assn. said that, under Covered California, doctors are having problems finding specialists and specialty facilities for referrals. Julianne Broyles of California Health Underwriters said, “From our meetings with our members, over the past few days, the issue of network adequacy has certainly come up as one of their top concerns that they are hearing from their clients.”

Enrollment
Lee said that Covered California expecting to have the next open enrollment available from November 15 to February 15. “We will have three months to renew a million people and hopefully sign up 500,000 more. It is a lot of work,” he added. Sixty percent of the people who have enrolled agreed to let Covered California use their financial data to automatically check their eligibility.” Covered California expects to have 1.2 million enrollees who have paid their premium by May 2014, increasing to 1.7 million by April of 2015, and 2 million by April 2016.

Bill Would Expand HSAs & FSAs

Senate Finance Committee Ranking Member Orrin Hatch (R-Utah) and Senator Marco Rubio (R-Fla.) introduced the Family and Retirement Health Investment Act of 2013 to strengthen and expand health savings accounts (HSAs) and flexible spending arrangements (FSAs). Companion legislation was introduced in the House by U.S. Rep. Erik Paulsen (R-Minn.).

Hatch, whose Committee has jurisdiction over health care policy said, “Over the years, these plans have grown in popularity, and it’s well past time Congress act to improve them. Streamlining these popular health care products…will provide millions of families, workers, and retirees the opportunity to put away tax-free savings to pay for their personal medical costs. It’s smart policy to increase access to quality and affordable health care for consumers at an affordable price and I hope to see this bill enacted into law.”

The legislation would do the following:
• Allow a husband and wife to make catch-up contributions to the same HSA.
• Remove the onerous new restrictions on the use of HSA and FSA dollars for the purchase of over-the-counter drugs.
• Clarify the use of prescription drugs as preventive care that will not be subject to an HSA-eligible plan deductible.
• Reauthorize the use of Medicaid health opportunity accounts.
• Promote wellness by expanding the definition of qualified medical expenses to encourage more exercise and better nutrition.
• Allow seniors enrolled in Medicare Part A to continue contributing to their HSAs.
• Allow for the purchase of low-premium health insurance and long-term care insurance with HSA dollars.

Medical Carriers Expand Into Voluntary Benefits

Medical carriers are looking to become total solution providers by expanding their voluntary product portfolios and creating alliances with voluntary carriers. Many medical companies surveyed by Eastbridge, now consider voluntary to be a major benefit business, especially in light of healthcare reform’s potential to erode customer loyalty through health exchanges and the entrance of non-traditional carriers. “When we first looked at the involvement of medical carriers in the voluntary market in 2007, all but a few already offered some worksite products. Today, voluntary has penetrated their portfolios even more. In fact, the majority of medical carriers indicated that voluntary has seen double-digit growth in their company over the last five years as they add more products to their offering,” said Bonnie Brazzell, vice president at Eastbridge.

More than half of the medical carriers participating in the recent survey offer four or more voluntary products. In addition, many are developing strategies and assigning accountability to the voluntary line to maintain a connection with their customers. For more information, visits www.eastbridge.com.

Last Updated 12/01/2021

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