Sebelius concedes reform could raise premiums

Overview: Years after the insurance industry began warning that premiums will rise due to health reform, the Obama administration acknowledged Tuesday that it might actually be the case.

Health and Human Services Secretary Kathleen Sebelius told reporters at the White House that some people may see their premiums rise under the Patient Protection and Affordable Care Act.

Article:  Sebelius concedes reform could raise premiums

Study: Health overhaul to raise claims cost 32 pct

Overview: A new study finds that insurance companies will have to pay out an average of 32 percent more for medical claims on individual health policies under President Barack Obama's health care overhaul.

What does that mean for you?  It could increase premiums for at least some Americans.

Article: Study: Health overhaul to raise claims cost 32 pct

Small Businesses Pursue Health Law ‘Loophole’

Summary: Self-insurance, once the purview of only large companies, is becoming popular with small employers, too. But it could be a threat to the Affordable Care Act, since self-insured companies are exempt from many of the health law's requirements.

Article:  Small Businesses Pursue Health Law ‘Loophole’

Affordable Care Act at 3: Looking Forward and Expanding Access

By Kathleen Sebelius, Secretary of Health and Human Services

Posted March 22, 2013

Thanks to the health care law, qualified individuals will have access to quality insurance through the Health Insurance Marketplace.

Full Article:  Affordable Care Act at 3: Looking Forward and Expanding Access

Small Employers Are Clueless About Obamacare

Article:  http://www.businessweek.com/articles/2013-03-21/small-employers-are-clueless-about-obamacare

Most PPACA Provisions for Expatriate Plans Delayed Until 2015

On March 8, 2013, the Departments of Labor, Health and Human Services and Treasury issued a Frequently Asked Question (FAQ) announcing that compliance with most Patient Protection and Affordable Care Act (PPACA) provisions is being delayed for expatriate plans meeting this definition:

HRAs & PCORI Fees

As part of The Patient Protection and Affordable Care Act (PPACA) a new fee was introduced to be paid by health insurers and self-funded plan sponsors to fund the Patient-Centered Outcomes Research Institute (PCORI). The PCORI was established by the Act to promote the use of evidence-based medicine by disseminating comparative clinical effectiveness research findings. In mid December, the IRS released final regulations and guidance on the calculation and payment of the PCORI fees. Plans that are subject to the fee are:

Health Care Reform News for 2013

With the Supreme Court Ruling and the Elections behind us, the majority of the obstacles to the implementation of the Affordable Care Act (ACA) have been cleared. The question is no longer if, but when and how ACA will be established in each state.

Please review the Health Care Reform News for some key provisions for Health Care Reform new in 2013 and provisions from prior years impacting 2013:

• Exchange/Marketplace Creation,
• Employer Exchange Notices—DELAYED,
• New Taxes, Limits, and Fees,
• Uniform Summary of Benefits and Coverage (SBC) Forms and Notice of Material Modifications,
• Women's Preventive Services,
• Medical Loss Ratio Rebate,
• W-2 Reporting, and
• Small Business Health Care Tax Credit—available through 2013.

Medicaid Expansion

The Supreme Court's ruling on the Affordable Care Act (ACA) allowed states to opt out of the law's Medicaid expansion, leaving each state's decision to participate in the hands of the nation's governors and state leaders.

Some governors of states who weren’t expected to support Medicaid expansion have announced the intention to do so. Still others are holding firm that expanding a system they view as flawed is a recipe for disaster.

Medical Loss Ratio Rebates - Final Rule Update

HHS is amending the Medical Loss Ratio program, also known as the 80 / 20 rule, to ensure that, beginning in 2014, issuers include premium stabilization amounts in medical loss ratio and rebate calculations. HHS is extending the annual medical loss ratio reporting deadline from June 1 to July 31, and the rebate disbursement deadline from August 1 to September 30 to take into account the premium stabilization programs. This change will allow issuers to accurately calculate their medical loss ratios while ensuring that consumers receive rebates as quickly as possible. HHS is also allowing tax-exempt not-for-profit issuers to deduct community benefit expenditures (subject to caps) and State premium tax from premium in calculating medical loss ratios and rebates. This change promotes a level playing field for issuers within each State.

Welcome to our Health Care Reform News Feed!

As part of our ongoing commitment to keep you informed, Sterling Benefits has added a resource to release the latest updates in a timely manner without inundating you with emails. We encourage you to read our News Feed at your leisure or you may subscribe to the “blog” to receive a digest of any communications.

We have populated the News Feed with past communications to better assist you.

We’ll continue to send out updates as they become available, but we encourage you to review the information and utilize our website and office as a resource in addressing questions and concerns. The website includes previous Sterling publications, hot topics, resource links, highlights, timelines and calendars.  Please feel free to share this website and invite people to sign up for electronic Reform updates!

As always, we appreciate the opportunity to be of service.

Thank you,
Christina & Brenda

HHS Conditionally Approves Four More Partnership Exchanges

On 3/7/2013, HHS'announced that it was offering conditional approval to four more partnership exchanges under the Affordable Care Act.

Michigan, New Hampshire, West Virginia and Iowa are the final four states to receive conditional federal approval to run state partnership health insurance exchanges.

The announcement means 24 states and the District of Columbia have submitted plans to operate or partially operate health exchanges.

Small Business Health Care Tax Credit Reduction

Effect of Sequestration on Small Business Health Care Tax Credit
Pursuant to the requirements of the Balanced Budget and Emergency Deficit Control Act of 1985, as amended, certain automatic cuts took place as of March 1, 2013. These required cuts include a reduction to the refundable portion of the Small Business Health Care Tax Credit for certain small tax-exempt employers under Internal Revenue Code section 45R. As a result, the refundable portion of your claim will be reduced by 8.7 percent. The sequestration reduction rate will be applied until the end of the fiscal year (Sept. 30, 2013) or intervening Congressional action, at which time the sequestration rate is subject to change.

IRS Press Release 3/6/2012