Idaho Health Insurance

CQ Share to FacebookShare to Twitter (5/18, Adams, Subscription Publication) reported that under a final rule HHS released Friday, “the reimbursement rate for medical services provided under the high-risk pools,” known as the Pre-Existing Condition Insurance Plan, “will be lowered to Medicare rates.”

Further, the rule “bans medical providers in the program…from asking patients to pay the difference between what the program will cover and what the provider wants to charge.”

According to the rule, that is “to protect enrollees in the federally administered PCIP from having to shoulder potentially significant costs that could be shifted to them as a result of this new payment policy.”

The House voted to repeal Obamacare on Thursday, May 16th for the third time since Republicans took over the chamber in 2011 and the 37th time the House GOP has voted to repeal or defund a part of the bill.

The 229-195 vote included two Democrats who sided with Republicans — Jim Matheson of Utah and Mike McIntyre of North Carolina. All Republicans voted in favor.

In a Congress where spin often trumps legislation, Republicans see a political advantage to keeping the pressure up as the administration tries to get all the moving parts of the law finally working.

Starting this fall, uninsured people who can’t get coverage through their jobs will be able to sign up for government-subsidized insurance that takes effect Jan. 1. The rollout promises to be bumpy because about half the states are still resisting the law, and Republicans in Congress won’t provide the administration with funds it says are needed for a smooth implementation.

Democrats said the House vote was a pointless exercise. They noted that the ACA — as the law is known — has been upheld by the Supreme Court, and millions are already receiving some benefits, from young adults able to stay on a parent’s insurance until age 26, to seniors on Medicare whose high prescription drug bills have been reduced.

Democratic leader Nancy Pelosi of California said repeal vote is “clear waste of time and of taxpayer dollars.”

“Unfortunately, House Republicans seem to think that their main responsibility is to do nothing,” Pelosi said.

But Republicans see a soft target in a costly program that continues to divide the country.

They’re hoping that implementation problems next year will help the GOP take control of the Senate in the midterm congressional elections and build on its House majority. Part of the political strategy behind Thursday’s vote was to give freshmen Republicans a chance to vote on full repeal of what they dismiss as “Obamacare.”

“Republicans will continue to work to scrap the law in its entirety so we can focus on patient-centered reforms that lower costs and protect jobs,” said House Speaker John Boehner, R-Ohio.

What that alternative would look like, no one really knows, because Republicans have not presented a plan of their own since Obama’s law was debated in Congress more than three years ago.

Boehner said a GOP approach would include medical malpractice reforms, risk pools for people with pre-existing medical problems, and allowing individuals to buy coverage from out-of-state insurers to spur competition. But nothing has been finalized.

Boehner also pointed out that not even Obama believes the healthcare law is perfect. On seven previous occasions GOP efforts to scale back parts of the law were eventually accepted by the president and signed into law. They included a Medicaid formula allowing thousands of middle-class people to qualify for nearly free coverage, a long-term care insurance plan likely to go belly-up, and paperwork requirements protested by small businesses. The administration sees those as relatively minor changes.

The House debate got creative. Rep. Michele Bachmann, R-Minn., compared the health care law both to a looming iceberg and an impending train wreck. “The more we learn about Obamacare, the more unpopular it becomes,” she said.

“In light of the recent revelations that have just come out within this last week regarding the outrageous activities of the Internal Revenue Service pointed against the people of the United States, every American should be concerned about the negative consequences of this bill, Obamacare,” Bachmann said.

“The Supreme Court has ruled that Obamacare is in fact a tax. Knowing that it’s a tax, the logical conclusion is that the entity in the United States tasked with enforcing tax policy is the IRS.”

Editor’s Note: New ‘Obamacare Survival Guide’ Reveals Dangers Ahead for Your Healthcare

Majority Leader Eric Cantor said that more government is not the answer, reports The Hill.

“Sweeping mandates on individuals and businesses will not improve our healthcare.”

Rep. Mark Sanford echoed Cantor’s sentiments, saying Obamacare uproots the American tradition of “not having the government force on the consumers the notion of the purchase of a product.”

Three years after its passage, Americans remain divided over Obama’s signature domestic policy achievement. Even the uninsured are confused about whether they will be helped. Many people who have coverage worry it will raise their costs and make it harder for them to see their doctors. Some of the law’s underlying goals, such as a ban on insurers turning away people with pre-existing conditions, remain popular. However, the requirement that virtually all Americans carry coverage or face fines is still widely disliked.

Payment cuts to Medicare Advantage plans are on the horizon, but Democrats and Republicans disagree greatly on how those cuts will affect beneficiaries.

In the recent past — from 2010 to 2012 — payments to Medicare Advantage plans were at least $3.2 billion higher than they should have been, the Government Accountability Office (GAO) said Monday in a report requested and released by Democrats. The GAO recommended the Centers for Medicare and Medicaid Services (CMS) take further steps to improve the accuracy of risk-adjustment scores.

While those steps may still be an option, Democrats also tout pending cuts to Medicare Advantage plans in the Affordable Care Act (ACA) that they say represent overpayments to the managed care plans that participate in the Medicare Advantage program. Obama’s signature health law will reduce payments to Medicare Advantage plans by more than $300 billion over a decade as a way to pay for implementing the law.

“The Affordable Care Act reined in overpayments to private plans, but this report makes it clear that there is more to be done,” Rep. Sander Levin (Mich.), the top Democrat on the House Ways and Means Committee, said in a statement. “As we continue to look for opportunities to eliminate waste, fraud, and abuse in Medicare and pay for physician payment reform, payment accuracy should be one of the first steps we take.”

Levin also noted that “While a more accurate adjustment would increase payments for some beneficiaries, it would decrease payments for others.”

CMS pays the private health insurers that administer Medicare Advantage plans a predetermined amount per beneficiary, adjusted for health status. However, Medicare Advantage plan administrators have been criticized for exaggerating the health status of their patients in order to recoup more money from CMS.

Meanwhile, Republicans maintain that the cuts to Medicare Advantage plans mandated by the ACA will cause decreases in benefits and increased cost-sharing, and they may lead providers to withdraw from the program, all of which will increase the number of beneficiaries who drop out of Medicare Advantage.

They point to a report from the Medicare Chief Actuary that projects patient enrollment to be cut in half by 2017 when the ACA’s cuts are fully implemented.

“While the president promised that Americans could keep the health plans they liked, we are concerned that the combined effects of these policies will jeopardize beneficiary access to the Medicare Advantage plans of their choice,” the Republican heads on the Senate Finance, House Ways and Means, and House Energy and Commerce committees stated late last week.

The letter they sent Thursday to Acting CMS Administrator Marilyn Tavenner outlined their concerns with how the pending cuts are being implemented and sought CMS’s response to them. These concerns included lack of transparency by CMS, artificially optimistic assumptions about physician payment rates, confusion caused by delays in issuing regulations related to the cuts, and limiting patient choice with arbitrary price controls.

The lawmakers also cited a report released last week by America’s Health Insurance Plans (AHIP) that showed the effects of CMS’ proposed 2.3% reduction in Medicare Advantage payments for 2014. That would be on top of the cuts already slated under the ACA.

Seniors can expect to pay $50 to $90 per month more in premiums under the proposed cuts, according to the AHIP report. The health insurance trade group painted the rise in premiums as devastating, noting 41% of seniors enrolled in a Medicare Advantage plan had an annual income of less than $20,000.

Political bickering over the Medicare Advantage cuts is nothing new to Washington.

Republicans tried to characterize the cuts in a negative light throughout last fall’s election season.

Meanwhile, the Obama administration has asserted that the Medicare Advantage program is strong since the passage of the ACA. Officials said premiums have fallen 10% and enrollment jumped 28% since the law was passed in 2010. Furthermore, the number of plan choices will increase by 7% in 2013, with monthly premiums projected to increase by an average of $1.47.

On the other side, Republicans have noted that only a small fraction of the Medicare Advantage plan’s cuts — 4% — have taken effect so far.

What is the Affordable Care Act?
The Affordable Care Act is a comprehensive health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” is used to refer to the final, amended version of the law. (1)

What is the age band rating?
Beginning on January 1, 2014, the Affordable Care Act mandates the implementation of a nationwide 3:1 age band rating. This system regulates the differential in costs between older and younger individuals in health insurance pools. Basically, the ACA requires that older people (e.g., a 63 year old) are not to be charged more than three times the amount of younger people (e.g., a 27 year old). The law’s new age rating system will impact most states, where ratios are currently 5:1 or higher, and could trigger dramatic and disproportionate rate increases for younger individuals. (2)

What does a balanced insurance pool mean?
Having a balanced insurance pool that includes enough young, healthy people to help offset the costs of those that are older and sicker is critical to keeping coverage affordable for everyone. If younger people do not participate in the insurance pool, premiums will increase for everyone.

What is a catastrophic health plan?
Beginning in 2014, catastrophic health plans will be available to young Americans up to age 30 and to individuals who are exempt from the individual mandate because no affordable coverage is available or they have a hardship exemption. At this point, it’s difficult to predict how affordable catastrophic health plans will be in 2014. While premiums for some catastrophic plans may be lower than other plans available, catastrophic plans will not be eligible for subsidies. Catastrophic plans will have higher deductibles, meaning individuals will be responsible for initial health care costs but will be protected from unexpected high costs due to a major illness or accident (after meeting their deductible – estimated by HHS to be $6,400 in 2014 (3) ). They will also provide first-dollar coverage for preventive health services and three annual primary care visits. Once the deductible is met, the catastrophic plan will cover the essential health benefits.

What is a deductible?
A deductible is the amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1000, your plan won’t pay anything until you’ve paid $1000 deductible covered health care services subject to the deductible. The deductible may not apply to all services. (3)

What are essential health benefits?
The Affordable Care Act calls for health plans offered in the individual and small group markets to include 10 broad categories of services known as “essential health benefits” (see list below). The ACA create a structure of standardized tiers of cost-sharing associated with those benefits – insurers will be required to offer plans that fit within four levels of coverage: bronze, silver, gold and platinum. Bronze plans will have the least generous coverage with more out-of-pocket costs and platinum plans will have the most generous coverage with the least out-of-pocket costs.

Essential health benefits are defined as:
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care (4)

What are federal subsidies?
The Affordable Care Act provides subsides for eligible people in an income range of 138 to 400 percent of the federal poverty level (5). The subsidies will be offered on a sliding scale, with those earning the least getting the most assistance. Those with lower incomes, earning less than 138 percent of the poverty line (about $33,000 for a family of four), in some case less than 100 percent of the poverty line depending on decisions made by states, may receive coverage through Medicaid. Those earning up to 400 percent of the poverty line (about $92,000 for a family of four) may receive subsidies to buy private insurance. According to the Congressional Budget Office, more than 40 percent of people purchasing coverage in the individual market today will not be eligible for the premium subsidies in 2014 (6). About one-third of 25-34 year olds will not be eligible for the premium subsidies in 2014 and will be responsible for the full premium if they buy coverage on their own. Individuals and families who are not eligible for the federal subsidies (those with incomes above $44,680 for an individual, or 400% of the federal poverty level) will see their premiums increase by at least 30%, with many in this category facing even higher increases.

What does individual responsibility mean?
Under the Affordable Care Act, starting in 2014, you must be enrolled in a health insurance plan that meets basic minimum standards (7). If you aren’t, you may be required to pay a penalty. You won’t have to pay the penalty if and the required coverage is unaffordable for you, or for other reasons including your religious beliefs. You can also apply for a waiver asking not to pay the penalty if you don’t qualify automatically.

What is minimum essential coverage?
The type of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act. This includes individual market policies, job-based coverage, Medicare, Medicaid, CHIP, TRICARE and certain other coverage.

[1] http://www.healthcare.gov/
[2] http://www.contingenciesonline.com/contingenciesonline/20130102#pg33
[3] Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment (CMS-9964-P), 156.420(a) preamble
[4] http://www.healthcare.gov/news/factsheets/2012/11/ehb11202012a.html
[5] http://healthreform.kff.org/health-reform-glossary.aspx?source=QL
[6] http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/107xx/doc10781/11-30-premiums.pdf
[7] http://healthreform.kff.org/health-reform-glossary.aspx?source=QL#i
[8] http://healthreform.kff.org/health-reform-glossary.aspx?source=QL#m

The Obama administration is terminating new enrollment and cutting benefits for existing enrollees in the Pre-existing Condition Insurance Plan (PCIP).

The federal government will no longer enroll people with pre-existing conditions in its temporary high-risk insurance pool amid signs that the $5 billion program could run out of money sooner than expected. This program was included under the Affordable Care Act (ACA) as a solution for individuals who could not otherwise obtain coverage.

On Friday, the US Department of Health and Human Services alerted plan contractors…that no enrollments will be allowed after March 2, 2013 in the Pre-Existing Condition Insurance Plan, which was created through the federal health-care overhaul.

By suspending enrollment in March will create a 10-month gap in the availability of health insurance coverage for individuals who would have been served by PA Fair Care.

Why is PCIP enrollment being suspended?

PCIP is a temporary program for those locked out of the current insurance marketplace. The program has a limited amount of funding from Congress.

Based on program experience and trends since the start of the program, PCIP enrollees have serious and expensive illnesses with significant and immediate health care needs. More information can be found in the Annual Report on the Implementation and Operation of the PCIP Program
available here Exit Disclaimer Icon.

This suspension will help ensure that funds are available through 2013 to continuously cover people currently enrolled in PCIP.

The Health Insurance Marketplace

Starting next year, the Affordable Care Act guarantees that all Americans – regardless of their health status or pre-existing conditions – will finally have access to quality, affordable coverage. People will be able to apply for affordable health insurance coverage choices in Health Insurance Exchanges when open enrollment begins on October 1. Starting in 2014, the uninsured will be able to obtain health insurance through state and federally run health exchanges.

Health insurance exchanges will change the way people buy coverage and will help millions of uninsured people get a private plan. Nearly 49 million people are uninsured in the United States, but the numbers vary dramatically by state.

Exchanges will be the most visible part of President Barack Obama’s health care overhaul law in everyday life. Open enrollment starts Oct. 1, less than 10 months away.
Some questions and answers on how the exchanges will work:

Q: What’s a health insurance exchange?

A: “Exchange” is just another word for “marketplace.” The plans sold in the new markets will start covering patients on Jan. 1, 2014. Each state will have its own exchange serving people who buy their health insurance directly, as well as a separate one for small businesses. The vast of majority of people now covered by employer plans will not see a change.

There will be three types of exchanges at the beginning: those run by states, those run by the federal government, and partnerships. Most Republican governors opposed to “Obamacare” are letting Washington run the exchanges in their states.

For consumers, the benefits should be the same no matter who runs the exchange.

Q: How will exchanges work?
A: Exchanges are supposed to have the feel of an online travel site — think Orbitz or Expedia.

Middle-class people will be able to pick from a range of private insurance plans, and most people will be eligible for help from the government to pay their premiums.

Low-income people will be steered to safety-net programs for which they might qualify. This could be a problem in states that choose not to expand their Medicaid programs under a separate part of the health care law. In that case, many low-income residents in those states would remain uninsured.

Q: How will I know if I can get help with my health insurance premiums?
A: You’ll disclose your income to the exchange at the time you apply for coverage and they’ll let you know. Only legal residents of the United States can get financial assistance.

The health care law offers sliding-scale subsidies based on income for individuals and families making up to four times the federal poverty level, about $44,700 for singles, $92,200 for a family of four.

But do yourself a favor and read the fine print because the government’s help gets skimpier as household income increases.

For example, a family of four headed by a 40-year-old making $35,000 will get a $10,742 tax credit toward an annual premium of $12,130. They’d have to pay $1,388, about 4 percent of their income, or about $115 a month.

A similar hypothetical family making $90,000 will get a much smaller tax credit, $3,580, meaning they’d have to pay $8,550 of the same $12,130 policy. That works out to more than 9 percent of their income, or about $710 a month.

The estimates were made using the nonpartisan Kaiser Family Foundation’s online calculator. Some people will also be eligible for help with their copayments.

Final note: Though it’s called a “tax credit” the government assistance goes directly to the insurer. You won’t see a check.

Q: What will the benefits look like?
A: The coverage will be more comprehensive than what’s now typically available in the individual health insurance market, dominated by bare-bones plans. It will be more like what an established, successful small business offers its employees. Premiums are likely to be higher for some people, but government assistance should mostly compensate for that.

All plans in the exchange will have to cover a standard set of “essential health benefits,” including hospitalization, doctor visits, prescriptions, emergency room treatment, maternal and newborn care, and prevention. Insurers cannot turn away the sick or charge them more. Middle-aged and older adults can’t be charged more than three times what young people pay. Insurers can impose penalties on smokers.

Because the benefits will be similar, the biggest difference among plans will be something called “actuarial value.” A new term for consumers, it’s the share of expected health care costs that the plan will cover.

There will be four levels of coverage, from “bronze,” which will cover 60 percent of expected costs, to “platinum,” which will cover 90 percent. “Silver” and “gold” are in between. Bronze plans will charge the lowest premiums, but they’ll have the highest annual deductibles. Platinum plans will have the highest premiums and the lowest out-of-pocket cost sharing.

Here’s a wrinkle: The government’s subsidy will be tied to the premium for the second-lowest-cost plan at the silver coverage level that’s available in your area. You could take it and buy a lower cost bronze plan, saving money on premiums. But you’d have to be prepared for the higher annual deductible and copayments.

___

Online:

Federal government health care site: www.healthcare.gov

Kaiser Health Reform Subsidy Calculator: http://healthreform.kff.org/subsidycalculator.aspx

It seems like a simple idea: create new marketplaces, called exchanges, where consumers can comparison shop for health insurance, sort of like shopping online for a hotel room or airline ticket.

But, like almost everything else connected with the health law, state-based insurance exchanges are embroiled in politics. Some Republican governors have refused to set up any exchanges. Arizona Gov. Jan Brewer and New Jersey Gov. Chris Christie, both Republicans, say that the law gives states “little actual authority” over the exchanges even if they run them and they lack information about the alternatives.

If done well, proponents say, exchanges could make it easier to buy health insurance and possibly lead to lower prices because of increased competition. But, if designed poorly, experts warn, healthy people could avoid the exchanges, leaving them to sicker people with rising premiums.

Here are some answers to common questions about exchanges:

What is an exchange, as envisioned by the health law?

It’s a marketplace where individuals and small employers will be able to shop for insurance coverage. They must be set up by Oct. 1 of this year for policies that will go into effect on Jan. 1, 2014. The exchanges will also direct people to Medicaid, the government health insurance program for the poor, if they’re eligible.

Will all states have exchanges?

Yes. States have the option of setting up their own exchanges, partnering with the federal government to run an exchange, or opting out. In that case, the federal government will run the exchanges for their residents.

The Obama administration has approved applications for state-run exchanges in 17 states and the District of Columbia. The application deadline was Dec. 14. Those states are California, Colorado, Connecticut, Hawaii, Idaho, Kentucky, Massachusetts, Maryland, Minnesota, Nevada, New Mexico, New York, Oregon, Rhode Island, Utah, Vermont and Washington.

States that did not apply to set up their own exchange have until Feb. 15 to apply for a partnership with the federal government to run a local exchange. Two states, Arkansas and Delaware, have already been approved for a state-federal partnership. An application by Mississippi to start its own exchange is also pending.

Will anyone be allowed to buy from the exchanges?

No. Initially, exchanges will be open to individuals buying their own coverage and employees of firms with 100 or fewer workers (50 or fewer in some states). Most Americans will continue to get insurance through their jobs, not via the exchanges. Most will be people who are eligible for subsidies, which will average an estimated $4,600 per person in 2014. Undocumented immigrants will be barred from buying insurance on the exchanges.

Will exchanges be like travel websites or some existing health insurance sites?

In some ways, but they will be more complex. People will be able to compare policies sold by different companies. Purchasing insurance can be confusing, so information on the plan benefits will be standardized in an effort to make it easier to compare cost and quality. Plans will be divided into four different types, based on the level of benefits: bronze, silver, gold and platinum. The exchanges are also required to operate toll-free hotlines to help consumers choose a plan, determine eligibility for federal subsidies or Medicaid, rate plans based on quality and price and conduct outreach and education.

What will the coverage sold on the exchanges look like?

Plans will have to offer a set of “essential benefits.” Those details, still being developed by the Obama administration and states, will include hospital, emergency, maternity, pediatric, drug, lab services and other care. Annual cost-sharing, or the amount consumers must fork over before insurance payments kick in, will be capped at the amounts allowed for health savings accounts — currently, nearly $6,000 for individual policies and $12,000 for family plans.

How much will the policies cost?

The premiums will vary by type of plan and location. Insurers won’t be able to charge more based on gender or health status. They will be able to charge older people up to three times more than younger ones.

What if I can’t afford the premiums?

The health law expands Medicaid to all people who earn less than 138 percent of the federal poverty level, $14,856 in 2012. However, the Supreme Court ruled in June 2012 that states have the ability to opt out of that Medicaid expansion, and it is not yet clear how many states will do that. Above the 138 percent level, sliding scale subsidies for private insurance on the exchanges will be available for residents who earn up to 400 percent of the poverty level, about $44,680. Most people will be required to have coverage of some sort beginning in 2014.

Will all insurers have to offer policies through the exchange?

No. Insurers won’t be required to sell through the exchanges.

Will all state exchanges be the same?

No. States can design their exchanges differently, an issue that’s sparking debate nationwide. Another important issue: The makeup and power of the governing boards overseeing the exchanges.

What will be the difference to consumers between a state and federal exchange?

In broad details, they should work the same way. Consumers shopping in either type of exchange will choose among insurer offerings that are standardized into four coverage levels: bronze, silver, gold and platinum. There will also be a young adults’ plan. Rules on how much insurers can vary premiums based on age or geography are set in the federal law, although states could adopt rules making them stricter.

Differences between federal and state exchanges are likely to be subtle, but important to some consumers.

States that establish their own exchanges, for example, can decide which insurers participate and whether to require benefits beyond those set under federal law. They can accept all insurers whose policies meet the law’s requirements, for instance, or limit participation by requiring that insurers meet specific quality or pricing guidelines.

California, for example, has chosen to limit the number of insurers, which they say allows them to choose the highest value plans, while Colorado’s model will accept all plans that meet the requirements. The federal exchanges will accept all qualifying plans.

States that build their own exchanges can also decide whether to be more proactive in selecting insurers that offer benefits targeted to a state’s particular needs. For example, a state with a high rate of diabetes might select insurers with special programs to combat diabetes.

Some exchanges and state insurance commissioners will be able to recommend whether specific insurers should be allowed to sell in the exchange, partly based on their patterns of rate increases.

What about federal workers?

Members of Congress and their staffs will be required to buy through exchanges if they want coverage from the federal government. Other federal employees will continue to be covered by the Federal Employees Health Benefits Plan (FEHBP) .

This is an update of a story originally published on March 30, 2011.

jappleby@kff.org

All employers that have employees must give notice of the health exchange requirements by March 1, 2013. No one currently knows what the notice must include.

Last March, the U.S. Department of Health and Human Services issued final regulations concerning the establishment of exchanges and qualified health plans and exchange standards for employers. Within the final regulations, the general standards for the exchange notice requirement were provided. However, additional information is forthcoming from the U.S. Department of Labor (DOL). The DOL is expected to release a model notice, along with additional guidance, prior to the March 1, 2013, effective date.

Employer Action Required

On March 1, 2013, employers will be required to distribute a notice of exchange to current employees and new employees. Employees hired on or after the effective date must be provided the notice of exchange at the time of hiring, while employees already employed on the effective date of March 1, 2013, will need to receive the notice no later than that date. The notice requirement applies to employers who are subject to the Fair Labor Standards Act (FLSA).

Penalties for Noncompliance

There is no known penalty at this time.

Frequently Asked Questions

Q1: What employers are subject to the FLSA and thus subject to the notice of exchange requirement?
A: The term “employer” is defined in the FLSA as “any person acting directly or indirectly in the interest of an employer in relation to an employee.” This broad definition will likely encompass most employers.

Q2: Is the notice required to be distributed to all employees or only those who are eligible for coverage?
A: Until further guidance is issued, it is believed that the notice should be distributed to all employees. The FLSA defines an employee as “an individual employed by an employer.”

Q3: May the notice be provided electronically (i.e., via email)?
A: The accepted methods of distribution are not yet known. However, it is expected that the notice may be distributed electronically in accordance with DOL guidelines for electronic disclosure.

For more information on Idaho’s Health Exchange Insurance please give us a call at (208) 377-7101.

Good news came out of the Governor’s office today when Governor C.L. “Butch” Otter declared that Idaho will opt for a state-based health exchange, subject to legislative approval. Governor Otter said today that his decision reflects “my continued determination for Idaho to be actively engaged in making the best possible choices-to the degree we are allowed- in the interest of more accessible and affordable health care for our citizens.”

The Idaho Health Exchange Alliance is extremely pleased to hear Governor Otter has chosen to build a health exchange for Idahoans, by Idahoans. To read more on Governor Otter’s decision, please click here.

Many Idaho lawmakers had opted to do nothing on an health exchange, gambling unsuccessfully that the U.S. Supreme Court would overturn the national health insurance law, will now receive health exchange legislation from Governor Otter when they convene in January.

Governor Otter’s decision follows the overwhelming vote of a working group he appointed to study the issue for months. Sen. John Goedde, R-Coeur d’Alene, who served on the group, said, “I think the governor did the right thing, in the face of certainly a lot of opposition.”

Goedde said, “I don’t think that we have any choice – we’re going to establish a state-based exchange, or we are going to get the federal exchange by default.”

The Idaho Health Exchange Alliance was also effective in writing letter to the editors, opinion pieces and calling your local legislators and the Governor’s office. Due to their efforts they were able to spread the word and advocate for a state-based exchange for the last four and a half months.

WORKING GROUP ON HEALTH INSURANCE EXCHANGE:

• Senator John Goedde of Coeur d’Alene
• Representative John Rusche of Lewiston
• Representative Lynn Luker of Boise
• Zelda Geyer-Sylvia, Blue Cross of Idaho
• Scott Kreiling, Regence Blue Shield
• Dave Self, Pacific Source Health Plans
• Tom Shores, independent health insurance broker
• Kevin Settles, business owner
• Dr. John Livingston, Boise physician
• Alex LaBeau, Idaho Association of Commerce and Industry
• Wayne Hoffman, Idaho Freedom Foundation
• John Watts, Idaho Chamber Alliance

Governor Otter still remained critical of the national health care reform law, which he maintains won’t lower health care costs. “But it is an unfortunate and unwelcome reality, and it would be irresponsible of me to simply abandon the field to federal bureaucrats,” he said. “ In the face of uncertainty we must assert our independence and our commitment to self-determination while fulfilling our responsibility to the rule of law.”

Health insurance exchanges, under the national health care reform law, will be created to provide an online marketplace where consumers can shop for the plans, rates and features they want, and also access government subsidies if they qualify for them. States have the option of setting up their own exchanges, partnering with the federal government, or doing nothing and allowing the federal government to operate their state exchanges.

After an election in which both parties demonized cuts in Medicare spending, the Congressional Budget Office issued a reminder Thursday of the need to cut Medicare spending.

Healthcare programs are quickly outgrowing their historical share of the federal budget, CBO said, and the cost of those programs will only grow faster as more Baby Boomers reach retirement and underlying healthcare costs continue to soar.

CBO’s latest figures confirm what Republicans and Democrats acknowledge only selectively — that healthcare is a huge part of what’s driving federal spending and debt. Healthcare programs are eating up an ever-increasing share of the economy, while tax revenues and other domestic spending are holding relatively steady, CBO said.

Federal spending on major healthcare programs will reach 6.3 percent of gross domestic product by 2020, CBO said — up from 4.7 percent this year, and far outstripping a 40-year average of just 2.7 percent.

Medicare makes up about half of the projected spending. The program for retirees will cost the government more than $700 billion in 2020, or 3.5 percent of GDP, according to CBO’s estimates. Medicaid clocks in at $514 billion, or 2.3 percent of GDP.

Roughly 0.5 percent of GDP will go toward the Children’s Health Insurance Program and subsidies for private insurance under President Obama’s healthcare law, CBO said.

Those figures indicate that “ObamaCare” isn’t the explosion in federal spending Republicans fear, at least in comparison to Medicare. But Congress has come up with more aggressive plans to roll back spending on the healthcare law than to tackle Medicare spending.

CBO’s latest report, released as lawmakers return seriously to the looming fiscal cliff, lists healthcare cost-cutting proposals CBO has previously analyzed.

Raising the retirement age for Medicare — a change Obama and House Speaker John Boehner (R-Ohio) agreed to in their failed “grand bargain” — would save the federal government about $30 billion in 2020, CBO said. Raising seniors’ premiums would save another $40 billion. Limiting medical malpractice suits, an area where Obama has at least said he’s willing to work with Republicans, adds $10 billion.

The biggest savings on CBO’s list come from repealing the healthcare law’s coverage expansion — eliminating subsidies and the Medicaid expansion, while leaving in place Medicare cuts and tax increases.

Repealing the coverage expansion would save $150 billion, cutting total healthcare spending by 15 percent, CBO said. But repeal is politically impossible now that Obama has won a second term and Democrats have expanded their Senate majority. It also would leave roughly 29 million people uninsured.

CBO has said repealing the entire healthcare law would increase the deficit because the law includes taxes and spending cuts that outweigh its new spending.

Those provisions are the ones Republicans have attacked most aggressively, deriding the healthcare law as a tax cut of historic proportions and hammering Democrats for the law’s $716 billion reduction in Medicare payments to doctors and insurance companies.

Democrats, meanwhile, attack Republicans for their plan to change the basic structure of Medicare. Democrats support some changes to the program, but have vowed to preserve the Medicare “guarantee.” The GOP plan would give seniors a fixed amount of money to put toward a health plan, requiring them to pay more out of pocket for the level of coverage Medicare now provides.