Tag Archives: premiums

Fallout of the End of ACA Subsidies

Joe Paduda today gave a very succinct and clear-minded assessment of the fallout of the ending of the ACA subsidies, also known as Cost-Sharing Reimbursement (CSR) payments.

Here is Joe’s article.

It makes perfect sense that what the Orange man said yesterday will do more damage to health care than his false and misleading pronouncements of the past year that the ACA is failing and doing harm.

It is you, sir, who are doing harm. To the poor, to minorities like those in Puerto Rico despite your morning mea culpa, to African-Americans and Latinos,  to women, to international agreements and organizations,  and to our credibility with our allies and adversaries.

 

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Insurers Jacking Up Premiums Ahead of End of CSRs

An article in Healthcare Finance News.com on Friday, said that insurers are factoring in the end of the cost-sharing reduction payments into their rate increases from 2 to 23 percent, according to a report from the Kaiser Family Foundation.

The article states the following:

“Insurers in 20 states and the District of Columbia have filed premium rate requests for the federal exchange ahead of an August 16 deadline, many on the assumption that cost-sharing reduction payments will not be paid and that the individual mandate will either not be enforced or weakly enforced, according to a Kaiser Family Foundation report released Thursday.”

According to Kaiser, silver premiums would have to increase by 19 percent on average to compensate for the loss of CSR payments.

Susan Moore, the Associate Editor for Healthcare Finance News.com, also said that insurers are building uncertainty into their rates, filing under multiple scenarios involving CSRs and the individual mandate.

The threat from the POTUS to Mitch McConnell to push him to repeal and replace the ACA means that if POTUS does get his way, CSR’s would end and so would the individual and employer mandates. Also, the health insurance tax return in 2018 will add 3 percent to premiums.

You can read the rest of the article yourselves, but consider this. Isn’t time to end this nonsense of charging people insurance premiums that are constantly rising just so that a bunch of greedy health insurance companies and their Wall Street investors profit from people’s health?

When are we going to wise up and put and end to this game of playing with people’s health and forcing many into bankruptcy because they have severe medical issues?

When are we going to realize that health care is a human right, and not a commodity that can be marketed like consumer goods?

Medicare for All will end this constant round of rate increases and shenanigans the health insurers perpetrate on the American people.

And Then There Was One

In what may well be one of the last posts written about opt-out for workers’ comp, Joe Paduda today reports that Oklahoma is opting out of opt-out.

That leaves the Lone Star State as the only state that allows employers to “opt out” of the statutory system, but as Joe indicates, most Texas employers opt in.

There is a strange relationship in Texas between opting out and insurance premiums that runs counter to what many might think natural otherwise. Large employers opt out when the rates are low, and small employers opt out when the rates are high, a point I highlighted in the post, “Large Employers in Texas Opting Out of Work Comp.”

So as rates are decreasing in Oklahoma, according to Joe, employers there are opting out of opting out.

Maybe at last we are seeing the end of this extremist, turn-the-clock-back to the 19th century way of providing workers’ compensation to injured workers.

And amen to that.

 

“Florida, We Have a Problem”

Tuesday, Judge David Langham, Deputy Chief Judge of Compensation Claims for the Florida Office of Judges of Compensation Claims and Division of Administrative Hearings, wrote a rather lengthy post about the differences between cost-shifting and case-shifting in workers’ comp.

Much of what the Judge wrote were subjects that I already discussed in a number of previous posts about cost-shifting and case-shifting, so I won’t go into it here. I am only focusing on the parts that relate to Florida workers’ comp. You can read the entire article yourselves.

But what caught my attention was what he said about Florida and what the Workers’ Compensation Research Institute (WCRI) reported in some of their studies on these issues.

As Judge Langham wrote this week, he wrote a post two years ago that asked the question “Why Does Surgery Cost Double in Workers’ Compensation?”

Judge Langham noted in that post that Florida employers have been documented paying almost double for shoulder or knee surgery that is paid for under workers’ compensation, compared to group health costs.

The implication of case-shifting in Florida, he says, could arguably be a doubling of cost.

He cited a WCRI report released earlier this year that suggests however that case-shifting is perhaps not as likely in Florida.

According to the report, Judge Langham continues, “as of July 2011, six states had workers’ comp medical fee schedules with rates within 15% of Medicare rates. They were California, Massachusetts, Florida, North Carolina, New York and Hawaii.”

However, Judge Langham pointed out that the WCRI concluded that case-shifting is more likely in states where the workers’ compensation fee schedule is 20% or more above the group health rates, and not in Florida.

Judge Langham stated that this analysis of workers’ compensation fee schedules does not appear to include analysis of the reimbursement rates for hospitals, and that It also seems contradictory to the assertions that Florida workers’ compensation costs for various surgeries have been documented as roughly double the group health rates (100% higher, not 15% higher).

Injured workers who missed work in the Florida workers’ compensation system could be compensated in 2016 at a rate as high as $862.51 per week, the “maximum compensation rate.”

So, if recovery from such a “soft-tissue” injury required ten weeks off-work, he wrote, the case-shifting to workers’ compensation might add another four to nine thousand dollars to the already doubled cost of surgical repair under workers’ compensation.

This could be directly borne by the employer if the employer is self-insured for workers’ compensation; or, if the employer has purchased workers’ compensation insurance, the effect on the employer would be indirect in the form of potentially increased premium costs for workers’ compensation following such events and payments, Judge Langham states.

According to WCRI, the Judge quotes, “policymakers have always focused on the impact (workers’ compensation) fee schedules have on access to care as well as utilization of services.

This has been a two-part analysis, he says:

First, fee schedules have to be sufficient such that physicians are willing to provide care in the workers’ compensation system; and second, the reimbursement cannot be too high, or perhaps overutilization is encouraged.

Lastly, Judge Langham points out that the disparity between costs has also been noted in discussions of “medical tourism.”

The last question he posits is this, “might medical decision makers direct care to more efficient providers, across town, across state lines?”

What about national borders?


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Blog is now viewed all over the world in 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

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Survey Says, Employers Shifting Health Care Costs to Workers: Will Workers Shift to Work Comp?

In September, Jay Hancock wrote an article for Kaiser Health News, that reported that premiums for employment-based medical insurance rose moderately, to 4% in 2015, but that employers continued to shift in expenses to workers, according to a new survey.

According to Mr. Hancock, the average premium for single coverage rose to $6,251 while the average premium for a family plan increased to $17,545, according to a survey published by the Kaiser Family Foundation and the Health Research & Educational Trust.

Deductibles have been rising substantially faster than total health costs, according to Hancock, and 46% of covered workers have a deductible of at least $1,000 this year for single coverage as employers shift to “consumer-directed” plans that give members incentives to seek less-costly care.

Deductibles are more than $2,000 for single coverage for almost a fifth of covered workers.

Drew Altman, KFF’s CEO said in the article, “The so-called great slowdown in health care costs has been all but invisible to consumers because deductibles have been going up so much faster than their wages.”

The following chart illustrates this shift from 1999 to 2015.

kff-image-1

Other takeaways from the survey of nearly 2,000 large and small employers are as follows:

  • In the face of measures from the 2010 health law that took effect this year to encourage coverage, some employers expanded insurance while a small percentage shifted jobs to part-time to avoid the obligation to offer a plan.
  • One in five companies with at least 200 employees expects its most popular plan to be liable for the “Cadillac tax” on high-value coverage that takes effect in 2018. Employer efforts to avoid the tax will probably shift new costs to workers, analysts said.
  •  It’s not only workers’ deductibles that are rising. The portion of premiums they pay has gone up, too. Employee premium costs have increased 83 percent since 2005 while the total cost of a policy went up 61 percent.
  • Worker wellness programs continue to surge, with nearly a third of large firms offering employees financial incentives to take health-risk screening tests.

A prior article I wrote stated that the Affordable Care Act (ACA) may shift claims into workers’ compensation.

If employers continue to shift costs to their employers, their employees may shift the cost of their health care to workers’ comp. Case in point, another article I wrote in 2013 said that employees are not prepared for increased costs,  and may not want control of their options, and lack education about what is meant by “consumer-driven health care.”

So it is not too far out of the realm of possibility that some workers whose employers have shifted the cost of medical insurance on them, will turn around and shift it to their employer’s work comp carrier.

If that happens, and they require expensive surgeries, unique alternatives may need to be implemented, even if it is outside the box, and outside the border.

Original article by Jay Hancock, September 22, 2015, Kaiser Health News

 

 

Employers Facing Double-Digit Premium Hikes

Now that the summer is almost at an end, time to get back to the topic at hand…health care.

In an article late last week, Kathryn Mayer, Managing Editor of Benefits Selling magazine, wrote that nine in 10 employers said that they are facing increases in the premiums they pay for employee health plans.

Nearly 25%, or 1 in 4 employers are seeing rate increases in double-digits, according to research released last Thursday by Arthur J. Gallagher & Co.

Gallagher surveyed more than 3,000 US employers from dozens of industries around the country.

According to James Durkin, president of Gallagher Benefit Services, Inc.:

“Employers are examining all available options to rein in medical costs, while still offering competitive benefits packages that help them attract and retain the best employees in a tightening labor market, With the Cadillac tax due to take effect in 2018, employers are expected to turn to newer, alternative cost-control tactics.”

Employers are increasingly requiring employees to shoulder a larger share of the expense in higher deductibles, and Gallagher reported that 67% are cost-shifting [emphasis added] to employees.

Gallagher also said that in-network family plan deductibles average $3,000, while out-of-network deductibles average $4,500.

Annual deductibles for employee-only, in-network plans now average $1,200, and out-of-network deductibles are an average of $2,000.

About half of employers said they are considering changing carriers to lower costs.

Lastly, nearly all employers (97%), said they will continue to provide employer-sponsored coverage to employees.

Some of the other things Gallagher’s report said was that employers would offer health savings accounts to employees (36%), implement mandatory generic drug policies (15%), and offer reduced network access or narrow provider networks (11%). 35 % may self-insure, while 13 % might offer narrower networks in the next three years.

So, what does this mean to you?

If employers cost-shift the premium hikes to their employees, many of them might do the same, and cost-shift health care to workers’ comp, which has been discussed many times in the past.

One way Gallagher did not mention that employers should try, and why should they, because they can’t think outside of the box, is have them think outside of the border, and consider medical travel for surgery and certain medical treatments and procedures too expensive in the US, and especially if the employees cost-shift to workers’ comp.

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I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.