At House Budget Committee hearing at which CBO director Douglas Elmendorf said the health insurance subsidies in the Affordable Care Act will create “a disincentive for people to work,” Rep. Chris Van Hollen of Maryland, the senior Democrat on the panel, defended the law.
Reported by msnbc.com 11 hours ago.
Democrats Mount Affordable Care Act Counteroffensive
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Obamacare Foes to Newly Insured: Put Down the Donut
Critics of Obamacare and health insurance on the taxpayer's dime have a few choice words for the newly insured: Put. Down. The. Donut.
Reported by msnbc.com 11 hours ago.
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Why Your Employer May Be Eyeing the New Obamacare Exchanges
The Obamacare exchanges may be a cheaper way for your employer to offer health insurance, a new analysis suggests.
Reported by msnbc.com 11 hours ago.
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What It Means to Be 'A Nun on the Bus'
It is difficult to believe that it has been fifty years since I joined my religious community, the Sisters of Social Service, and began a lifetime of commitment to the quest for justice based in the Gospel. Over the decades my spirituality and prayer life have deepened to be a contemplative life of "walking willing.""Walking willing" to all sorts of unusual places including lobbying on Capitol Hill - and even places like the Colbert Report! It has been a challenging life of joy and struggle nurtured in community and alive in the Spirit!
Over the years I have learned from my community's history the intersection of faith and politics. We were founded in 1923 in Budapest, Hungary, in response to Pope Leo XIII's call to work for just wages and safe working conditions in the midst of the industrial revolution there.
Our foundress, Sister Margaret Slachta, was the first woman in the Hungarian Parliament when she headed our community. She spoke passionately about how the Holy Spirit led her to the quest for justice in the light of Jesus's message in the Gospel. My community's orientation to both charity and justice shaped my young spirit from the day I entered and does so to this day. All of my Sisters have encouraged me to open my heart to touch real people's lives, hear their stories, and share encouragement along the way.
Recently, I was talking with a television producer about my coming interview. We talked a bit about the struggle to create community and to be grounded in this speeding world. She surprised herself by choking up and getting tears in her eyes. It touched me deeply that she would let herself be vulnerable with me in that setting. Something I said mattered to her and let her know that she is not alone in this life. I hugged her and feel more connected to her for her wordless eloquence.
This phenomenon is not uncommon and is part of the reason that being "A Nun on the Bus" is so sacred. I often hear the stories of folks who are working hard every day to make ends meet - people like Robin, who works fulltime for minimum wage but has to live in a homeless shelter because she cannot afford rent in the Washington DC area. Or Billy and his wife at a free dining room with their two boys because they have no money left for food after they pay their rent. This is even though both of them are working. Or Katrina in the literacy program overcoming her learning disability and now contributing to our society by helping others. Or Cynthia who celebrates that her husband can get cancer treatment because their family finally got health insurance through the Affordable Care Act.
It is deeply moving to be able to share their stories. But a further joy is that everyone has a story to share.
In our nation, where Robin and Billy and his wife all work for minimum wage and don't have enough to support themselves and their families, median CEO pay has topped $10 million dollars a year. This means that CEOs are paid about $5,000 per hour. Or in three hours they earn as much as a minimum wage worker like Robin makes in a whole year. How can a CEO have a clue about the reality of low-wage workers?
So part of my service on the bus is to share the stories beyond the big divides.
But the TV producer reminded me that in our speeding society many feel alone and struggling. Economics is not the only poverty that exists. Rather, the plight of even the "economically secure" is that fear and insecurity can seep into life so that they feel they are on their own and no one "has their back." This feeling of loneliness is undermining our democracy. By focusing on our individualism we are losing the reality that democracy requires a community committed to collaborative problem- solving. This requires that everyone stay engaged and that no one can really "go it alone."
So I have discovered that the hunger we experience for the bus and the message that we bring are hungers for inclusion, deeply held values and space for the 100%. This is the joy of my life that I can help individuals see and understand the struggles of others. Like all of the popes before him since Pope Leo, Pope Francis is challenging the world to create an economy of inclusion. Pope Francis is correct when he says that peace building and this new economy must be grounded in the reality of people's lives and not in the theories of academics.
But this is more than just a faith response.
In our polarized politics we need to build peace that can create a future together. We need to foster peace among the current three dominant political parties: Democrats, Republicans and Tea Party. This peace needs to be grounded in the stories of real people so that we can work together to actually solve the problems of the 21st century - such as economic disparity, a broken immigration system, and global warming.
I work at this because of my faith that has been nourished by so many in my religious community and in our country. But in our pluralistic world, we come together as a nation in the Constitution.
For me, this is the joy of the bus. We come with our faith and welcome all who want to join us in the quest for justice. You don't have to be a Catholic or a Sister. All are welcome to join us to create community in our hungry world.
So I urge all of you to join us on the bus as we drive for faith, family and fairness. It is my prayer that this commitment will continue to be nourishment for our spiritually hungry nation and will, in the end, help to "form a more perfect union."
Sister Simone Campbell is executive director of NETWORK, A National Catholic Social Justice Lobby, and author of A NUN ON THE BUS: How All of Us Can Create Hope, Change, and Community (HarperOne, 2014). Reported by Huffington Post 11 hours ago.
Over the years I have learned from my community's history the intersection of faith and politics. We were founded in 1923 in Budapest, Hungary, in response to Pope Leo XIII's call to work for just wages and safe working conditions in the midst of the industrial revolution there.
Our foundress, Sister Margaret Slachta, was the first woman in the Hungarian Parliament when she headed our community. She spoke passionately about how the Holy Spirit led her to the quest for justice in the light of Jesus's message in the Gospel. My community's orientation to both charity and justice shaped my young spirit from the day I entered and does so to this day. All of my Sisters have encouraged me to open my heart to touch real people's lives, hear their stories, and share encouragement along the way.
Recently, I was talking with a television producer about my coming interview. We talked a bit about the struggle to create community and to be grounded in this speeding world. She surprised herself by choking up and getting tears in her eyes. It touched me deeply that she would let herself be vulnerable with me in that setting. Something I said mattered to her and let her know that she is not alone in this life. I hugged her and feel more connected to her for her wordless eloquence.
This phenomenon is not uncommon and is part of the reason that being "A Nun on the Bus" is so sacred. I often hear the stories of folks who are working hard every day to make ends meet - people like Robin, who works fulltime for minimum wage but has to live in a homeless shelter because she cannot afford rent in the Washington DC area. Or Billy and his wife at a free dining room with their two boys because they have no money left for food after they pay their rent. This is even though both of them are working. Or Katrina in the literacy program overcoming her learning disability and now contributing to our society by helping others. Or Cynthia who celebrates that her husband can get cancer treatment because their family finally got health insurance through the Affordable Care Act.
It is deeply moving to be able to share their stories. But a further joy is that everyone has a story to share.
In our nation, where Robin and Billy and his wife all work for minimum wage and don't have enough to support themselves and their families, median CEO pay has topped $10 million dollars a year. This means that CEOs are paid about $5,000 per hour. Or in three hours they earn as much as a minimum wage worker like Robin makes in a whole year. How can a CEO have a clue about the reality of low-wage workers?
So part of my service on the bus is to share the stories beyond the big divides.
But the TV producer reminded me that in our speeding society many feel alone and struggling. Economics is not the only poverty that exists. Rather, the plight of even the "economically secure" is that fear and insecurity can seep into life so that they feel they are on their own and no one "has their back." This feeling of loneliness is undermining our democracy. By focusing on our individualism we are losing the reality that democracy requires a community committed to collaborative problem- solving. This requires that everyone stay engaged and that no one can really "go it alone."
So I have discovered that the hunger we experience for the bus and the message that we bring are hungers for inclusion, deeply held values and space for the 100%. This is the joy of my life that I can help individuals see and understand the struggles of others. Like all of the popes before him since Pope Leo, Pope Francis is challenging the world to create an economy of inclusion. Pope Francis is correct when he says that peace building and this new economy must be grounded in the reality of people's lives and not in the theories of academics.
But this is more than just a faith response.
In our polarized politics we need to build peace that can create a future together. We need to foster peace among the current three dominant political parties: Democrats, Republicans and Tea Party. This peace needs to be grounded in the stories of real people so that we can work together to actually solve the problems of the 21st century - such as economic disparity, a broken immigration system, and global warming.
I work at this because of my faith that has been nourished by so many in my religious community and in our country. But in our pluralistic world, we come together as a nation in the Constitution.
For me, this is the joy of the bus. We come with our faith and welcome all who want to join us in the quest for justice. You don't have to be a Catholic or a Sister. All are welcome to join us to create community in our hungry world.
So I urge all of you to join us on the bus as we drive for faith, family and fairness. It is my prayer that this commitment will continue to be nourishment for our spiritually hungry nation and will, in the end, help to "form a more perfect union."
Sister Simone Campbell is executive director of NETWORK, A National Catholic Social Justice Lobby, and author of A NUN ON THE BUS: How All of Us Can Create Hope, Change, and Community (HarperOne, 2014). Reported by Huffington Post 11 hours ago.
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'Wait, Is This Thing On?': Health Care Reporters Share Obamacare War Wounds
The open enrollment period for Obamacare ended in April, and with it came a form of closure for all of the people who worked on health care reform.
For the past four years, operatives, politicians, aides, lobbyists, activists and the like have toiled, first to craft a bill and then to defend it. They watched Congress nearly derail the prospects of reform and the Supreme Court nearly rule it unconstitutional. They waded through a presidential election during which repeal was on the table. They saw the launch of the health insurance exchanges marred by a glitchy website. And then they observed more than 8 million people sign up for insurance through those same exchanges.
Health care reporters documented the process every step of the way. And now that it's over, they have a chance to relax a bit and reflect on everything that happened. The Huffington Post figured we would facilitate that relaxation and tape that reflection.
In the first part of a series titled "Wait, Is This Thing On?" we brought together four of the top health care reporters in the business: Sarah Kliff of Vox, Julie Rovner of Kaiser Health News, Alex Wayne of Bloomberg News and Jeffrey Young of The Huffington Post. Over some beers, they discussed virtually every element of the Affordable Care Act, from its construction and ultimate passage to its failures and triumphs.
The whole thing was basically an excuse to imbibe. But along the way, they also exchanged stories on everything from the most overwrought Obamacare controversy, to the one early enrollee that EVERY media outlet decided to interview, to how a hot dog vending machine became a legitimate food option for reporters covering the story.
We hope you enjoy it -- at least more than you would enjoy a hot dog that came from a vending machine.
*Watch the video above. Here's an index of key moments in the discussion:*
*00:00* - Meet The Reporters
*04:10* - Why Did It Take So Long To Pass Obamacare?
*07:52* - The Rise And Fall Of Sen. Ben Nelson
*10:19* - The Historic Sunday Of The Bill's Passage
*12:16* - The White House Media Strategy (Or Lack Thereof)
*14:24* - Critiquing The Press
*15:33* - The Story Of The Bungled Website
*18:00* - Canceled Plans Become A Scandal
*20:34* - Chad Henderson Causes A Media Fiasco
*24:16* - The Future Of Obamacare Reported by Huffington Post 10 hours ago.
For the past four years, operatives, politicians, aides, lobbyists, activists and the like have toiled, first to craft a bill and then to defend it. They watched Congress nearly derail the prospects of reform and the Supreme Court nearly rule it unconstitutional. They waded through a presidential election during which repeal was on the table. They saw the launch of the health insurance exchanges marred by a glitchy website. And then they observed more than 8 million people sign up for insurance through those same exchanges.
Health care reporters documented the process every step of the way. And now that it's over, they have a chance to relax a bit and reflect on everything that happened. The Huffington Post figured we would facilitate that relaxation and tape that reflection.
In the first part of a series titled "Wait, Is This Thing On?" we brought together four of the top health care reporters in the business: Sarah Kliff of Vox, Julie Rovner of Kaiser Health News, Alex Wayne of Bloomberg News and Jeffrey Young of The Huffington Post. Over some beers, they discussed virtually every element of the Affordable Care Act, from its construction and ultimate passage to its failures and triumphs.
The whole thing was basically an excuse to imbibe. But along the way, they also exchanged stories on everything from the most overwrought Obamacare controversy, to the one early enrollee that EVERY media outlet decided to interview, to how a hot dog vending machine became a legitimate food option for reporters covering the story.
We hope you enjoy it -- at least more than you would enjoy a hot dog that came from a vending machine.
*Watch the video above. Here's an index of key moments in the discussion:*
*00:00* - Meet The Reporters
*04:10* - Why Did It Take So Long To Pass Obamacare?
*07:52* - The Rise And Fall Of Sen. Ben Nelson
*10:19* - The Historic Sunday Of The Bill's Passage
*12:16* - The White House Media Strategy (Or Lack Thereof)
*14:24* - Critiquing The Press
*15:33* - The Story Of The Bungled Website
*18:00* - Canceled Plans Become A Scandal
*20:34* - Chad Henderson Causes A Media Fiasco
*24:16* - The Future Of Obamacare Reported by Huffington Post 10 hours ago.
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Wonkblog: Just 13 percent of uninsured people will pay the Obamacare penalty, report predicts
About 2 million people fewer than previously projected will pay Obamcare's penalty for not having insurance in 2016, according to a revised estimate from federal budget scorekeepers.
About 4 million people in 2016 are expected to pay the penalty for skipping health insurance, the Congressional Budget Office and the Joint Committee on Taxation say in a new report. That's down from 6 million in their September 2012 projection, mostly because of an increase in those who qualify for an exemption from the individual mandate. Reported by Washington Post 10 hours ago.
About 4 million people in 2016 are expected to pay the penalty for skipping health insurance, the Congressional Budget Office and the Joint Committee on Taxation say in a new report. That's down from 6 million in their September 2012 projection, mostly because of an increase in those who qualify for an exemption from the individual mandate. Reported by Washington Post 10 hours ago.
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Reps Say Obamacare Isn't Doing Enough To Encourage Voter Registration
WASHINGTON -- Several progressive members of Congress have asked for a meeting with newly confirmed Secretary of Health and Human Services Sylvia Mathews Burwell, evidently worried that the federally run health care exchange used in more than 30 states is not in compliance with a 1993 law intended to encourage voter registration.
The National Voter Registration Act requires that people applying for public assistance or getting a license at the DMV be offered the chance to register to vote. Right now, the paper form to enroll in health insurance under the Affordable Care Act only includes a one-line sentence directing people to a web address if they wish to register to vote. On Healthcare.gov, a link directs applicants to another website where they can print off a voter registration form they need to mail in.
That's not good enough, say voting rights groups. Now, Democratic Reps. Keith Ellison (Minn.), Raul Grijalva (Ariz.) and Mike Honda (Calif.) want Burwell to make some changes.
"It has been brought to our attention that the health care enrollment process of the [federally-facilitated Health Benefits Exchanges] may not be providing adequate access to voter registration applications," the representatives wrote in a letter sent shortly after Burwell's confirmation by the Senate on Thursday afternoon. The members of the Congressional Progressive Caucus requested a meeting with Burwell on the topic.
In theory, the Justice Department's Civil Rights Division could sue states that run their own exchanges that aren't complying with the NVRA. But the fact that more than 30 states use federally run health care exchanges -- including crucial swing states like Ohio, Florida and Virginia -- makes things there a bit more complicated.
At this point, only outside organizations, rather than the federal government, have been aggressive about making sure states comply with the NVRA. California mailed voter registration applications to the millions of residents who used the state-run health care exchange there.
Voting rights groups say that in order to comply with the NVRA, a health care exchange should distribute voter registration forms unless individuals decline in writing, ask applicants in writing if they want to update their voter registration address, and help applicants complete the voter registration form, among other requirements.
Many progressives believe that the Obama administration soft-pedaled the NVRA requirement because of conservative outrage over the feds using the Affordable Care Act to register voters. A Breitbart.com headline in October, for example, declared Obamacare the "BIGGEST VOTER REGISTRATION FRAUD SCHEME IN HISTORY," and Rush Limbaugh said there was "obviously massive Democrat voter registration going on at these exchanges.” Reported by Huffington Post 9 hours ago.
The National Voter Registration Act requires that people applying for public assistance or getting a license at the DMV be offered the chance to register to vote. Right now, the paper form to enroll in health insurance under the Affordable Care Act only includes a one-line sentence directing people to a web address if they wish to register to vote. On Healthcare.gov, a link directs applicants to another website where they can print off a voter registration form they need to mail in.
That's not good enough, say voting rights groups. Now, Democratic Reps. Keith Ellison (Minn.), Raul Grijalva (Ariz.) and Mike Honda (Calif.) want Burwell to make some changes.
"It has been brought to our attention that the health care enrollment process of the [federally-facilitated Health Benefits Exchanges] may not be providing adequate access to voter registration applications," the representatives wrote in a letter sent shortly after Burwell's confirmation by the Senate on Thursday afternoon. The members of the Congressional Progressive Caucus requested a meeting with Burwell on the topic.
In theory, the Justice Department's Civil Rights Division could sue states that run their own exchanges that aren't complying with the NVRA. But the fact that more than 30 states use federally run health care exchanges -- including crucial swing states like Ohio, Florida and Virginia -- makes things there a bit more complicated.
At this point, only outside organizations, rather than the federal government, have been aggressive about making sure states comply with the NVRA. California mailed voter registration applications to the millions of residents who used the state-run health care exchange there.
Voting rights groups say that in order to comply with the NVRA, a health care exchange should distribute voter registration forms unless individuals decline in writing, ask applicants in writing if they want to update their voter registration address, and help applicants complete the voter registration form, among other requirements.
Many progressives believe that the Obama administration soft-pedaled the NVRA requirement because of conservative outrage over the feds using the Affordable Care Act to register voters. A Breitbart.com headline in October, for example, declared Obamacare the "BIGGEST VOTER REGISTRATION FRAUD SCHEME IN HISTORY," and Rush Limbaugh said there was "obviously massive Democrat voter registration going on at these exchanges.” Reported by Huffington Post 9 hours ago.
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Ted Lieu, Elan Carr Advance To General Election In Primary To Replace Henry Waxman
Republican Elan Carr and Democratic rival Ted Lieu will advance to the general election in November to replace Democratic Rep. Henry Waxman, 74. The Southern California representative has been in office for 40 years, and his retirement announcement back in January set off a frenzied campaign race that at one point included 25 people.
Waxman endorsed Lieu on Thursday, according to the LA Times.
"I'll be proud to have him take my place," Waxman said of Lieu.
By Tuesday, primary voting day, the field had been whittled down to 17 candidates. Carr won 21.5 percent of the vote, while Lieu won 19 percent. Wendy Greuel, a Democrat, trailed with 16.8 percent.
Waxman was voted into office in 1974, and he represents the second-wealthiest congressional district in the U.S., according to the Los Angeles Times. The 33rd District's boundaries include tony Los Angeles county cities like Malibu, Beverly Hills, Santa Monica, Rancho Palos Verdes and Agoura Hills, as well as affluent communities like Bel-Air, Venice, Pacific Palisades and Redondo Beach.
In his 40-year-career on Capitol Hill, Waxman focused on health care and the environment. His most important legislation includes the Affordable Care Act, the Children’s Health Insurance Program (which extends health insurance to nearly 8 million children) and the Ryan White Care Act (it gives more than half a million people access to HIV-related services).
He is the ranking member of the House Energy and Commerce Committee, and from 1979 to 1994, he chaired the appointments on Energy and Commerce Committee's Subcommittee on Health and the Environment.
Waxman is also well-known for grilling officials, executives and other notables during his congressional oversight hearings. Joshua Green of Bloomberg notes that Waxman's 1994 hearing for the CEOs of the nation's biggest tobacco companies was "iconic" and captured "a moment when lawmakers weren’t despised, but viewed as valuable public servants."
Jim Newton of the Los Angeles Times sums up Waxman's accomplishments thusly:
Waxman is best known for his leadership on big issues — he championed universal health insurance, clean air and water, gay rights, and he took on Big Tobacco at a time when that seemed like a lost cause — but he's also practical, grounded in the concerns of his constituents and sensitive to the nuances of this part of California. The challenge for his successor will be to muster those same qualities.
In other words, he's a tough act to follow. Reported by Huffington Post 8 hours ago.
Waxman endorsed Lieu on Thursday, according to the LA Times.
"I'll be proud to have him take my place," Waxman said of Lieu.
By Tuesday, primary voting day, the field had been whittled down to 17 candidates. Carr won 21.5 percent of the vote, while Lieu won 19 percent. Wendy Greuel, a Democrat, trailed with 16.8 percent.
Waxman was voted into office in 1974, and he represents the second-wealthiest congressional district in the U.S., according to the Los Angeles Times. The 33rd District's boundaries include tony Los Angeles county cities like Malibu, Beverly Hills, Santa Monica, Rancho Palos Verdes and Agoura Hills, as well as affluent communities like Bel-Air, Venice, Pacific Palisades and Redondo Beach.
In his 40-year-career on Capitol Hill, Waxman focused on health care and the environment. His most important legislation includes the Affordable Care Act, the Children’s Health Insurance Program (which extends health insurance to nearly 8 million children) and the Ryan White Care Act (it gives more than half a million people access to HIV-related services).
He is the ranking member of the House Energy and Commerce Committee, and from 1979 to 1994, he chaired the appointments on Energy and Commerce Committee's Subcommittee on Health and the Environment.
Waxman is also well-known for grilling officials, executives and other notables during his congressional oversight hearings. Joshua Green of Bloomberg notes that Waxman's 1994 hearing for the CEOs of the nation's biggest tobacco companies was "iconic" and captured "a moment when lawmakers weren’t despised, but viewed as valuable public servants."
Jim Newton of the Los Angeles Times sums up Waxman's accomplishments thusly:
Waxman is best known for his leadership on big issues — he championed universal health insurance, clean air and water, gay rights, and he took on Big Tobacco at a time when that seemed like a lost cause — but he's also practical, grounded in the concerns of his constituents and sensitive to the nuances of this part of California. The challenge for his successor will be to muster those same qualities.
In other words, he's a tough act to follow. Reported by Huffington Post 8 hours ago.
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Obamacare Is Worse Than 9/11
We are nine months into the era of Obamacare, and so far, it looks like a success. Between the state exchanges, healthcare.gov, and the Medicaid expansion, an estimated 17.2 million people have received health insurance under the law. In turn, according to Gallup, the percentage of Americans without health insurance has dipped to 13.4 percent, down 3.7 percentage points from where it was at the end of last year. Democratic candidates are touting its benefits, while a few Republicans have shied away from harsh attacks to avoid a backlash from voters.
Reported by Slate 8 hours ago.
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Medicaid Expansion Leads To Fewer High School Dropouts And More College Graduates: Study
Amid the ongoing debate over 24 states’ refusal to expand Medicaid eligibility under the Affordable Care Act, a recent report by the National Bureau of Economic Research has found that expanding health insurance coverage for low-income children resulted in fewer high school dropouts, higher college attendance rates and a better likelihood of attaining a bachelor's degree.
Cornell and Harvard researchers examined the effects of Medicaid expansion among eligible children in the 1980s and 1990s in states that broadened their public insurance programs and concluded “better health is one of the mechanisms driving our results by showing that Medicaid eligibility when young translated into better teen health.” Better health, in turn, led to substantial long-term educational benefits.
According to the working paper, published in May, states that increased childhood Medicaid eligibility by 10 percent reduced high school dropout rates by 5.2 percent and increased college attendance and BA attainment by 1.1 percent and 3.2 percent, respectively.
After examining two decades of Medicaid eligibility expansion in various states, the authors argued that in addition to immediately improving children’s health statuses, public health expansion renders long-term benefits by working to reduce "inequality and higher economic growth that stems from the creation of a more skilled workforce.”
The researchers attributed the outcomes to two plausible explanations. First, children with health insurance benefited from healthier lifestyles -– they missed less school due to illness, were less likely to engage in risky sexual activity, had lower likelihoods of obesity and fewer mental health problems.
Indirectly, the authors explained that by spending less money on health care, low-income families eligible for Medicaid were able to shift a greater share of their resources toward helping their children succeed in school.
As of 2013, roughly 10 percent of children in the U.S. -- or 7.9 million -- remain uninsured. About 70 percent of them are eligible for coverage under Medicaid or the Children's Health Insurance Program. Under the Affordable Care Act, that number is estimated to decrease by 40 percent.
(h/t Washington Post) Reported by Huffington Post 7 hours ago.
Cornell and Harvard researchers examined the effects of Medicaid expansion among eligible children in the 1980s and 1990s in states that broadened their public insurance programs and concluded “better health is one of the mechanisms driving our results by showing that Medicaid eligibility when young translated into better teen health.” Better health, in turn, led to substantial long-term educational benefits.
According to the working paper, published in May, states that increased childhood Medicaid eligibility by 10 percent reduced high school dropout rates by 5.2 percent and increased college attendance and BA attainment by 1.1 percent and 3.2 percent, respectively.
After examining two decades of Medicaid eligibility expansion in various states, the authors argued that in addition to immediately improving children’s health statuses, public health expansion renders long-term benefits by working to reduce "inequality and higher economic growth that stems from the creation of a more skilled workforce.”
The researchers attributed the outcomes to two plausible explanations. First, children with health insurance benefited from healthier lifestyles -– they missed less school due to illness, were less likely to engage in risky sexual activity, had lower likelihoods of obesity and fewer mental health problems.
Indirectly, the authors explained that by spending less money on health care, low-income families eligible for Medicaid were able to shift a greater share of their resources toward helping their children succeed in school.
As of 2013, roughly 10 percent of children in the U.S. -- or 7.9 million -- remain uninsured. About 70 percent of them are eligible for coverage under Medicaid or the Children's Health Insurance Program. Under the Affordable Care Act, that number is estimated to decrease by 40 percent.
(h/t Washington Post) Reported by Huffington Post 7 hours ago.
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Hundreds of Catholic employers exempted from HHS mandate
Oklahoma City, Okla., Jun 5, 2014 / 04:59 pm (CNA/EWTN News).- A federal court has ruled that the Catholic Benefits Association and its hundreds of employer members are exempt from a federal mandate requiring coverage of contraceptives and abortifacient drugs.
“We are grateful for the ruling, but continue to pray that our leaders recognize that Catholics, whether bishops or businessmen, cannot in good conscience provide insurance that covers drugs and procedures that undermine the dignity of the human person and the sanctity of human life,” Archbishop Paul Coakley of Oklahoma City, the benefit association’s vice-president, said June 5.
“Religious freedom entails more than the right to worship and any contrary legislation must be opposed,” he added.
Archbishop William Lori of Baltimore, the association’s president, also welcomed the decision.
“We formed the Catholic Benefits Association to support Catholic employers in providing quality, cost-competitive, morally compliant health care benefits for their employees,” he said June 5. “Yesterday’s decision makes this a reality.”
On June 4, the U.S. District Court for the Western District of Oklahoma ruled that the more than 450 employer members of the benefits association are exempt from the mandate. The ruling enjoined the U.S. government and its agents from attempting to enforce the mandate against the association’s members.
The benefits association’s general counsel, Martin Nussbaum., said the ruling is “especially gratifying” because the lawsuit is the only challenge to the HHS mandate that includes Catholic-owned for-profit businesses and other non-exempt organizations like colleges, Catholic Charities and healthcare institutions in addition to houses of worship.
The benefits association's employers include 23 Catholic archdioceses and dioceses and almost 2,000 parishes in addition to non-profits and Catholic-owned for-profit businesses. Its membership is also open to Catholic religious congregations, Catholic medical facilities, and Catholic universities.
The Catholic Benefits Association formed a subsidy, the Catholic Insurance Company, to allow Catholic employers to exercise their faith in what health care coverage they provide to their employees. The association also arranges health provider networks to help Catholic employers provide comprehensive health care that is consistent with Catholic ethics.
The Department of Health and Human Services mandate requires employers to provide insurance coverage or access to insurance coverage of sterilization and contraception, including some drugs that can cause early abortions.
Widespread complaint led to a series of changes in the mandate into its current finalized form. A religious exemption to the mandate does exist, but it applies primarily to houses of worship and their affiliated organizations.
Religious employers that do not qualify for the exemption are instead offered an “accommodation” by the government, under which employees automatically receive contraceptive coverage from the objecting groups’ health insurance issuers.
These provisions have continued to draw criticism and legal complaints from hundreds of individuals and organizations who argue that their right to exercise their religious beliefs freely is being violated by the requirements.
In addition, neither the exemption nor the accommodation apply to individuals with religious or moral objections to the requirements who own for-profit businesses.
Wednesday’s federal ruling on the class action lawsuit recognized that the benefits association could represent all its individual members without their explicit participation because its members are “so uniform in their beliefs.”
The named participants in the lawsuit include the Archdiocese of Oklahoma City, Catholic Charities of Oklahoma City, Inc., Archbishop Lori and the Archdiocese of Baltimore.
Archbishop Coakley said that the U.S. government has already “effectively granted exemptions from the mandate to various employers whose plans cover more than 130 million employees.”
“We’re simply seeking the same exemption for Catholic employers who have religious objections to the unjust requirements of the mandate.”
According to the Becket Fund for Religious Liberty, the mandate has prompted some 100 lawsuits from more than 300 plaintiffs, including non-profits, for-profits, Catholic and non-Catholic organizations, and individual states. So far, court decisions have predominantly favored the objecting groups.
A significant Supreme Court case involving the legal challenge filed by craft store giant Hobby Lobby is expected to be decided later this month. Reported by CNA 6 hours ago.
“We are grateful for the ruling, but continue to pray that our leaders recognize that Catholics, whether bishops or businessmen, cannot in good conscience provide insurance that covers drugs and procedures that undermine the dignity of the human person and the sanctity of human life,” Archbishop Paul Coakley of Oklahoma City, the benefit association’s vice-president, said June 5.
“Religious freedom entails more than the right to worship and any contrary legislation must be opposed,” he added.
Archbishop William Lori of Baltimore, the association’s president, also welcomed the decision.
“We formed the Catholic Benefits Association to support Catholic employers in providing quality, cost-competitive, morally compliant health care benefits for their employees,” he said June 5. “Yesterday’s decision makes this a reality.”
On June 4, the U.S. District Court for the Western District of Oklahoma ruled that the more than 450 employer members of the benefits association are exempt from the mandate. The ruling enjoined the U.S. government and its agents from attempting to enforce the mandate against the association’s members.
The benefits association’s general counsel, Martin Nussbaum., said the ruling is “especially gratifying” because the lawsuit is the only challenge to the HHS mandate that includes Catholic-owned for-profit businesses and other non-exempt organizations like colleges, Catholic Charities and healthcare institutions in addition to houses of worship.
The benefits association's employers include 23 Catholic archdioceses and dioceses and almost 2,000 parishes in addition to non-profits and Catholic-owned for-profit businesses. Its membership is also open to Catholic religious congregations, Catholic medical facilities, and Catholic universities.
The Catholic Benefits Association formed a subsidy, the Catholic Insurance Company, to allow Catholic employers to exercise their faith in what health care coverage they provide to their employees. The association also arranges health provider networks to help Catholic employers provide comprehensive health care that is consistent with Catholic ethics.
The Department of Health and Human Services mandate requires employers to provide insurance coverage or access to insurance coverage of sterilization and contraception, including some drugs that can cause early abortions.
Widespread complaint led to a series of changes in the mandate into its current finalized form. A religious exemption to the mandate does exist, but it applies primarily to houses of worship and their affiliated organizations.
Religious employers that do not qualify for the exemption are instead offered an “accommodation” by the government, under which employees automatically receive contraceptive coverage from the objecting groups’ health insurance issuers.
These provisions have continued to draw criticism and legal complaints from hundreds of individuals and organizations who argue that their right to exercise their religious beliefs freely is being violated by the requirements.
In addition, neither the exemption nor the accommodation apply to individuals with religious or moral objections to the requirements who own for-profit businesses.
Wednesday’s federal ruling on the class action lawsuit recognized that the benefits association could represent all its individual members without their explicit participation because its members are “so uniform in their beliefs.”
The named participants in the lawsuit include the Archdiocese of Oklahoma City, Catholic Charities of Oklahoma City, Inc., Archbishop Lori and the Archdiocese of Baltimore.
Archbishop Coakley said that the U.S. government has already “effectively granted exemptions from the mandate to various employers whose plans cover more than 130 million employees.”
“We’re simply seeking the same exemption for Catholic employers who have religious objections to the unjust requirements of the mandate.”
According to the Becket Fund for Religious Liberty, the mandate has prompted some 100 lawsuits from more than 300 plaintiffs, including non-profits, for-profits, Catholic and non-Catholic organizations, and individual states. So far, court decisions have predominantly favored the objecting groups.
A significant Supreme Court case involving the legal challenge filed by craft store giant Hobby Lobby is expected to be decided later this month. Reported by CNA 6 hours ago.
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Study Results Show Trends in Private, Nonprofit-Sponsored Employee Benefits Plans
PPI Benefit Solutions Fourth Annual Nonprofit Employee Benefits Study reveals that despite challenges, private nonprofit employers remain committed to delivering health and welfare benefits to their employees but are seeking solutions to help manage costs and improve employee engagement.
Wallingford, CT (PRWEB) June 05, 2014
PPI Benefit Solutions (PPI), a leading provider of benefits administration technology and services with over 40 years of experience working with nonprofit organizations, has released the results of The Fourth Annual Nonprofit Employee Benefits Study that measures and tracks benchmarks of private, nonprofit employee benefit plans. The study results indicate a growing trend toward consumer-driven options (such as High Deductible Health Plans) and online employee self-service tools in an attempt by employers to curb rising premiums and cut administration costs while continuing to offer competitive benefit programs.
The nationwide survey, completed by over 250 small to mid-sized nonprofit organizations in November 2013, found that the use of traditional “medical” plans has decreased from 96.0% in 2009 to 83.6% in 2013, while the use of High Deductible Health Plans (HDHPs) has nearly doubled, rising from 22.0% in 2009 to 43.5% in 2013. At the same time, employers are offering more voluntary benefits to help subsidize the higher deductibles and offer employers more choice.
“Nonprofits are really struggling to maintain a comprehensive benefits package, and consumer-driven plans like HDHPs, health savings accounts and flexible spending accounts can be great, lower-cost options.” said Karen Greco, Director of Marketing for PPI Benefit Solutions. “The growth in these plan types, combined with the appeal of a predictable benefits budget, is also driving a lot of interest in alternative funding and enrollment solutions like defined contribution with an online marketplace that offers a wide array of product options.”
To address issues of efficiency, a growing number of nonprofit employers are recognizing the value of automated benefits administration and enrollment, as indicated by the 77.2% of employers (up from 28.4% in 2012) who consider benefits administration platforms to be very important and the 44.3% of employers (up from 9.6% in 2012) who believe employee self-service portals to be very important.
“Although the nonprofit sector has been somewhat slow in adopting employee self-service enrollment, the number is steadily growing,” says Greco. “We see it in our own business, as year after year more nonprofit employers recognize how online, employee-directed enrollment improves accuracy, transparency, and engagement and provides employees with a greater understanding of their benefit options.”
As the health care marketplace continues to evolve, nearly 85% of nonprofit employers remain committed to delivering health and welfare benefits to employees in order to improve satisfaction and maintain a competitive advantage for talent. The findings of PPI’s Fourth Annual Nonprofit Employee Benefits Study can help these employers benchmark their own benefit plans and management practices, and also includes information on average payroll deductions, waiting periods, and contribution strategies, among other topics.
Among the key findings of the study:· Prevalence of benefits:
o 83.6% offer traditional medical plans (down from 87.0% in 2012)
o 43.5% offer HDHPs (up from 39.0% in 2012)
o 88.7% offer group dental (down from 90.0% in 2012)
o 59.1% offer ancillary coverage (up from 46.5% in 2012)· Voluntary benefits (percentage of nonprofit employers who offer):
o 20.3% offer voluntary dental (up from 17.0% in 2012)
o 49.7% offer voluntary life (up from 43.0% in 2012)
o 9.6% offer critical illness insurance (up from 6.0%)
o 34.5% offer accident insurance (up from 34.0% in 2012)
o 24.3% offer transit reimbursement (up from 17.0% in 2012)· Contribution strategies:
o 16.1% pay the full cost of health insurance
o 74.8% share the cost of health insurance between employer and employee
o 21.9% already use or are likely to use a defined contribution funding approach· Benefits administration:
o 77.2% view benefits administration platforms as very important
o 44.3% believe employee self-service portals are very important (up from 9.6% in 2012)
o 14.5% of employees utilize employee self-service (up from 8.8% in 2012)· Health Care Reform:
o 16.2% are moderately to very likely to discontinue health care coverage and send employees to a public, state, or federal exchange
o 60.5% of nonprofits have not calculated the cost of compliance with Health Care Reform (ACA) regulations· Private Exchange Marketplace:
o 15.8% are somewhat to very likely to begin offering benefits through a private exchange
o 47.6% would consider using a private exchange if they had more information
PPI Benefit Solutions has compiled these findings into a free report, which is available at http://www.ppibenefits.com/public/resources/research.aspx. If you are a private nonprofit and are interested in participating in the next survey, please contact research(at)ppibenefits(dot)com.
About PPI Benefit Solutions
PPI Benefit Solutions helps smaller, mid-sized employers relieve the day-to-day challenges of managing an employee benefits program. With over 40 years of benefits administration experience working with nonprofit organizations, PPI leverages strategic relationships with a broad array of nationally recognized insurance carriers and powerful, web-based technology to provide a single solution for multiple carrier enrollments and eligibility processing (including online enrollment and employee self-service), electronic eligibility data and discrepancy management, true premium billing and payments, COBRA Administration, and member advocacy services, all at little or no cost to the employer. Working exclusively through brokers, PPI serves over 1,300 clients, mainly in the Tri-State, Northeast and Mid-Atlantic regions. For more information, visit http://www.ppibenefits.com. Reported by PRWeb 6 hours ago.
Wallingford, CT (PRWEB) June 05, 2014
PPI Benefit Solutions (PPI), a leading provider of benefits administration technology and services with over 40 years of experience working with nonprofit organizations, has released the results of The Fourth Annual Nonprofit Employee Benefits Study that measures and tracks benchmarks of private, nonprofit employee benefit plans. The study results indicate a growing trend toward consumer-driven options (such as High Deductible Health Plans) and online employee self-service tools in an attempt by employers to curb rising premiums and cut administration costs while continuing to offer competitive benefit programs.
The nationwide survey, completed by over 250 small to mid-sized nonprofit organizations in November 2013, found that the use of traditional “medical” plans has decreased from 96.0% in 2009 to 83.6% in 2013, while the use of High Deductible Health Plans (HDHPs) has nearly doubled, rising from 22.0% in 2009 to 43.5% in 2013. At the same time, employers are offering more voluntary benefits to help subsidize the higher deductibles and offer employers more choice.
“Nonprofits are really struggling to maintain a comprehensive benefits package, and consumer-driven plans like HDHPs, health savings accounts and flexible spending accounts can be great, lower-cost options.” said Karen Greco, Director of Marketing for PPI Benefit Solutions. “The growth in these plan types, combined with the appeal of a predictable benefits budget, is also driving a lot of interest in alternative funding and enrollment solutions like defined contribution with an online marketplace that offers a wide array of product options.”
To address issues of efficiency, a growing number of nonprofit employers are recognizing the value of automated benefits administration and enrollment, as indicated by the 77.2% of employers (up from 28.4% in 2012) who consider benefits administration platforms to be very important and the 44.3% of employers (up from 9.6% in 2012) who believe employee self-service portals to be very important.
“Although the nonprofit sector has been somewhat slow in adopting employee self-service enrollment, the number is steadily growing,” says Greco. “We see it in our own business, as year after year more nonprofit employers recognize how online, employee-directed enrollment improves accuracy, transparency, and engagement and provides employees with a greater understanding of their benefit options.”
As the health care marketplace continues to evolve, nearly 85% of nonprofit employers remain committed to delivering health and welfare benefits to employees in order to improve satisfaction and maintain a competitive advantage for talent. The findings of PPI’s Fourth Annual Nonprofit Employee Benefits Study can help these employers benchmark their own benefit plans and management practices, and also includes information on average payroll deductions, waiting periods, and contribution strategies, among other topics.
Among the key findings of the study:· Prevalence of benefits:
o 83.6% offer traditional medical plans (down from 87.0% in 2012)
o 43.5% offer HDHPs (up from 39.0% in 2012)
o 88.7% offer group dental (down from 90.0% in 2012)
o 59.1% offer ancillary coverage (up from 46.5% in 2012)· Voluntary benefits (percentage of nonprofit employers who offer):
o 20.3% offer voluntary dental (up from 17.0% in 2012)
o 49.7% offer voluntary life (up from 43.0% in 2012)
o 9.6% offer critical illness insurance (up from 6.0%)
o 34.5% offer accident insurance (up from 34.0% in 2012)
o 24.3% offer transit reimbursement (up from 17.0% in 2012)· Contribution strategies:
o 16.1% pay the full cost of health insurance
o 74.8% share the cost of health insurance between employer and employee
o 21.9% already use or are likely to use a defined contribution funding approach· Benefits administration:
o 77.2% view benefits administration platforms as very important
o 44.3% believe employee self-service portals are very important (up from 9.6% in 2012)
o 14.5% of employees utilize employee self-service (up from 8.8% in 2012)· Health Care Reform:
o 16.2% are moderately to very likely to discontinue health care coverage and send employees to a public, state, or federal exchange
o 60.5% of nonprofits have not calculated the cost of compliance with Health Care Reform (ACA) regulations· Private Exchange Marketplace:
o 15.8% are somewhat to very likely to begin offering benefits through a private exchange
o 47.6% would consider using a private exchange if they had more information
PPI Benefit Solutions has compiled these findings into a free report, which is available at http://www.ppibenefits.com/public/resources/research.aspx. If you are a private nonprofit and are interested in participating in the next survey, please contact research(at)ppibenefits(dot)com.
About PPI Benefit Solutions
PPI Benefit Solutions helps smaller, mid-sized employers relieve the day-to-day challenges of managing an employee benefits program. With over 40 years of benefits administration experience working with nonprofit organizations, PPI leverages strategic relationships with a broad array of nationally recognized insurance carriers and powerful, web-based technology to provide a single solution for multiple carrier enrollments and eligibility processing (including online enrollment and employee self-service), electronic eligibility data and discrepancy management, true premium billing and payments, COBRA Administration, and member advocacy services, all at little or no cost to the employer. Working exclusively through brokers, PPI serves over 1,300 clients, mainly in the Tri-State, Northeast and Mid-Atlantic regions. For more information, visit http://www.ppibenefits.com. Reported by PRWeb 6 hours ago.
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Overhaul of Health-Care Site in the Works
The Obama administration is revamping HealthCare.gov and scrapping significant parts of the federal health-insurance marketplace in an effort to avoid the problems that plagued the site's launch.
Reported by Wall Street Journal 4 hours ago.
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↧
Previewing Tomorrow's Payroll Number
With a *9 standard deviation range between the highest and lowest excuse for a forecast* from the 81 "qualified" economists on Bloomberg's survey, there is plenty of room for noise to dominate signal with tomorrow's payrolls data. Goldman forecasts a *softer-than-consensus 210k increase in non-farm-payrolls as May employment data flow looks more mixed*, and they expect that the unemployment rate rose two-tenths to 6.5% in May (vs. consensus 6.4%). Average hourly earnings (AHE) are likely to be in focus again following several months of heightened attention to wage growth and labor market slack; Goldman expects an increase of 0.2% in May (vs. consensus 0.2%).
Recent employment data has been mixed... (and today's dismal Challenger Layoffs data)...
And Goldman is less exuberant than many on the street...
*We forecast a 210k increase in nonfarm payrolls in May, a touch below the consensus estimate of 215k. *We expect that private payrolls increased 210k (vs. consensus 210k), with government a neutral contributor. This would mark a substantial decline from April's better-than-expected 288k gain. The reason for our more modest expectations for May is that the employment data have been considerably more mixed this month after pointing almost uniformly to a stronger number in April. As a result, we expect this month's gain to fall somewhere in between the 6-month (203k) or 12-month (197k) moving average and the roughly 225k trend rate we expect as growth accelerates this year. *Based on May data from recent years, we also see some risk of a net downward revision to the prior two months.*
*Arguing for a stronger report:*
· *The employment components of business surveys sent a mixed-to-positive overall message this month. *Among manufacturing surveys, the ISM (-1.9 to 52.8) and Dallas Fed (-16.8pt to 2.9) surveys declined, but the Philly (+0.9pt to 7.8), Empire (+12.7pt to 20.9), Richmond (+6pt to 10), and Kansas City (+7pt to 10) Fed surveys improved. Among service sector surveys, the employment components of the ISM non-manufacturing (+1.1pt to 52.4) and New York Fed (+10.3pt to 16.4) surveys improved, while the Richmond (-2pt to 4) and Dallas (-2.6pt to 13.8) surveys declined. The Beige Book also reported "steady to stronger" hiring in almost all districts.
· *The labor differential?the difference in the percentage of respondents in the Conference Board's consumer confidence survey describing jobs as plentiful vs. hard to get?improved 1.6pt* to -18.2 in May. The index has shown a fairly steady recovery since late 2011, but was a misleading indicator last month, when it fell 2.2pt.
*Arguing for a weaker report*
· *Private job gains reported by ADP disappointed consensus expectations this week at 179k in May*, down from an initially-reported April gain of 220k. That said, we attach only limited weight to the ADP report because its initial print has yet to prove itself as a reliable indicator of payroll job growth as measured by the Labor Department.
· *Announced layoffs rose about 25% in May on a seasonally-adjusted basis, according to Challenger, Gray, and Christmas*, with the largest cuts coming in the computer industry. As in April, job cuts in the health care sector remained at a normal level, suggesting little impact from layoffs of temporary workers after the end of the sign-up period for health insurance under the Affordable Care Act.
*Neutral indicators*
· *The four-week moving average of initial claims for unemployment benefits increased slightly *from the April to the May reference week. However, the April weekly data might have been distorted by the Easter holiday and spring break from schools, and the difference between the two months was relatively small.
· *New and total online job ads fell a touch in May.* Both series have been fairly stable over the last few months relative to their usual volatility, and we therefore view this as a neutral indicator. The Help Wanted OnLine report noted weaker demand for workers in sales, management, and computing, but increases in transportation, production, and construction job ads.
· *Weather conditions returned to seasonal norms *in April and were a bit more supportive than usual in May.
*We expect that the unemployment rate rose two-tenths to 6.5% in May (vs. consensus 6.4%), following an unexpected four-tenths decline to an unrounded 6.28% in April. *The reason is that we expect the participation rate will partially reverse last month's unusually large four-tenths decline. Building on our decomposition of non-participators into the retired, disabled and other categories shown in the household survey micro data, we find that the 'other' category contributed most of the decline in participation in April.
At the margin, this might point to a larger retracement of last month's decline because--as researchers who use the household survey often note--survey respondents sometimes confuse unemployment with being out of the labor force for other reasons (the marginally attached are a subset of this category). To test this possibility, we model the change in the share of non-participators with a constant and last month's change. *We find a tendency for about one-quarter of the change to reverse*, but when we replace last month's total change with the changes in the three components of non-participation, we find that the effect is driven by changes in the 'other' category.
*Average hourly earnings (AHE) are likely to be in focus again on Friday following several months of heightened attention to wage growth and labor market slack.* We expect an increase of 0.2% in May (vs. consensus 0.2%). Wage data released over the last few months have remained soft, and qualitative evidence from yesterday's Beige Book also noted subdued wage growth. AHE for all workers grew just 0.1% in March and were flat in April. The Employment Cost Index showed compensation growth of 1.3% (annualized) and wage & salary growth of 1% (annualized) in Q1, while the national accounts data showed 2.3% (annualized) growth of compensation per hour in the nonfarm business sector in Q1. *Our wage tracker--a smoother aggregate of all three wage measures--grew 1.8% over the past year.*
Here is the full distribution - with Lavorgna actually slightly below consensus also... Reported by Zero Hedge 5 hours ago.
Recent employment data has been mixed... (and today's dismal Challenger Layoffs data)...
And Goldman is less exuberant than many on the street...
*We forecast a 210k increase in nonfarm payrolls in May, a touch below the consensus estimate of 215k. *We expect that private payrolls increased 210k (vs. consensus 210k), with government a neutral contributor. This would mark a substantial decline from April's better-than-expected 288k gain. The reason for our more modest expectations for May is that the employment data have been considerably more mixed this month after pointing almost uniformly to a stronger number in April. As a result, we expect this month's gain to fall somewhere in between the 6-month (203k) or 12-month (197k) moving average and the roughly 225k trend rate we expect as growth accelerates this year. *Based on May data from recent years, we also see some risk of a net downward revision to the prior two months.*
*Arguing for a stronger report:*
· *The employment components of business surveys sent a mixed-to-positive overall message this month. *Among manufacturing surveys, the ISM (-1.9 to 52.8) and Dallas Fed (-16.8pt to 2.9) surveys declined, but the Philly (+0.9pt to 7.8), Empire (+12.7pt to 20.9), Richmond (+6pt to 10), and Kansas City (+7pt to 10) Fed surveys improved. Among service sector surveys, the employment components of the ISM non-manufacturing (+1.1pt to 52.4) and New York Fed (+10.3pt to 16.4) surveys improved, while the Richmond (-2pt to 4) and Dallas (-2.6pt to 13.8) surveys declined. The Beige Book also reported "steady to stronger" hiring in almost all districts.
· *The labor differential?the difference in the percentage of respondents in the Conference Board's consumer confidence survey describing jobs as plentiful vs. hard to get?improved 1.6pt* to -18.2 in May. The index has shown a fairly steady recovery since late 2011, but was a misleading indicator last month, when it fell 2.2pt.
*Arguing for a weaker report*
· *Private job gains reported by ADP disappointed consensus expectations this week at 179k in May*, down from an initially-reported April gain of 220k. That said, we attach only limited weight to the ADP report because its initial print has yet to prove itself as a reliable indicator of payroll job growth as measured by the Labor Department.
· *Announced layoffs rose about 25% in May on a seasonally-adjusted basis, according to Challenger, Gray, and Christmas*, with the largest cuts coming in the computer industry. As in April, job cuts in the health care sector remained at a normal level, suggesting little impact from layoffs of temporary workers after the end of the sign-up period for health insurance under the Affordable Care Act.
*Neutral indicators*
· *The four-week moving average of initial claims for unemployment benefits increased slightly *from the April to the May reference week. However, the April weekly data might have been distorted by the Easter holiday and spring break from schools, and the difference between the two months was relatively small.
· *New and total online job ads fell a touch in May.* Both series have been fairly stable over the last few months relative to their usual volatility, and we therefore view this as a neutral indicator. The Help Wanted OnLine report noted weaker demand for workers in sales, management, and computing, but increases in transportation, production, and construction job ads.
· *Weather conditions returned to seasonal norms *in April and were a bit more supportive than usual in May.
*We expect that the unemployment rate rose two-tenths to 6.5% in May (vs. consensus 6.4%), following an unexpected four-tenths decline to an unrounded 6.28% in April. *The reason is that we expect the participation rate will partially reverse last month's unusually large four-tenths decline. Building on our decomposition of non-participators into the retired, disabled and other categories shown in the household survey micro data, we find that the 'other' category contributed most of the decline in participation in April.
At the margin, this might point to a larger retracement of last month's decline because--as researchers who use the household survey often note--survey respondents sometimes confuse unemployment with being out of the labor force for other reasons (the marginally attached are a subset of this category). To test this possibility, we model the change in the share of non-participators with a constant and last month's change. *We find a tendency for about one-quarter of the change to reverse*, but when we replace last month's total change with the changes in the three components of non-participation, we find that the effect is driven by changes in the 'other' category.
*Average hourly earnings (AHE) are likely to be in focus again on Friday following several months of heightened attention to wage growth and labor market slack.* We expect an increase of 0.2% in May (vs. consensus 0.2%). Wage data released over the last few months have remained soft, and qualitative evidence from yesterday's Beige Book also noted subdued wage growth. AHE for all workers grew just 0.1% in March and were flat in April. The Employment Cost Index showed compensation growth of 1.3% (annualized) and wage & salary growth of 1% (annualized) in Q1, while the national accounts data showed 2.3% (annualized) growth of compensation per hour in the nonfarm business sector in Q1. *Our wage tracker--a smoother aggregate of all three wage measures--grew 1.8% over the past year.*
Here is the full distribution - with Lavorgna actually slightly below consensus also... Reported by Zero Hedge 5 hours ago.
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Half The Country Makes Less Than $27,520 A Year And 15 Other Signs The Middle Class Is Dying
Submitted by Michael Snyder of THe Economic Collapse blog,
*If you make more than $27,520 a year at your job, you are doing better than half the country is. * But you don't have to take my word for it, you can check out the latest wage statistics from the Social Security administration right here. But of course $27,520 a year will not allow you to live "the American Dream" in this day and age. After taxes, that breaks down to a good bit less than $2,000 a month. You can't realistically pay a mortgage, make a car payment, afford health insurance and provide food, clothing and everything else your family needs for that much money. That is one of the reasons why both parents are working in most families today. In fact, sometimes both parents are working multiple jobs in a desperate attempt to make ends meet. Over the years, the cost of living has risen steadily but our paychecks have not. This has resulted in a steady erosion of the middle class. Once upon a time, most American families could afford a nice home, a couple of cars and a nice vacation every year. When I was growing up, it seemed like almost everyone was middle class. But now "the American Dream" is out of reach for more Americans than ever, and the middle class is dying right in front of our eyes.
One of the things that was great about America in the post-World War II era was that we developed a large, thriving middle class. Until recent times, it always seemed like there were plenty of good jobs for people that were willing to be responsible and work hard. That was one of the big reasons why people wanted to come here from all over the world. They wanted to have a chance to live "the American Dream" too.
*But now the American Dream is becoming a mirage for most people. No matter how hard they try, they just can't seem to achieve it.*
*And here are some hard numbers to back that assertion up. The following are 15 more signs that the middle class is dying...*
*#1* According to a brand new CNN poll, 59 percent of Americans believe that it has become impossible for most people to achieve the American Dream...
The American Dream is impossible to achieve in this country.
So say nearly 6 in 10 people who responded to CNNMoney's American Dream Poll, conducted by ORC International. They feel the dream -- however they define it -- is out of reach.
Young adults, age 18 to 34, are most likely to feel the dream is unattainable, with 63% saying it's impossible. This age group has suffered in the wake of the Great Recession, finding it hard to get good jobs.
*#2* More Americans than ever believe that homeownership is not a key to long-term wealth and prosperity...
The great American Dream is dying. Even though many Americans still desire to own a home, they are losing faith in homeownership as a key to prosperity.
Nearly two-thirds of Americans, or 64%, believe they are less likely to build wealth by buying a home today than they were 20 or 30 years ago, according to a survey sponsored by non-profit MacArthur Foundation. And nearly 43% said buying a home is no longer a good long-term investment.
*#3* Overall, the rate of homeownership in the United States has fallen for eight years in a row, and it has now dropped to the lowest level in 19 years.
*#4* 52 percent of Americans cannot even afford the house that they are living in right now...
"Over half of Americans (52%) have had to make at least one major sacrifice in order to cover their rent or mortgage over the last three years, according to the “How Housing Matters Survey,” which was commissioned by the nonprofit John D. and Catherine T. MacArthur Foundation and carried out by Hart Research Associates. These sacrifices include *getting a second job, deferring saving for retirement, cutting back on health care, running up credit card debt, or even moving to a less safe neighborhood* or one with worse schools."
*#5* According to the U.S. Census Bureau, only 36 percent of Americans under the age of 35 own a home. That is the lowest level that has ever been measured.
*#6* Right now, approximately one out of every six men in the United States that are in their prime working years (25 to 54) do not have a job.
*#7* The labor force participation rate for Americans from the age of 25 to the age of 29 has fallen to an all-time record low.
*#8* The number of working age Americans that are not employed has increased by 27 million since the year 2000.
*#9* According to the government's own numbers, about 20 percent of the families in the entire country do not have a single member that is employed at this point.
*#10* This may sound crazy, but 25 percent of all American adults do not even have a single penny saved up for retirement.
*#11* As I noted in one recent article, total consumer credit in the United States has increased by 22 percent over the past three years, and 56 percent of all Americans have "subprime credit" at this point.
*#12* Major retailers are shutting down stores at the fastest pace that we have seen since the collapse of Lehman Brothers.
*#13* It is hard to believe, but more than one out of every five children in the United States is living in poverty in 2014.
*#14* According to one recent report, there are 49 million Americans that are dealing with food insecurity right now.
*#15* Overall, the U.S. poverty rate is up more than 30 percent since 1966. It looks like LBJ's war on poverty didn't work out too well after all.
Sadly, it does not appear that there is much hope on the horizon for the middle class. More good jobs are being shipped out of the country and are being lost to technology every single day, and our politicians seem convinced that "business as usual" is the right course of action for our nation.
Unless something dramatic happens, it is going to become increasingly difficult to eke out a middle class existence as a "worker bee" in American society. The truth is that most big companies these days do not have any loyalty to their workers and really do not care what ends up happening to them.
To thrive in this kind of environment, new and different thinking is required. The paradigm of "go to college, get a job, stay loyal and retire after 30 years" has been shattered. The business world is more unstable now than it has been during any point in the post-World War II era, and we are all going to have to adjust. Reported by Zero Hedge 4 hours ago.
*If you make more than $27,520 a year at your job, you are doing better than half the country is. * But you don't have to take my word for it, you can check out the latest wage statistics from the Social Security administration right here. But of course $27,520 a year will not allow you to live "the American Dream" in this day and age. After taxes, that breaks down to a good bit less than $2,000 a month. You can't realistically pay a mortgage, make a car payment, afford health insurance and provide food, clothing and everything else your family needs for that much money. That is one of the reasons why both parents are working in most families today. In fact, sometimes both parents are working multiple jobs in a desperate attempt to make ends meet. Over the years, the cost of living has risen steadily but our paychecks have not. This has resulted in a steady erosion of the middle class. Once upon a time, most American families could afford a nice home, a couple of cars and a nice vacation every year. When I was growing up, it seemed like almost everyone was middle class. But now "the American Dream" is out of reach for more Americans than ever, and the middle class is dying right in front of our eyes.
One of the things that was great about America in the post-World War II era was that we developed a large, thriving middle class. Until recent times, it always seemed like there were plenty of good jobs for people that were willing to be responsible and work hard. That was one of the big reasons why people wanted to come here from all over the world. They wanted to have a chance to live "the American Dream" too.
*But now the American Dream is becoming a mirage for most people. No matter how hard they try, they just can't seem to achieve it.*
*And here are some hard numbers to back that assertion up. The following are 15 more signs that the middle class is dying...*
*#1* According to a brand new CNN poll, 59 percent of Americans believe that it has become impossible for most people to achieve the American Dream...
The American Dream is impossible to achieve in this country.
So say nearly 6 in 10 people who responded to CNNMoney's American Dream Poll, conducted by ORC International. They feel the dream -- however they define it -- is out of reach.
Young adults, age 18 to 34, are most likely to feel the dream is unattainable, with 63% saying it's impossible. This age group has suffered in the wake of the Great Recession, finding it hard to get good jobs.
*#2* More Americans than ever believe that homeownership is not a key to long-term wealth and prosperity...
The great American Dream is dying. Even though many Americans still desire to own a home, they are losing faith in homeownership as a key to prosperity.
Nearly two-thirds of Americans, or 64%, believe they are less likely to build wealth by buying a home today than they were 20 or 30 years ago, according to a survey sponsored by non-profit MacArthur Foundation. And nearly 43% said buying a home is no longer a good long-term investment.
*#3* Overall, the rate of homeownership in the United States has fallen for eight years in a row, and it has now dropped to the lowest level in 19 years.
*#4* 52 percent of Americans cannot even afford the house that they are living in right now...
"Over half of Americans (52%) have had to make at least one major sacrifice in order to cover their rent or mortgage over the last three years, according to the “How Housing Matters Survey,” which was commissioned by the nonprofit John D. and Catherine T. MacArthur Foundation and carried out by Hart Research Associates. These sacrifices include *getting a second job, deferring saving for retirement, cutting back on health care, running up credit card debt, or even moving to a less safe neighborhood* or one with worse schools."
*#5* According to the U.S. Census Bureau, only 36 percent of Americans under the age of 35 own a home. That is the lowest level that has ever been measured.
*#6* Right now, approximately one out of every six men in the United States that are in their prime working years (25 to 54) do not have a job.
*#7* The labor force participation rate for Americans from the age of 25 to the age of 29 has fallen to an all-time record low.
*#8* The number of working age Americans that are not employed has increased by 27 million since the year 2000.
*#9* According to the government's own numbers, about 20 percent of the families in the entire country do not have a single member that is employed at this point.
*#10* This may sound crazy, but 25 percent of all American adults do not even have a single penny saved up for retirement.
*#11* As I noted in one recent article, total consumer credit in the United States has increased by 22 percent over the past three years, and 56 percent of all Americans have "subprime credit" at this point.
*#12* Major retailers are shutting down stores at the fastest pace that we have seen since the collapse of Lehman Brothers.
*#13* It is hard to believe, but more than one out of every five children in the United States is living in poverty in 2014.
*#14* According to one recent report, there are 49 million Americans that are dealing with food insecurity right now.
*#15* Overall, the U.S. poverty rate is up more than 30 percent since 1966. It looks like LBJ's war on poverty didn't work out too well after all.
Sadly, it does not appear that there is much hope on the horizon for the middle class. More good jobs are being shipped out of the country and are being lost to technology every single day, and our politicians seem convinced that "business as usual" is the right course of action for our nation.
Unless something dramatic happens, it is going to become increasingly difficult to eke out a middle class existence as a "worker bee" in American society. The truth is that most big companies these days do not have any loyalty to their workers and really do not care what ends up happening to them.
To thrive in this kind of environment, new and different thinking is required. The paradigm of "go to college, get a job, stay loyal and retire after 30 years" has been shattered. The business world is more unstable now than it has been during any point in the post-World War II era, and we are all going to have to adjust. Reported by Zero Hedge 4 hours ago.
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Obama administration revamps federal healthcare website: WSJ
(Reuters) - The Obama administration is revamping the health insurance marketplace HealthCare.gov and removing significant parts from it to ensure that glitches on the site do not return, the Wall Street Journal reported, citing presentations to health insurers and interviews with government officials and contractors.
Reported by Reuters 3 hours ago.
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State requires health-insurance parity for gay spouses
Washington state officials have sent letters to 48 insurance companies and businesses reminding them that it is illegal in Washington to deny health benefits to same-sex spouses if they provide those benefits to heterosexual spouses.
Reported by Seattle Times 2 hours ago.
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Healthcare.gov Revamped To Ensure Glitches Do Not Return: WSJ
(Reuters) - The Obama administration is revamping the health insurance marketplace HealthCare.gov and removing significant parts from it to ensure that glitches on the site do not return, the Wall Street Journal reported, citing presentations to health insurers and interviews with government officials and contractors.
The revamp and its tight timeline are raising concerns that consumers could encounter another troubled rollout when they return to the site to choose health plans, the paper said.
Open enrollment on the site for 2015 coverage starts Nov. 15 with a new homepage and tools.
A system to automate payments to insurers was running behind schedule, the WSJ reported, quoting a presentation that federal officials made to health insurers. (http://link.reuters.com/pup89v)
The government is turning its focus to cloud computing from Amazon.com Inc's web services unit to host many of these functions, the paper said.
Amazon was not available for comment outside regular business hours.
The poor performance of HealthCare.gov in October was the first in a series of setbacks that posed a political challenge for President Barack Obama and his Democratic allies.
Earlier on Thursday, the U.S. Senate confirmed Sylvia Mathews Burwell as Obama's new health secretary, making her chiefly responsible for implementing the controversial healthcare law known as Obamacare.
(Reporting by Shailaja Sharma in Bangalore; Editing by Eric Walsh) Reported by Huffington Post 1 day ago.
The revamp and its tight timeline are raising concerns that consumers could encounter another troubled rollout when they return to the site to choose health plans, the paper said.
Open enrollment on the site for 2015 coverage starts Nov. 15 with a new homepage and tools.
A system to automate payments to insurers was running behind schedule, the WSJ reported, quoting a presentation that federal officials made to health insurers. (http://link.reuters.com/pup89v)
The government is turning its focus to cloud computing from Amazon.com Inc's web services unit to host many of these functions, the paper said.
Amazon was not available for comment outside regular business hours.
The poor performance of HealthCare.gov in October was the first in a series of setbacks that posed a political challenge for President Barack Obama and his Democratic allies.
Earlier on Thursday, the U.S. Senate confirmed Sylvia Mathews Burwell as Obama's new health secretary, making her chiefly responsible for implementing the controversial healthcare law known as Obamacare.
(Reporting by Shailaja Sharma in Bangalore; Editing by Eric Walsh) Reported by Huffington Post 1 day ago.
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NAIRO Helps Health Plans Assess Ramifications of Essential Health Benefits and Coverage Determinations
Understanding the Rules and Regulations about Statutory Coverage Benefits
Portland, OR (PRWEB) June 06, 2014
The 2010 Patient Protection and Affordable Care Act (PPACA) continues to have direct ramifications on health insurance providers, consumers and other stakeholders, as stipulations within the law shift from future outlook to present tense. One important trend, now officially part of healthcare coverage, is the topic of Essential Health Benefits (EHBs).
Under the law, the coverage of designated EHBs is a regulatory necessity for the vast majority of plans in the marketplace. For consumers, questions remain as to what benefits are covered and, in general, what patients’ insurance rights look like in this new environment.
As both health plans and consumers assess the practical ramifications of EHBs, accredited independent review organizations (IROs), led by the National Association of Independent Review Organizations (NAIRO), are commonly used as a trusted source to provide non-biased, clinically supported decisions to resolve coverage disputes involving these new EHB requirements.
“Payers are facing many new claims determinations regarding whether a particular service falls into one of the EHB categories, and/or if a requested EHB is a medically necessary and appropriate treatment,” says Erik Halse, Vice President of NAIRO and Peer Review Product Manager for the IRO for which he currently works. “Accredited IROs can help payers make clinically appropriate determinations by leveraging medical experts with the experience and expertise to address the EHB under review.”
Essential Health Benefits: A Primer
As of January 1, 2014, all non-grandfathered health plans available in the individual and small group markets are required to cover a group of 10 EHBs, or categories of statutory coverage. The coverage of EHBs applies to health plans offered within the Health Insurance Marketplace, as well as those not offered in the Marketplace, and represents one of PPACA’s goals of ensuring a baseline level of consumer protections among available health plans.
The Department of Health and Human Services (HHS) names the 10 categories that comprise the EHBs.1 They include:
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.
For specific coverage requirements, many differences can exist – depending on the insurer’s state, the type of insurance plan being offered, the type of services covered, terms of coverage and other variables. Although health plans are required to offer coverage within these 10 categories, it is important for patients to closely review their own plan policy and coverage provisions related to the 10 EHBs.
In general, however, the new benefits package is a boost to consumers’ overall coverage. “For consumers in these markets, this means that in many instances they will be provided richer benefits packages than they would have before the ACA was in effect,” says Aja Ogzewalla, Secretary of NAIRO and Director of Compliance of the IRO for which she currently works.
Yet the same general rules govern available benefits for consumers. Total benefits may only be covered under certain provisions established by the health plan or under a definition of medical necessity or the provision of experimental/investigational coverage. Interpretation of coverage, including the finer points of EHBs, can often require clinical expertise to assess the service or treatment under review. IROs have established themselves as experts in providing non-biased, evidence-based opinions.
The following are some helpful definitions related to the EHBs cited in this paper:
Pediatric Services. HHS defines “pediatric services” as “services for individuals under the age of 19 years.”
Mental Health and Substance Use. Mental health and substance use disorder services, including behavioral health treatment services required under § 156.110(a)(5), must be provided in a manner that complies with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
Prescription Drug Benefits. The EHB coverage applies specifically to prescription drug coverage, which is of ongoing importance to health plans and consumers alike. In order to remain compliant, health plans must cover at least the greater of:
1. One drug in every United States Pharmacopeia (USP) category and class; or
2. The same number of drugs in each category and class as the EHB-benchmark plan.
Furthermore, plans offering EHBs must have procedures in place to ensure that enrollees have access to clinically appropriate drugs that are prescribed by a provider but are not included on the plan’s drug list.
This Prescription Drug Exception Process must include two steps, according to Ogzewalla. The two steps include internal review and independent review, to determine whether a drug is clinically appropriate to treat the enrollee’s medical condition, based on criteria that is consistent with the Medicare Part D program.
“By definition, IROs that are accredited adhere to evidence-based standards that guide which benefit is covered and which is not,” says Ogzewalla. “This means that consumers and health plans who work with IROs to determine coverage benefits, such as prescription drugs, will receive an outcome that is clinically appropriate and in line with industry best practices.”
The section below outlines further information on how IROs provide evidence-based coverage determinations.
The Benefit of Accredited IROs
IROs provide an independent determination regarding coverage disputes between patients and health plans. IROs will consider the following when making such determinations, including those determinations related to EHBs:
Medical Necessity Determinations:· Member’s medical records.
· Attending provider’s recommendation.
· Terms of coverage under the member’s health benefits plan (unless the terms are inconsistent with applicable law).
· Prior case information including rationale from prior review determinations.
· Reports from appropriate health care professionals and other documents provided by: Referring entity, member or attending provider.
· Clinical review criteria and/or medical policy developed and used by the benefits plan or with applicable law.
· Appropriate practice guidelines, which must include evidence-based standards and may include any other practice guidelines developed by the state, federal government, national or professional medical societies, boards and associations.
Experimental or Investigational issues shall also consider existing medical research and peer‐reviewed literature regarding the proposed treatment with respect to effectiveness and efficacy, including:· Whether the recommended service has been approved by the federal food and drug administration for the condition.
· A description of the indicators relevant to whether there is sufficient evidence to demonstrate that the recommended service is more likely than not to be more beneficial to the covered person than any available standard health care service. And the adverse risks of the recommended service would not be substantially increased over those of available standard health care services.
· Whether medical or scientific evidence or evidence based standards demonstrate that the expected benefits of the recommended service is more likely than not to be more beneficial to the covered person than any available standard health care service. And the adverse risks of the recommended service would not be substantially increased over those of available standard health care services or treatments.
References
1. Federal Register. “Patient Protection and Affordable Care Act: Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation.” § 156.110, EHB-Benchmark Plan Standards. HHS. Vol. 78, No. 37. February 25, 2013. Reported by PRWeb 23 hours ago.
Portland, OR (PRWEB) June 06, 2014
The 2010 Patient Protection and Affordable Care Act (PPACA) continues to have direct ramifications on health insurance providers, consumers and other stakeholders, as stipulations within the law shift from future outlook to present tense. One important trend, now officially part of healthcare coverage, is the topic of Essential Health Benefits (EHBs).
Under the law, the coverage of designated EHBs is a regulatory necessity for the vast majority of plans in the marketplace. For consumers, questions remain as to what benefits are covered and, in general, what patients’ insurance rights look like in this new environment.
As both health plans and consumers assess the practical ramifications of EHBs, accredited independent review organizations (IROs), led by the National Association of Independent Review Organizations (NAIRO), are commonly used as a trusted source to provide non-biased, clinically supported decisions to resolve coverage disputes involving these new EHB requirements.
“Payers are facing many new claims determinations regarding whether a particular service falls into one of the EHB categories, and/or if a requested EHB is a medically necessary and appropriate treatment,” says Erik Halse, Vice President of NAIRO and Peer Review Product Manager for the IRO for which he currently works. “Accredited IROs can help payers make clinically appropriate determinations by leveraging medical experts with the experience and expertise to address the EHB under review.”
Essential Health Benefits: A Primer
As of January 1, 2014, all non-grandfathered health plans available in the individual and small group markets are required to cover a group of 10 EHBs, or categories of statutory coverage. The coverage of EHBs applies to health plans offered within the Health Insurance Marketplace, as well as those not offered in the Marketplace, and represents one of PPACA’s goals of ensuring a baseline level of consumer protections among available health plans.
The Department of Health and Human Services (HHS) names the 10 categories that comprise the EHBs.1 They include:
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.
For specific coverage requirements, many differences can exist – depending on the insurer’s state, the type of insurance plan being offered, the type of services covered, terms of coverage and other variables. Although health plans are required to offer coverage within these 10 categories, it is important for patients to closely review their own plan policy and coverage provisions related to the 10 EHBs.
In general, however, the new benefits package is a boost to consumers’ overall coverage. “For consumers in these markets, this means that in many instances they will be provided richer benefits packages than they would have before the ACA was in effect,” says Aja Ogzewalla, Secretary of NAIRO and Director of Compliance of the IRO for which she currently works.
Yet the same general rules govern available benefits for consumers. Total benefits may only be covered under certain provisions established by the health plan or under a definition of medical necessity or the provision of experimental/investigational coverage. Interpretation of coverage, including the finer points of EHBs, can often require clinical expertise to assess the service or treatment under review. IROs have established themselves as experts in providing non-biased, evidence-based opinions.
The following are some helpful definitions related to the EHBs cited in this paper:
Pediatric Services. HHS defines “pediatric services” as “services for individuals under the age of 19 years.”
Mental Health and Substance Use. Mental health and substance use disorder services, including behavioral health treatment services required under § 156.110(a)(5), must be provided in a manner that complies with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
Prescription Drug Benefits. The EHB coverage applies specifically to prescription drug coverage, which is of ongoing importance to health plans and consumers alike. In order to remain compliant, health plans must cover at least the greater of:
1. One drug in every United States Pharmacopeia (USP) category and class; or
2. The same number of drugs in each category and class as the EHB-benchmark plan.
Furthermore, plans offering EHBs must have procedures in place to ensure that enrollees have access to clinically appropriate drugs that are prescribed by a provider but are not included on the plan’s drug list.
This Prescription Drug Exception Process must include two steps, according to Ogzewalla. The two steps include internal review and independent review, to determine whether a drug is clinically appropriate to treat the enrollee’s medical condition, based on criteria that is consistent with the Medicare Part D program.
“By definition, IROs that are accredited adhere to evidence-based standards that guide which benefit is covered and which is not,” says Ogzewalla. “This means that consumers and health plans who work with IROs to determine coverage benefits, such as prescription drugs, will receive an outcome that is clinically appropriate and in line with industry best practices.”
The section below outlines further information on how IROs provide evidence-based coverage determinations.
The Benefit of Accredited IROs
IROs provide an independent determination regarding coverage disputes between patients and health plans. IROs will consider the following when making such determinations, including those determinations related to EHBs:
Medical Necessity Determinations:· Member’s medical records.
· Attending provider’s recommendation.
· Terms of coverage under the member’s health benefits plan (unless the terms are inconsistent with applicable law).
· Prior case information including rationale from prior review determinations.
· Reports from appropriate health care professionals and other documents provided by: Referring entity, member or attending provider.
· Clinical review criteria and/or medical policy developed and used by the benefits plan or with applicable law.
· Appropriate practice guidelines, which must include evidence-based standards and may include any other practice guidelines developed by the state, federal government, national or professional medical societies, boards and associations.
Experimental or Investigational issues shall also consider existing medical research and peer‐reviewed literature regarding the proposed treatment with respect to effectiveness and efficacy, including:· Whether the recommended service has been approved by the federal food and drug administration for the condition.
· A description of the indicators relevant to whether there is sufficient evidence to demonstrate that the recommended service is more likely than not to be more beneficial to the covered person than any available standard health care service. And the adverse risks of the recommended service would not be substantially increased over those of available standard health care services.
· Whether medical or scientific evidence or evidence based standards demonstrate that the expected benefits of the recommended service is more likely than not to be more beneficial to the covered person than any available standard health care service. And the adverse risks of the recommended service would not be substantially increased over those of available standard health care services or treatments.
References
1. Federal Register. “Patient Protection and Affordable Care Act: Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation.” § 156.110, EHB-Benchmark Plan Standards. HHS. Vol. 78, No. 37. February 25, 2013. Reported by PRWeb 23 hours ago.
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Public hearing on HIP 2.0 at Ivy Tech
State officials will be in Fort Wayne on Monday for a public hearing on the proposed expansion of the Healthy Indiana Plan, the state's health insurance program for low-income people.The hearing will be at 1 p.m. in the Student Life Center, Room 121, at Ivy Tech Community College-Northeast, 3701 Dean Drive.
Reported by Journal Gazette 23 hours ago.
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