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BY KATHRYN MAYER

The debate over Obamacare prices — and data supporting both sides — rages on. New analysis from HealthPocket indicates plans are cheaper on the exchanges than off them.

Analyzing premium prices from four major carriers that are offered off the exchanges with comparable bronze, silver and gold plans on the exchanges, researchers found that off-exchange plans on average are 40 percent more expensive. For the off-exchange plans, HealthPocket — a consumer resource website — examined ones from United Healthcare, Aetna, Cigna and Assurant.

Part of the reason is because exchange plans tend to be more transparent, helping consumers compare health prices, HealthPocket said. At the same time, researchers noted the higher prices could be in lieu of lower deductible and co-insurance, which some consumers consider as more important when choosing a plan.

Premium prices under Obamacare continues to be a major talking point, and a battle among political parties. Some firms, including Avalere Health — as well as many brokers — say the law is responsible for double-digit premium increases. Others say that assumption is unfounded. Last week, the Commonwealth Fund released a report that found that premium prices were rising 10 percent annually before Obamacare went into effect.

HealthPocket researchers said carriers who plan to join the exchanges in 2015 would need to lower their premiums if they wanted to be competitive.

“Given the current expense of the off-exchange plans we examined, we don’t expect their entrance on exchanges will introduce higher levels of premium competition,” said Kev Coleman, head of research and data at HealthPocket. “However, health plans are more than premiums and we are interested in exploring other issues such as out-of-pocket costs and health care provider network breadth.”

We’ve heard it all before. Survey after survey finds consumers are still blissfully unaware of or simply confused by the Patient Protection and Affordable Care Act. This despite the fact that the exchanges have been open for weeks now and the law’s other main provisions go live in just a few weeks.

Many are even confused about the name of the law, not realizing PPACA and Obamacare are one and the same, as revealed by a recent bit on Jimmy Kimmel Live, in which the show’s film crew took to the streets of Hollywood, underscored confusion seen in polls about the federal health care law.

“It’s a challenge, having to skirt the line between what’s going on with the politics of it, what the health plans actually offer and what the facts of the matter are,” says Rudy Garcia of Qandun Insurance Agency in California.

Garcia formed the agency in Los Angeles earlier this year to cater to small-business owners and individuals struggling to navigate PPACA’s complex — and changing — landscape. He serves about 40 small businesses, most with fewer than 50 employees. Garcia has been an agent since 1995, working with larger firms, public and private entities and small businesses. He decided to focus solely on small businesses and individuals, who have regularly asked about health reform and what it will mean for them.

“There’s so much information out there, and misinformation, people aren’t really sure whether they like it — is it socialism? Can someone get a tax credit? Will there be lower premiums? Is it something that could benefit them?” he says. “If you take politics out of the conversation, it becomes about laying out the facts, helping businesses become compliant and letting people make decisions about what plans they like or are best for them.

“There are people who believe they can just walk into a doctor’s office Jan. 1 and have national coverage. That’s not how it works. This is about educating consumers.”

No doubt, PPACA is very much a part of the public conversation. Public relations firm WCG found 8.5 billion online references to the law over the past year on news sites, blogs, forums and Twitter.

It’s easy to see where confusion lies — in conversations mentioning PPACA, more than half of them make no reference to specific components of the law and were focused on defunding or repealing efforts.

“It is all about marketing – calling it the Affordable Care Act is, in my opinion, misleading,” says Margareth Flowers, a Maryland pediatrician and a Congressional fellow for the Physicians for National Health Program. “Studies show most people just don’t understand at all the complexities of health insurance, what networks are or what it means to have a high co-pay. It’s a complicated subject.”

“It’s easy to believe half of the population has been living under a rock and does not know the difference (between ACA and Obamacare), but anyone with an ounce of brains should know exactly what this all is. There’s no excuse,” says Clark Newhall, a physician and the executive director of Health Justice, which opposes the health care law.

Once people do understand it, their opinion of it becomes pretty clear, Garcia says.

“Many do not realize, a major milestone is that they can buy a medical plan without questions from the insurer about their medical history, and they cannot be denied,” he says. “Others do not realize that, if they do not get on a plan by March 31, open enrollment has ended and they may face fines or not be able to get a plan until the following year.

“Some are pleasantly pleased, some unhappy. What’s important is that they understand.”

Garcia, who says he expects the questions about the reforms to grow as 2014 draws closer, is among a number of brokers who have tapped into a market of baffled consumers as insurance exchanges have launched.

But for the most part, people are not aware that going through a broker is even an option, says Dennis Watkins, a health insurance broker for Select Insurance Group in Viera, Fla.

“I’ve spoken to so many people who have told me they had no idea they could sit down with an agent; they were convinced they had to go through the government, that they had to use the website,” says Watkins, who has been licensed for more than 20 years. “People are genuinely confused and think they are buying insurance from the government rather than from a government-regulated insurance carrier.”

Watkins has launched a campaign to educate people in Florida’s Brevard County, speaking at churches, businesses, rotaries, civic organizations and hospitals. He says that PPACA has changed his role in the community.

“I am now partly an educator, and with my clients it’s no longer just their height, weight and do they smoke or not; I must also act as a financial adviser, to find out whether they qualify for a subsidy,” he says. “This is confusing and my job all changes now. It’s a whole different formula.”

Watkins worries that PPACA is not only confusing to consumers, but also to a raft of newly certified brokers looking to profit.

“Because everyone feels the need now to explore the opportunity to buy health insurance, there are so many people jumping into this market,” he says. “But if you don’t know the ins and outs of the providers, if you don’t know the plans forwards and backward — the maximum out of pocket, deductibles – then you can’t really give any valuable guidance, you will only add to the confusion.”

David Cagliola, senior vice president of Radnor Benefits Group in Wayne, Pa., agrees that the market is changing.

“You have to well understand what the laws are, and you have to act as a consultant, not just a salesman,” he says.

What many consumers shopping for insurance may not realize is that they have nothing to lose by hiring an agent, experts says. Insurance brokers get paid commissions through carriers, which varies by state, so policy costs are already set to include this fee. For individual consumers, the policy will cost the same whether it is bought through a broker or directly from a carrier.

Some states are doing their best to help residents navigate the law. The Texas Association of Health Underwriters, for instance, offers a directory of certified agents.

Many carriers are also working on educating their customers. Tufts Health Plan, already familiar with working within an exchange environment since Massachusetts began offering universal coverage in 2006, has been working closely with brokers to prepare for the change in federal law.

“There’s much to learn with ACA, so we’ve created a health care reform microsite with information; we developed an “ACA 2014 and beyond” booklet which we’ve distributed at our sessions with them; we’ve provided updates during our regular meetings with them; and also done emails blasts with information and articles on ACA,” spokeswoman Sonya Hagopian says.

BY BRUCE JACOBS

Add “Obamacare” to the phrase “unintended consequences” and a lot of people sprint straight to the storm cellar.

But the unintended consequences (none of which are direct) of the Patient Protection and Affordable Care Act on the workers’ compensation system may present employers, workers and carriers with perhaps more silver lining than cloud.

According to figures from the government’s Centers for Medicare and Medicaid Services, the health care bill in 2012 totaled $2.8 trillion, with about 2 percent of that figure, say experts, supporting medical costs associated with workers’ compensation.

See also: Sifting for physically fit applicants

The exact impact of Obamacare on that 2 percent probably won’t really be understood for a little while, but there’s no doubt some kind of impact will be felt, said Professor Jonathan Gruber, an MIT economist who lent his expertise in crafting both Mitt Romney’s 2006 Massachusetts health care law and the 2010 PPACA.

First, the one, big cloud:

Shortage of doctors

Some 9.5 million individuals, some previously uninsured, signed up for healthcare through the PPACA exchanges as of March. By 2017, the Congressional Budget Office estimates that the law will have reduced the about 47 million uninsured Americans by half, bringing some 23.5 million people into the healthcare system.

At roughly the same time, the Association of American Medical Colleges estimates the United States will be short some 45,000 primary-care doctors.

While business will no doubt be brisk for those physicians who remain in practice, Gruber worries that patients seeking medical attention for workplace injuries – particularly in already underserved parts of the country – will be unable to access convenient, high-quality, reasonably-priced care. This isn’t a problem that will afflict workers only, obviously. Everyone will feel it.

Now, the silver lining(s):

Healthier employees/lower costs

 

Derek A. Jones, an actuary and insurance specialist in the New York office of Milliman, sums up the expectations of many, saying he anticipates expanded medical coverage to foster a healthier U.S. population, which should lead to savings in the workers’ compensation system by reducing the number of claims.

Moreover, healthier workers who do get injured will recover quicker, return to work faster, and discontinue claims sooner.

Jones, again, isn’t alone in making this point; it’s one you’ll hear repeatedly in any conversation with a workers’ comp expert.

Cost shifting/fraud reduction 

For at least some employees who don’t carry health insurance, the workers’ compensation system is often the only way to address temporary and even chronic medical problems, many of which are not work-related. One such abuse, dubbed “Monday injuries,” involves waiting until the start of the week to attribute a non-job-related injury to the workplace.

See also: Medical marijuana leaves workers’ comp in cloud of confusion

Workers’ compensation deceits like “Monday injuries” and just plain false claims amount to some $7.2 billion annually, according to the National Insurance Crime Bureau, a number that includes cheating by employees, employers and providers alike.

However, as more workers are able to purchase and carry affordable medical insurance through the exchanges, they will use this new coverage – and not the workers’ comp system – to address their medical needs.

“Monday injuries” and other forms of worker-inspired fraud should decrease significantly, predict the authors of an article appearing in the May 2014 issue of the American Academy of Orthopedic Surgeons.

Administrative savings

These same authors anticipate that new PPACA regulations regarding reporting standards and coordination of benefits may help companies reign in costs by reducing administrative and overhead spending.

Best practices research

Through 2019, the PPACA has authorized some $650 million annually to support the Patient-Centered Outcomes Research Institute, whose mission is simple: fund relevant research to create a body of “evidence-based” information so that people confronting difficult healthcare choices can make informed decisions “that reflect their desired health outcomes.”

Joe Paduda, principal of Health Strategy Associates, a Madison, Conn., consulting firm specializing in managed care for workers’ compensation and group health, believes strongly that comparative effectiveness research can bring consistency and reason to the “wide variation in quality of care, over-use of surgery, inability to manage chronic pain, impact of obesity, and the often inconsistent medical care delivered to far too many injured workers.”

In short, PCORI’s work also should help cut workers’ comp claims.

BY DAN COOK

Are meetings leaving you feeling drained, frustrated and concerned about how much of your life has been spent in pointless banter with colleagues who’d rather be anywhere than in a meeting?

Guess what — you’re in the majority. According to a Robert Half Management Resources survey of more than 400 employees who attend meetings, most of them said that a quarter of their meeting times are wasted. Asked to cite the primary reasons behind unproductive meetings, here’s how their answers (multiple answers were permitted) broke down:

• 30 percent identified no clear purpose or agenda for meetings;
• 30 percent cast their vote for agenda straying;
• 20 percent were cranky about meetings that don’t end when they are supposed to;
• 15 percent carped about late starting times;
• 14 percent complained that people were invited to meetings who didn’t need to be there.

What to do? Robert Half doesn’t just supply data, it offers solutions as well. Here are five ways to create a more successful meeting.

Review the invite list. Limit attendees to those participants who have a stake in the outcome of items on the agenda. Indicating “required” versus “optional” attendance lets employees know when their participation and input is necessary and can help them prioritize their time.

Keep on track. Good leaders ensure the agenda and any supporting materials are accessible and publicized in advance, and that the discussion remains focused. Be prepared to cut off or table an unrelated conversation until a later time.

Plan accordingly. If it’s an in-person meeting, make sure there are enough seats in the room for everyone. Leave time for setup and pre-meeting technology challenges that may arise.

Monitor time. Keep it short and sweet. If a standing meeting is booked for an hour each week, but it usually lasts just 30 minutes, consider rethinking the time allotted. If there’s not much to discuss, consider using email or a memo as an alternative to a meeting.

Finish strong. If anyone leaves the meeting wondering what the next steps are, you haven’t done your job as meeting host. Allow time for people to ask questions, and determine who has responsibility for each follow-up item.

BY KATHRYN MAYER

Though it’s the talk — and concern — of companies nationwide (and has been for years, now), most employers still haven’t gotten around to measuring the cost impact of Obamacare.

That’s the significant finding from a new survey of more than 1,000 employers from broker Willis.

Only 37 percent of respondents said they’ve identified the cost impact of the Patient Protection and Affordable Care Act on their health plans in 2014. While that’s more than the 28 percent of respondents who said they identified the costs in last year’s survey, “it demonstrates that for many organizations, determining an accurate assessment of these figures is still a challenge,” Willis said.

Those that have measured the expected impact say the Patient Protection and Affordable Care Act will be increasing their costs. More than half (54 percent) noted a cost increase between 0 percent and 5 percent while 22 percent estimated their increase in the 5 to 10 percent range.

“Responding to the mandates and changes required by health care reform has been an evolving challenge for employers since the law’s implementation,” said Jay Kirschbaum, practice leader of the Willis Human Capital Practice’s national legal and research group.

And without actively figuring out how much compliance is going to cost, employers will be left in the dark about how to best adjust benefit strategies.

“Without that knowledge, employers may not be able to accurately assess the impact and determine the optimal way to proceed with their plans,” Kirschbaum said.

Obamacare has been affecting employers in other ways, too: For example, 14 percent of respondents said they’ve already eliminated coverage for part-time employees in 2014, and another 8 percent plan to do so moving forward.

Still, the survey found that most employers remain committed to offering benefits, as well as trying to ease cost fears for their employees. Though rising health costs were identified as concerning — 74 percent said their health plan costs increased in 2014 — they said cost shifting is only part of the solution to rising costs. The majority of respondents experienced an increase in their health plan costs from 2013 to 2014, but of those who reported a cost increase, almost a quarter kept employee contributions the same.

 

BY MICHAEL B. MAROIS

May 29 (Bloomberg) — California’s minimum wage would increase to $13 a hour, the highest in the nation, under a bill approved by the state Senate and sent to the Assembly.

BY GIL LOWERRE AND BONNIE BRAZZELL

Sometimes, payroll deduction for voluntary products isn’t an option. Whether for technical reasons, employee demographics, or employer preference, payroll deduction might not be available. But when it is, it’s usually the preferred methodology.

But only considering what is easiest for us and the HR department is risky. It’s just as important to take heed of what’s best for the employees who buy our products. In a recent Eastbridge study, employees were asked to choose the payment method they’d prefer for benefits they contributed to or paid for entirely. Payroll deduction was the overwhelming choice among those surveyed at 76 percent.

All age groups, except the under-30 group, had strong preferences (84-97 percent) for payroll deduction. About half (51 percent) of the under-30 group prefers payroll deduction while 35 percent said they had no preference or were unsure. Only 14 percent prefers credit card or bank account payment systems.

In fact, the convenience of payroll deduction is one of the most important reasons employees buy voluntary products.

So if you decide to not recommend payroll deduction, understand which parties will benefit from the decision and which won’t. Even if you plan to recommend payroll deduction, ask how you might improve the way it is set up and the resulting implementation of the billing processes. But most importantly, it appears that our customers think this is where our efforts should be directed.

 

By TOM MURPHY, AP Business Writer

Associated Press

Customers who bought health insurance on the overhaul’s public exchanges can expect a flurry of reports about big price hikes and some decreases for 2015 as insurers finalize their rates over the next few weeks. But they shouldn’t give much weight to any of this.

The actual change in a person’s policy will depend mostly on factors particular to their market and the other people covered by their plan. Here are five variables that could affect the prices you will see when you shop for 2015 coverage starting next fall.

1) Medical costs: A key reason behind premium changes, this reflects both the price of care and whether people are using more or less of it. This varies widely across the country.

2) Customer health: Insurers may have to raise rates if the number of customers with expensive medical conditions exceeds their projections. They also have to design their plans to make them attractive to healthy people, who will contribute more in premiums than medical claims.

“The bottom line is attracting enough healthy people to pay for the sick,” said insurance industry consultant Bob Laszewski. “That is 98 percent of the ball game.”

A temporary reinsurance fund set up by the overhaul is shielding insurers from some of this risk while they get used to the exchanges.

3) Age: The overhaul limits how much more an insurer can charge older people, who typically use more health care. An insurer needs premiums from younger customers to make up for what they can’t charge older policyholders anymore.

4) Competition: The cost of care can be higher in areas where one hospital or care provider dominates a market. Competition between insurers also can play a big role in holding down premium hikes in a market. Insurers don’t want to lose customers by hiking rates too high, especially since the exchange made it easier for people to shop for coverage.

5) The overhaul: Insurers say rates could climb due to a host of overhaul-related changes that happened after companies set their 2014 prices. Technical problems with the HealthCare.gov website last year frustrated many trying to buy coverage on the exchanges and may have turned off some younger customers.

President Obama also decided late last year to allow some policyholders to keep individual coverage they had before 2014. That may keep some healthy customers off the exchanges.

BY DAN COOK

You can offer employees a lavish buffet lunch onsite every day, bring in a masseuse on Fridays and hold the company picnic at Disney World. But at the end of the day, if you have the wrong people in the wrong jobs, you will still not have a happy workforce.

That is the message from social-recognition software provider Globoforce in a white paper titled “The Science of Happiness.” Most of the material cited in the paper comes from sources other than Globoforce. However, the company teases out tips for creating a culture of happiness based on its research of others’ research. And therein one can find tasty tidbits of advice that may begin to transform your workplace into a happy one.

“HR leaders encounter a lot of advice about how to manage culture — to increase engagement, decrease turnover, and drive recruitment. But when it comes to creating a culture employees love and don’t want to leave, employee happiness is the metric that really matters,” Globoforce says in a preamble to its data and advice. “Happy employees are what make a culture great.”

The paper says happy employees:

• stay twice as long in their jobs as their least happy colleagues;

• believe they are achieving their potential twice as much;

• spend 65 percent more time feeling energized;

• are 58 percent more likely to go out of the way to help their colleagues;

• identify 98 percent more strongly with the values of their organization;

• are 186 percent more likely to recommend their organization to a friend.

“Unlike culture itself, we have hard numbers on the science of employee happiness and how to directly increase it. It all leads to one conclusion: concentrating your efforts on making employees happy is the most direct and powerful way to impact your organizational culture,” Globoforce says.

Now, to the tips for putting a smile on your workers’ face.

5 ways to build alignment

1. Pay closer attention to job-person fit.

2. Fire people who don’t fit your culture.

3. Help employees find greater meaning in your values.

4. Show workers how your company fits into a bigger picture.

5. Cultivate more trust and flexibility into your policies.

5 ways to build positivity

1. Broadcast personal and team successes.

2. Offer fast, positive feedback.

3. Open up multidirectional communication lines.

4. Offer resources and emotional support.

5. Encourage employees to express gratitude.

5 ways to build progress

1. Set clear, measurable and achievable organizational goals.

2. Show employees how they fit into the bigger picture.

3. Offer training for mastery of new and existing skills.

4. Respect individualism.

5. Reward excellence and effort.

WASHINGTON (AP) — Small businesses seeking to buy health insurance under President Barack Obama’s health care law will have to wait a couple of months before they can complete the process online, administration officials said Thursday in the latest delay of the high-stakes rollout.

New online health insurance markets created by the law for individuals and small businesses are scheduled to open Tuesday. Small- business owners will be able to go online, compare their options and start an application, but they won’t be able to finalize it until sometime in November. That would still allow the firms to get coverage for their employees by Jan. 1.

“We wanted to make sure this was going to work properly and be effective for small businesses,” Gary Cohen, the Health and Human Services Department official overseeing the rollout, said in an interview. “We just felt like taking the additional time to make sure everything was functioning the way we wanted was the right thing to do.”

Delays and pared-back expectations are a standard feature of most big technology rollouts. Although the Obama administration has tried to project an image of efficiency, the small business delay was the second announced in as many days.

On Wednesday, the administration told Hispanic groups that the Spanish-language version of the healthcare.gov website will not be ready to handle enrollments for a few weeks. An estimated 10 million Latinos are eligible for coverage, and 4 million of them speak Spanish primarily.

Cohen said no further delays are anticipated. “The individual market will open on time Oct. 1 with full online enrollment and plan shopping,” he said.

Some states may still be able to launch fully functional small business markets Oct 1. The delay applies to 36 states where the federal government is taking the lead in building the insurance markets.

Obama’s health care law created small business markets known as SHOP exchanges for companies with up to 100 employees to buy coverage from a range of competitive plans. Small firms with low-wage workers can also apply for tax credits to help make the coverage more affordable.

Under the law, most small businesses do not have to provide coverage. But firms with 50 or more employees face a mandate to offer insurance or risk fines from the government. That mandate was supposed to take effect Jan. 1, but the administration earlier delayed it by a year to address employer complaints about overly complicated paperwork.