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Category: Healthcare Law

Healthcare Law

MBA HR Update: With the ACA's Future Uncertain, MBA Assembles Proactive Task Force to Keep Clients Informed

MBA has assembled a Task Force to monitor changes to the ACA as they relate to issues that impact employers once President Elect Trump takes office and provide regular updates as well as reports of significant developments when they occur.

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Will Insurance companies continue to cut physicians wages to balance ACA losses?

Insurance company Highmark recently lowered doctor’s rates in the health plans offered through the Affordable Care Act in an effort to even the scales after massive losses. The move has left many angry and raised concerns among those in the industry wondering if other insurance companies might take a similar course of action. Highmark is an affiliate of Blue Cross and Blue Shield in the middle-Atlantic region. The insurance company claimed losses of $221 million on its exchange marketplace plans in 2014. The company also anticipated losses of $500 million in 2015 because plan members needed more care than the health plan had anticipated. As a result, the company is paying more claims than it is collecting in premium revenue. In an effort to combat the loss, the insurer announced nearly a 5 percent pay cut among providers in Pennsylvania. Experts say that angry physicians might react by accepting fewer patients in Exchange plans. Worse yet, some might opt to no longer participate in Exchange plan net ...

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Low Income Enrollees Flock to Government Insurance Options through Obamacare

With its requirement that all states expand Medicaid eligibility, it was always expected that Obamacare would swell the enrollment in government-funded health insurance. However, it was also hoped that even more enrollees would seek out insurance that was tax-subsidized but still essentially private. As it is, this trend is expected to balloon the costs of Medicaid over the next ten years, and this despite the fact that to date 19 states have refused to take part in the Medicaid expansion after a Supreme Court decision rendered it option instead of mandatory. The numbers gathered by the CBO indicate enrollment in Medicaid is exceeding projections by about 16 million people, and the expansion of Medicaid was expected to be even larger than that originally. Nevertheless, these enrollment figures are greater than what analysts predicted even before Medicaid expansion was made optional. State legislatures who have refused the expansion have done so claiming concern about the eventual costs involved as the federa ...

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Health benefits to cover transgender surgery might become a requirement for companies

New regulations associated with the Affordable Care Act and the Department of Health and Human Services might make it a requirement for company-sponsored group health insurance plans to cover transgender surgery. There might be additional requirements for other transgender health benefits. This requirement would likely go into effect January 1st, 2017 or at the beginning of the plan’s new coverage year. The new requirements aim to completely prohibit any type of discrimination based on sex, age, disability, race, color or national origin. Not all employer health plans are required to comply with the new provisions. These plans are required, however: Any group plans sponsored by home health groups, hospitals, nursing homes or any organizations that receive funding from Medicaid or Medicare Part A.  Employer- sponsored health plans that are fully insured when the insurance company offers any type of coverage on the exchange.  Employer-sponsored group health plans that are s ...

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ACA regulations and ERISA violations – what your company should know

As companies try to ensure they are compliant with all the regulations within the Affordable Care Act, some are finding a spike in health benefit costs. A recent court case shows that although programs to decrease the number of full-time employees might lead to lower costs for health care in the short term, they might also lead to ERISA class-action lawsuits. A federal district judge in New York recently denied a motion to eliminate a lawsuit that claimed that Dave and Buster’s violated ERISA by eliminating hours for employees to avoid having to provide them with health care benefits to a group of employees. The employer share responsibility portions of the Affordable Care Act require large employers to offer minimum essential health insurance to just about all of their full-time workers. If they don’t, they can face severe fines and penalties. Per the legislation, full-time employees are those who work at least 30 hours each week. Employers do not face these penalties if they don’t offe ...

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