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BCBSGA and HCA Reach an Agreement

Good news for Blue Cross and Blue Shield of Georgia members! Blue Cross and Blue Shield of Georgia (BCBSGa) and Hospital Corporation of America (HCA®) announced recently that they have reached a new agreement where BCBSGa HMO/POS, PPO and Indemnity members can continue to access HCA’s facilities as in-network providers with no break in their network participation.

The new agreement covers HCA’s eight hospitals in Georgia: Doctors Hospital, Coliseum Medical Center, Coliseum Northside Hospital, Coliseum Psychiatric Hospital, Cartersville Medical Center, Eastside Medical Center, Redmond Regional Medical Center, and Fairview Park Hospital.

“We are pleased to continue our relationship with HCA,” said Alexandra Leopold, vice president of Provider Engagement and Contracting, BCBSGa. “As the state’s largest health benefits provider, we strive to create access to the best in affordable health care for our customers through a broad network of quality health care providers.”

As always, give us a call you need any help with your employee benefits program.

Georgia Health Insurance Costs Rise

A recent survey from employee benefits Company Towers Watson echos what we have been seeing here with Atlanta health insurance premium costs. With 2012 open enrollment around the corner employees can expect to pay more for their group health insurance – via premium increases and changes in deductibles, copays and coinsurance.

The 2011 Towers Watson Health Care Trend Survey, released in late August, found that the annual cost of medical and pharmacy coverage would increase to $11,204 per employee for active coverage in 2012 (an increase of 5.9% versus 7.6% for 2011). According to the survey, roughly two-thirds of employers (66%) will increase employees’ share-of-premium contributions for single-only coverage for 2012, and 73% will increase them for dependent coverage.

The promise of lower health insurance premiums due to a Georgia health insurance exchange is in question. Aside from the fact the law necessary to govern such an entity has yet to be enacted, recent news articles indicate that consumer level premium savings just aren’t there.

Expect plenty of volatility in the health insurance marketplace over the next several years. As a leading health insurance broker in Atlanta know that you can call on us to develop a proactive strategy to deal with these important changes.

Relief for Employers Issuing Fewer than 250 W-2s

Many of our clients with group health insurance in Georgia and elsewhere have been concerned about the burdens placed on them by the Patient Protection and Affordable Care Act (PPACA). One of these new requirements is that the aggregate cost of applicable employer sponsored coverage be reported on Form W-2.

The Internal Revenue Service just issued additional interim guidance in the form of Notice 2011-28. This notice grants transitional relief for employers that in the previous calendar year issued fewer than 250 Form W-2s.

For these smaller employers, reporting is now required starting with W-2s for the 2013 tax year, which would be issued in 2014.

This relief will continue at least through the 2012 Forms W-2 which are required to be furnished to employees in January 2013. In other words, smaller employers that are required to file fewer than 250 2011 Forms W-2 will not be required to report the cost of health coverage on any forms required to be furnished to employees prior to January 2014.

Additionally, Notice 2011-28 provides more clarification on how employers can calculate the cost of coverage to meet this reporting requirement. Reference questions 24 – 27 and question 31 in the Notice 2011-28. The guidance reaffirms that this is a reporting requirement only and does not impact employees’ taxable wages.

As always, please give us a call if you need help understanding your responsibilities under PPACA.

Georgia and PPACA – 1 Year Anniversary

On the one year anniversary of the Patient Protection and Affordable Care Act (PPACA), Governor Nathan Deal correctly outlined two major issues for Georgia:

Impact on Taxes: “Georgia taxpayers would have to fork over, at a minimum, an additional $465 million per year to pay for a dramatic expansion of our state Medicaid program that is required by the new law. For Georgia families, this translates to an annual increase of approximately $1,000 per household.”

Impact on Availability of Doctors: “To cover some of the costs of Medicaid expansion and the mandated insurance exchange, Obamacare reduces the rate of reimbursement to doctors and other providers significantly. This reduction in reimbursement may affect the number of doctors who accept Medicaid patients, seriously impacting patient access at a time when demand will skyrocket.”

In trying to mitigate the impact of the new law, Commissioner of Insurance Ralph Hudgens has not been shy in voicing thoughts as well. In his cover letter to HHS Secretary Sebelius for the Georgia medical loss ratio waiver he writes:

“Although I believe that the Patient Protection and Affordable Care Act (”ACA”) is unconstitutional and fully support the various legal challenges to its constitutionality, it is my duty as Commissioner to do everything possible to protect the interests of Georgia citizens and the viability of the Georgia insurance market. It is for that reason that I am requesting a waiver to the MLR standard, and not because I believe that the ACA should or will be upheld by the court.”

One may have the sense that even its supporters are realizing that significant changes – if not all out failure – are on the horizon for PPACA. The two year anniversary of the law may be a whole lot more interesting than its first.

Georgia Health Exchange Legislation Withdrawn

Last week Georgia House Republicans pulled HB 476 which would have established the governing authority for Georgia health exchanges. The legislation was withdrawn due to a lack of support from “tea party” Republicans. The opposition’s major argument was that under Judge Roger Vinson’s ruling in Florida the Patient Protection and Accountable Care Act (PPCACA) was found unconstitutional and, therefore, why should Georgia work towards implementing its portion of that law.

In an AJC article Governor Deal spokesman Brian Robinson puts forth the his argument in favor of establishing a state-run health insurance exchange:

“If Georgia must have an insurance exchange under federal law, the governor wants to ensure that our exchange is established by and run by Georgians. The alternative is having an exchange established by and run by Washington bureaucrats. The governor considers the latter unacceptable.”

Expect HB 476 to resurface in one form or fashion – there is momentum on the side of states to address health care reform where efforts by the Federal government have failed.

GA Health Exchange Legislation Delivered

Representatives Smith and Meadows just brought to the Georgia House of Representatives legislation that begins the process of establishing state sponsored health insurance exchanges in Georgia. Click here to view a draft of the bill.

Georgia is considering two health insurance exchanges. The first is geared to provide affordable individual health insurance and the second coverage to small groups. Laymen generally think of an exchange as solely a web portal used to quote, compare and purchase health insurance. In reality they encompass a great deal more – they determine eligibility to various government welfare programs, provide administrative functions to aggregate premiums from policyholders and subsidies from the government, etc.

Ryan Teague, Deputy Executive Counsel at Office of Governor Nathan Deal, said, “This legislation is a product of our own internal efforts, with excellent input from the stakeholder community, to get the ball rolling on exchange implementation. The bill essentially creates the governing board of a Georgia exchange and tasks the board with direct involvement with a stakeholder advisory committee, with delivering legislation and an action plan to the Governor and General Assembly prior to the start of the 2012 legislative session.”

Given recent court rulings – and impending challenge in the US Supreme Court – the condition of PPACA is dynamic to say the least. With the introduction of this legislation the state of Georgia is ensuring that it stays in the game. To do otherwise would be detrimental to the interest of all Georgians as their hard-earned dollars would be sucked up to Washington DC through the Federal health exchange.

This is not to say the Georgia exchanges will be a panacea. That jury hasn’t even convened. But, under the circumstances the introduction of this legislation is a prudent move.

Health Insurance Coverage In Georgia

An interesting question is where will Georgians get health insurance coverage in 2014? Assuming ObamaCare survives intact we will have (i) an individual mandate to purchase health insurance, (ii) the health insurance exchanges, (iii) guarantee issue (insurance companies cannot deny coverage to people with pre-existing conditions), and (iv) premium subsidies for people with incomes of less than 400% of the Federal Poverty Level.

Dr. Bill Custer, Director of the Center for Health Services Research at Georgia State University, provided me with some figures about the distribution of where the non-elderly (under age 65) in Georgia found health insurance coverage in 2009:

The totals are greater than 100% because people were during the course of the year covered by more than one policy.

How many employers will drop their health insurance plans, thus forcing their employees onto the exchange or into the private individual health insurance market? Will we see a reduction of the number of uninsured in Georgia? How many people will opt to be uninsured (and therefore have to pay a fine to the Feds)?

Stay tuned and I will give you my best estimates in a later blog post.

GA Health Insurance Exchange Premium Subsidy Application

Starting January 1, 2014 certain qualified people will get monetary relief on their health insurance premium payments in the form of a government subsidy. Okay, you say. That should be a pretty straight forward transaction, right? Not so fast. Take a look at the subsidy request form currently in use in Massachusetts:

Massachusetts Medical Benefit Form (MBR)

The state of Georgia will have to have a similar form in place when PPACA goes online in 2014. Review the “Working Income” section found on page 2 and imagine the difficulty people will have in interpreting these questions – and the processes that will be necessary to audit and correct these form submissions.

So to put it bluntly Georgia has more less-educated, lower-income people dispersed over a wider area than does Massachusetts. None of this bodes well for having a health insurance premium subsidy form filled out correctly.

This is just one of the challenges the state of Georgia faces as it builds its health insurance exchange. It also highlights the fact that the knowledge and expertise possessed by Georgia health insurance agents will be in great demand. But will the exchange invite Georgia health insurance agents and brokers to the party?

Street Fighting Man

Did Republicans just discard a useful tool that would have helped frame the debate over health care reform? Last week the Senate voted 81-17 to repeal the 1099 provision from the Patient Protection and Accountable Care Act (PPACA). The lopsided vote makes one wonder why such a misguided provision ever made it into the law in the first place.

The 1099 provision required businesses to report to the IRS transactions worth $600 or more to the IRS. Imagine having a company car. Over the course of a year you fill up at your local gas station. Assuming your expenditures were over $600 you would need to collect the legal name of the gas station, its address and tax ID number and send them a 1099 at the end of the year. Given the fact many vendors are franchises this would be an accounting nightmare.

So why not keep this provision alive into 2012 – thus clearly illustrating to everyone that PPACA is not necessarily a well thought out piece of legislation? Sure it would be painful, but then so is much of PPACA. Forest meet trees.

Dumone’s 5 Point Plan for Entrepreneurs

Are you starting a business; maybe trying to raise some money? Need some advice? Men have died trying to obtain this valuable information, but I’ll give it to you for free.

1. Never let on how much you need the other guy’s money.
2. Stay in control. He wants a rate of return and you want to scale your business. This is not a unilateral transaction.
3. Express a level of confidence in your technology based on a solid understanding of it, your market and your competition.
4. Understand and be responsive to the interests of your investors.
5. Be sure to play side one of Led Zeppelin IV at the closing table.

I hope you get lucky…