Learn the Ins and Outs of Healthcare Reform, Because it’s Here to Stay!

Some of you may be thinking, “Democrats lost control of the House, so I can stop worrying about healthcare reform, it will be repealed.”

I need to get one point straight: The PPACA is President Obama’s signature piece of legislation. It is his legacy. It will not be repealed, at least not immediately and not completely. 

As expected, healthcare reform (along with the economy) dominated the November mid-term election. Many Republicans campaigned aggressively; with the promise of “repealing and replacing” the healthcare reform law and they scored some stunning victories. With their new majority in the House, there is no doubt that Republicans will push forward with their promise to undo the PPACA. However, even if Republicans manage to introduce a bill to repeal PPACA that could withstand a filibuster in the Senate, the chance of any such bill withstanding a Presidential veto is slim. Currently, Republicans do not have the majority in both chambers of Congress that is required to override a Presidential veto.

Between now and 2012, it seems likely that Republicans will target certain provisions of the law for piecemeal elimination. Early targets include the W-2 reporting requirement, recently postponed until 2012, and the new 1099 reporting requirements. Other initiatives will be focused on anything that would slow or disrupt the Administration’s preparations for 2014, which is when the most far-reaching provisions of the law will begin.

Republicans promise that over the next two years, they will deny any additional funding that President Obama requests for healthcare reform implementation. As evidenced in 1995, President Bill Clinton and the majority-Republican Congress were not able to agree on a budget and this standoff ultimately led to a federal government shutdown. The Congressional Budget Office has estimated that over the next ten years, the administrative costs of healthcare reform implementation could run anywhere between $5 billion to $10 billion each for the Internal Revenue Service and the Department of Health and Human Services.

The President and Democrats in Congress have vowed to push back at any attempts which could cause a funding battle. As a result, the Republican majority in the House will usher in frequent oversight hearings, which will be aimed at laying the groundwork for a broad-based public repudiation of the law. This act could give Republicans the political momentum to overturn the healthcare reform law, provided they can re-take the presidency in 2012.

There are a lot of “ifs” and “maybes” between now and 2014. It is likely that, for the next two-plus years, the PPACA will be with us. For now, what is it that employers need to do?

In two words: Get educated. Learn the fundamentals of healthcare reform.

Political commentators are fond of saying that the President “front-loaded healthcare reform with all the goodies that were designed to take effect right before the mid-term elections.” However, what does that really mean to employers? What are these goodies?

They are:

1. Dependent coverage must be extended to all children until age 26, regardless of marital or student status, or financial dependency.
2. Pre-existing condition exclusions or limitations may not be applied to anyone under age 19.
3. There are no lifetime limits on essential health benefits and only restricted annual limits on essential health benefits between now and 2014.
4. Coverage may only be rescinded in the instance of member fraud.

Not only do the above provisions cost the government nothing, everyone is in favor of them, Democrats and Republicans alike. In fact, in 3,000 pages of PPACA legislation, these four provisions are about the only things that no one disagrees on. Simply put, they are here to stay.

For compliant healthcare benefits plans, the main four necessary plan changes must be implemented no later than your first plan year after September 23, 2010. As the PPACA continues to evolve, the best thing to do is to remain informed of upcoming developments, to ensure your plans continue to be in compliance.

About the Author:

Andrea Balogh is the Executive Vice President and General Counsel for Meritain Health, the country’s largest private health services company, offering employers comprehensive, integrated wellness and cost management services.

To successfully control healthcare and health benefit costs, today’s employers need fully integrated, end-to-end solutions to their health benefit requirements. Meritain Health’s client service approach includes customized plan designs, high touch plan management and a strong focus on wellness and education.

A Total Solution to Employers’ Health Benefit Requirements

Meritain Health services are comprehensive, fully integrated and customized to each client’s unique needs. These include:

• Consultation and innovative plan design.
• Healthy MeritsSM wellness, disease management and lifestyle management programs.
• Long-term cost management solutions.
• URAC-accredited medical management programs.
• Multi-media employee education.
• High-touch member services.
• Efficient plan administration.
• Pharmacy benefits management.
• PPO administration.

Employee Wellness, Education and Communication

Meritain Health is an industry leader in promoting healthy lifestyles for employees. Healthcare industry experience and research has shown that health and wellness programs are critical drivers in creating health-conscious members. The Meritain Health Healthy MeritsSM Total Population Management Program includes wellness, Disease Management and lifestyle management programs that provide employee health screenings and assessments, smoking cessation programs, weight loss assistance, lifestyle coaching and more. The programs are designed to reach employees at all levels of health: employees who are currently well, employees considered at-risk or high-risk, who need to take immediate action to prevent illness, and employees with chronic or acute disease.

Programs and online health education and decision-support tools.

These, and other program components, are fully integrated with an employer’s overall health benefits plan.

Meritain Health also delivers triple-URAC accredited in-house medical management programs. These programs, which incorporate personal health coaching, online wellness tools and informational mailings, improve employees’ abilities to select effective, appropriately priced healthcare services. This, in turn, leads them to become more independent, knowledgeable healthcare consumers.

Customized, Flexible Plan Design

Meritain Health consultants are knowledgeable, experienced industry professionals. Working closely with clients and their brokers, Meritain Health consultants design customized benefits plans that include innovative cost-management strategies and support the client’s short and long-term goals. As the pioneer and now the leading independent provider of Consumer-Directed Health Plans (CDHPs), Meritain Health proudly offers these plans, as well as traditional PPO plans, for incorporation into flexible plan designs. Throughout the plan year, Meritain Health consultants monitor plan activity and results, routinely meeting with clients to review plan reports and analyses. By developing lasting client relationships, they are able to identify opportunities and formulate recommendations to strengthen plan performance.

Meritain Health History and Operations

Meritain Health has been exceeding the expectations of clients for more than 30 years. With more than 2,000 benefits management clients, 130 payer clients and over 1.4 million members in all 50 states, Meritain Health is the largest private health services company in the country. A top Consumer-Directed Health Plan provider, Meritain Health serves clients and members through its dedicated 1,445 employees across 12 principal locations.

For more information, visit www.meritain.com.