Help employees avoid 5 health insurance mistakes, then reap the benefits

During open enrollment, employees usually familiarize themselves with their coverage. But just a few months later, much is forgotten. Even the savviest employees can get confused – and frustrated – with their health insurance. Over time, two out of ten employees regret their benefits decision, according to an online Harris Poll.

Employers can avoid these pitfalls by highlighting plan information in meetings, newsletters, emails and posters throughout the year. As a bonus, communicating about insurance coverage results in two key benefits for employers:

  • When employers communicate about benefits four or five times a year, 85 percent of employees report being extremely or very engaged with their organization as a whole, according to Thomsons Global Employer Benefits Watch 2016/17.
  • Clearing up confusion will help employees appreciate your benefits investment, according to the Society for Human Resource Management.

An effective communications plan can also help employees avoid these five common health insurance mistakes:

Mistake #1 Underutilizing health savings accounts (HSAs).

Employees are easily confused by HSAs. They may not know which expenses are eligible for reimbursement, or they don’t realize they can contribute funds at any time.

To help, point employees to the IRS list of eligible expenses from acupuncture to X-rays.

Next, educate employees about their ability to add extra cash to the HSA anytime throughout the year. For example, after a root canal or a trip to the emergency department, employees can deposit money to pay their out-of-pocket costs.

Mistake #2 Paying too much for prescriptions.

Everyone loves to save money, and understanding prescription coverage can help. If your plan has a mail-order option or a preferred pharmacy, be sure employees know about these economical alternatives.

Also, publicize information about your carrier’s online formulary to help employees choose less expensive options when available. One caveat: Online formularies aren’t always up-to-date. When in doubt, employees should call their insurer’s customer service department for clarification.

Mistake #3 Getting confused about preventive care.

Knowledge is power. Most health plans provide preventive care like routine physical exams, immunizations and screenings at no charge. But confusion about what’s preventive – and what’s not – can cause angst.

There are two key issues:

  • Guidelines change from year-to-year. For example, prostate-specific antigen (PSA) cancer screening was considered “preventive” in the past, but most insurers have removed it based on scientific research. Many doctors still recommend PSA screening, however, which leaves employees footing the bill.
  • Identical services can be either preventive (no-cost) or diagnostic (subject to copayments, deductibles or coinsurance) based on circumstances. For example, a blood glucose test is preventive if the patient doesn’t have any symptoms. But patients with diabetes have the same lab test for diagnostic purposes.

To clear up confusion, provide employees with a link to your insurer’s preventive care guidelines, which outlines no-cost services based on age and gender.

Mistake #4 Getting unexpected out-of-network bills.

If your company benefits plan includes an HMO, it’s essential that employees understand how claims will be processed:

  • When hospitalized, employees should request care from in-network providers when possible. In some cases, an anesthesiologist or another behind-the-scenes provider may be out-of-network even when the hospital is in-network, which means the employee will be billed.
  • For emergency care, health plan copayments or coinsurance must be the same whether the emergency department is in-network and out-of-network, according to the Affordable Care Act. Employees may be balance billed by an out-of-network provider for services, however, and they may be responsible for this bill.

Even employees with a PPO may have surprises. Although PPO plans cover a predetermined percentage of the cost, this payment is based on “reasonable and customary” charges. This could leave employees paying more than anticipated. Read Consumer Reports “The $20,000 Tick Bite” for a dramatic example.

Mistake #5 Ignoring EOBs.

Some employees make the mistake of paying a provider’s bill before reviewing their explanation of benefits (EOB). When that happens, they may inadvertently pay too much.

How to help? Remind employees to take a wait-and-see approach with medical bills. Once the EOB arrives, they can compare it with their provider invoices to be sure the information aligns.

The good news? Many insurers have redesigned – and even renamed – their EOBs to make the information easier to understand. Insurers also provide online member centers, so employees can log into their accounts and review claim details online.

Trend report: Precision medicine and personalized healthcare

If you think genetic testing options like 23AndMe and Ancestry.com are just a flash-in-the-pan, think again. Genetic data is creating a new paradigm in healthcare: Forbes reports that precision medicine could eventually remove the need for guesswork and make medical treatment more efficient and cost-effective.

The roots of this approach can be traced to the Human Genome Project, completed in 2003, which provided researchers with tools to understand the genetic factors in human disease. This information has led to a targeted approach to cancer treatment, but that’s only the beginning.

There’s also a trend toward personalized healthcare, a virtual “crystal ball” that helps doctors assess an individuals’ risk for future illnesses by combining genetic information with more traditional means including age, lifestyle, health history, medical records, compliance and other factors. Currently 10,000 conditions can be identified using genetic tests.

What do precision medicine and personalized healthcare mean in practical terms?

  • Lower costs, better outcomes. Doctors, researchers and pharmaceutical companies are finding new ways to leverage genetic information to help patients avoid chronic diseases and deliver precise, effective treatments to the right patients at the right time.
  • New “miracle” drugs. Pharmaceutical companies are revisiting their traditional business model and finding new revenue streams through precision medicine. According to Forbes, leading pharma/biopharma companies have almost doubled their investment in personalized medicine since 2012 and are planning more increases over the next five years. The focus goes beyond oncology to other therapeutic areas including infectious diseases, central nervous system disease conditions (like Parkinson’s and Alzheimer’s) and cardiovascular diseases.
  • Genomics could go mainstream. As the cost of genome sequencing goes down, healthcare systems could begin putting that knowledge to work. Modern Healthcare reports that patients are getting their DNA sequenced and doctors are using that information to check medications for genetic suitability.
  • Big data is being leveraged. The Veteran Affairs Department is enrolled 500,000 veterans as part of its goal to created the largest genomic research database in the world. And Geisinger Health System has recruited 130,000 patients as part of a plan to create the MyCode Community Health Initiative biobank.
  • Entrepreneurs see opportunity. Gene-sequencing giant Illumina Corp. was highlighted by The Motley Fool, thanks to the company’s dominant position in the market. The company’s newest machines, with their $1 million price tag, began shipping this quarter.
  • The market is growing. MarketWatch reports that personalization of healthcare, dominated by oncology, cardiovascular and infectious disease treatment and diagnostics, could be worth $149 billion by 2020.
  • Consumerism will drive accountability. As patients become more engaged in healthcare information and the decision-making process, they are becoming more conscious about the cost of care. Personalized healthcare dovetails perfectly with this emphasis on accountability between patients and caregivers.

The overall impact on employer benefit plans is still out for debate. Currently, genetic testing is often a covered benefit when recommended by a doctor but pre-authorization may be required. In general, insurers also require genetic counseling as part of the process.

The emphasis on genetics could also impact employer wellness plans. The Genetic Information Nondiscrimination Act (GINA) was passed in 2008 to prohibit discrimination by employers or insurers based on genetic information. The limits of this act are being put to the test, however, with HR1313. This controversial House bill would allow employers to require genetic testing as part of their wellness program. Opponents say this may undermine employees’ privacy, while supporters see this as an opportunity strengthen wellness plans.

As genetic testing becomes more ubiquitous, expect this topic to garner increased attention.

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Indiana may be the next state to mandate coverage for fertility treatments

IVF coverage is not required in most states.

Indiana state representative Robin Shackleford (D) recently drafted House Bill 1059, a proposal that would mandate the offer of coverage for women seeking infertility treatments.

In order to qualify for in vitro fertilization coverage under the proposal, women must have exhausted all other options. The proposal notes that eligible patients must prove unable to "attain a successful pregnancy through a less costly infertility treatment for which coverage is available under the accident and sickness insurance policy." Other qualifying patients are those who have a history of infertility dating as far back as five years, or one of four preexisting medical conditions that inhibit pregnancy. 

In its current form, language in the bill stipulating that the procedure can only be covered when executed "with the sperm of the patient's spouse." This indicates that coverage does not apply if donor sperm is used, which isn't unusual.

If passed in its current form, the bill would become effective July 1, 2017.  

Averages cost for infertility treatments 

"The total combined cost can easily exceed $50,000."

According to the National Conference of State Legislators, about 12 percent of women seek out infertility treatments. The "less costly" infertility treatments referenced in Shackleford's bill most commonly consist of artificial insemination – which on average costs anywhere between $300 and $1000 – or hormone therapy – which will typically run patients $2,500 to $3,500 per month.   

Women who are unable to conceive through other methods may be recommended for IVF, which costs, on average, $12,000 per treatment, according to Forbes contributor Jennifer Gerson Uffalussy. She added that additional medications will tack on another $3,000 to $5,000.

The total combined cost for IVF paired with other infertility treatments can easily exceed $50,000.

States that currently mandate coverage
As of this writing, 15 states have laws in place regarding the coverage of infertility treatments

  • Arkansas
  • California
  • Connecticut
  • Hawaii
  • Illinois
  • Louisiana
  • Maryland
  • Massachusetts
  • Montana
  • New Jersey
  • New York
  • Ohio
  • Rhode Island
  • Texas
  • West Virginia 

It's worth nothing that California insurers cannot cover IVF. In Louisiana and New York, insurers are forbidden to exclude medical treatment for patients "solely because the medical condition results in infertility," but they are not required to offer coverage for infertility treatments. 

Other exclusions may vary according to state law, for instance, treatments that use donor eggs or sperm.

If passed, House Bill 1049 would make Indiana only the 16th state to have an active law regarding infertility insurance coverage. 

Meeting Millennials’ needs (and wants)

Millennials are coming of age. They comprise one-third of today’s workforce, with more Millennials on the job than Gen X’er or baby boomers, according to a Pew Research report. Their needs — and their preferences — have a growing influence on the way health insurance and health care are delivered.

Millennials are generally defined as those born from 1982 to 1994. Ranging in age from their early 20s to mid-30s, they include entry-level employees and rising young stars in management roles.

In a nutshell, they are the business leadership of the future.

Hidden health concerns

Insurance carriers often refer to the “young and healthy” Millennial population, but in reality this age group faces a host of current medical needs and future risks.

According to a survey by the Transamerica Center for Health Studies, 54 percent say they have been diagnosed with a chronic illness and 28 percent are on medication. Their most common concerns are depression, being overweight and anxiety disorders. Stress is often a contributing factor to health issues.

Contraceptive coverage also continues to be a priority; 58 percent of Millennials believe employers should provide it at no cost.

Not your grandfather’s health insurance

Millennials grew up with technology, so they consume and share information differently than their older coworkers. And they place a very high value on a work-life balance, which puts a new spin on health care benefits.

Consider these five priorities when designing your benefit plan:

  1. To please Millennials, look for benefit plans that stay on the digital cutting edge. This is an opportunity to rethink the enrollment experience, communication strategies and the actual delivery of health care services.
  2. Millennials expect to be in charge of their own destiny, so it helps to offer options, letting them “shop” for the benefits they prefer. (Think like Amazon, with side-by-side comparisons, product reviews and a “shopping cart” for purchases.) Also consider offering holistic options that meet their lifestyle needs.
  3. Although Millennials may find discussions about copays and coinsurance to be tedious, they generally are unfamiliar with the insurance terminology and how their coverage works. Online tools can help.
  4. Mobile apps. Look for a carrier with a Smartphone app that lets beneficiaries access their plan information the same way they read the news and stay in touch with friends.
  5. Seek out plans that don’t rely on traditional methods of delivering care. A Salesforce 2016 Connected Patient Report found that 60 percent of Millennials prefer a primary care doctor that offers a patient app for scheduling appointments, billing and health data. They also prefer online chats over traditional phone calls. More than half of Millennials expect their doctor to offer virtual care treatment options.

As the number of Millennials in the workforce continues to grow, designing benefits plans around their needs and preferences can contribute to business success.

5 health care resolutions every employer should make

You’ve already chosen your health plan and introduced it to employees. Now it’s time to leverage your investment with these five resolutions:

  1. Think wellness. Millions of Americans create New Year’s resolutions annually, but 80% of them fail. This year, make lifestyle changes easier for employees by integrating wellness initiatives into your company. It can be as easy as holding a weight loss contest, tabulating employees’ miles walked (an across-the-country or around-the-world challenge) and offering healthier snacks in the vending machines. Does your insurance carrier offers fitness center discounts to members? If yes, remind your employees to take advantage of this perk.
  1. Emphasize an ounce of prevention. Your health plan includes no-cost preventive coverage ranging from an annual checkup to mammograms and colonoscopies. Let employees know you care about their health by encouraging them to take full advantage of their preventive care benefits. (You may also reduce medical costs and absenteeism when employees catch small health issues before they become big problems.)
  2. Encourage shopping. Your employees wouldn’t buy a car or a television without comparison shopping. Encourage them to reduce health care costs by also shopping for health services. To encourage participation, test out your insurance company’s transparency tool to see how it works, and then hold a lunch-n-learn to share the information with employees.
  1. Control chronic conditions. Chronic diseases account for 86% of the nation’s health care costs and are responsible for 7 of 10 deaths each year. Encourage employees who have diabetes, high blood pressure, asthma, heart conditions or other health issues to work with their doctors and their insurance company to get healthier. Not only will your employees feel better, they’ll also be more productive at work and have fewer absences.
  1. Skinny down from the top down. Obesity costs the nation $147 billion in medical costs annually and reduces productivity by $79 to $132 per obese individual. It’s also tied to heart attack, stroke, diabetes, cancer and many other illnesses. Want slimmer employees? Begin with the management team. Develop a “biggest leadership loser” contest and celebrate successes with healthy snacks in the lunchroom.

This is your chance to make 2017 one of the healthiest, more productive years in the history of your company.

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Wellness programs can promote employee engagement, retention and productivity

Voluntary wellness programs may be increasing employee retention and productivity.

Experts are speaking out on the positive impact employee wellness programs can have on an organization's growth, productivity and retention rates. 

A survey from health care technology company HealthMine Inc. found that 62 percent of the 750 wellness plan participants surveyed felt their programs were helping to lower their medical costs. Additionally, 38 percent felt wellness programs led to a reduction in the number of sick days they took, and 33 percent said their wellness program helped them be more productive.

"Healthier populations carry less risk, have fewer claims and lower premiums," Bryce Williams, CEO and President of HealthMine, said in a statement. "So, it's true that wellness programs have the potential to improve health and lower costs for the entire population, one person at a time. The benefits of successful wellness programs are cumulative."

Using wellness programs for positive growth
As Bloomberg BNA reported, human resources professionals speaking at the WorldatWork Total Rewards conference in San Diego said wellness programs can do more than reduce health care costs. A well-designed wellness program can also be used to engage employees and encourage productivity and growth. Experts speaking at the conference noted many businesses are tracking multiple metrics to see how wellness programs positively influence the company's growth. Factors that can be affected by wellness programs include employee engagement, turnover, absenteeism, productivity and recruitment/referral rates.

"Businesses are tracking multiple metrics to see how wellness programs positively influence the company's growth."

"At the end of the day, good health is good business," Lauren Benz, a clinical account manager at MVP Health Care, said at the conference. "We're now in a huge global market, so for you to remain competitive you need to have a healthy workforce because a healthy workforce will outperform an unhealthy workforce time and time again."

A second panelist, Dan Harding, director of employee relations at MVP Health Care, noted that when designing an employee wellness program, human resources professionals should be sure the branding of the program aligns with that of the company. Participation in a wellness program will likely be higher if the program's values and mission echo those of the business, which will likely resonate with its employees.

Harding further noted that while employers will want to see a return on investment for their wellness programs, it's important to track more than reduced health care costs when determining the program's ROI. Wellness programs that focus on employee engagement and well-being tend to have higher ROI than those simply looking at health cost reduction, Harding asserted.

When structuring wellness programs, risk managers should also ensure the program is in compliance with health privacy regulations outlined by the U.S. Equal Employment Opportunity Commission. The Obama administration recently issued rules defining how Title I of the Americans with Disabilities Act and Title II of the Genetic Information Nondiscrimination Act apply to wellness programs offered by employers that request health information from employees and their spouses. These guidelines include regulations for data encryption and breach notification, as well as restrictions on wellness screen programs. The new EEOC wellness plan rules take effect on Jan. 1. 2017, and risk managers can review the full regulations through the Federal Register.

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OSHA injury reporting changes may affect workers comp insurers

As OSHA makes changes to its injury reporting policies, workers compensation insurers may be affected.

As the Occupational Safety and Health Administration makes changes to its workplace injury and illness reporting guidelines, workers compensation insurers may have to reconsider their internal risk management and accident prevention policies.

OSHA's Improve Tracking of Workplace Injuries and Illnesses rule will require employers in high-hazard industries to meet electronic recordkeeping guidelines for reporting workplace injuries and illnesses. In addition, they must make these records publicly available as data to be posted on OSHA's website. According to a report in Business Insurance, this should provide an additional incentive to workers compensation insurers to prevent workplace safety incidents, as this information is used by OSHA to publicly shame repeated violators and their workers comp insurers.

"OSHA has made a habit of naming both employers and their workers comp insurers in news releases about citations."

Speaking at a National Advisory Committee on Occupational Safety & Health, David Michaels, assistant secretary of Labor for Occupational Safety and Health, said the agency has previously made a habit of naming both employers and their workers comp insurers in news releases about citations and fines issued for violations of safety regulations.

"These are cases in which the employer's actions really were egregious, one or more workers were hurt very seriously and the actions taken by employers should have been stopped long before the workers got hurt," Michaels said. "I had a discussion with one executive at one [insurance] carrier saying, 'Why did you list us on the press release, we had nothing to do with this. I said, 'That's exactly right. The workers compensation carriers should play a role in this.'"

Collaboration between insurer and client crucial 
Business Insurance had previously reported that OSHA has begun naming both cited employers and their workers compensation insurers in instances where citations and fines were above $40,000.

"For some companies, the damage to their corporate image may be more of a deterrent than the fines OSHA may issue," the agency said in a statement released to Business Insurance. "Likewise, we recognize that workers compensation insurers can have a role in influencing companies to implement safety and health management systems and reduce the risk to employees."

Many states require workers comp insurers to provide accident prevention services to employers. However, even if this is not required by law, insurers are encouraged to offer these programs. As PropertyCasuatly 360 reported,  a properly run workers' compensation insurance program is the property and casualty coverage where a business has the most opportunity to reduce its claims and cost.

PC360 recommended that workers comp insurers work with employers to implement the most current methodologies for evaluating and tracking the performance of the workers' compensation program, including determining what areas of the company have the highest risk for injury. Insurers should also make sure the company's executives understand the cost of a workplace injury beyond immediate compensation, especially as OSHA changes may present public relations challenges. Businesses can also use this information to evaluate their insurer and grade its performance in helping the organization to mitigate its risks.  

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Presidential election promises to shake up ‘Obamacare.’ What to expect.

Presidential Candidates and Healthcare

The 2016 presidential election will mean changes to Affordable Care Act (ACA), and two candidates – on opposite sides of the issue – say they would eliminate employer-sponsored health benefits.

In general, the Democrats want to expand government-sponsored healthcare coverage, while Republican candidates are united in their determination to repeal “Obamacare.”

No matter who wins, you can expect employee benefit plans to undergo changes and last-minute rulings that create temporary chaos and confusion during the transition.

Here’s a snapshot of how candidates plan to improve the cost and quality of healthcare:

Hilary Clinton plans to build on the foundation set by the Affordable Care Act. An advocate for universal coverage for more than 20 years, Clinton has pledged to expand coverage for millions of Americans by:

  • Lowering premiums and out-of-pocket expenses for those buying coverage on the exchanges.
  • Encouraging Medicaid expansion with incentives to states, including a 100 percent match for three years.
  • Making enrollment easier with support from navigators and other outreach activities.
  • Supporting a “public option” in interested states.

Bernie Sanders is calling for “Medicare for all.” He wants to create a single-payor health plan, which he says will save the typical middle class family $5,000-plus, and save businesses $9,400 per employee annually.  Sanders’ plan includes:

  • Implementing a universal health plan for all medical care and treatment.
  • Eliminating provider networks— anyone could see any doctor.
  • Eliminating copays, deductibles and other out-of-pocket costs.
  • Paying for the plan with income-based health care premiums (6.2 percent from employers and 2.2 percent from households) along with changes to income tax, capital gains tax and estate taxes.

Senator Ted Cruz would have Congress repeal the Affordable Care Act. In 2013, before the law went into effect, he famously filibustered for an historic 21 hours in an effort to halt its implementation.  Cruz says he’ll make healthcare more personal, portable and affordable by:

  • Expanding the use of Health Savings Accounts to provide tax advantages.
  • Allowing individuals to purchase insurance across state lines to increase competition and drive down premiums.
  • De-linking health insurance from the workplace so Americans wouldn’t lose coverage if they change jobs or are laid off.

Ohio Governor John Kasich would repeal the Affordable Care Act.  His plan uses market-based principles to hold down costs and improve health by:

  • Expanding Medicaid.
  • Placing more emphasis on patient-centered primary care, with added incentives for providers.
  • Encouraging episode-based payments and other forms of payment reform.
  • Allowing states to control insurance market regulations.

Donald Trump also wants to repeal the Affordable Care Act, bringing “free market reforms” to the healthcare industry. Trump’s plan includes:

  • Eliminating the individual mandate.
  • Allowing health insurance sales across state lines.
  • Allowing individuals to deduct health insurance premium payments on their tax returns.
  • Expanding the use of Health Savings Accounts.
  • Requiring price transparency for doctors and healthcare organizations.
  • Providing Medicaid block-grants to states.
  • Driving down prescription drug prices by allowing consumers to buy drugs from other countries.
  • Whether this becomes a tornado or a tsunami in the world of employer benefits depends largely on which candidate is elected, how much cooperation comes from Congress, and the inevitable challenges and decisions at the Supreme Court level.
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Large insurer reports losses, calls for ACA reform

Large insurance companies are continuing to show loses on ACA plans.

Another large health insurance provider is reporting losses from plans offered on the Affordable Care Act's public health insurance exchange and spelling out concerns for the future of the public exchange.

Aetna Inc. announced the plans it offers through the ACA Marketplace remained unprofitable in 2015. Although profits on ACA plans improved as the year progressed, the company still reported losses of 3 to 4 percentage points, according to Business Insurance.

Despite the financial setback of marketplace plans, the insurer reported a 38.3 percent net income increase in the fourth quarter of 2015 over the year before. The company's revenue also increased by 1.9 percent last year.

However, overall losses suffered on the ACA were down from the previous year for the insurer. As reported by Business Insurance, Aetna Executive Vice President Shawn M. Guertin attributed the improved performance to higher rates, the promotion of medical cost initiatives and risk adjustment. However, CEO Mark T. Bertolini added that the company maintains reservations about the long-term health of ACA plans.

"Aetna's CEO said the company maintains reservations about the long-term health of ACA plans."

"We continue to have serious concerns about the sustainability of the public exchanges," Bertolini said in a call to investors. "We remain concerned about the overall stability of the risk pool."

Speaking with Bloomberg, Guertin added that even though Aetna's ACA performance is improving, that shouldn't distract from the need for changes in the marketplace.

"I don't want that to get lost in this discussion," Guertin said. "We do need things in the long haul to be done to make this a stable risk pool and one that can provide affordable coverage to people over time."

Additional losses reported
As Nasdaq reported, Aetna's announcement is one of many in recent weeks from insurers reporting ACA plans had a negative impact on their 2015 earnings. Anthem Inc. announced enrollment fell below expectations, though it was able to break even for the year. Blue Cross Blue Shield of North Carolina also reported a net loss of $400 million for its first two years on the ACA exchange. The company responded by eliminating sales commissions for its agents and suspending advertising of Obamacare plans.

UnitedHealth Group Inc. announced it suffered around $475 million in losses on its ACA plans and deepened its projected losses for 2016. Its latest projections call for $1 billion in losses on Obamacare plans, and the company has suggested it may withdraw from the marketplace in 2017.

According to Forbes contributor Chris Conover, larger insurers such as Blue Cross Blue Shield and Aetna will be better able to sustain financial setbacks on ACA plans as the marketplace adjusts. However, it will be more difficult for smaller insurers to continue offering these plans under current ACA policies.

As Conover noted, the Obama administration has already implemented a few changes in response to insurer complaints, including eliminating six special circumstances under which consumers could sign up for health coverage outside of the standard open enrollment period. However, many insurers, including Aetna, have vocalized the desire for additional reform.

That said, Aetna also announced it was satisfied with its overall performance for 2015. In previous statements earlier in the year, Bertolini cautioned it is too early to give up on the ACA exchanges. 

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Experts argue over effect of Rubio’s provision on the ACA

While Marco Rubio's presidential campaign claims his spending provision has killed Obamacare, some experts say this claim is overinflated.

A health care provision spearheaded by Republican senator and presidential candidate Marco Rubio may have dealt a significant blow to the Patient Protection and Affordable Care Act. On the other hand, some media outlets and industry experts are cautioning such claims are merely overstated political fodder for campaign season. 

According to a Tweet published by Rubio's campaign, the senator was able to "kill Obamacare" through a health care provision he pushed into a 1,603-page spending bill in December 2014. The New York Times reported the provision has "tangled up the Obama administration, sent tremors through health insurance markets and rattled confidence in the durability of President Obama's signature health law." 

"Through his provision, Rubio was able to cut funding sources for the risk corridor."

At issue is Rubio's effort to dismantle the Affordable Care Act's risk corridor provision, which is designed to provide federal compensation for health insurers and stabilize insurance premiums during the initial years of the ACA. As Obamacare requires insurers to sell policies without screening for pre-existing conditions, the risk corridor would help to offset losses if insurers set premiums too low and paid out too much in medical coverage due to a high volume of unhealthy policyholders.

As The New York Times reported, Rubio attacked risk corridors as "a taxpayer-funded bailout for insurance companies," and through his spending provision was able to cut funding sources for the measure. As a result, insurance companies will only receive 13 percent of the compensation they were expecting in this fiscal year.

Without risk corridors, insurers are likely to raise their premiums or withdraw from the public exchange markets, hurting consumers and undermining confidence in the ACA, the Times reported. Meanwhile, Rubio's campaign claimed reduced funding for the provision saved taxpayers $2.5 billion.

Things are complicated, but not dire
However, in a column for The Los Angeles Times, economic reporter Michael Hiltzik called both Rubio's and the Times' claims "a little overheated, wholly misleading and spectacularly cynical."

"The risk corridor created a system of checks and balances while discouraging racketeering."

For one, the risk corridor provision is funded by the U.S. Department of Health and Human Services through charges on premiums that exceeded claimed costs, not taxpayer money. The system effectively created a system of checks and balances designed to compensate insurers while also discouraging racketeering – and protect consumers in the process, Hiltzik argued.

What Rubio's provision did do was prevent the HHS from funding the risk corridor through any other revenue streams – meaning if insurers needed to recover more than the profitable plans can cover, as was the case for the last fiscal year, the government may have a hard time coming up with the difference.

But while that prospect is more difficult, it's not impossible. As Nicholas Bagley, an assistant professor of law at the University of Michigan Law School, noted, the HHS has already announced its intent to cover the risk corridor in full. Furthermore, if the HHS is unable to come up with the funds, insurers could sue the government for failing to meet the promise of the risk provision and possibly force Congress to repeal Rubio's provision.  

"Marco Rubio hasn't killed Obamacare and he hasn't saved taxpayers any money," Bagley wrote. "All he's done is throw a wrench in the works."