As premiums spiral out of control, there is a drying up of employer-sponsored worker benefits. At the root of rising healthcare costs is the “third party payor system”. One party (the patient) seeks service, a second party (the provider) sells the service, and a third party (the insurer) is responsible for payment. The natural protection brought by buyer’s concern about cost has been bypassed and negated.
Gallup reported that the nation’s employers are providing fewer Americans than ever with health insurance. Just 43.3 percent of the nation’s adults said they got coverage from an employer in the second quarter of 2013. That is the lowest quarterly average Gallup has recorded to date. And, employer-based health insurance has been in steady decline since 2009.
From the perspective of physicians and other healthcare providers, the time-worn third party payment system is breaking down. The designated replacement, ObamaCare, is struggling to meet its commitments. The employer mandate has been delayed for a year, the individual mandate may need to be delayed, and the problem of rising premiums may be accellerating.
There is a better answer. The Flagship Network can help employers move toward ERISA-based self-funded benefits plans. We have a local community solution for our national problem. As Flagship physicians, we all know business owners in our community. If we can make them aware of the Flagship Network, we can help protect our own practices from the chaos swirling around us.
The Patient Protection and Affordable Care Act has created massive uncertainty for companies that wish to provide a health benefits plan for their employees. One area of difficulty is the requirement that ten “essential health benefits” be covered by every plan. This creates a one-size-fits-all approach that forces premiums to be higher than they would be if the plan were customized.
As with many features in the ObamaCare regulations, there is a perfect escape route: partial self funding of the insurance plan. With a partially self funded plan, the premiums must still provide for these essential health benefits, but if any of these benefits are not needed, the savings are retained by the employer and employees rather than by the insurance company.
Self funding a benefits plan involves taking a calcuclated risk, but PARTIAL SELF FUNDING carries no risk at all. The plan can be customized so that if claims exceed premiums paid, that risk is covered by a reinsurance (stop loss) carrier. Furthermore, partial self funding creates many other savings opportunities. The Flagship Network is designed to help businesses take advantage of these opportunities.
If you are interested in Flagship patients, then contribute to our effort. As physicians, we care for business owners and we have friends who are business owners. By getting the Flagship message to them, you can generate a steadily increasing flow of Flagship patients to your office. By sharing these ideas with them, you can help them with their business needs, and you can be compensated for this help.
As we reported to you 18 minutes after its public release, the Patient Protection and Affordable Care Act employer penalties have been postponed by President Obama for one year. The impact of this delay will be far-reaching. Most importantly, it introduces a new level of uncertainty into the system. Whatever confidence had been generated as kickoff approached has quickly evaporated. We were on the brink of making the commitment, and suddenly there is another whole year when changes may or may not be regulated into existence. Employers have spent big dollars working toward compliance, but the rules are changing again. From the revenue side, the government has lost the cash flow that penalties would have generated, throwing the projections even further into the red.
At a much quieter level, the subsidies to individuals are being rethought as well. As designed, the subsidies depended on verification that (1) the individual’s employer did not offer compliant insurance and (2) that the individual earned less than four times the federal poverty level. Without fanfare, the government has now admitted that it is not ready with a verification process. Instead, it will grant subsidies based on the information provided by the individual and will rely on the honor system to prevent fraud.
As PPACA continues to evolve, the Flagship will keep you informed.
The Treasury Department announced this evening that penalties for failure to provide health insurance for employees has been delayed one year.
According to the Huffington Post: “Employers who don’t provide health insurance will be spared penalties of up to $3,000 per worker until 2015, a one-year delay of a major component of President Barack Obama’s health care reform law, the Treasury Department announced Tuesday.”
“A delay – conveniently past the 2014 election – only adds to the uncertainty these job creators face because of Obamacare,” said Senator Orrin Hatch, top Republican on the Senate Finance Committee.
This delay provides an opportunity for the Flagship to implement its vision of high quality, cost-effective healthcare for community employers. The tumult will continue, and we must seize this opportunity to move forward.
The Flagship Network is a team comprised of your local hospitals, physicians and benefits consultants. It is a community based solution to the national challenge of runaway healthcare premiums. The Flagship Network can assist employers in this confusing period of policy change and can rescue their benefits programs. The legal aspects are many, but the core issue is to view benefits as a compensation cost. That is the way it is in the USA…and in your home town.
Contact the Flagship today to find out how our benefits consulting team can help ensure that your business is squared away regarding the oncoming October 2013 PPACA events.
FOR LEGAL PROOFING OF THE BENEFIT PLAN:
Michelle D. McKinney, J.D. is available to offer insight from the perspective of both a practicing attorney and SeniorCorporate Counsel of The Miers Group, LLC. Michelle brings a unique perspective to the team because in addition to private practice, she is lead counsel for a healthcare delivery system that includes benefits consulting, population health enhancement, physician association management and access to diverse healthcare programs. Michelle is an experienced contracting professional and is also a Texas Department of Insurance licensed agent. She is recognized by the National Association of Health Underwriters as a Certified Patient Protection and Affordable Care Act Professional and will be immersed with the company’s healthcare delivery assets such as the Flagship “Narrow Network”.
Michelle McKinney is an active member of the State Bar of Texas and the Dallas Bar Association. She received her Juris Doctorate from the University of Arkansas School of Law in Fayetteville, Arkansas. Prior to attending law school, Ms. McKinney received her Bachelor of Arts from Rutgers University in New Brunswick, New Jersey. Michelle McKinney also earned Dean’s List Honors every semester and won several academic scholarships and awards throughout her undergraduate career.
FOR MEDICAL CARE PERSPECTIVES:
Daniel Karin, M.D. is available to offer insight from the perspective of both a practicing operating suite physician and a Corporate Medical Director. Dr. Karin is also licensed by the Texas Department of Insurance as a Life and Health Benefits Counselor. He is an officer in a benefits consulting firm and brings years of major corporate and small business benefit marketing experience to the marketplace. Dr. Karin is also member of the Dallas Association of Health Underwriters.
To schedule a benefits review or secure billing rates from the Flagship team, please contact us at (972) 484-5888. For more information, visit our website at www.FlagshipNetwork.com. The Flagship is the community based solution to a national problem. Be ready.