Friday, May 04, 2012


In 2014, the Affordable Care Act will subject health insurance companies operating in the health insurance exchanges and the FEHBP to a 2% premium tax.  The Sunshine State News reports on ongoing efforts to repeal that tax. Employers or employee organizations that self fund their health plans will not be subject to the tax. The Labor Department earlier this week issued its annual ACA required report to Congress on self-funded group health plans. Private sector group health plans that are self-funded also are exempt from state, but not federal, benefit mandates. Not surprisingly more and more private employers are looking at the feasibility of self-funding with the protection of stop loss insurance. Bloomberg Businessweek reports that on Tuesday the ACA regulating agencies issued a request for public input on that trend.  The agencies' request explains that

It has been suggested that some small employers with healthier employees may self-insure and purchase stop loss insurance policies with relatively low attachment points to avoid being subject to these requirements while exposing themselves to little risk. This practice, if widespread, could worsen the risk pool and increase premiums in the fully insured small group market, including in the Small Business Health Options Program (SHOP) Exchanges that begin in 2014.
It's not clear what the regulators could do but the Businessweek article indicates that certain states are beginning to react by creating a minimum attachment point for stop loss insurance. The attachment point has been analogized to the annual deductible under an individual's health insurance coverage.

In yesterday's post, the FEHBlog discussed the ongoing spat between Walgreens and Express Scripts. The FEHBlog was pleased to read a Pittsburgh Post Gazette article reporting that Highmark Blue Cross, which recently invested in a large Pittsburgh hospital chain has settled its long term dispute with a competing hospital chain the University of Pittsburgh Medical Center.  The parties reached agreement on a new Highmark network contract for UPMC with higher reimbursement rates and a term that extends through 2014.

Finally, Medscape reports that most doctors are wary of the financial risk associated with Accountable Care Organizations, the ACA innovation that are intended to reward hospitals and doctors for improving the quality of care. "Only a handful of physicians are involved in alternative patient-care delivery models. About 3% participate with Accountable Care Organizations (ACOs) but another 5% say that they plan to become involved in the coming year." 52% of the 3200 survey physicians expect ACOs to lower physician income. The article is further evidence that the ACA is encouraging risk averse physicians to adopt the employment model of practicing medicine.

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