With so much being said and written about healthcare reform, many employers don't know where to begin to find practical information about how the law. How will if affect the workplace? What they should be doing to prepare, even now?
More importantly, employees are being bombarded with information they don't understand, or even downright misinformation, and are looking to their employers to help them wade through this complicated maze of new legislation.
This article will hopefully clear up some of the confusion and provide a practical roadmap to what is already in effect and what is coming down the road.
What Should I Be Worrying About Now?
Although much of the healthcare law takes effect years down the road, there are a number of provisions which are of immediate impact to employers. Three examples are addressed below: new whistleblowing protections, right to privacy for workplace nursing, and deciding whether to "grandfather" your health plan.
First, all employers should understand that the healthcare reform law dramatically expanded whistleblower protections in the workplace. For example, an employee who makes a complaint about a perceived violation of the new healthcare law is protected from retaliation. Similarly, if an employee opts out of an employer's plan and chooses to be covered in one of the new healthcare exchanges scheduled to start in 2014, that act is protected from retaliation.
Second, in addition to the creation of whistleblower protections under the FLSA, the new law requires employers to provide:
Unpaid, reasonable break time to non-exempt nursing mothers to express breast milk; and
A place to express breast milk that is:
Not a bathroom;
Shielded from view; and,
Free from intrusion.
An employer with less than 50 employees will not be required to implement this provision if doing so would cause the employer an "undue hardship." However, an employer with more than 50 employees will be required to follow the law, even if its employees are working on a client's premises or at a location where it is difficult to provide privacy. The nursing mother protections created by the law are available for one year after the child's birth.
Lastly, this year poses a one time opportunity to grandfather a health plan from many of the changes required under the new healthcare law. healthcare plans which were in existence as of March 23, 2010 (the day the law was enacted) can be exempted from a multitude of requirements imposed by healthcare reform so long as the plan does not substantially change the benefits offered, change insurers, or increase employee costs by a significant percentage (as defined in the regulations).
Employers should talk to their insurance brokers or carriers to determine whether grandfathering makes sense. The benefit to grandfathering is an employer can avoid mandated changes such as first dollar coverage of preventive care, and new recordkeeping requirements. The downside is that grandfathering means severe limits to passing on rate increases to employees, and an inability to shop carriers for a better rate. With the seemingly annual rise in costs, these limits will make grandfathering a bad deal for many employers.
What Is Coming Down the Road?
The healthcare reform law has far reaching effects and drastic changes to the healthcare system. Necessarily, these changes are spread out over an extensive period of time, with a gradual rollout. A timeline of important dates to keep in mind for strategic purposes is listed below.
2011
Beginning in 2011, employees will have a right to request a W-2 form anytime during the year, once they have been terminated. Although it is not likely that most employees will get an early start on their taxes, employers should be aware of this new possibility. More importantly, for the 2011 tax year, employers will be required to start reporting on the W-2 form the value of the health insurance premiums paid for each employee. This would include both the employee and employer's share of the premium. Out of all the changes in the healthcare law, this one might be one of the most beneficial, as employees will finally get to see what their healthcare really costs (not just their share). Contrary to rumors that have been circulating recently, these amounts will not be taxable.
Also in 2011, flexible spending amounts (FSA)'s will be changed to only allow reimbursement for prescription drugs and not over the counter medication.
2013
Starting in 2013, there will be additional Medicare taxes on individuals making more than $200,000 per year and couples making more than $250,000 annually. These Medicare taxes will not be paid by the employer, but instead only the employee. In 2013, the law also implements changes to FSA's limiting the maximum amount available for such accounts to $2,500.
2014
In 2014, the most significant changes to the healthcare law will take effect. Every individual will be mandated to have health insurance and employers with more than 50 employees who do not offer heath insurance will be penalized. Each state will implement healthcare exchanges where individuals can buy health insurance as part of a larger group for cost savings. Employees earning less than 400% of the federal poverty level will receive federal subsidies to purchase health insurance.
2018
The last step to be implemented is the 40% tax on expensive healthcare plans, dubbed "Cadillac plans." These high cost health plans are defined as having a value of $10,200 for a single employee or $27,500 for a family. The law contains certain exclusions for high risk jobs and other special occupations. Healthcare reform will have a far-reaching effect on companies in the United States. Armed with the information necessary to make educated decisions, however, companies will be able to implement the requirements of reform in a timely, and efficient manner and make good strategic decisions on how their business goals fit within the new law.
David Barron and Daniel Schuch are attorneys at Epstein Becker Green Wickliff & Hall, P.C. (www.ebglaw.com) and represent management exclusively in labor and employment matters.
During a healthcare fraud summit in Los Angeles, Atty. Gen. Eric H. Holder Jr. and Health and Human Services Secretary Kathleen Sebelius said their agencies were jointly targeting fraud in the federal Medicare and Medicaid programs. They said the initiative, launched in May 2009, had so far produced more than 580 criminal convictions and recovered more than $2.5 billion in fraudulent proceeds.
"Our healthcare system is essentially under siege by criminals intent on lining their own pockets at the expense of the American taxpayers," Holder told the gathering of law enforcement officials, regulators, healthcare executives and others at Los Angeles City College. "In Los Angeles, these crimes have reached crisis proportions, driving up healthcare costs for everyone and also bringing the long-term solvency of our essential Medicare and Medicaid programs into doubt."
Mr. Roe, the former vice president of finance at Moses Taylor Healthcare System, was arrested Aug. 17 on a two-count criminal complaint that charged him with wire fraud and interstate transport of stolen funds. The complaint has been sealed so it could not be determined why he was arrested, but court papers filed to have him jailed for violating bail conditions suggest the charges involve his job at Danbury Hospital and a financial arrangement he had with the hospital and the sale of a house.
Mr. Roe, who was appointed CFO at Danbury Hospital in March 2009, according to the hospital's website, was released following his arraignment on the wire fraud charges on Aug. 17. As a condition of his bail, he was instructed not to contact any witnesses and to stay away from Danbury Hospital, except to get his car.
Despite the warnings, Mr. Roe placed hourly phone calls to Dr. Murphy and fired off a series of e-mails, including one saying he wanted the case against him to "go away," prosecutors said.
Agreeing to disagree has been what most of us, doctor and patient, have done since concierge, or retainer, practices first appeared in the mid-1990s. Developed as an alternative to the constraints of traditional practice, this new model allowed doctors to offer more personalized care that in turn increased patient and professional satisfaction. By decreasing the total number of patients seen in an office from well over 2,000 to as few as 500, doctors could offer longer visits, increased and immediate accessibility, personalized coordination of hospital care and, in some cases, even house calls and accompanied visits to specialists. In return for these services, patients would pay retainer fees, ranging from just under $2,000 to as much as $15,000 per year.
By 2003, according to a national survey, the number of doctors practicing concierge medicine numbered fewer than 200. And while critics raised ethical concerns about the “abandonment” of patients left without primary care physicians while their doctors downsized and the creation of a “two-tiered” system that exacerbated disparities in health care access, little was done to address those concerns. These boutique practices were a relatively rare curiosity, and practitioners were left alone.
But over the years and particularly in recent months, the debate about the ethics of concierge doctoring has grown more heated, with more and more physicians unabashedly lining up to take sides. An editorial in the Annals of Internal Medicine this spring, for example, questioned not only the ethics but also the quality of care delivered in such practices. The writer went on to urge other physicians to abandon “the neutrality with which the medical community has addressed” this issue thus far.
Blue Cross Blue Shield of Michigan, Blue Care Network, the University of Michigan Medical Center and 16 other hospitals will begin a quality improvement study in October to reduce risk of blood clots in hospitalized patients.
Blood clots – also known as venous thromboembolism – affect an estimated 900,000 people in the U.S. each year, resulting in several hundred thousand hospitalizations and about 300,000 deaths, said Blue Cross in a statement.
Blue Cross also estimates reducing blood clots could cut health costs $5 million over five years.
Medical device maker Stryker Corp. said Wednesday it agreed to buy privately held Gaymar Industries for $150 million in cash.
The boards of both companies have approved the sale, which is expected to close by Oct. 1.
Stryker, which makes hip and knee implants and other orthopedic devices and surgical equipment, said the deal was expected to have no impact in Stryker's 2010 and 2011 earnings per share but to increase earnings in later years.