Carter's Benefits

eNewsletter Volume 4, Issue 9 September 2011

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Review Of Insurance Rate Hikes
To Begin September 01, 2011

Recent News

  1. Review Of Insurance Rate Hikes To Begin September 01, 2011.
  2. 5 best-selling drugs coming off patent.
  3. Small Business Owners Upset At House Subcommittee Hearing On Employee Mandate.
  4. HHS Issues Rules on Preventive Care for Women.
  5. Recommendations To HHS On Essential Benefits Expected To Be Released Soon.
  6. CMS Unveils New Website With Hospital Quality Data.
  7. 11th Circuit Finds Individual Mandate UnConstitutional But Upholds Remainder of PPACA.
  8. Affordable Care Act: NPRM Issued for Uniform Summary of Benefits and Coverage.
  9. Experts Predict 165 Million Americans Will Be Obese By 2030.
  10. Postal Service Plans To Withdraw From Federal Health Benefits.

Review Of Insurance Rate Hikes To Begin September 01, 2011.
The Wall Street Journal (8/30, Adamy, Subscription Publication) reports that under a health-reform law provision, which goes into effect Sept. 1., states and the Obama Administration will scrutinize health insurance company's proposals for rate increases on individual and small-employer plans. Insurers will be required to submit a seven-page document, justifying the increase to the Department of Health and Human Services; and information on any insurers that propose premium increases exceeding 10% will be posted on HHS' website. It remains to be seen, however, whether bad publicity will deter insurers from implementing the proposed rates, as the reform law does not give HHS the authority to block the increases.

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5 best-selling drugs coming off patent
Throughout 2011 and 2012, a wave of generic versions for several top-selling drugs will roll out as brand-name prescriptions go off patent.

According to the Associated Press, the magnitude of this wave of expiring drugs patents is unprecedented. [See Drug prices to plummet]

Sales for these drugs is more than $250 billion annually, and it's expected that generic competition will "decimate sales of the brand-name drugs and slash the cost to patients and companies that provide health benefits."

Generics will continue to come out throughout the next decade, as about 120 brand-name prescription drugs lose market exclusivity.

Here are 5 top-selling drugs coming off patent in the next two years:
Click to read more

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Small Business Owners Upset At House Subcommittee Hearing On Employee Mandate.
CQ (7/29, Reichard, Subscription Publication) reports small business owners appearing as witnesses at a "House subcommittee hearing Thursday offered sharply differing views of the impact of the healthcare law," with a Burger King franchisee "saying it will force him to turn all his workers into part-time employees and a law professor challenging claims that the overhaul will lead many businesses to drop coverage." Brian Vaughn, the owner of "four Burger King franchises in Georgia" indicated he would "rather pay penalties under the law than provide all his full-time workers unaffordable, 'Washington-defined' coverage." Timothy Jost, a law professor at Washington and Lee University, challenged a National Federation of Independent Business report, which projects that "26 percent of small employers are very drop coverage after the ACA is fully implemented." He said the data were "based on a fundamental misunderstanding."

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HHS Issues Rules on Preventive Care for Women
HHS issued two rules addressing the preventive care requirements in the Patient Protection and Affordable Care Act (PPACA). The first is a proposed rule which would codify recommendations issued last month by the federal Institute of Medicine and require new health insurance plans to cover women’s preventive services without charging a co-payment, co-insurance or a deductible. Read More

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Recommendations To HHS On Essential Benefits Expected To Be Released Soon.
The "Inside Politics" blog of the Washington Times (8/30, Cunningham) reports, "Insurers and patients are waiting to find out what types of medical services will be considered 'essential benefits' by the Obama administrative and singled out for mandatory coverage." Paul Fronstin, a director for the Employee Benefit Research Institute, said that until the HHS Secretary makes that decision, "it's hard to predict how much insurance companies will be affected by the new mandates." A report by the Institutes of Medicine panel tasked with recommending definitions of "essential benefits and go about updating them each year" is expected to be released in September

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CMS Unveils New Website With Hospital Quality Data.
The Hill (8/6, Baker) reported in its "Healthwatch" blog that the Centers for Medicare and Medicaid Services "announced new programs Friday to help consumers compare hospitals based on quality." The agency "launched a new website that allows users to compare not just hospitals, but also doctors and nursing homes. The site compares facilities based on several criteria, including the satisfaction of previous patients." CMS Administrator Don Berwick said, "These efforts are designed to also encourage providers to deliver safe, patient-centered care that consumers can rely on and will motivate improvement across our health care system."
        CQ (8/6, Reichard, Subscription Publication) reported that CMS "officials said they have also updated data on an existing website devoted to hospitals in an effort to help consumers compare facilities. And they've added new information, including how well hospitals guard against infection during outpatient surgical procedures." In addition, "the agency outlined a fresh set of goals for the 'QIOs' -- the independent organizations that contract with Medicare to improve the quality and efficiency of care under the program."
        Modern Healthcare (8/6, Evans, Subscription Publication) reported that according to Berwick, the site "would allow 'one-stop shopping' for consumers looking for information on quality or the type of services provided by hospitals, physicians, nursing homes, home care or dialysis providers." Also on Friday, the agency "released data...on hospital readmissions for heart attacks, heart failure and pneumonia that found little change in performance." In fact, the data showed "only small changes to the readmissions rate, according to Medicare, which compared data for the years 2007 through 2010 against data for the years between 2006 and 2009." The Daily Record (NJ) (8/7, Ungaro) also covered the story.

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11th Circuit Finds Individual Mandate UnConstitutional But Upholds Remainder of PPACA
On Friday, the United States’ 11th Circuit Court of Appeals ruled that the PPACA individual mandate requirement that requires nearly all Americans to buy insurance is unconstitutional. However, when ruling on the case that 26 states and the National Federation of Independent Businesses (NFIB) have brought against the federal government, the appeals panel did find that the law’s expansion of the Medicaid program is constitutional and that the remainder of the law can stand. Read More

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Affordable Care Act: NPRM Issued for Uniform Summary of Benefits and Coverage
The U.S. Department of Health and Human Services (HHS) issued a Notice of Proposed Rulemaking (NPRM) on the Uniform Summary of Benefits and Coverage (SBC). As you probably know, beginning March 23, 2012, the Affordable Care Act requires health insurers and group health plans to provide consumers an SBC at the time of application, enrollment, and yearly upon re-enrollment. 

A brief summary of the standards for the SBC, as defined by Wednesday’s proposed ruling, are as follows:

  • Maximum four-page length
  • Minimum 12-point font
  • Uniform glossary of insurance and medical terms
  • Cost-sharing provisions of the plan
  • Continuation of coverage provisions
  • Examples of benefits scenarios pertaining to common health issues
  • Internet Web address for obtaining copies of the coverage policy or certificate of coverage

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Experts Predict 165 Million Americans Will Be Obese By 2030.
ABC World News (8/25, story 7, 2:00, Stephanopoulos) reported, "Tonight, sobering new numbers on America's struggle with obesity." A new series on obesity published in "the medical journal Lancet says if trends continue, half of all American men will be obese by 2030."
Bloomberg News (8/26, Gerlin) reports, "US health-care spending will rise by as much as $66 billion a year by 2030 because of increased obesity if historic trends continue," the study suggested. "Almost 100 million Americans and 15 million Britons are already considered obese, based on body-mass index," while "another 65 million American adults and another 11 million British adults would join them in the next two decades based on past trends."
        The Washington Post (8/26, Huget) "The Checkup" blog reported that "The series, which had support from the federal government and foundations, is published in advance of the first High-Level Meeting of the United Nations General Assembly focused on non-communicable disease prevention and control, which will take place in New York City Sept. 19 and 20."
        According to CNN's (8/26, Cooper) "The Chart" blog, one report in the series "includes suggestions for ways governments can implement policies that it says will reduce obesity and save money. Proposals include a tax on unhealthy foods and beverages, school programs to promote good nutrition and physical activity, and cutting junk food advertising."

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Postal Service Plans To Withdraw From Federal Health Benefits.
The Washington Post (8/24, Davidson) reports in its "Federal Eye" blog, "If the US Postal Service is successful in its plan to withdraw from the Federal Employees Health Benefit Program (FEHBP), it would have ramifications for the entire federal workforce." Postmaster General Patrick R. Donahoe explained that the effort is intended to give the postal service greater control of healthcare costs. He hopes to "cut...costs by somewhere between 8 to 10 percent," though that "could mean greater costs to postal employees, through higher insurance premiums or lower benefits." The story cites one expert who ridicules Donahoe's suggestion that the postal service will be able to cut costs in ways other than cutting benefits or charging employees more.

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How does Carter's Benefits help ?
We continue to stay on top of changes in this industry. In a consultative role, Eddie Carter has begun hosting live seminars to update employers and Human Resource Managers on these changes. If you would like to host a meeting with your local community or civic organization, please contact me for details.

Eddie Carter, Consultant Eddie Carter,
Benefit Consultant
If you have questions or would like more information please give us a call or send us an email.  Our email address is Questions@CartersBenefits.Com

Carter's Benefits
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