Category Archives: Health Care

Ripley Discusses Medicaid Expansion with IBJ

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Mike Ripley, the Indiana Chamber's VP of health care policy, was recently interviewed by the Indianapolis Business Journal about Medicaid expansion in Indiana. Here's what he said:

Mike Ripley, a health care lobbyist for the Indiana Chamber of Commerce, talked about the business group’s views on a proposed expansion of coverage by the Indiana Medicaid program. As it stands now, the 2013 Indiana budget bill includes a plan passed by the Senate as Senate Bill 551, which would have OK’d the Pence administration to negotiate a block grant deal with the U.S. Department of Health and Human Services to expand Medicaid coverage via a program like the Healthy Indiana Plan. When that bill was altered in the House to remove the block grant concept, the chamber dropped its support. The altered House bill is now dead, and the original Senate plan has been added to the budget bill. Its ultimate fate is still unknown.

IBJ: Why did the chamber drop its support of SB 551 when the House altered it so it no longer required the state to negotiate a block grant with the government?

A: The inference is that, you’re on the hook for the full expansion, however you do that. And at the end of the day, how do you pay for that? How I’ve interpreted the block grant is, "OK, we’re going to get X amount of dollars and then we expand as much as we can." But without that, it’s pretty much open-ended.

IBJ: Why is an open-ended expansion of Medicaid, which is what President Obama’s health reform law originally called for, a problem—particularly considering that the federal government will pay 100 percent of the expansion costs for three years and then step its support to no less than 90 percent by 2020?

A: Then after 2020, what happens then? Where do you come up with those resources? That’s where we’ve been very concerned from a business perspective. Because who’s going to foot that bill? Employers are.

IBJ: Why do you prefer expanding coverage via the Healthy Indiana Plan, which gives participants a health savings accounts to pay for health care, but also caps enrollment if their use of health care exhausts the state’s allotted revenue for the program?

A: It has better reimbursement [than Medicaid] for doctors and hospitals. And it puts some skin in the game for individuals. I think that’s the best of all worlds. You’re not going to get everybody covered. But it’s something we can cope with financially.

Mayo: Money Talks When it Comes to Losing Weight

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Categories: Health Care, Wellness

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A little cash goes a long way, even when the topic is wellness and shedding a few pounds.

Details from a recent study:

Weight loss study participants who received financial incentives were more likely to stick with a weight loss program and lost more weight than study participants who received no incentives, according to Mayo Clinic research.

Previous studies have shown that financial incentives help people lose weight, but this study examined a larger group of participants (100) over a longer period (one year), says lead author Steven Driver, M.D., an internal medicine resident at Mayo Clinic. One hundred healthy adult Mayo employees or their dependents, ages 18-63 with a body mass index of 30 to 39.9 kg/m2, were assigned to one of four weight loss groups: two with financial incentives and two without. An adult who has a body mass index — a calculation determined by using weight and height — of 30 or higher is considered obese, according the Centers for Disease Control and Prevention.

All participants were given a goal of losing 4 pounds per month up to a predetermined goal weight. Participants were weighed monthly for one year; previous financial incentive studies followed patients for 12 and 36 weeks. Participants in the incentive groups who met their goals received $20 per month, while those who failed to meet their targets paid $20 each month into a bonus pool. Participants in both incentive groups who completed the study were eligible to win the pool by lottery.

Study completion rates for the incentive groups were significant compared with the non-incentive groups: 62 percent versus 26 percent. In the incentive groups, participants' mean weight loss was 9.08 pounds, compared with 2.34 pounds for the non-incentive groups.

"The take-home message is that sustained weight loss can be achieved by financial incentives," Dr. Driver says. "The financial incentives can improve results, and improve compliance and adherence."

Researchers found that even participants in the incentive group who paid penalties were more likely to continue their participation in the study than those in the non-incentive groups, Dr. Driver says.

Senior study author Donald Hensrud, M.D., preventive medicine expert at Mayo Clinic and medical editor of The Mayo Clinic Diet, says obesity continues to be a major concern in the United States because extra weight contributes to many conditions, such as heart disease and diabetes.

"Traditional therapies are not working for a lot of people, so people are looking for creative ways to help people lose weight and keep it off," Dr. Hensrud says. "The results of this study show the potential of financial incentives."

Promise Gala Assists in Fight Against Diabetes

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Categories: Health Care, Wellness

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More than three million Americans currently have Type 1 diabetes (T1D) and 30,000 more – 15,000 children and a like number of adults – will be diagnosed in the coming year. Although 85% of Americans with T1D are adults, its prevalence in people under the age of 20 has increased by 23% from 2001 to 2009.

The annual health care costs associated with T1D – a staggering $14.9 billion a year. Like so many other diseases, the goals are prevention, more effective treatment and attempts to find a cure.

The Juvenile Diabetes Research Foundation (JDRF) is the leading global organization focused on T1D research. It, will present its 2013 Promise Gala on April 27 at the Indianapolis JW Marriott. The “Heroes for a Cure” theme will acknowledge several heroes, including the JDRF Living and Giving Honoree – Roche Diagnostics Corporation.

Between 700 and 800 business and community leaders are expected to attend. The event will include a reception, live and silent auctions, dinner and entertainment.

Learn more about JDRF, the 2013 Promise Gala and how you can be involved in helping find a cure.

CBO Estimate of Those Who Will Lose Employer-Provided Health Insurance Under ACA Doubles

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Categories: Health Care

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The Washington Times reports that many more Americans than previously thought will lose employer-provided health insurance due to the newly enacted health care law, supported by President Obama. This unfortunately contradicts his campaign rhetoric during the 2012 debates and speeches on the matter.

President Obama's health care law will push 7 million people out of their job-based insurance coverage — nearly twice the previous estimate, according to the latest estimates from the Congressional Budget Office released Tuesday.

CBO said that this year's tax cuts have changed the incentives for businesses and made it less attractive to pay for insurance, meaning fewer will decide to do so. Instead, they'll choose to pay a penalty to the government, totaling $13 billion in higher fees over the next decade.

But the non-partisan agency also expects fewer people to have to pay individual penalties to the IRS than it earlier projects, because of a better method for calculating incomes that found more people will be exempt.

Overall, the new health provisions are expected to cost the government $1.165 trillion over the next decade — the same as last year's projection.

With other spending cuts and tax increases called for in the health law, though, CBO still says Mr. Obama's signature achievement will reduce budget deficits in the short term.

During the health care debate Mr. Obama had said individuals would be able to keep their plans.

Governor Gets Down to Business Quickly

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Categories: Business News, Education, Government, Health Care, Tax/Finance

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While the Indiana General Assembly began its work on January 7, new Gov. Mike Pence had to wait a week for his January 14 inauguration. He quickly went to work, however, with significant positive actions on his first two days on the job.

A series of executive orders that Pence signed following his official ascension into office included a moratorium on new rules and regulations (with obvious emergency exceptions) that were not proposed before January 14, as well as a cost-benefit analysis of existing administrative rules. Priority will be given to review of those rules with the most negative effect on job creation and economic development.

Candidate Pence promised this action leading up to the election. While federal regulatory challenges are often at the forefront today, this step will help ensure that state government is not unnecessarily limiting job and economic growth.

On day two, the Pence team delivered a two-year, $29 billion spending plan to the State Budget Committee. The first six pages of this extensive document provide an overview of the key elements.

This is a very good starting point for legislators. It is a fiscally sound proposal, with a focus on meeting key state priorities and providing the 10% individual income tax relief (which also encompasses 90% of Hoosier businesses) that Pence proposed in his campaign. As we’ve indicated previously, lawmakers have questioned whether the income tax cut should take precedence over other budget desires. That will be worked out in the legislative process and could be determined by the updated revenue forecast that will be presented in early April.

A few highlights:

  • A 1% increase in each of the next two years for K-12 and higher education. The second year for K-12 would have that 1% be divided among the state’s highest performing schools. Combined, the education funding totals 65% of the budget.
  • While the administration did not include money to specifically expand the Medicaid program as outlined under federal health care reform, it does significantly increase funding for health insurance for the poor – from $1.65 billion this year to $2.1 billion in 2015.
  • The budget calls for a change in projected excess revenues. After 12.5% of annual spending is set aside in reserves, the remainder would be divided between the automatic income tax credits that were enacted during the Daniels administration and a new fund to help maintain roads, bridges and other infrastructure critical to economic growth.
  • Spending is kept in line in this proposal. A structural surplus is maintained and reserves are allocated effectively, with the infrastructure fund a good start to the larger question of financing future transportation needs. The Chamber will be working with the governor’s team and legislators to help ensure that as many pro-job, pro-economy priorities as possible are achieved in a responsible manner.

Worst of the Worst in 2012 Regulations

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Categories: Environment, Government, Health Care

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There’s room for one last "Bottom 10" list of 2012. With thousands of new government regulations each year, it’s difficult to select the worst new rules put into place. Two Heritage Foundation experts give it a try, starting with 1,099 pages of new mortgage disclosure rules that have the stated goal of simplifying home loans.

(10) Mortgaging the Future: New mortgage disclosure rules were released in July by the newly created Consumer Financial Protection Bureau, with a stated goal of simplifying home loans. The rules run an astonishing 1,099 pages. The net result of this and similar rules? Fewer consumer mortgage lending options and increased costs.

(9) Tracking Your Travels: In December, the Department of Transportation proposed that electronic data recorders, popularly known as "black boxes," be required in most cars starting in 2014. The stated goal is to collect more information about car accidents. But this spooks privacy advocates, who warn that federal bureaucrats could misuse this information.

(8) Essential Choice Cutbacks: Under the Obamacare "essential benefits" rule, health insurers will be forced to cover health care services that the government deems essential, whether you want to buy them or not. The net result will be to increase health care costs, increasing the burden on consumers, employers and taxpayers.

(7) Instant Union: In April, the National Labor Relations Board issued new rules that shortened the time allowed for union-organizing elections to between 10 and 21 days. This leaves little time for employees to make a fully informed choice on unionizing, threatening to leave workers and management alike under unwanted union regimes.

(6) Don’t Let Them Eat Cake: The Department of Agriculture in January published detailed new nutrition standards for school lunch and breakfast programs. More than 98,000 elementary and secondary schools are affected – at a cost exceeding $3.4 billion over the next four years. The new rules sparked protests, and even a few hunger strikes, from students nationwide.

(5) Cleaned Out: Regulators admit that the new Energy Department rules governing dishwashers will do little to improve the environment. Rather, proponents claim they will save consumers money. But they will also increase the price of dishwashers, and only about one in six consumers will keep their dishwasher long enough to recoup the cost.

(4) Soda Socialism: On Sept. 13, at the behest of Mayor Michael Bloomberg, the New York Board of Health banned the sale of soda and other sweetened drinks in containers larger than 16 ounces. New Yorkers apparently are still allowed refills, at least for now. No word on how many NYC cops will be moved from crime prevention to monitor the city’s soda fountains.

(3) Sticker Shock: Adopted in August, these new automobile mileage rules require a whopping average fuel economy of 54.5 miles per gallon by 2025. Sticker prices will jump by hundreds of dollars. Regulators argue that the fuel savings will make up these costs. Whether consumers want to make such a tradeoff doesn’t matter. The government has decided for them.

(2) Increasing Energy Costs: The Environmental Protection Agency in February finalized strict new emissions standards for coal- and oil-fired electric utilities. The benefits are highly questionable, with the vast majority being unrelated to the emissions targeted by the regulation. The costs, unfortunately, are certain: estimated to be $9.6 billion annually. The regulations are likely to undermine energy reliability and raise energy costs across the entire economy.

(1) Conscience Denial: The Department of Health and Human Services on Feb. 15 finalized its mandate that all health insurance plans include coverage for abortion-inducing drugs, sterilization procedures, and contraceptives. The mandate allows no exception for church-affiliated schools, hospitals and charities whose religious principles conflict with the mandate. To date, 42 lawsuits representing more than 110 plaintiffs have been filed challenging this restriction on religious liberty as a violation of First Amendment.

Bottom Line: Not a Lot of Extra Money in State Budget Forecasts

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The Indiana State Budget Committee listened to three separate forecasts recently regarding Medicaid, the economy and revenue; together these will set the stage for debates in the coming session over the next state biennium budget.

Medicaid Forecast
The day started with the Medicaid presentation by Michael A. Gargano, secretary of the Family and Social Services Administration (FSSA) and Robert M. Damler, an actuary with the firm of Milliman, Inc., a financial and health care consultant on contract to the FSSA. The duo outlined the various projections relative to Medicaid expenditure obligations anticipated over the next two years. While predicting Medicaid expenses is particularly difficult this year due to the unknowns of the Affordable Care Act (ACA), the forecast nevertheless attempts to estimate the potential liabilities of the state by making a series of assumptions regarding: the implementation of programs, reimbursement amounts, the impact of new provisions, additional federal actions, long-term trends, and ultimately, the increase in Medicaid recipients and the state’s financial obligations.

Their forecast projects the general fund monies needed to provide Medicaid assistance will grow by 17.1% in fiscal year (FY) 2014 and 8.7% in FY2015. That translates to almost $450 million over the biennium. Fortunately, however, the appropriations for Medicaid have exceeded the actual expenditures in FY2012 and are expected to do so again in FY2013 (by $264 million and $234 million, respectively). The over appropriation in FY2013 will help offset the FY2014 increase some, but overall dollar obligations will nevertheless grow significantly. If you compare the appropriated amounts in the last budget with the projections of what will be needed for Medicaid in the next two years, you still end up with a difference of $428 million (The math: FY12 appropriation = $1716M, FY13 appropriation = $1882M, projected FY14 = $1929M, FY15 = projected $2097M; 1716 +1882= 3598; 1929 + 2097 = 4026; 4026-3598 = 428) Keep this additional $428 million dollars in mind when we consider the general fund revenue projections below.

Economic Forecast
This presentation was given by James Diffley, chief regional economist for IHS Global Insight. Diffley gave the big picture on the U.S. and Indiana economic outlooks. His overview considered the effects of global and domestic uncertainties on exports and business capital spending, housing and vehicle markets, consumer spending, employment and income levels, potential tax changes and the chance of recession if we go over the “fiscal cliff.” In short, IHS is predicting a continuation of modest/slow growth. Indiana is situated well, but remains vulnerable to all the outside factors.

Revenue Forecast
The main attraction of the day was the general fund revenue forecast for fiscal years 2013-2015. This forecast is based on the underlying economic projections of IHS Global Insight but gets down to the nitty-gritty of how much money the budget-makers will have to work with as they put together and debate the details of the next budget. These projections are arrived at by consensus of a bipartisan and non-partisan committee of fiscal analysts who look very closely at all state revenue sources. They meet regularly, apply sophisticated models, track a multitude of factors, receive counsel from numerous advisors, academics and other sources, and have in recent years proven very accurate.

The report took into account recent legislative changes and such things as how alterations to the gaming laws in surrounding states will likely lead to even further reduction in Indiana’s gaming revenues. The bottom line of the revenue forecast committee: Total general revenues are projected to increase by a very modest 2.2% for FY2014 and then another 2.9% in FY2015. In dollar terms, that is $14.65 billion in FY2014 and $15.08 billion in FY2015. The collections for FY2013 were $14.33 billion. The projections represent a slight increase of $320 million for the first year of the new budget and another $430 million in the second year – a mere $750 million over the biennium.

Now let’s go back to the additional $428 million needed simply to meet the projected increase in Medicaid: $750 million minus $428 million leaves only $322 million (a little over 2% of the annual budget) to pay for all other desired budget and fiscal priorities that have been put forth. These include restoring over $350 million in K-12 education cuts, an approximately $100 million pre-school program, several hundred million in stymied university capital projects, billions in long-term road maintenance and other infrastructure needs, as well as the incoming Governor’s proposal to cut individual income taxes by well over $500 million. Clearly, there’s not enough money to go around – let’s see what gets done!

Sick of Trying to Figure Out New Health Care Regs?

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This entry was posted in Health Care by Matt L. Ottinger. Bookmark the permalink.

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Obamacare. The PPACA. The ACA. However you label it, federal health care reform is a confusing mixture of laws and requirements for Indiana businesses to grapple with.

To help you understand the changes more clearly, the Indiana Chamber has just released Health Care Reform for Indiana Employers – an online guide (ePub) authored by attorneys from Ice Miller LLP.

"In enacting the Patient Protection and Affordable Care Act of 2010 (PPACA), Congress fundamentally changed the landscape for employer-sponsored health care plans," says co-author and Ice Miller attorney Christopher Sears. "This guide is intended to provide employers a road map to navigate the uncertain waters of PPACA, in order to be in a position to timely comply with its different requirements as they become effective."

The guide provides you with a resource to understand PPACA and what it means for you, your employees and your health plans. The ePub discusses the following:

  • Individual mandate and exchanges
  • Employer coverage mandates
  • Employer disclosure and reporting requirements
  • Employer coverage and responsibility provisions
  • Wellness programs 

Online access to this publication is available for $74.25 for Indiana Chamber members. To place your order, call (800) 824-6885 or order online.

Noblesville’s RMI Expanding Business, Adding Talent

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Categories: Business News, Health Care, Technology

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Historically, RMI in Noblesville has focused on orthopedic solutions for spinal surgeries, as well as hip and knee replacements. It’s had quite a bit of success in this industry, but RMI leadership now sees an opportunity to expand its focus.

"More recently, we’ve been looking for opportunities for growth in the non-medical field," President James Evans explains. "So we’re in the process of getting our aerospace certification."

Evans relays that expansion is one of the key reasons the company moved to Noblesville from Rochester in fall 2011. He explains the move gave the company more access to talent, and provided a more central location and close proximity to customers. While quite an undertaking, 19 of RMI’s Rochester staffers made the move south with the company, which currently has 25 employees (although that number will grow to 28 in the near future and well beyond once it expands into aerospace).

"We build low volume precision components out of exotic materials for the medical industry," Evans clarifies. "It’s a natural outgrowth opportunity to build products for other markets. Aerospace (and government, high-reliability military and aviation industries) all have requirements for the kind of capability that we have. Fairly high value componentry and assemblies are what we specialize in. In the spinal parts we build, the cervical plates, the hooks, the rods, the screws, which are mainly out of titanium and stainless steel and exotic plastics — we could really apply those to other markets."

Evans adds that the company has worked to evolve from just a component supplier and has expanded into full assemblies, which now comprise 40% to 50% of its business.

"When you start adding components together as part of an assembly, you have all of the interferences and system-level issues that you uncover," he notes. "And frankly, most of our competitors don’t want that hassle — so we look for more of those opportunities and that separates us from the competition."

He adds that the company now focuses on getting products to market faster by increasing engineering staff and adding equipment, which has helped build customer satisfaction and loyalty.

Evans remarks that RMI now serves more second tier developers.

"In 2005, most of our business was with large OEMs (original equipment manufacturers), and we had very little flexibility in defining the manufacturing of these products," he says. "We had little say in product improvements, and now we’re with customers who are competitive with large OEMs; they’re design houses and they’re working with orthopedic groups. … they look to us for manufacturing solutions."

Challenges still face Hoosier companies in the medical device industry.

"With people out of work, they don’t have insurance and put off having surgeries," Evans offers. "People are also doing tigher inventory controls, so purchasing habits have changed and so we don’t get as many large orders as we used to get. And of course Obamacare has had its own set of challenges, as well as the medical device tax — those things will affect the marketplace."

When asked about Indiana’s pipeline of talent for his industry, Evans explains central Indiana provides more access to talent, but he believes the state has room for improvement.

"The people who actually run our machinery, they need to be trained machinists and need to know a lot about metallurgy and inspection processes, and we have to train every one of them that comes in here," he asserts. "So there’s always a talent gap."

Would you like to know more about RMI or its products? Reach out to Evans at jevans@rmi.us.com.