Congress Can Do It, But You Can’t

An interesting blurb in a recent Kiplinger newsletter on one of the privileges of congressional service:

Congress can do what employers can’t when it comes to health coverage: use tax-advanced funds to reimburse workers who buy individual health care policies on exchanges. Employers face a tax penalty of $100 a day per worker for violations.

Yet the government gives lawmakers and Capitol Hill staffers tax free contributions to help offset insurance premiums, covering about 72% of exchange-bought insurance. The government allowed the payments because of concerns about higher premiums and the loss of the government subsidy for insurance for both lawmakers and staff.

The IRS restated its view that such subsidies aren’t permitted in the private sector after some vendors told employers that the pretax payments would allow them to meet the mandate to provide insurance. The double standards isn’t likely to change.

Study: Time for Docs to Advise Patients to Kick the Habit

Indiana maintains its unfortunate top 10 ranking as a state with one of the highest levels of people who smoke. A goal of Indiana Vision 2025 is to reduce that 24% adult rate.

A recent study says doctors can help, but many are skipping the opportunity to guide their patients.

Nationally, less than half of adult smokers report that their physicians advise them to stop smoking, while about two-thirds of physicians say lack of patient motivation to quit smoking is a barrier to medical interventions.

The JAMA Internal Medicine study, titled “Patient Engagement During Medical Visits and Smoking Cessation Counseling,” examined the relationship between patient engagement — or how involved people are in their health care — and the likelihood that physicians would counsel patients to stop smoking.

The study by Peter Cunningham, Ph.D., of Virginia Commonwealth University, was conducted for for the National Institute for Health Care Reform while he was a senior fellow at the former Center for Studying Health System Change. Based on a 2012 survey of 8,656 current and retired autoworkers and their spouses younger than 65, the study included 1,904 current smokers and assessed their engagement levels depending on whether they had ever talked with their physician about health information they found on the Internet, had someone accompany them to a medical visit for support, had taken notes during a medical visit to help remember what was said, and had brought a list of questions to ask during a medical visit.

Highly engaged patients were more likely to report that their physicians had advised them to stop smoking, the study found. And, highly engaged patients whose physicians counseled them to stop smoking were the most likely to attempt to quit (75%), while patients with low engagement levels who did not receive counseling were the least likely to attempt quitting (46%). However, if counseled by their physician, 60 percent of smokers with low engagement levels attempted to quit smoking, the study found.

“Clinicians should not misinterpret lack of patient engagement during medical encounters as unwillingness to quit because the results of this study suggest that counseling of even less engaged patients is effective in getting them to attempt quitting,” the article states.

The findings strongly suggest “that clinicians respond differently to patients who are highly engaged during medical encounters than they do to less engaged patients in terms of advising patients to stop smoking. Nevertheless, even patients with low levels of engagement can benefit from this counseling,” the article concludes.

It’s a Big Fat Global Problem

It’s been well documented that Indiana has an obesity problem. It doesn’t diminish that challenge to know that we’re not alone.

According to a recent ABC News story, “almost a third of the world is now fat, and no country has been able to curb obesity rates in the last three decades.”

Researchers at the Institute for Health Metrics and Evaluation at the University of Washington reviewed more than 1,700 studies (that took place between 1980 and 2013) from 188 countries. A few findings:

  • Two billion people worldwide are overweight or obese
  • In the Middle East and North Africa, nearly 60% of men and 65% of women are heavy
  • About two in three adults in the United Kingdom are overweight, making it the fattest country in Western Europe

The research showed a link between income and obesity — as people obtain more money, their waistlines also expand.

As we’ve been telling you the last two-and-a-half years, the Indiana Chamber’s Indiana Vision 2025 plan has a goal — reduce obesity levels to less than 20% of the population — as part of its Attractive Business Climate driver. We’re focusing on workplace wellness this summer during our free Connect & Collaborate luncheons.

It’s a big, global challenge — one that each of us needs to try to tackle in our state by working together.

Chamber Analysis of Governor’s Request to Expand Healthy Indiana Plan

The Pence administration last week unveiled plans to request a waiver from the Centers for Medicare & Medicaid Services (CMS) to expand the Healthy Indiana Plan (HIP). This expansion of HIP would be in lieu of a traditional Medicaid expansion. The announcement had been anticipated for several weeks.

The Healthy Indiana Plan, or HIP 2.0 as it is now being referred to, will have three “pathways” to coverage: HIP Basic, HIP Plus and HIP Employer Benefit Link. It is funded through the existing cigarette tax, the hospital assessment fee and federal Medicaid funds.

The Basic HIP plan is for Hoosiers below 100% of the federal poverty level (FPL). Basic members use an entirely state funded power account (similar to a health savings account) to cover a $2,500 annual deductible. The HIP Plus plan is for Hoosiers under 138% of FPL. They will be required to make contributions that range from $3-$25 per month. Members of HIP Plus and the state will jointly fund the power account based on a sliding income scale. This plan also includes dental and vision coverage.The HIP Employer Benefit Link allows HIP eligible individuals to enroll in either HIP Plus or receive a defined contribution power account funded by the state to access an employer-sponsored program. The defined contribution must be used to pay for premiums, co-pays or deductibles.

The Indiana Chamber has supported the expansion of HIP as an alternative to a traditional Medicaid expansion. The HIP plan has encouraged individual responsibility by attempting to mirror consumer driven health plans. HIP also reimburses at 100% of Medicare (higher than Medicaid), which ensures more provider participation and reduces cost shifting to the private sector, a point that is important to employers. The Indiana Chamber believes that the HIP Employer Benefit Link option will be an interesting program to potentially provide coverage to Indiana’s working poor. The Indiana Chamber will be securing more details on how the program will be implemented and will provide our members that information as it is received.

On a related note, this $25 million budget savings to the state – if the HIP expansion is approved by CMS – could cause some problems for insurance carriers providing health insurance coverage to the individual market in the insurance exchange/marketplace. The state is transitioning from a (209b) state, with its own disability definition, to what is called a “1634” state. Under a 1634 state, the administration will accept disability definitions of the Social Security Administration. As a result of the switch, the state will no longer be required to maintain a spend-down program. This program allowed those with high medical expenses to become eligible for Medicaid after they spent a designated portion of their monthly income on medical expenses. As of December 2013, there were over 134,000 people in this spend-down program.

Of that spend-down population, nearly 7,500 have incomes over 100% of FPL. It is this population that will be transferred to the insurance exchange/marketplace to purchase qualified plans in the commercial market. Medicaid claims for those individuals have been over $1,800 per member per month. Total claims for March 2013 through March of 2014 were $134 million. That amount is significantly higher than under normal individual insurance plans.

Insurance carriers participating in the insurance exchange filed their rates in May of last year. Those rates included calculations for the high risk pool being transitioned into the exchange, but the 7,500 “1634” transition eligibles are not included in those rates. This has serious impacts on those carriers: Significant losses to those participating which will result in considerable increases in current rates to cover the cost; those carriers that waited and will be coming into the exchange in 2015 have an advantage over those current participants in that they are taking on none of this additional risk; and for the smaller carriers there is a concern whether they will be able to participate in the exchange in the future, thus potentially jeopardizing Hoosier choices.

The Indiana Chamber will continue to evaluate and comment on this issue as more information is available.

Moving Grandma: Resources for Loved Ones with Dementia, Alzheimer’s

Over the weekend, my family came together to begin the process of moving my grandmother to a long-term care facility.

She is in the middle stages of vascular dementia, caused by a series of mini-strokes that have cut off blood flow to parts of her brain over the years (with symptoms that aren’t all too different from Alzheimer’s).

We organized and boxed up treasures and junk, and years of papers, magazines, photos and clutter, getting her home ready to list on the market. Right now, we don’t have the luxury of time to sit around and read the notes that my mother wrote home from college in the ‘70s (though, I did skim it and laughed at how she sounded as a teen), or look through the photos of their early lives; we’ll get to that when things are more settled.

Now that we’re to this point, it’s begun to sink in that cognitive diseases are extremely hard to deal with for patients and caregivers. It will take a group effort from my grandmother’s family and friends to help her – and each other – through this emotional time.

I began looking online for resources to help us make informed decisions going forward. The Alzheimer’s Association has a lot of great information, a 24/7 helpline, programs for education and support, access to local support groups and online message boards. Most hospitals around have caregiver support groups, and there are several books available on the topics of caring for those with dementia. The National Institute on Aging also offers a wealth of knowledge about cognitive diseases.

One really interesting thing I’ve found is an online community for friends and family to sign up and see a shared calendar of activities, lists of medications, doctor contact information, a place to share announcements and more.

We are getting to the point that decisions about my grandmother’s future have to be made – typically without her input – which is hard for my parents, aunts and uncles: to make major life choices for the person that gave them life.

But, being prepared ahead of time with proven resources and a bit of organization will be one of the more important things that we are able to do for my grandmother. If you’re in a similar situation, I urge you to do some research and find these answers for your family as well.

What to Expect From Congress in an Election Year

The answer to the query in the headline is “not much,” but that is considered a vast improvement over recent years. Here is the analysis from Bo Harmon, vice president of political affairs for BIPAC.

There are a number of legislative items that members of both parties acknowledge need to be addressed. Implementation of Obamacare. Immigration reform. Tax code and entitlement reform. A long term solution to the debt ceiling crisis. Privacy security. Patent reform. Trade.

With all of these issues, the public increasingly frustrated with gridlock in Washington, and an election coming up where Congress will want to be able to talk about their accomplishments, we should expect to see some major legislative action in 2014, right? Wrong. Well, mostly wrong. There is actually a glimmer of hope that 2014 will produce more than 2013. Though, that’s a bit like saying “we scored zero points last game and expect to do better than that this time.”

The reason that Congress hasn’t accomplished much since 2010 is the same reason we don’t expect to see much more in 2014. With the House in the hands of Republicans and the Senate and White House controlled by Democrats, and each side increasingly responsive to the most ideological polarizing parts of their base, they disagree on how to proceed. Both sides understand the things that need to be addressed, but there is zero consensus on how to do it.

The Obamacare debate is a prime example. Not a single Republican in either chamber voted for original passage though many key features of the legislation were included in previous GOP health care reform bills. Once Republicans took the House in 2010, GOP leadership took the position that repeal of the legislation in total was the only option and have refused to offer or support tweaks or fixes to problems. The Republicans believe “it’s not possible to ‘fix’ something fundamentally incompatible with our ideology.” Politically, they also believe if the legislation fails they will benefit and thus have little political incentive to improve the law. From their perspective, it is BETTER politically to have as many things go wrong with ObamaCare as possible.

This same standoff occurs on issue after issue – taxes, immigration, entitlement reform, etc. But, it is a new year and in our optimistic resolutions, we see some possibility of federal action on a handful of bills. There was a small bright spot in December when a two-year budget compromise passed that would avoid the possibility of a shutdown and eliminated some of the most irrational sequester cuts. This rare bipartisan effort was criticized by many however as small ball for not addressing bigger, long term issues. Even still, it was the best that could be achieved in the current gridlock environment.

The environment is also different than it was in 2013. At that time, Democrats were emboldened by the President’s popularity and felt little need to compromise, believing they had received a mandate from the 2012 elections to do as they wanted. With the President’s approval ratings significantly lower now, the confidence to act as boldly is similarly evaporating. Conversely, Republicans spent 2013 in fear of retribution from the Tea Party. Now, Boehner in the House and McConnell in the Senate have openly broken ranks with the Tea Party and seem almost eager to act in ways that show consensus.   The budget deal and the changed political environment provide the foundation for some compromise legislation to take place on issues that need to be addressed. Small, incremental changes to a handful of issues is possible, likely driven by the middle. We may see some movement on immigration, trade, patent reform, etc; even if more contentious things like tax reform remain unlikely.

While many would like to see more comprehensive solutions and small, incremental changes to immigration or Obamacare implementation may not be at the top of your industry agenda, we are dealing with a situation where NOTHING has been getting done and we need to make an effort to support and reward even baby steps at basic government functionality. Only then will members of Congress have the political courage to attempt larger, more comprehensive changes and take a look at issues that are at the forefront of your industry agenda. It is a shame that we have reached this point where expectations for our Congressional “leaders” is so low but they have demonstrated over the last three years that nothing else can be expected from divided government driven by ideological extremes.

 

Chamber’s Top Legislative Priorities in 2014

Eliminating business personal property tax, allowing employers to screen prospective hires for tobacco use and establishing a work share program are among the top legislative priorities for the Indiana Chamber of Commerce in 2014.

“In many categories of commercial and industrial property tax, Indiana is among the very highest states in the country. That’s largely due to our taxing of machinery and equipment. It’s a remaining black mark on our tax climate – an area where we simply can’t compete,” declares Indiana Chamber President and CEO Kevin Brinegar.

“All of our surrounding states have done away with the tax except for Kentucky, which taxes personal property at a lower rate than Indiana. It’s past time to remove this burden that can greatly hinder business expansion and innovation.”

On the health care front, the Indiana Chamber is seeking to repeal what is termed the smokers’ bill of rights for prospective employees.

“This is an intrusion into the rights of employers in making hiring decisions. Holding smoking up to the same standards as we hold discrimination based upon race, gender, religion and ethnicity seems arbitrary and without justification,” Brinegar offers.

“There are other behaviors (such as substance abuse and having a criminal record) which are also personal choice and over which employers do have discretion in hiring decisions; this reinforces that the state’s protection for smokers is unnecessary and not well founded.”

One policy the Indiana Chamber believes would benefit employers, employees and the state is a work sharing initiative that would allow employers to maintain skilled, stable workforces during temporary economic downturns.

“Employers would be able to reduce hours without layoffs and provide unemployment compensation to partially compensate workers for their lost hours. Then when circumstances improve, employees could return to full-time work status for the company,” Brinegar explains.

“What’s more, a federal grant is available for three years to pay for the cost of the program. It’s a positive scenario for all parties.”

When it comes to K-12 education, Brinegar says the Indiana Chamber will continue to push for the absolute best academic standards for the state.

“That’s the bottom line. We need to improve student learning, meet the essential college- and career-ready requirement and have an appropriate student assessment system. Those elements all currently exist within the Common Core State Standards program, which we continue to fully support.”

Below are the Indiana Chamber’s top legislative priorities. The complete list is also available on the Indiana Chamber web site (www.indianachamber.com).

CIVIL JUSTICE
Support regulating the practice of lawsuit lending, in which a third party provides a plaintiff a cash advance loan while the legal case is pending. In turn, a plaintiff agrees to repay the advance (which is usually at a high interest rate) from the lawsuit proceeds. This practice complicates the legal process by forcing more cases to go to trial because the plaintiffs can’t afford to settle due to their repayment agreement with the lender. In turn, this causes more and more Indiana businesses to pay expensive legal fees. This lending practice is legal in most states, but regulation and transparency do not exist in Indiana.

ECONOMIC DEVELOPMENT
Support a voluntary vehicles miles travelled (VMT) pilot program as a potential replacement for existing fuel taxes. With Indiana’s already insufficient fuel tax revenues for roads/transportation trending down and more fuel efficient and electric/hybrid vehicles on the roads, a new funding mechanism for road maintenance needs to be found. Owners of alternative-fuel vehicles, including electrical vehicles, should pay for the roads they use just like other drivers. Voluntary VMT pilots in other states are currently taking place and Indiana cannot afford to ignore this potential road funding alternative.

Support expanding the patent-derived income tax exemption to the pre-patent phase. This incentive change would allow innovative, high-tech businesses that typically pay high wages to qualify during the earlier patent-pending phase of the (often long) patent application process, thus carrying forward any credit. Many emerging businesses would find this helpful in capitalizing their start-ups and expanding hiring. (Current law states you must have had a patent issued by the federal government before you can apply for the exemption.)

EDUCATION
Support maintaining high-achieving academic standards, such as the Common Core, and allowing the State Board of Education (SBOE) to determine student assessments. Indiana needs standards that improve student learning and meet the college- and career-ready requirement. The testing component of the standards can best be determined by the SBOE.
Support a framework for the future development of publicly-funded preschool initiatives for low-income families. There is critical need for improved preschool opportunities, especially for low-income children whose families may not have the means to provide a high-quality preschool experience or to provide needed learning opportunities in the home. The Indiana Chamber supports publicly-funded preschool programs that are: focused on those families in greatest need, limited to initiatives that maintain parental choice, focused on concrete learning outcomes and integrated with reforms at the elementary school level that will maintain and build upon the gains.

ENERGY/ENVIRONMENT
Support a water policy to stabilize our economic future and effectively compete with other states. A policy/plan is needed in order for the state to effectively manage its significant water resources, as well as to ensure delivery of an adequate, reliable and affordable supply of water.

HEALTH CARE
Support repealing the smokers’ bill of rights for prospective employees from the Indiana Code. The Indiana Chamber believes that all employers should have the right to choose whether or not to screen and/or hire prospective employees who use tobacco products. Since employers are footing most of the bill for health care costs for their employees, they should be able to have some discretion in determining whether new employees use tobacco products or not.

Support reinstating the wellness tax credit. The Indiana Chamber supports this incentive to start a wellness program, which can increase attendance, boost morale and productivity, as well as positively impact health care coverage costs.

LABOR RELATIONS
Support a work sharing program that will allow employers to maintain a skilled stable workforce during temporary downturns. Employers then could reduce hours without layoffs, enabling workers to keep their jobs – which hopefully could be returned to full-time status once economic circumstances improve. Also part of the equation: Unemployment compensation to partially compensate workers for their lost hours.

LOCAL GOVERNMENT    
Support common sense simplification and reforms to local government structures and practices. Creating the option for counties to have a single county commissioner and county councils with legislative and fiscal responsibilities is one that several Indiana counties desire. There should be incentives to reward local government efficiencies and performance in the delivery of services to taxpayers.

TAXATION
Support legislation to reduce the dependence on the taxation of business machinery and equipment. This tax discourages capital investment, places a disproportionate property tax burden on businesses and puts Indiana at a competitive disadvantage with surrounding states that have eliminated it or are moving to do so.

Indiana Medical Device Leaders Wary of Taxes from ACA

Gabrielle Karol of FoxBusiness.com reports on the looming taxes and fallout from the Affordable Care Act that could give some of Indiana's medical device makers big headaches. The Chamber and other business organizations continue to fight this.

In Warsaw, Indiana, known as the “Orthopedic Capital of the World,” the CEOs of medical-device companies are none too pleased with the medical-device tax imposed by ObamaCare.

In this edition of Conference Room, Iconacy CEO Tom Allen and OrthoPediatrics CEO Mark Throdahl tell FBN’s Jeff Flock that the 2.3% excise tax will have a major impact on their businesses.

“This is a tax on sales. We have no profits to pay it from, so the only way to stump up the money to pay a tax of this size is by cutting programs,” says Throdahl, whose company makes orthopedic products for children with fractures or leg or spine deformities.

Throdahl says the tax will prevent his company from growing.

“All of the engineers who surround me – their payroll is equivalent to the tax we’re now paying Washington. So we could double the size of our technical staff were it not for the medical-device tax,” says Throdahl. While Allen’s company is still in the launch phase, so the tax hasn’t yet had a major effect, he says it has hindered his ability to add staff as well.

Given that Warsaw is known for its medical-device companies, the tax could also have a profound effect on both the community and the state of Indiana.

“There are estimates that over 40,000 jobs will be impacted in the medical technology industry by the medical-device tax,” says Throdahl.

Indiana Economic Development Corp. president Eric Doden says the tax is particularly disappointing to the community given the strides made to reduce the tax burden paid by these companies.

“In Indiana, we have had a history of entrepreneurship particularly in this arena. And these are high paying jobs and the thing that sort of disappointed us as a state is that Governor Pence and the State House [have] done an incredible job of lowering taxes and trying to create a better environment for these businesses to start to grow,” says Doden. 

Chamber Members: New ACA Helpline can Help Alleviate Your Health Care Stress

Concern over the Affordable Care Act (ACA) — from its complexity to actual implementation — is something we continue to hear a lot about from the business community. To better assist with those inquiries, we are pleased to introduce a new service exclusively for Indiana Chamber members.

The Indiana Chamber's ACA Helpline is now here to help your organization navigate through the complicated health care reform processes and obligations. This FREE service is similar to the popular HR Helpline; we encourage employers of ALL sizes to use this member benefit.

Mike Ripley, Chamber vice president of health care policy, will be answering your questions. He is a former insurance agency owner and was chairman of the House Insurance Committee as a state representative.

Ripley says while employers are faced with a more reasonable timeline overall due to the employer mandate being delayed until January 2015, there is still plenty that needs to be taken care of between now and then. Virtually all the rest of the employer responsibilities and various levels of compliance remain the same — as other ACA provisions were unchanged.

Among the common questions from employers:

  • Who is considered a full-time employee?
  • What if we offer coverage but our employees don't take it?
  • What is the employer shared responsibility payment?
  • Do we have to provide notice to our employees?
  • How do we know if our coverage is affordable/provides minimum value?
  • Will our company qualify for small business tax credits?

Make your own list of issues and start using the Chamber's ACA Helpline today! Call Mike Ripley at (317) 264-6883 or send an email to mripley@indianachamber.com.

Indiana’s New Medical School Opens

Tried to get in to see your primary care physician lately? It’s possible you’ve found it harder and harder to get a quick turnaround time on an appointment, unless it was scheduled months in advance.

There’s a likely reason for that: a shortage of primary care physicians, plus more patients in the system, equals less time for you to see your doctor. (That’s not to mention what will happen when the full brunt of the Affordable Care Act begins in 2014, forcing huge numbers of new patients to vie for attention from a dwindling number of physicians.)

In 2011, I wrote a story for BizVoice® magazine about Marian University opening the first college of osteopathic medicine in the state – and the first new medical school to open here in more than a century.

The Marian University College of Osteopathic Medicine will open next week and will produce about 150 graduates per year, according to a press release from the school.

While writing that story I found some sobering facts about our looming doctor shortage:

“The American Association of Colleges of Osteopathic Medicine is predicting a shortage of more than 150,000 doctors by 2025 (nationwide).

“Indiana’s statistics are staggering: The state is short 5,000 physicians. By 2020, Indiana will need 2,000 more primary care physicians. Of 92 counties, 57 are medically underserved. The mental health provider shortage is 38%, while the deficiency in primary health care physicians is 30%”

So you can see we have a dire need for more physicians.

Do you know the difference between an osteopathic college and a college of medicine? Here’s a quick run-down of the differences:

  • Doctors who graduate from an osteopathic college earn a DO degree; those who graduate from a college of medicine earn an MD degree
  • DO’s and MD’s are in the same medical board; qualifications are essentially the same
  • It mainly comes down to philosophy. When I spoke to the college’s dean, Dr. Paul Evans, in 2011, he said this about the difference: “The philosophy of osteopathic medicine stresses looking at the patient as a whole and the wellness and prevention aspects of medical care. The bottom line (for both) is to treat the patient”
  • Students in both types of school earn a four-year degree and then begin three to seven years of postdoctoral medical education, residencies and fellowships
  • Osteopathic medicine traditionally graduates more primary care physicians

After that story, I sought out a DO for my primary care physician and am quite happy with the results. Cheers to the new school of osteopathic medicine!