Letter: Federal Health Insurance Tax Harmful to Employers

The federal Health Insurance Tax is an aspect of the Affordable Care Act that poses a threat to businesses across the country. The following letter of concern from Caryl Auslander, the Indiana Chamber’s vice president of federal affairs, was sent to Sen. Joe Donnelly and explains the Chamber’s position on the issue.

Senator Donnelly,

As Hoosiers, we are proud that our state has shown strong and sustained economic growth ever since the nationwide recession in 2009. It is our concern that the Federal government is hurting, rather than helping, by enacting policies that harm the employer community, specifically small businesses. In particular, we are deeply concerned by the Health Insurance Tax (or “HIT”) that is embedded in the Affordable Care Act.

This provision ensures that those individuals and businesses that have to turn to private insurance companies for coverage are stuck with a disproportionate share of the costs of the ACA. While the original intent of the HIT was supposed to be paid by the insurance companies, in reality the companies really act only as tax-collecting proxies for the Federal government.

When a consumer cannot avoid purchasing a good or service, they have little or no power to resist price increases imposed by suppliers. And when all of the suppliers are charged the same tax, they all have the same incentive to pass it along to their consumers. Thus the HIT forms a hidden tax on health insurance consumers: The families and small businesses who can’t afford to self-insure.

By some estimates, the HIT will cost more than $500 per family every year. A tax burden like that can place real hardship on a middle-class family, push poor families straight into insolvency, and keep small businesses from being able to hire new workers, reinvest in their company or provide other services to consumers. In a small firm with 80 employees, the hidden HIT alone could cost more than $40,000 a year — well over the state’s per-capita income.

The HIT is a hidden and regressive tax, and bipartisan agreement has been enough thus far to delay its full implementation. But middle-class Hoosiers and small business owners here cannot afford the continued uncertainty. On behalf of 24,000 Chamber members and customers across the state of Indiana, it is our request that you place the permanent elimination of the Health Insurance Tax at the top of your agenda. Its unconditional repeal would be a victory for transparency, good government, and economic opportunity for all.

Thank you for your leadership on this issue and for defending the people of Indiana.

Sincerely,

Caryl Auslander
Vice President, Federal Affairs

Telemedicine Movement Moving Forward in Indiana

Virtual doctor measures blood pressure

Our friends at Gibson Insurance posted a blog today about the advancement of telemedicine in Indiana. They also included comments from Indiana Chamber VP Mike Ripley:

Prior to March 21, 2016, Indiana was one of just a handful of states that had not legislatively addressed the subject of telemedicine. Meanwhile Illinois and Ohio currently have proposed telemedicine parity bills but nothing set in stone – and Wisconsin has no parity legislative activity at this time. Michigan’s laws went into effect in 2012 and Kentucky was well ahead of the game with legislation in 2000, but the first state to address telemedicine by law was actually Louisiana in 1995. 21 years ago?! Why was Indiana so late to answer the call?…

WHAT SHOULD INDIANA EMPLOYERS KNOW?
According to Mike Ripley, the Vice President of Health Care and Employment Law Policy at the Indiana Chamber of Commerce, it was surprising the law was not passed sooner, as it had many supporters. Ripley explained that insurance carriers, employers, and health care providers were ready to embrace telemedicine technology, yet the stakeholders could not agree on exactly how it should work in the Hoosier state.
The competing interests that delayed the law were ultimately united when the stakeholders agreed that the standard of care for a virtual visit would have to be the same as the standard of care for an in-person visit. Once all parties were able to rally around this central concept, the bill passed swiftly through the legislature. The standards of care at the heart of the bill are yet to be clearly defined in terms of telemedicine, but you may read the specific language of Indiana’s House Bill 1263 to gain a better understanding of the law.
Although the issues around the standards of care continue to develop, the law clearly states a phone call is insufficient to satisfy the standard of care. We anticipate technology such as video chatting and Skype will be used to effectuate the provision of care by telemedicine. The law also addresses the types of maladies that may (and may not) be treated through telemedicine. In Mr. Ripley’s words, one easy way to remember what is fair game under the bill is “anything ending with ‘-itis’ – is permissible to treat via telemedicine.” The law prohibits narcotic prescribing and psychiatric services through telemedicine.

Furthermore, see our recent blog about the importance of telemedicine, and its potential impact on many quality of life factors.

Telemedicine a Potentially Healthy Benefit of Broadband Access

Virtual doctor measures blood pressure

For the upcoming July/August edition of BizVoice, I spoke with Smithville Fiber Executive Vice President Cullen McCarty about developments in broadband — both in Indiana and around the globe.

One aspect he mentioned was the significant impact on health broadband access could play for Americans living in rural areas as telemedicine capabilities increase.

“The importance is having the ability to stay at home and talk with your doctor from there, whether it’s through FaceTime or some type of interactive technology,” McCarty says. “You can have a doctor’s visit without a stethoscope. You can take blood pressure over a device and have that information shot back to the doctor.”

Fitbits and Apple Watches may also be able to transfer diagnostics to doctors as well, he adds, noting aging Hoosiers will need to take advantage of all avenues to increase medical efficiency.

“In Southern Indiana, a lot of hospitals and clinics are a far drive for some in rural areas, like Orange and Greene Counties,” McCarty offers. “It takes a lot of gas and money, so I think that’s where telemedicine will take off. Plus, you have specialists who read X-rays. An example we were given several years ago is that there are people in other parts of the country and the world who read X-rays, and they send it back to the doctor.”

He relays an example of someone getting an X-ray in Bloomington and having it sent to a radiologist who lives on a golf course in Texas.

“There are many different applications for telemedicine,” McCarty points out. “I think it’s a big driver in getting broadband into people’s homes who don’t see the value yet.”

Health Care to be Focus of Connect & Collaborate Events in 2016 (Coming to a City Near You!)

97867199Six years after the Affordable Care Act became law, employers and employees continue to be impacted, and sometimes confused, by its various rules and regulations. You can learn about new tools to answer your questions and benefit your organization as part of the 2016 Connect & Collaborate series.

The events – presented by the Indiana Chamber in partnership with Anthem Blue Cross and Blue Shield and free for Chamber members – will take place in 11 cities across the state. In addition to breakfast or lunch and networking with business leaders from your area, the health care emphasis will include these three important benefits:

  1. Advocacy: The Chamber’s longstanding role in seeking implementation of the best possible public policies at both the state and federal levels
  2. Education: Conferences, publications, the affiliated Wellness Council of Indiana and additional member services to assist companies and their workers
  3. Navigation: New options being made available this year, in conjunction with Anthem and additional partners, to help you produce cost savings while best meeting your employee needs. These products are structured for organizations of all types and sizes

Past Connect & Collaborate series have focused on workforce development, workplace wellness and energy saving guidance. Chamber Communications VP Tom Schuman, Director of Membership Brock Hesler and Anthem representatives will be featured presenters at each event.

The series begins May 4 in Carmel and concludes June 21 in Fort Wayne. Additional stops are Terre Haute, Richmond, Anderson, Lafayette, Bloomington, Evansville, Gary, Winona Lake and Elkhart. Pre-registration is required for the 90-minute programs.

Full lineup and registration. If you have additional questions, contact Nick Luchtefeld (nluchtefeld@indianachamber.com) at (317) 264-6898.

Telemedicine a Major Health Issue in 2016 Session

16358656House Bill 1263 (Telemedicine), authored by Rep. Cindy Kirchhofer (R-Indianapolis), was enthusiastically supported by the Indiana Chamber during the 2016 Indiana legislative session. Numerous organizations supported the concept and not one opposed; the Indiana State Medical Association remained neutral. The bill allows physicians, physician assistants, advanced practice nurses that have authority to prescribe drugs and optometrists to prescribe medicine to a patient via telemedicine services.

While everyone supported the concept, getting everyone to agree on the final version was a rocky process. Concerns ranged from existing patient/provider relationships, out of state providers, hospital relationships to standards of care and jurisdiction for medical malpractice. But by the end, the conference committee report had only one vote against in both houses.

Senate Bill 165 (Healthy Indiana Plan or HIP), authored by Sen. Patricia Miller (R-Indianapolis), is the Governor’s measure to repeal the former HIP plan and codify into statute the current HIP 2.0. The Pence administration believes that codifying the current plan strengthens its position with the Centers for Medicare and Medicaid Services for when the new 1115 Medicaid waiver is negotiated.

Opponents believe that codifying the existing plan leaves no room for flexibility. Chiropractic services under the HIP 2.0 plan were added in the House on second reading but removed in conference committee. The bill passed both houses, mostly along party lines with a few exceptions. The Chamber has been supportive of the core principles of HIP and HIP 2.0, offering an alternative to the Medicaid system by providing a power account (similar to an HSA) which encourages individual responsibility in a participant’s medical decisions.

 

Pseudoephedrine and Pharmacists

statehouse picEphedrine, pseudoephedrine and meth received a lot of discussion during session, especially when House Speaker Brian Bosma (R-Indianapolis) came out in November and said that something needed to be done about the state’s meth problem. The Chamber supported HB 1157/SB 161, which included putting individuals with drug-related felonies on the National Precursor Log Exchange (NPLEx) and thus would trigger a stop-sale alert; both bills passed. The Chamber has historically been opposed to making ephedrine products prescription only because of the inconvenience to consumers that need these products and the impacts on businesses that supply them; HB 1390 in its original form would have done that.

During the last week of session, the Chamber provided a written letter to the General Assembly on the conference committee report for SB 80 that was voted on in the House. The letter stated that the conference committee language prohibited consumers from
accessing multi-ingredient, time-released allergy products, such as Claritan-D, Allegra-D, Zyrtec-D and Mucinex-D – the most effective products for consumers suffering from allergies. The multi-use products are less likely to be used in meth than the single-ingredient products referenced in the conference committee report. The letter also suggested how to fix the problem.

Representative Ben Smaltz (R-Auburn) was the House sponsor and although he did not make the changes necessary to fix the conference committee report of SB 80, he did agree that the House-passed third reading version of SB 80 should be concurred upon in the Senate.That essentially amounted to the same thing as the fix and addressed the concerns the Chamber had.

The Indiana Chamber joined CVS, the Consumer Healthcare Products Association, the Indiana Pharmacists Alliance, the Indiana Retail Council, Bayer and Johnson & Johnson in penning a letter to encourage the Senate to concur on the House-passed version of SB 80 because it allowed legitimate cold and allergy sufferers the medicine they need while dramatically reducing sales of pseudephedrine to meth cooks and those they hire to purchase the drugs. Senate Bill 80 allows individuals who have a relationship with a pharmacist to purchase ephedrine and pseudoephedrine products.

It also allows the pharmacist to sell lesser amounts of ephedrine and pseudoephedrine products if there is no relationship. The House version was what ultimately became law.

Internship Gets IUPUI Senior International Experience in Dentistry

Nicole-Quint-graphic

Nicole Quint is a senior at IUPUI studying chemistry. She plans to apply to dental school this summer. This post originally appeared on the Indiana INTERNnet blog.

quint pic tallIndiana INTERNnet: How did your mission trip to Panama solidify your interest in becoming a dentist?

Nicole Quint: When I went to Panama last August, I was able to see how challenging and rewarding the profession of dentistry can be. Not only did I recognize the joy in the eyes of community members after they had their painful teeth removed, but I was able to see the strong impact a dentist has on the community. People may think that dentistry is a silly profession, but when you have witnessed a person that is completely malnourished because their teeth are giving them so much pain they are unable to eat, it is thought otherwise. I have seen the good, bad and ugly side of dentistry, and I still can’t wait to enter dental school and become a strong leader in the community.

IIN: What has your research focused on in the IUPUI Life-Health Sciences Internship?

NQ: My research consisted of analyzing oral bacterial that are known to create cavities called Streptococcus mutans. I treated the bacteria with various dilutions of nicotine and then analyzed the results. The hypothesis of my research was: those who smoke increase their chance of containing a higher amount of oral bacteria, causing an increase in the amount of cavities and leaving the patient with a higher chance of the serious heart disease known as atherosclerosis. All because oral bacteria have the opportunity to thrive in nicotine, then make their way into the blood system, and bind to the walls of arteries potentially reducing blood flow to the heart. Overall my research has taught me that it is just as important to have good oral hygiene as it is to maintain a healthy lifestyle.

quint pic2

IIN: You frequently presented your work, even at IUPUI Research Day and at the annual meeting of the Indiana Branch of the American Society for Microbiology. How were those experiences?

NQ: While presenting my research at both events, I had multiple people come up to me who were interested in my research. I was able to share with them the importance of good oral hygiene. It was my first time ever presenting my research when I attended the Indiana Branch of the American Society for Microbiology annual research conference, so I was quite nervous. However, I was able to prove to myself that I was confident in my work by proudly presenting my research again at the IUPUI Research Day.

IIN: You’ve completed more than 100 hours of community service during your undergrad at IUPUI. Why is community service so important to you?

NQ: One of the main reasons I like to donate my time is because it has such a strong value to the community. I also find joy in seeing what an impact I have made around the community. For example, when I volunteered with Keep Indianapolis Beautiful, I spent five hours one day cleaning up the streets. I had a lady come up that thanked me because she no longer had to worry about her children cutting their hands on broken glass that was in the streets. It’s small moments like that one that encourage me to continue to volunteer.

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A More Effective War On Meth

EDITOR’S NOTE: Indiana legislators are currently negotiating a compromise on efforts to limit methamphetamine production through controls on pseudoephedrine and ephedrine purchases. The following opinion is submitted by Alex Brill, a fellow at the American Enterprise Institute and former chief economist for the U.S. House Committee on Ways and Means.

Communities across the country are being torn apart by methamphetamine (meth) abuse and addiction, and local legislators are taking notice, especially in Indiana.

Demand for meth remains high, and meth produced in Mexico has replaced domestic supply. In 2016, many state lawmakers are again considering legislation to address the meth problem but unfortunately are focusing on a recurring misguided solution: requiring a prescription for medications that contain pseudoephedrine (PSE), an ingredient in some cold and allergy medicines that is used in domestic meth production.

In Indiana, lawmakers are considering legislation that would require at least a pharmacy consultation before an individual could purchase a PSE-based medicine. For anyone who does not have a relationship with the pharmacist, a prescription could also be required. This type of policy would unduly burden law-abiding cold and allergy sufferers and would do nothing to address either the growing supply of meth from Mexico or the underlying causes of addiction.

As I noted in a recent study, requiring a prescription for PSE-based medicines would impose significant costs on consumers, private insurers, and state and federal government. According to Avalere Health, a national prescription-only policy would result in an estimated 1.2 million new doctor visits per year, including over 25,000 in Indiana alone. If such a policy were imposed nationwide, consumer out-of-pocket costs would jump $42.7 million, private insurer costs would spike $56 million, and Medicare and Medicaid would pay $19.5 million more. On top of this would be the indirect costs imposed on the millions of consumers who would be forced to take time off from work or school to visit a doctor for a prescription. For those who are unable to do so, their colds and allergies may go untreated, as a PSE-based medicine is the only oral decongestant that works for some people.

There is another option for states, like Indiana, that face immediate pressure to reduce domestic meth supply: the National Precursor Log Exchange (NPLEx), which allows law enforcement to electronically track the purchase of medicines that contain PSE in real time (making it easier for them to identify potential criminal activity and intervene at the point of sale), and drug-offender block lists that ban those convicted of drug-related criminal offenses from purchasing these medicines.

Alabama and Oklahoma have both introduced NPLEx coupled with a drug offender block list and have seen 77 and 88 percent declines, respectively, in meth lab seizures. In addition, state policymakers should support federal efforts to increase drug interdiction at the U.S.-Mexico border to address the meth supply coming over the border.

More must be done to address the meth problem, but the tools being used must be shown to be effective. My recent study draws a clear conclusion: lawmakers should reject the costly, burdensome, and ineffective strategy of requiring prescriptions or a pharmacy consult for PSE-based medicines. Instead, our leaders should work to reduce the supply of illicit drugs from Mexico and curb the demand by those in our country suffering from addiction.

‘Lawsuit Lending’ and Asbestos Litigation Bills Expected

statehouse-picLast month the Indiana Chamber reported that a Colorado Supreme Court decision determined that “lawsuit lending” is a loan and will be regulated under the Uniform Consumer Credit Code (UCCC) in Colorado – and that it could impact what happens in the Indiana General Assembly. (Lawsuit lending is the practice of advancing money to a plaintiff/someone involved in an accident in anticipation of winning a lawsuit in court. If the plaintiff is awarded a settlement, the advance must be repaid at considerably high interest rates. If the plaintiff loses the suit, there is no obligation to repay the loan.)

Representative Matt Lehman (R-Berne), recently elected the House GOP Floor Leader, has indicated that he indeed will be filing his annual lawsuit lending bill – though it will look different. Previously the measure was titled Civil Proceeding Advance Payment Transaction (CPAP), which was defined as a nonrecourse transaction in which a person (CPAP provider) provides to a consumer claimant in a civil proceeding a funded amount. However, this year’s version will mirror the language in Colorado. The 2015 language specifically stated that the UCCC does not apply to a CPAP transaction; but his year’s bill (although not yet filed) will place the transaction under the UCCC.

Separately, Rep Tom Washburne (R-Evansville) will be filing a bill regarding asbestos litigation. It’s expected to require a plaintiff who files a personal injury action involving an asbestos claim to provide information to all parties in the action regarding each asbestos claim the plaintiff has filed or anticipates to file against an asbestos trust. The bill’s intent is to provide transparency to asbestos litigation and to discourage a plaintiff from being able to file an asbestos suit against an employer and also file a claim to an asbestos trust.

Insurance Claims on Interim Agenda

The Interim Public Health, Behavioral Health and Human Services Committee conducted its final hearing in late October. The only topic of debate was the preliminary draft language that was offered by the chair, Sen. Patricia Miller (R-Indianapolis). The committee also prepared its final report for the Indiana General Assembly.

Senator Miller’s proposal addressed problems that she believes are occurring related to the handling and denial of health insurance claims. Her proposal would require the Department of Insurance to post on its web site information concerning internal and external grievance procedures for health insurance contracts. Examples include the process that a consumer should follow in filing a grievance along with a contact phone number of the department for the consumer. These provisions were generally accepted as reasonable provisions of the draft.

Controversy arose over the quarterly requirements that will be imposed on insurers regarding the denial of claims and additional burdens placed on them. The Indiana Department of Insurance testified that there really isn’t a problem regarding health claim denial in Indiana and while there have been problems among property and casualty insurers, that has not been the case with health insurers. Further testimony reflected that the department has the ability to do market conducts (on the distribution and sale of insurance), which determine problems with carriers.

Furthermore, the department conducts financial audits once every five years on every Indiana domestic insurer to make certain of insurer solvency and the ability to pay claims. Representative Matt Lehman (R-Berne) commented that the claim problem was .0004 of one percent – implying that there really isn’t any need to impose further requirements. The language passed the committee, with Sen. Jean Breaux (D-Indianapolis) and Rep. Lehman voting against the draft.

Look for Sen. Miller to draft legislation in the 2016 session similar to the language proposed in the draft. A bill may even move through the Senate, but may find more difficulty getting traction in its current form in the House. Still, there will be a fairly good chance that the grievance procedures and the web site information will find their way through the legislative process. The Chamber will be involved in the debate during the upcoming legislative session.