Health Care Takes Federal Spotlight

Since the passage of the Affordable Care Act, there have been calls from the Republican Party to repeal the federal health care law. There were many votes in the House to try to accomplish that goal, but efforts stalled after that. The results of the November election, however, have put the issue on the fast track.

This week, the American Health Care Act was introduced in the House of Representatives; it’s a House Republican leadership-led plan that would repeal and replace the Affordable Care Act and is said to contain patient-centered reforms that drive down costs and expand access to care. More information can be found online.

The legislation has received mixed reactions from both sides of the aisle in the Indiana delegation. And overall, more mixed reaction – especially more from Republicans – has been prevalent in the Senate.

Representatives Larry Bucshon (IN-08) and Susan Brooks (IN-05) participated in the 27-hour hearing by the Energy and Commerce Committee on the new legislation. This markup phase lasted from Wednesday morning to Thursday afternoon before it was finally approved for advancement 31-23. During and since that marathon, Bucshon and Brooks have taken to social media to offer their support for the American Health Care Act. Here
are two updates they provided:

Brooks subsequently also stated: “The goals of the American Health Care Act are to provide states with more flexibility, lower health care costs for families and offer people more options when it comes to their health care decisions. Our plan protects coverage for people with pre-existing conditions, allows kids to stay on their parents’ insurance plans until the age of 26, continues to protect seniors from the high costs of prescription drugs caused by the Medicare Part D donut hole and bans lifetime caps to ensure that people will never have a limit imposed on their care.”

Meanwhile, Rep. Jim Banks (IN-03) offered: “While the replacement plan contains positive reforms like a permanent repeal of the medical device tax and repeal of the individual mandate, I have concerns about several aspects of the bill. These include the overall cost of the plan, the length of time it takes to repeal many Obamacare taxes, the possible creation of a new entitlement program and whether essential pro-life protections will be maintained. I will carefully study this legislation and evaluate how these concerns are addressed as this bill moves through the legislative process.”

Banks further stated that he supported two amendments to the replacement bill supported by the Republican Study Committee (of which he is a member) that he thinks would improve the underlying bill: one would freeze new enrollment in Medicaid expansion at the end of this year; the other would institute work requirements for able-bodied, childless adults on Medicaid.

On the Senate side, Indiana Republican Todd Young took to Twitter to give his quick thoughts on the new proposal: “Americans will have weeks to see what’s in the GOP health care plan before the Senate votes on it. (We) will not repeat mistakes of 2009. Feedback from both D’s & R’s alike will be welcome. We need input from all sides to fix the Obamacare mess.”

In an interview with WANE-TV in Fort Wayne, his counterpart – Democratic Sen. Joe Donnelley – implored Congress to not rush to pass a new law, but instead to work on a bipartisan effort to install some commonsense measures in the existing health care law that would be more beneficial to Hoosiers. Watch the full video interview.

Questions About Open Enrollment? The Indiana Chamber has Answers

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Open enrollment for health care insurance is now upon us, and many businesses are faced with difficult choices for 2017. Premiums are expected to increase sharply under the Affordable Care Act (ACA) according to many experts – the Department of Insurance says some in Indiana have seen premiums go up by almost 70%!

The Indiana Marketplace (Indiana’s federally mandated online health care insurance exchange) has not been the answer many were hoping for. And don’t forget about the penalty for businesses choosing not to offer insurance to their employees – a penalty that will be adjusted each year to account for inflation.

The Indiana Chamber of Commerce has been working since 2004 to provide members with reasonable health care insurance options supported by brands you trust. In 2016 and beyond, we’re excited to offer a new program called ChamberCare Solutions, with a larger portfolio of health plan options.

This partnership between the Indiana Chamber and Anthem Blue Cross and Blue Shield can help you find the coverage that is right for your business. We are committed to coverage that is simple to understand and affordable. All plans comply with the ACA.

ChamberCare Business Resources: A professional employer organization (PEO) administered by Human Capital Concepts (HCC). Why a PEO? PEOs allow employers to outsource their HR functions and employee benefits programs to ensure they’re in compliance with HR laws and the ACA. By outsourcing to a PEO, you can focus on what you do best — running your business. According to the National Association of Professional Employer Organizations, businesses that use a PEO grow 7% to 9% faster, enjoy 23% to 32% lower employee turnover and are over 50% less likely to go out of business.

ChamberCare Savings: An excellent choice for companies with 51-99 employees, with 5% savings on any Anthem plan.

ChamberCare Exchange: Access to flexible, affordable health plans for companies with 2-50 employees.

Which solution is right for you and your employees? Contact your insurance broker today or call/email Brett Hulse, Indiana Chamber, at (317) 264-6858 or BHulse@indianachamber.com.

Telemedicine Law Now Officially in Place

Virtual doctor measures blood pressure

The new telemedicine law went into effect July 1. The legislation (House Enrolled Act 1263), authored by Rep. Cindy Kirchhofer (R-Indianapolis), was enthusiastically supported by the Indiana Chamber because it increases access to care and potentially could reduce costs. Prior to the bill’s passage, Indiana was one of only four states that had not adopted telemedicine legislation.

Telemedicine is defined as the delivery of health care services using electronic communication and information technology, including: secure videoconferencing; interactive audio – using store and forward technology; or remote patient monitoring technology between a provider in one location and a patient in another location. Physicians, physician assistants who have authority to prescribe, licensed advanced practice nurses who have authority to prescribe and optometrists are all authorized to utilize telemedicine.

To provide the telemedicine service, a provider must have established a patient-provider relationship. In that patient-provider relationship, the provider, at a minimum, must obtain the patient’s name and contact info and location; disclose the provider’s name and title; obtain informed consent; obtain the patient’s medical history and other information to establish a diagnosis; discuss that diagnosis with the patient along with the evidence for and risks and benefits of various treatment options including when it is advisable to seek in-person care. The provider must also create and maintain a medical record for the patient and notify the patient’s primary care physician; issue proper instructions for appropriate and follow-up care and provide a telemedicine visit summary to the patient, including any prescriptions.

The law allows for a provider to issue a prescription through telemedicine even if the patient has not seen the provider in person previously as long as: the provider has satisfied the applicable standard of care in treating the patient; the issuance of a prescription is within the provider’s scope of practice; and the prescription is neither a controlled substance nor an abortion-inducing drug. At this time, the law prohibits ophthalmic devices such as glasses, contact lenses or low-vision devices.

An out-of-state provider may conduct telemedicine business in Indiana but must certify to the Indiana Professional Licensing Agency that it agrees to be subjected to the jurisdiction of the courts of law of Indiana and all substantive and procedural laws concerning a claim against the provider.

There was concern during session about liability in providing telemedicine services. Therefore, the General Assembly included a provision that if a provider provides telemedicine services then that provider would be held to the same standards of care as if the health service was provided in an in-person setting.

Regarding the aforementioned prohibition against providing eye glasses and contact lenses, the Indiana Chamber has recently been in discussion with a company that would like to have that provision changed during the next legislative session. This company says it has the capability, via the Internet, of providing a refractive eye exam as accurate as one completed in the doctor’s office. The way the law stands currently, this telemedicine company (based upon its business model) would be prohibited from conducting any business in Indiana.

Health Care Just Keeps Getting Bigger

16446238A few health care economic facts to consider:

  • The United States spends more on health care than any other country – $3 trillion in 2014. That equals $9,523 per person or 17% of gross domestic product
  • In the six years after the recession, health care added 2.1 million jobs, more than the next three industries combined – leisure and hospitality, professional services and education
  • Employment in health care is projected to grow by 19% from 2014 to 2014, adding about 2.3 million new jobs
  • Nearly one in 11 overall jobs is in the health care field. In 2014, that was 12.2 million jobs
  • The top five states with highest percentage of jobs classified as health care jobs: West Virginia, 11.4%; Rhode Island, 11%; Maine, 10.8%; Ohio, 10.6%; and Massachusetts, 10.4%

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.

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.

2016 Legislative Returns on Indiana Chamber Investment

in chamberThe 2016 General Assembly saw the Chamber advocate for and achieve numerous public policy victories that will have a lasting positive impact on the state’s economy and the prosperity of its residents. Additionally, the Chamber defeated several measures that would have cost businesses over $200 million.

In total, the Chamber’s work yielded savings of $1.435 billion for Hoosier businesses OR $546 per employee. Specific savings are listed below by bill and subject matter, in total and per employee. Also noted is the indeterminable value of a vital policy area: education and workforce development; the majority of which cannot be quantified.

Business Savings:
$1.435 billion or $546 per employee

Civil Justice
– Reasonable and controlled increased medical malpractice limits (SEA 28):
$50 million; $19.02/employee
– Restrictions on legal practice known as “lawsuit lending”
(HEA 1127): $40 million; $15.21/employee

Economic Development and Infrastructure
– Supplemental distribution of local income tax for local infrastructure (SEA 67): $400 million; $152.13/employee
– Short-term road funding and allowance for additional Regional Cities initiative (HEA 1001): $300 million; $114.10/employee
– Defeated – Unreasonably high data breach fines (HB 1357): $10 million; $3.80/employee

Employment and Labor
– Prohibition against ordinances restricting employee scheduling (SEA 20): $75 million; $28.52/employee
– Defeated – Option for prevailing wage (SB 319 and SB 346): $50 million; $19.02/employee
– Defeated – Mandated paid leave policies (HB 1139 and HB 1328): $30 million; $11.41/employee
– Defeated – Mandated increases in minimum wage (HB 1265): $25 million; $9.51/employee
– Defeated – Loss of business license for employing unauthorized aliens (SB 285): $25 million; $9.51/employee
– Changes to unemployment insurance procedures (HEA 1334): $20 million; $7.61/employee

Energy and Environment
Long-term water infrastructure maintenance funding (SEA 257 and SEA 383)
$100 million; $38.03/employee
More efficient solid waste handling (SEA 256 and SEA 366) $20 million; $7.61/employee
Underground tank remediation fund (SEA 255) $10 million; $3.80/employee
Planning future water usage needs (SEA 347) $10 million; $3.80/employee

Health Care and Insurance
– Prescribing authority for telemedicine (HEA 1263): $80 million; $30.43/employee
– Codification of Healthy Indiana Plan 2.0 (SEA 165) $70 million; $26.62/employee
– Defeated – Mandated health insurance coverages (SB 370) $25 million; $9.51/employee
– Defeated – Provisions for prescription drug requirements (HB 1390) $25 million; $9.51/employee

Taxation
– Repeal and replacement of commercial assessment mandates (HEA 1290)
$40 million; $15.21/employee
– Defeated – Egregious income tax reporting provisions (SB 323) $30 million; $11.41/employee

Total Savings for Indiana Business: $1.435 Billion
Total Savings Per Employee: $546

Your Return on Investment
10 employees = savings of $5,460
25 employees = savings of $13,650
50 employees = savings of $27,300
100 employees = savings of $54,600
200 employees = savings of $109,200
500 employees = savings of $273,000

Plus the Value of Education and Workforce Development Initiatives:
The Indiana Chamber also played a leading role in the development and passage of important education and workforce development legislation. While difficult to quantify the specific fiscal impact of these changes, we know from economic research, economic development professionals, site selection consultants and our own membership the importance of these matters to the cost of doing business. Thus, we note the important accomplishments in education and workforce development as a significant – albeit unquantifiable – return on investment.

IMPORTANT NOTES: Business impact calculations are based on fiscal impact estimates of the Legislative Services Agency, independent studies, other available data and research materials, and Indiana Chamber analysis. Business impact per employee is calculated by using the estimated number of employed workers statewide in March 2016 (2,629,300).

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.

Chamber on Federal Approval of HIP 2.0 to Satisfy ACA Requirement

Indiana Chamber of Commerce President and CEO Kevin Brinegar comments on the federal Centers for Medicare & Medicaid Services giving the green light to the Healthy Indiana Plan expansion (HIP 2.0), which is in lieu of traditional Medicaid expansion required under the Affordable Care Act (ACA).

“We are very pleased that the Centers for Medicare & Medicaid Services (CMS) appreciated Indiana’s unique brand of addressing the needs of our uninsured population and recognized HIP 2.0 as the best option for Indiana to expand health care coverage. The Indiana Chamber had reviewed HIP 2.0 and urged CMS to approve it.

“HIP provides reimbursement to health care providers at Medicare rates. Otherwise, health care providers recover such losses by increasing prices for private sector employers and their employees through cost shifting. Any attempt to lessen that cost shift is welcome.

“What’s more, the approval of HIP 2.0 will provide health care coverage for tens of thousands of additional Hoosiers and bring billions of dollars into Indiana’s economy.

“We applaud Gov. Pence and his administration for recognizing that HIP 2.0 was the best course for the state and for staying firm in that belief.”

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.