Senate Health Care Reform – Act III

A bipartisan agreement has been reached in the Senate to help stabilize health care markets – from Senate Health, Education, Labor and Pensions Committee Chairman Sen. Lamar Alexander (R-TN) and ranking member Sen. Patty Murray (D-WA).

Among other things, the Alexander-Murray agreement would:

  • fund cost-sharing reduction payments, which help lower consumers’ deductibles and co-pays, for two years;
  • broaden the pool eligible for a “copper plan” (catastrophic medical) coverage option, which would help reduce the mandate implications for essential benefits;
  • include funding to help Americans navigate signing up for health insurance, which had been cut by the Trump administration; and
  • set up high-risk pools that will allow for continued coverage for these individuals.

What this is not is a “repeal and replace”. That said, the two-year funding promise is good news for insurers and would help alleviate their unease, which would also be felt by consumers. But this bill does nothing to address the core problems in the individual marketplace that threaten its sustainability.

Indiana Sen. Joe Donnelly, who has been pushing for bipartisan fixes to the Affordable Care Act (ACA), has thrown his support behind the Alexander-Murray agreement and is a co-sponsor of the legislation. He stated, “This is the product of hard work from members on both sides of the aisle, and it’s an important step in providing much needed stability to the market. I’m proud to be part of the effort, and I will continue working with Republicans and Democrats to move this much-needed legislation forward.”

President Trump has alternately met the agreement with both optimism and skepticism. Overall, he’s indicated that he would favor a short-term subsidy fix; however, he doesn’t want to help insurers either.

It would appear the bipartisan legislation would garner most, if not all, Senate Democrat votes (as Minority Leader Chuck Schumer alluded to on Thursday), so that would leave a lot of wiggle room for passage if some, or even many, Republicans vote against it. The question is what Senate Majority Leader Mitch McConnell will do and what he says to his caucus.

Meanwhile, Sens. Bill Cassidy (R-LA) and Lindsey Graham (R-SC), the authors of the Senate’s second ACA reform attempt, have been working with Alexander and Murray on ways the bill can be made palatable to the very conservative arm of the congressional Republicans – most notably in the House.

In other words, this is far from a done deal.

Recognizing Signs of Domestic Violence at Work

Domestic violence

October is Domestic Violence Awareness month. Unless you or someone close to you has experienced domestic violence, you might think of it as something that only impacts people at home. Unfortunately, abuse is often subtle and happening to people of all socio-economic classes, ages, races, genders, etc.

There’s a fine line to employers getting involved in the personal lives of employees. But often domestic abuse doesn’t stay within the confines of a home’s walls. And the sheer number of people impacted by domestic violence are staggering: Nearly one in three women and one in seven men are victims of domestic violence during their lifetime. Even more numbing is that 53% of people know someone who has been a victim of abuse.

Domestic violence harms the health and well-being of your employees. And it can hurt a company’s bottom line through lost productivity and missed work.

Domestic Violence Network statistics show that 74% of women who are abused were harassed by their abuser while on the job. More than half were late for work at least five times per month because of abuse. Nearly 30% had to leave work early at least five days a month. And 54% missed three or more full days of work per month due to abuse.

Abuse is estimated to cost employers over $5.8 billion a year; $4.1 billion of that is directly related to medical expenses.

In a workforce of 50 people, approximately 27 people know someone impacted by domestic violence. If the employee mix is equal (25 female and 25 male), approximately eight females and three males are victims of abuse. And the U.S. Department of Justice statistics estimate that four women and one man per day are killed by abuse from an intimate partner.

Central Indiana statistics are sobering: agencies received 22,758 calls in 2016 related to domestic violence, according to the State of Domestic Violence Report.

Employers should understand that this violence won’t always be obvious. Abused employees will not always come to work with bruises or other injuries; if they do, it’s a safe bet that they’ve been emotionally abused for much longer.

Here are common abuse signs to watch for in employees:

  • Increase in absenteeism and/or tardiness: abusers may start fights prior to work, take vehicles to prevent the abused individual from getting to work, etc. Or the absences may be due to injuries if the abuse has reached the physical stage
  • Increased distraction: someone may suffer from poor concentration, anxiety and isolation. They may always keep a cell phone nearby and answer it quickly and then appear nervous or upset after answering the call or reading the text
  • Changes in social interaction: employees may stop doing things socially with co-workers. They may stop going to lunch with others and may avoid certain people
  • Increased or frequent visits by the abuser: visits alone aren’t enough to indicate something is wrong, but if the individual has negative reactions when the abuser is there or right after, there could be a problem

What are employers able to do for employees they suspect may be in an abusive situation? If you suspect your employee is a victim of abuse, the first thing you can do is offer a safe place for discussion.

If you suspect an employee is being abused, show kindness in your approach. Ask the employee if there is anything that you can help with and avoid telling him or her you think that abuse is occurring. If the employee is showing up with physical evidence of abuse, an employer should ask, “Is someone hurting you?”

If the answer is no, accept it. The employee may not be ready to share the abuse or may not yet see themselves as victims. Let the employee know you care and that you are there to help if you can. Refer them to a local domestic violence network or shelter if necessary.

New Senate Health Care Bill An Improvement for Employers

The U.S. Senate appears to be gearing up for another health care vote, with a measure from Sens. Bill Cassidy (R-LA) and Lindsey Graham (R-SC) headed to the floor as soon as the middle of next week.

At its core, the Graham-Cassidy proposal creates a block grant program, taking much of the funding provided in the Affordable Care Act (ACA) and sending it to the states for them to set up their own health care systems and determine where to direct the funds.

It also does away with several pillars of the ACA, including the mandate for individuals to have insurance or pay a penalty. The true ramifications of that are uncertain, but could mean higher premiums for those in the health care exchanges (aka those who don’t have insurance through their workplace).

From the standpoint of employers, the Indiana Chamber believes Graham-Cassidy is an improvement over the ACA. This is primarily due to two changes:

  1. The removal of the employer mandate to offer coverage. If that goes away, so too does the ACA’s definition of a full-time employee as someone working an average of 30 hours per week; this has negatively impacted businesses and workers – many of whom saw their hours reduced.
  1. The permanent elimination of the medical device tax, which is detrimental to vital Hoosier employers like Cook Medical in Bloomington, Zimmer Biomet in Warsaw and many others.

Overall, those in favor of increased state control are more receptive to the Graham-Cassidy effort.

As Vice President Mike Pence put it on Fox News yesterday: “…The question that people ought to ask is, who do you think will be more responsive to the health care needs in your community? Your Governor and your state legislator, or a congressman and a President far off in the nation’s capital?…”

 What has opponents worked up is two-fold: affordable coverage for pre-existing conditions isn’t specifically guaranteed; and population size will determine the amount of the block grant, which will reduce funding for a number of states – including some in the Rust Belt and more rural states in general.

Republican Sen. Jeff Flake of Arizona told MSNBC on Thursday he has absolute faith that governors will keep pre-existing condition protections, because of the severe political cost if they don’t. Opponents are less convinced.

At this point, Kentucky Sen. Rand Paul is the lone Republican who has sworn opposition to the Graham-Cassidy bill publicly – in part because his state appears to be set to lose funds in this model.

Likewise, Indiana is expected to see less federal dollars, but the Hoosier state has been preparing for what it saw as an eventuality for several years – setting aside hundreds of millions of dollars to subsidize its Healthy Indiana Plan (HIP) 2.0.

The HIP model is unique in the country; it requires participants to have “skin in the game” with their health care decisions and allows for capping the number of participants. Both of these make it an inherently more nimble program. And ultimately, the state Legislature can also determine to put more funds into HIP 2.0, if it’s deemed necessary.

These facts and the lure of more state control were likely factors in Gov. Eric Holcomb’s decision to sign a letter supporting Graham-Cassidy; he was one of 15 state executives to do so. The reality is other states may not be as fiscally prepared for a possible funding reduction as Indiana is.

That leads us to who may end up being the pivotal figure in the floor vote: Sen. Lisa Murkowski of Alaska. She joined Sen. Susan Collins (Maine) and Sen. John McCain (Arizona) in voting no on the last health care reform measure. Collins is seen as a likely “no” again, joining Paul, while McCain is a predicted (or at least hoped for) “yes.”

As a result, the bill authors are pulling out all the stops and making special accommodations for Alaska in the bill to woo Murkowski’s vote – because they can’t lose her and have the bill survive for Vice President Pence to break the tie. If no specific provisions for Alaska are made, the state would be a big loser in the bill in funding because of its size vs. population and geography.

The Indiana Chamber plans to talk about health care reform with Sen. Joe Donnelly, who has announced his opposition to Graham-Cassidy, and Republican Sen. Todd Young during Wednesday’s D.C. Fly-in event.

UPDATE: This afternoon, McCain announced he would oppose the Graham-Cassidy bill, making passage of the bill seemingly very difficult.

Donnelly Urges Market Stability on Health Care; Association Plans in the Offing?

Senator Joe Donnelly is urging the Trump administration to make a public commitment to continue cost sharing reduction (CSR) payments, which lower consumers’ deductibles and co-pays.

Early in the week, Donnelly continued his push for stability in the insurance markets in a letter to Hoosier Seema Verma – the administrator of the Centers for Medicare and Medicaid Services (CMS) – who he partnered with to help establish Indiana’s bipartisan Healthy Indiana Plan (HIP) 2.0 program through the Affordable Care Act. Donnelly’s letter comes as President Trump has declined to commit to continue making CSR payments. Donnelly says if these aren’t maintained, it could cause people to pay at least 15-20% more for health care.

In the letter to Verma, Donnelly wrote: “…It is our job to protect American families from unnecessary increases in the cost of health care, particularly those within our control. That is why I am very concerned by recent comments and actions made by the administration demonstrating a willingness and desire to undermine the health care system, even at the expense of the health and economic security of millions of Americans. These efforts to create uncertainty are harming working people and are already having a detrimental effect in Indiana.

“As we work to improve our health care system, we must first do no harm … The administration has the ability to help provide market stability today, and I respectfully request that the administration make a strong public commitment to continuing the CSR payments so that Congress can work together in a bipartisan fashion in an effort to reduce costs, expand access and strengthen the American health care system.”

Additionally, Donnelly said he’s recently heard from several insurance companies which provide coverage to Hoosiers – including two that have recently left the market – that cited lack of certainty, particularly as it relates to the CSR payments, as a key reason for increasing prices or leaving the market.

White House Press Secretary Sarah Huckabee Sanders said this week that CSR payments were, at this point, bailing out a failed law. She also said no final decision had been made by the President on continuing them.

Read Donnelly’s full letter to Verma.

Meanwhile, Sen. Rand Paul of Kentucky is making a case to President Trump to use his executive authority to permit associations and organizations to offer group health insurance plans. Paul says this could impact tens of millions currently in the individual marketplace. The White House has yet to comment on the possibility. This action would be very helpful to Indiana Chamber members and we have previously discussed this positive policy proposal with members of the Indiana delegation.

Federal Health Care – Republicans Can’t Do It Alone

Progress on health care reform by Senate Republicans came to a halt very early this morning as the so-called “skinny repeal” of the Affordable Care Act (ACA) narrowly failed 49-51. All Democrats were joined in their opposition by Republican senators Susan Collins (Maine), John McCain (Arizona) and Lisa Murkowski (Alaska).

While Collins and Murkowski’s votes came as no real surprise, the GOP hope was for McCain to allow the bill to proceed to an expected conference committee for further work. But in McCain’s statement explaining his decision, he mentions the lack of complete certainty provided by House Speaker Paul Ryan that the bill wouldn’t be voted on as-is and passed by the House instead – as well as his opposition to voting on what he considered to be a “shell of a bill.”

Essentially, this outcome means the only path to reform now would appear to be a bipartisan approach, as Senate Majority Leader Mitch McConnell (Kentucky) alluded to in his remarks following the defeat.

Indiana’s Democratic senator, Joe Donnelly, has been pushing for this path all along and reiterated those thoughts after today’s vote:

“I still believe that by working together we can improve our health care system and, at a minimum, Congress and the administration should do no harm to the millions of Americans’ whose health and economic well-being are at stake. I share the frustration of Hoosiers and Americans who are tired of partisan proposals that fail to address issues with our existing health care system and the continued legislative uncertainty that is undermining the insurance markets.

“We should do the hard and necessary work to gather the input of doctors, nurses, hospitals and patients, and work in a bipartisan manner to make coverage more affordable and accessible for Hoosier and American families.”

Of note: Donnelly attended a dinner Wednesday evening with a bipartisan group of senators to discuss ways to work together on health care. In May, Donnelly also had a similar meeting.

Our junior senator, Todd Young, voted for the “skinny repeal” bill as “another step towards relieving Hoosiers and millions of Americans from the burdens of Obamacare. Too many Hoosiers have been left with too few options and rising costs. It is more important than ever that we keep our promise to them and fundamentally reform our health care system.”

Like Donnelly, Young is eager to strengthen the ACA and work in a bipartisan fashion to get that done.

“Going forward, I will participate in hearings in the HELP (Health, Education, Labor and Pensions) Committee and continue to work with my colleagues, on both sides of the aisle, to come up with a solution that provides long-term stability to our health care system and gives each and every Hoosier the opportunity to access quality and affordable insurance.”

Additionally, Young has previously looked for ways to find common ground. In the spring, he sent a letter to all Democratic senators urging them to share their views on what’s working and what’s not with the ACA.

Indeed, there are aspects of the ACA that both Democrats and Republicans have acknowledged as problematic; the medical device tax, which needs to be permanently repealed, is among them. So hopefully these areas can serve as a starting point for crafting a bipartisan solution.

From the Indiana Chamber’s perspective, the reality is that the ACA has not made life easier or costs cheaper for businesses (or many Hoosiers).

Separately, the ACA’s pending collapse – with insurers pulling out – isn’t surprising based on its inherently flawed assumptions. Unfortunately, very little of the congressional debate so far has focused on shoring up the ACA at its core, or how to put forth a replacement program that is stronger foundationally. Hopefully, that will occur in future discussions.

Chamber Goes to D.C., Talks Top Member Issues With Hoosier Delegation

The Chamber’s Caryl Auslander met with Sen. Todd Young last Wednesday in Washington, D.C.

Indiana Chamber members were once again represented in Washington as Caryl Auslander, VP of federal relations, returned to meet with over half of Indiana’s congressional delegation last week. On the agenda: the most pressing public policy matters the Chamber hears about from its member companies throughout the state.

On this trip, Auslander met with Sen. Todd Young, Rep. Susan Brooks (IN-05), Rep. Larry Bucshon, M.D. (IN-08) and Rep. Trey Hollingsworth (IN-09), as well as with key legislative staffers from the offices of Rep. Jim Banks (IN-03), Rep. André Carson (IN-07) and Rep. Pete Visclosky (IN-01).

Below are the five main policy areas discussed with these delegation members:

Health Care Reform
The Indiana Chamber wants to see lower health care costs and improvement to the overall system. We believe the Affordable Care Act is overly complex, administratively burdensome and financially unsustainable as-is. We support a “repeal and replace” approach, but in the absence of that, substantial changes should be made to make the law more workable and viable for the long term.

Infrastructure
The Chamber is looking for a stable, long-term way to pay for highway infrastructure, with a separate, sustainable and dedicated transportation funding source. Whatever the upcoming Trump and congressional plans entail, Indiana deserves its fair share of federal transportation dollars. Equity guarantee would ensure that all states receive a minimum level of funding relative to other states. All states should receive a minimum of 95% return on their share of fuel tax contributions and on any additional funding sources. Without an equity guarantee, overall funding may increase; however, Indiana could receive less overall or comparatively.

Regulatory Reform
The federal government has consistently overreached its authority, which has left Hoosier companies facing a multitude of complicated and changing federal regulations. It’s not only burdensome and time-consuming, but has created a lot of business uncertainty and hinders the ability to expand in the U.S. NOTE: Auslander reiterated the top regulations to overturn from the Chamber’s standpoint and gave the delegation another copy of the list.

Rural Broadband
The Chamber believes that advanced communications and digital infrastructure is critical to long-term economic development. Yes, we have come a long way, but still not enough is happening and not quickly enough. We encouraged our delegation to find more ways to bring the most rural parts of the country and state up to date technologically to help reverse downward economic trends. Broadband in rural communities helps businesses, schools and communities at-large; it is no longer a luxury but now a necessity.

Tax Reform
We need a tax code that is certainly simpler. It’s complicated and it costs way too much to comply with. Lowering the corporate income tax rate – which puts us at a competitive disadvantage globally – is something virtually everyone agrees on. We also urged getting rid of the ineffective alternative minimum tax (AMT) and the federal estate tax, which poses a real threat to small businesses and family farms. And while it is important for comprehensive tax reform, we need to do it in a way that does not increase the deficit.

ChamberCare Business Resources Provides Long-Term Solution for Your Groups

In March, we shared information about ChamberCare Solutions, an enhancement to the partnership between the Indiana Chamber and Anthem. Now we’d like to tell you more about ChamberCare Business Resources, part of ChamberCare Solutions.

What is it?
ChamberCare Business Resources is a Professional Employer Organization (PEO) that allows Indiana Chamber members with 2+ employees to outsource human resource tasks like worker’s compensation, payroll and tax filing, employee benefit programs, compliance, and more. Using a PEO frees up time and resources so small businesses can focus on the well-being and direction of their company. ChamberCare Business Resources is administered by Human Capital Concepts (HCC), a leader in innovative technology and administrative solutions.

In addition, ChamberCare Business Resources offers affordable health benefits along with comprehensive human resources (HR) services that can help you keep your workforce healthy and save time and money. As a member of the Indiana Chamber of Commerce, you can choose a high-quality, affordable health plan from Anthem Blue Cross and Blue Shield (Anthem), with a wide range of options designed especially for small to medium-sized companies.

Why use ChamberCare Business Resources?
According to the National Association of Professional Employer Organizations (NAPEO), businesses that utilize 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.

Another benefit for Indiana Chamber members is access to high-quality, affordable health plan from Anthem, with a wide range of options designed especially for small to medium-sized companies. Through the PEO, Anthem pools membership so it can offer lower premiums on the same great head-to-toe coverage members expect from Anthem including medical, dental, vision, life and disability. As trusted organizations and pillars of the community, Anthem brings 73 years of experience coupled with the Chamber’s 95 years of service and HCC’s 125 years of combined staff experience offering a long term solution for your clients.

For more infomation about Anthem plans and benefits, check out our ChamberCare Business Resources Product Guide.

Need help finding the right solution for your clients?
Contact Indiana Chamber Director of Membership, Brock Hesler, at (317) 264-7539 or bhesler@indianachamber.com.

Donnelly Talks Policy to Chamber Group

Indiana Sen. Joe Donnelly discussed a wide variety of issues with members of the Indiana Chamber’s Executive Committee during an hour-long visit last week. Among his comments on the issues before Congress:

  • Opioid crisis: Senators are working on a federal law that would limit painkiller prescriptions to one week (hopefully reducing addictive outcomes)
  • Transportation infrastructure: There will be a big bill and he believes it will pass as long as it gets paid for
  • Tax reform: Stuck for now because money to pay for it was going to come from the failed health care overhaul
  • Health care bill: Legislation can’t be passed that would result in fewer people having insurance coverage. Democrats, Donnelly noted, have ideas that should be considered

Other topics of conversion: immigration, trade agreements and global threats (Donnelly is a member of the Senate Armed Services Committee).

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.