Podcasts about association health plans

Happy New Year! We hope you all enjoyed the holidays after a long fourth quarter and OEP. We're going to kick the year off today by discussing the comments that NABIP submitted to CMS regarding the recent, alarming, proposed regulations relevant to FMOs and Medicare agent compensation. We also saw a hotly anticipated proposed rule come out on Association Health Plans over the holidays, so we will be reviewing that as well. Additionally, we'll look at what to expect from Congress in early 2024. On this week's episode of the Healthcare Happy Hour, to discuss all of this, are none other than John Greene and Michael Andel.

In this episode, Alfredo and Elaine interview Dr. Molly Rutherford, the founder and medical director of Bluegrass Family Wellness Clinic. They discuss the challenges faced by small businesses in finding affordable healthcare solutions and highlight the "Healthcare for You" campaign, which advocates for healthcare reform rooted in the free market. Dr. Rutherford shares her experience with direct primary care and the benefits it offers to patients, including unlimited visits, telemedicine services, and discounted medications. The conversation also addresses the resistance and lack of support from the healthcare system and the role of pharmacy benefit managers in driving up costs. Main Street Matters is part of the Salem Podcast Network - new episodes debut every Wednesday and Thursday. For more information visit JobCreatorsNetwork.comSee omnystudio.com/listener for privacy information.

Did you know that NABIP regularly submits written testimony to Congress ahead of relevant healthcare hearings? From small-business tax credits to Association Health Plans to mental health network adequacy, NABIP submits statements to Congressional committees when they are debating policy that impacts our members. On this week's episode of the Healthcare Happy Hour, NABIP Senior Vice President of Government Affairs Marcy M. Buckner is back to review our latest testimony.

Did you know that NABIP regularly submits written testimony to Congress ahead of relevant healthcare hearings? From small-business tax credits to Association Health Plans to mental health network adequacy, NABIP submits statements to Congressional committees when they are debating policy that impacts our members. On this week's episode of the Healthcare Happy Hour, NABIP Senior Vice President of Government Affairs Marcy M. Buckner is back to review our latest testimony.

In reviewing the history of health efforts under President Trump, Joe and Eric continue their talk with Brian exploring what emerged from the ashes of the failed “repeal and replace” legislative efforts on Capitol Hill. Through executive orders and Brian's hard work at NEC, President Trump detailed a three part agenda: Association Health Plans; 2. short duration health insurance; 3. Health reimbursement accounts. These ideas became the center of health reform for conservatives even after Associated Health Plans were struck down by a federal court. *This episode originally aired Jun 3, 2022*

Mike Dendy / CEO & Co-Founder of Caryn Health & Association Health Plans of America Mike co-founded Caryn Health and AHPA along with Dr. Tom Price, Fran Tarkenton, Scott Miller and several other Atlanta business leaders. Caryn operates as a Management Services Organization (MSO) and provides administrative outsource services primarily in the healthcare benefits field.  Additionally, Caryn develops software programs for inward and outward facing communications with plan sponsors and members. Caryn initiated its client service portal in January 2020 and will show revenues of ~$22mm in 2022. CEO HealthWorth CTC, Inc Provides investment banking and consulting services to employers and private equity firms looking to enter or exit the healthcare space. 2005-2018 Advanced Medical Pricing Solutions Mike co-founded and served as CEO/President of Atlanta, GA based Advanced Medical Pricing Solutions (AMPS), a healthcare cost management company, serving the self-funded (ERISA) employer, payer and Workers Compensation communities.  After founding the Company in 2005, Mike oversaw all aspects of AMPS management, ranging from product development, sales and marketing, finance, operations, and client relations.  AMPS has seen organic growth of over 300% over the last five years and has continued to increase its offerings in the healthcare cost containment space to include large claim audits, reference based reimbursement, out of network claims management, nationwide narrow network – direct contract build-out,  and Workers Comp cost management services.  AMPS clients range in size from those in the Fortune 500 to mid sized regional employers. AMPS was recently honored as a Georgia Fast 40 company as one of the State's fastest growing concerns. AMPS revenues grew from start-up to $23,000,000 in 2017 with an EBITDA of over 45%.  In April, 2017, Mike led an external financing phase that brought three Private Equity firms in as financial partners with a valuation of $75,000,000.  1997-2004 HPS Paradigm Administrators Prior to founding AMPS, Mike served as Chairman & CEO of HPS Paradigm Administrators Inc. from 1997 until its subsequent sale in 2004.  HPS Paradigm is a health insurance Third-Party Administrator (TPA) serving corporate and government employer groups throughout the United States.  During his tenure as CEO, HPS Paradigm experienced strong corporate growth, increasing on average 30 percent in fee income per year, while achieving industry leading EBITDA margins of over 20%.  In 2000, Mike oversaw HPS' business process outsourcing (BPO) relationship with Memorial Hospital of Savannah, Georgia one of Georgia's largest hospital systems.  Mike served as Executive Director of Memorial's Community Healthcare System managing the TPA, HMO, PPO, UR/UM and Case Management services provided for the benefit of southeast Georgia employers.  Mike led business development efforts while managing operations and finance and consulted with and managed over 500 different mid-sized and large employer group relationships during his tenure. HPS Paradigm revenues grew from $1.05mm in 1997 to $10mm in 2004 when the company was purchased by STI Knowledge for $10.5mm. 1992-1997 HealthWorth CTC, Inc From 1992-1997, Mike founded and managed HealthWorth & Health Partners Services, Inc. (HPS), a brokerage and consulting firm, which specialized in group health benefits, stop-loss insurance, benefit plan design, provider negotiations, pharmacy benefit management, disease management, predictive analysis, and cost containment. HPS developed community health system plans in a number of southeastern U.S. markets and grew consulting revenues to $600,000 annually. Education Mike holds two Master's degree, from Georgia State University in Business Administration 1997 (MBA), and Healthcare Administration 2002 (MHA) and a bachelor's degree from the University of Georgia 1981 in Journalism and a minor in Psychology.  In addition to his graduate and undergraduate degrees, Mike attended executive management programs at Harvard University's Business, Public Health, and Law Schools. Mike serves on the Advisory Board for the Robinson College of Business School of Healthcare Administration at Georgia State University and is the former Board Chairman for the National Safe Care Campaign.  Mike was awarded the Georgia State University School of Health Administration's Healthcare Executive of the Year in 2015. Mike has authored over a dozen white-papers on the issues and future of healthcare finance in the United States. https://youtu.be/xFn2E6Fv-kY Ted Jenkin / Oxygen Financial (Host) Lee Heisman / Savant CTS (Host) Mike Dendy / Caryn Health, Association Health Plans of America (Guest)

This episode is also available as a blog post: http://donnyferguson.com/2017/07/07/dr-rand-paul-proposes-association-health-plans-as-solution-to-27-million-left-behind-by-obamacare/ --- Send in a voice message: https://anchor.fm/donny-ferguson/message

What are association health plans? Which industries are ripe to benefit from these plans? Discover this and more with Guest Speaker: Gabrielle Sansone, VP of Sales for Prominence Healthcare --- Send in a voice message: https://podcasters.spotify.com/pod/show/coffeewithchris/message

In this episode Fearless host, Matt Byrne, of Spiralight Group takes us through his roadmap for benefits during the COVID-19 crisis.  If you have a small business, navigating this pandemic can be one of, if not the most daunting task you've undertaken, this episode is full of useful information to help you break through the white noise. Here is a quick self-service Prezi Presentation that I created which provides details, guidance and links to resources all in one place, it should take you 10-15 minutes to view; https://prezi.com/view/h1g3Ar5fw2XiQUdwrXGr/ Matt Byrne has made a career helping people find affordable health insurance. He is the founder of Spiralight Group Benefits, a Dublin Ohio-based brokerage providing comprehensive insurance, HR consulting and compliance solutions for small- to mid-size businesses. Matt has a Bachelor of Arts degree from Boston University and holds a life and health insurance license. He also serves as the President elect for the Columbus chapter of the National Association Health Underwriters. Mr. Byrne is a subject matter expert speaking frequently about Health Care Reform, Employer Health Plans Affordability Programs, Association Health Plans, is certified in Self-Funded Solutions and is frequently quoted in national publications such as the Money Magazine, U.S. News and World Report and The Wall Street Journal. Matt can be reached at (614) 372-6377 or by visiting http://www.grouphealthohio.com/  Instagram/Twitter: @grouphealthohio  

Host Ron Bachman's Topics: Analysis of the Republican Study Committee (RSC) Health Reform Plan, State Guarantee Coverage, Portability, State Flexibility, Federal Funding, Tax Changes, HSA Expansion, Unleashing HSAs, Association Health Plans, Health Status Insurance.

In this episode of the ShapeShifters Podcast, Host and Chief Transformation Strategist David Saltzman features Kev Coleman, President and Founder of AssociationHealthPlans.Com to explain what AHP's are all about and how small businesses can benefit from them. Kev is a consumer advocate, researcher, and published writer whose works have appeared on The Wall Street Journal, The New York Times, Consumer Reports, USA Today. He has published a book as well called "Association Health Plans & The Future of American Health Insurance." You can find show notes and more information by clicking here: https://bit.ly/2J7maOa

A judge will hear arguments this month in a lawsuit challenging North Carolina’s certificate-of-need law. A Winston-Salem surgeon is challenging a provision in the CON law that blocks him from purchasing an MRI machine. Jon Guze, John Locke Foundation director of legal studies, has filed a friend-of-the-court brief supporting the surgeon’s case. Guze explains why he believes the CON law is unconstitutional. If North Carolina decides to move forward with legislation to allow dental therapy, it will be good to know how that process has played out in other states. Sal Nuzzo, vice president for policy at the James Madison Institute, has watched closely as Florida has considered dental therapy laws. He offers Tar Heel State policymakers ideas about how to proceed. State legislators debated this year a proposed change to school discipline rules. You’ll hear highlights from their discussion. A new state law will allow more small business owners to pursue health insurance options through Association Health Plans. During a recent news conference, legislators and small business advocates touted potential benefits from the plans. Protesters disrupted a recent meeting touting Gov. Roy Cooper’s energy plan. The protesters complain that the Cooper administration isn’t moving fast enough to reach environmental goals. Donald van der Vaart, John Locke Foundation senior fellow, responds to the protesters’ concerns. Van der Vaart also offers his own expert assessment of Cooper’s energy priorities.

Gov. Roy Cooper recently signed into law Senate Bill 584. It marks the latest step in an ongoing campaign to fight overcriminalization in North Carolina. Mike Schietzelt, John Locke Foundation criminal justice fellow, explains how the new legislation fits with the goal of cleaning up the state’s overly complicated criminal code. Overly burdensome occupational licensing rules restrict economic freedom in both North Carolina and South Carolina. During a recent meeting in Winston-Salem, the group Classical Liberals in the Carolinas learned how. Jon Sanders, John Locke Foundation director of regulatory studies, focused attention on North Carolina’s licensing restrictions. Jennifer McDonald, senior research analyst at the Institute for Justice, offered details about South Carolina’s rules. U.S. Sen. Thom Tillis, R-N.C., wants to do more to speed up the pace of government hurricane relief. Before Hurricane Dorian approached the N.C. coast, Tillis returned to Raleigh to discuss a bill that could help local governments bypass some layers of red tape in securing federal relief funding. Some state lawmakers want public schools to place more emphasis on phonics in early reading instruction. Rep. Larry Pittman, R-Cabarrus, tried to amend a recent education bill to mandate phonics instruction in the earliest elementary school grades. You’ll hear highlights from N.C. House debate of Pittman’s proposal. Without Cooper’s signature, the Small Business Health Care Act recently became law in North Carolina. It opens the door to Association Health Plans for small business owners and their employees. Jordan Roberts, John Locke Foundation health care policy analyst, assesses the significance of AHPs and their role in health care reform.

VT's Health Care Advocate and other healthcare authorities have consistently opposed all federal measures that would have made health insurance more affordable for Vermonters. On the one hand, the state's political class kills all measures that would have brought Vermonters financial relief, and on the other hand, its members complain about the unaffordability of health insurance in Vermont. This episode explains why the two remaining insurance companies in Vermont keep raising premium rates and why this trend is bound to continue year after year. Articles Referenced: Hansen, Meg. "Health insurance mandate a step backward for Vermont health care." https://www.manchesterjournal.com/stories/health-insurance-mandate-a-step-backward-for-vermont-health-care,542082 --. "Sticks and no carrots: Association Health Plans in Vermont." https://www.reformer.com/stories/meg-hansen-sticks-and-no-carrots-association-health-plans-in-vermont,544857 Kaiser Health News. "Did The ACA Create Preexisting Condition Protections For People In Employer Plans?" https://khn.org/news/did-the-aca-create-preexisting-condition-protections-for-people-in-employer-plans/ VTDigger. "Health insurance rate increases approved — 12.4% for BCBS, 10.1% for MVP." https://vtdigger.org/2019/08/08/insurance-rate-increases-approved-12-4-for-bcbs-10-1-for-mvp/

Keeping up to date on the recent policy changes for the Affordable Care Act can be challenging. Listen to Part 12 of the series as Kristi Bohn unpacks Association Health Plans, Short term health plans, small group happenings and the value of volunteering. 

Keith VanderZanden of Advanced Professionals Insurance and Benefits Solutions sits down with The Council’s Katie Oberkircher to talk AHPs.

The U.S. economy has posted impressive gains recently. Both President Trump and former President Barack Obama are claiming credit. Roy Cordato, the John Locke Foundation’s senior economist, puts the competing claims to the test. A Winston-Salem surgeon is taking North Carolina state government to court because of a law that blocks him from purchasing an MRI scanner. Dr. Gajendra Singh says the scanner would help him provide a valuable service to his patients at a reasonable cost. North Carolina’s certificate-of-need law blocks Singh from making the purchase. Singh and his attorney, Josh Windham of the Institute for Justice, explain why they’re challenging the CON law. One likely consequence of the 2018 elections is a renewed push for redistricting reform in North Carolina. John Locke Foundation Chairman John Hood offered that prediction during a recent post-election analysis. Hood says Republican legislative leaders looking ahead to 2020 elections might want to rethink their opposition to reform. Higher education faces significant challenges in North Carolina and across the United States. Jenna Robinson, president of the James G. Martin Center for Academic Renewal, highlighted key challenges during a recent speech in Raleigh. Robinson emphasized the lack of viewpoint diversity on college campuses, along with an overall decline in academic quality. As state and national politicians continue to debate the future of health care, the recent rise of Association Health Plans is offering a new option for many health care consumers. Jordan Roberts, John Locke Foundation health care policy analyst, explains AHPs. He also assesses their potential impact on the future of health care.

Rising healthcare costs is a problem that seems to be on everyone’s mind, from patients to government officials. But what are the possible solutions? That’s a tricky answer, but one that Blue Cross Blue Shield North Carolina Chief Medical Officer Rahul Rajkumar seeks to find. And he’s got a solid idea on how to keep costs down – and keep quality care high. On this week’s episode of “The Cost of Health,” Rahul shares his thoughts on the factors that drive rising costs, a strategy for value-based reimbursement in North Carolina, and how it all works. Doctor Rajkumar's executive profileDoctor Rajkumar on Twitter @RahulRajkumar11Follow the coalition and Michael on Twitter @fiscalhealthnc and michaelck and FacebookAnd be sure to join the coalition to help fight for lower health care costsThe North Carolina Coalition for Fiscal Health is a 501(c)(4) corporation, organized as a nonpartisan group focused on economic issues and the rising cost of healthcare in North Carolina. We’re here to talk about improving the fiscal health of all North Carolinians.

The Council’s Content Specialist, Market Intelligence & Insights, Katie Oberkircher, interviews Scott Sinder, partner at Steptoe & Johnson and chief legal officer for The Council, as he breaks down the new Association Health Plan (AHP) regulation and cites key items for brokers to understand.

In October 2017, President Trump issued an Executive Order including 3 things aimed at unraveling pieces of the Affordable Care Act when efforts in Congress failed to do so. One of those items was to seek more relaxed regulations on association health plans as a way to allow individuals and businesses the opportunity to purchase policies across state lines and avoid some ACA requirements. However, there are a few things employers should understand before forming or jumping into an association. Tune in to this podcast to learn more.

Todd Martin is an attorney at Stinson Leonard Street with over 20 years of experience in various functions in the healthcare industry including insurance regulation, administrative law, employee benefits, transactions, and governance. His work and in-depth experience regarding the healthcare regulatory environment has been instrumental in advising clients on the Affordable Care Act as well as the substantial work he has done with multiple health plan structures. Todd joins us today to explain the new rules and regulations regarding Association Health Plans. He explains the key differences between the old and new rules and how it may affect both old and new companies. He also discusses the requirements necessary for new associations to operate, and the pros and cons of starting a new association health plan. finally, he also describes how one state varies from the other when it comes to Association Health Plans and some of the primary concerns of those opposing the new regulations. “Some states are very receptive to association health plans, and some are very restrictive.” - Todd Martin Today on Spot On Insurance: The intended purposes of the new legislative regulations How the regulations limited Association Health Plans before the ACA rules. How the new regulations changed the current rules regarding associations. Requirements on how the association operates. How to form an association. The pros and cons of starting a new association. Do state laws still apply to association health plans? How states regulate association health plans. Concern from groups opposed to association health plan expansion. When the new rules will be in full effect. Key Takeaways: The association can't be controlled by the insurance issuer; it has to be controlled by the employer members of the association. Connect with Todd Martin: Stinson Leonard Street Email: todd.martin@stinson.com Phone: (612)335-1409 This episode was brought to you by….. Insurance Licensing Services of America (ILSA), America’s Premier Insurance Compliance and Licensing experts. To learn more about ILSA and their services, visit ILSAinc.com. Connect, Learn, Share Thank you for joining us on this week’s episode of Spot On Insurance. For more resources and episodes, visit SpotOnInsurance.com. Subscribe so you never miss an episode. Love what you’re learning, Spot Light your review on iTunes and share your favorite episodes with friends and colleagues!

Gary and Dee discuss current events and politics.  Lyn is on vacation this week.  We start with Good News!  The Sinclair-Tribune merger is on hold.  In Philadelphia, Christian adoption agencies don’t have a license to discriminate; and, in Delaware, reproductive rights are protected.  We discuss some of the events of Trump’s latest trip abroad.  What exactly did Trump agree to in the private meeting with Putin?  Putin seems to think we’ll be handing over a former US Ambassador and a British citizen (Browder.)  NY AG Underwood is investigating the Trump Foundation.  We discuss the lack of election security.  Of the millions set aside to protect the 2018 election, none has been spent.  It’s almost as if the Republican Administration wants it to get hacked.  There was a new executive order signed this week that let dark money to 501 (C) 4 organizations go without monitoring.  Could it be because of all the money that the Russians gave to the NRA?  We discuss the new rule that was supposed to make Association Health Plans more attractive.  It’s actually having the opposite effect.  Where is that military parade money coming from?  It’s coming from abandoning our ally, South Korea.  We discuss the Puerto Rico death toll.  Starting with Hurricane Irma and continuing through Maria and today, more people have died in Puerto Rico from the 2017 Hurricane season than died in the 9/11/2001 attacks.  We finish with a discussion on the suicide rates of interns.   Suicide rates are up in male interns. For a look at some of the best signs in the London protests: https://www.thecut.com/2018/07/best-signs-london-trump-protest.html #GoodNews #TrumpAbroad #NYv.Trump #Election2018 #DarkerMoney #AssnHealthPlans #MilitaryParade #PuertoRico #InternSuicides Do you enjoy listening to Peak Reality Check?  Would you like to help support this podcast?  Visit our Patreon page: https://www.patreon.com/DeirdreL The post Peak Reality Check, July 20, 2018 appeared first on Studio 809 Radio.

Alden Bianchi of Mintz Levin and Christopher Condeluci of CC Law & Policy join Talking Tax host Andrea L. Ben-Yosef to discuss the new rules for association health plans, which change the standards for determining which small employers are permitted to join with other small employers to form, maintain, and participate in single, large group health plans. These health care law experts discuss how association health plans work, who should consider using them, and how they will impact the health care marketplace.

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In this episode, Suzanne Spradley and K.C. Barner discuss the newly released final rule related to the creation and maintenance of association health plans (AHPs) under ERISA. The DOL’s final rule is a long-awaited response to the Oct. 12, 2017, executive order from Pres. Trump directing the DOL and other agencies to (among other things) expand the availability of AHPs. Suzanne breaks down the DOL’s final rule, which loosens restrictions on AHPs to allow more groups of employers to qualify as associations for the purpose of sponsoring group health plan benefits. The two discuss the impact on sole proprietors and other self-employed individuals, and how state and federal (including ACA) regulation of an AHP would work.

Association Health Plans by Dave and Peggy

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week in managed care, the top stories included Atul Gawande, MD, being named the CEO of the Amazon–Berkshire Hathaway–JPMorgan Chase healthcare venture; the Trump administration finalized rules for creating association health plans; an analysis found some cancer types are represented more than others in the Oncology Care Model. Read more about the stories in this podcast: Amazon, Berkshire Hathaway, JPMorgan Chase Announce CEO of Joint Health Company: https://www.ajmc.com/newsroom/amazon-berkshire-hathaway-jpmorgan-chase-announce-ceo-of-joint-health-company New Rule Allows Creation of Association Health Plans That Skirt ACA Regulations, Protections: https://www.ajmc.com/newsroom/new-rule-allows-creation-of-association-health-plans-that-skirt-aca-regulations-protections Participation in OCM May Transform Care for Certain Cancer Types More Quickly Than Others: https://www.ajmc.com/newsroom/participation-in-ocm-may-transform-care-for-certain-cancer-types-more-quickly-than-others Implementing Alternative Payment Models for Improved Population Health: Experiences from the OCM: https://www.ajmc.com/webcast/experiences-from-the-ocm UpWell Health Survey: 45% of Those With Diabetes Skip Care Due to Costs: https://www.ajmc.com/newsroom/upwell-health-survey-45-of-those-with-diabetes-skip-care-due-to-costs A Retrospective on the Oncology Care Model: https://www.ajmc.com/journals/evidence-based-oncology/2018/june-2018/a-retrospective-on-the-oncology-care-model Perspective: FDA/CMS Parallel Review Advances Coverage for Cancer Comprehensive Genomic Profiling: https://www.ajmc.com/journals/evidence-based-oncology/2018/june-2018/perspective-fdacms-parallel-review-advances-coverage-for-cancer-comprehensive-genomic-profiling Evidence-Based Oncology—June 2018: https://www.ajmc.com/journals/evidence-based-oncology/2018/june-2018

Todd Martin is a partner at Stinson Leonard Street, LLP., one of the largest law firms serving clients across the United States in a wide range of practice areas including Corporate Finance, Intellectual Property and Technology, Private Business, Product Liability, and Health Law. He has over 20 years of experience in insurance regulation, administrative law, and employee benefits and has worked with countless corporate legal departments of Fortune 500 companies. Currently, he advises insurers, third-party administrators, brokers, and employers on health plan regulatory concerns such as the Affordable Care Act.  Todd joins us today to share how his career as an attorney in the insurance industry began. He explains what Association Health Plans are and how they help organizations, agencies, and businesses offer affordable healthcare plans to their members. He also explains the regulatory and legal aspects associated with joining or creating a new association, what to consider when starting a new association, and future projections for federal and state regulatory laws regarding Association Health Plans.  “There must be a reason for the association to exist other than buying insurance.” - Todd Martin  Today on Spot On Insurance:  What is an Association Health Plan?  How Association Health Plans can help businesses lower the cost of offering health insurance to their organization members.  Laws and requirements associated with becoming an approved association.  How similar businesses can participate in Association Health Plans and how the laws are evolving regarding the rules on membership access.  Benefits of becoming a member of an Association.  How the Affordable Care Act has impacted Association Health Plan regulations.  Changes in laws and regulations at the state and federal levels.  What to consider when starting a new association.  Costs associated with starting an Association Health Plan.  How healthcare brokers can increase business awareness of Association Health Plans/ The estimated amount of time it takes to get an Association Health Plan ready to offer to members.  Factors that impact the healthcare savings for Association Health Plans.  Mitigating risks associated with the “death spiral concept.”  The importance of underwriting and reviewing new members to ensure the viability of association health plans.  Key Takeaways:  Connect with a good broker to learn what options are available for your association and members.  Consider the viability of your group for sponsoring a health plan.  Consider your state laws regarding health plan options.  Connect with Todd Martin:  Phone: (612) 335-1409  Email: Todd.Martin@Stinson.com  This episode was brought to you by…  Insurance Licensing Services of America (ILSA), America’s Premier Insurance Compliance and Licensing experts. To learn more about ILSA and their services, visit ILSAinc.com.  Connect, Learn, Share  Thank you for joining us on this week’s episode of Spot On Insurance. For more resources and episodes, visit SpotOnInsurance.com. Subscribe so you never miss an episode. Love what you’re learning, Spot Light your review on iTunes and share your favorite episodes with friends and colleagues! 

Ep 21: Association Health Plans by NFP's Insights from the Experts

We've paid a lot of attention this year to the bill that would “Repeal and Replace” the Affordable Care Act but that is not the only bill related to health care that is moving through Congress. In this episode, learn about the other health care bills that have made it just as far as the Repeal and Replace bill, including one that is already law. Also in this episode, we laugh at the Senate for inventing holidays and doing so in the dumbest way possible. Please support Congressional Dish: Click here to contribute using credit card, debit card, PayPal, or Bitcoin Click here to support Congressional Dish for each episode via Patreon Mail Contributions to: 5753 Hwy 85 North #4576 Crestview, FL 32536 Thank you for supporting truly independent media! Recommended Congressional Dish Episodes CD123: Health or Profits CD145: Price of Health Care CD151: AHCA - The House Version Bills Outline Laws H.J. Res. 430: Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the final rule submitted by Secretary of Health and Human Services relating to compliance with title X requirements by project recipients in selecting subrecipients. Overturns a rule finalized by the Obama Administration that would have prevented States from cutting off Federal funds for "family-planning services". Bills In Progress H.R. 372: Competitive Health Insurance Reform Act of 2017 Repeals an antitrust exemption that currently applies to health and dental insurance Allows antitrust exemptions for life insurance, and property or casualty insurance H.R. 1101: Small Business Health Fairness Act of 2017 Orders the Executive Branch to use regulations to create a procedure for certifying Association Health Plans (AHPs), which are not regulated like the state small group health insurance markets. Association Health Plans and the insurance companies that provide coverage will select the services included and their decisions are exempt from State laws. Creates a fund that will pay insurers to continue coverage if the plans disappears. The fund can be raided by the Executive Branch to pay for other things "whenever the Secretary determines that the moneys of the fund are in excess of current needs." A working group would be created to write the regulations. The applications for plans will include the States in which the plan intends to do business. If the association plan becomes insolvent, the government will become the trustee and can try to fix the plan, cancel the plan entirely, and can invest the plans assets. Would become effective one year after being signed into law and enactment regulations would be created by the Secretary of Labor. H.R. 1215: Protecting Access to Care Act of 2017 Enacts a statue of limitations on filing health care lawsuits which would be one year after the injury is discovered but never more than three years after the malpractice occurred The states can make the statue of limitations shorter Limits non-economic damages (such as pain, suffering, physical impairment, disfigurement, and mental anguish) to $250,000, "regardless of the number of parties against whom the action is brought or the number of separate claims or actions brought with respect to the same injury." "The jury shall note be informed about the maximum award for noneconomic damages." States will have the ability to adjust this number, up or down. Actual economic losses (such as medical expenses, past and future earnings losses, and loss of employment) in health care lawsuits will remain unlimited. Each guilty party in a health care lawsuit will only be held liable for the percentage of the damages in direct proportion to that party's percentage of responsibility. Doctors who prescribe a medicine that has been approved by the FDA can't be sued along with manufacturers, distributors, or sellers in product liability lawsuits Any statements or conduct expressing "fault" (along with apology, sympathy, etc.) made by a health care provider in regards to an unexpected medical outcome "shall be inadmissible" for any purpose as evidence of an admission of liability. States are allowed to make other communications inadmissible too. The statute of limitations would be effective immediately upon enactment and the limits on damages will be for all lawsuits started after the law is signed. Additional Reading Document: H.R. 1628 Obamacare Repeal Reconciliation Act of 2017 Cost Estimate, Congressional Budget Office, July 19, 2017. Article: The Washington Post's New Social Media Policy Forbids Disparaging Advertisers by Andrew Beaujon, Washingtonian, June 27, 2017. Document: H.R. 1628 Better Care Reconciliation Act of 2017 Cost Estimate, Congressional Budget Office, June 26, 2017. Document: H.R. 1628 American Health Care Act of 2017 Cost Estimate, Congressional Budget Office, May 24, 2017. Article: Examining The Final Market Stabilization Rule: What's There, What's Not, And How Might It Work? by Timothy Jost, Health Affairs Blog, April 14, 2017. Document: Guidance to States on Review of Qualified Health Plan Certification Standards in Federally-facilitated Marketplaces for Plan Years 2018 and Later, Centers for Medicare & Medicaid Services, April 13, 2017. Article: Treasury Inspector General Assesses ACA-Related Tax Issues by Timothy Jost, Health Affairs Blog, April 11, 2017. Document: Compliance With Title X Requirements by Project Recipients in Selecting Subrecipients by Department of Health and Human Services, Federal Register, Vol. 81, No. 243, December 19, 2016. Article: Is the ACA the GOP health care plan from 1993? by Jon Greenberg, Politifact, November 15, 2013. References American Civil Liberties Union: Public Funding for Abortion GovTrack: Health Bills Tracker Cornell Law School: 15 U.S. Code § 1013 Kevin McCarthy Majority Leader website: Health Care Phase 3: The Small Business Health Fairness Act ConsumersUnion: Letter to the House Opposing the Small Business Health Fairness Act OpenSecrets: Clients lobbying on H.R. 1215 American Medical Association: Support for House-Passed Bill on Medical Liability Google: UnitedHealth Group Stock US Senate Financial Disclosure: James Inhofe Stock Purchases American Health Insurance Plans: Letter to President Trump Dept of Health and Human Services: Letter to Governor regarding Medicaid Medicaid: About Section 1115 Demonstrations Washington Post: About WP Brandstudio Videos CSPAN: Pres. Trump Remarks on Senate Republican Health Care Bill YouTube: Hell to the Nah! Sound Clip Sources Hearing: Rules Committee Hearing, House of Representatives Committee on Rules, February 14, 2017. Timestamps & Transcripts 6:40 Rep. Jim McGovern (MA): I’ll make the point I continue to make about the process. Both of these rules, or protections, went through a long process, and whether you agree with them or not, there was a process. Here we are; the committees with jurisdiction did no hearings on this, have basically—there’ll be no opportunity for review. We know what the outcome is going to be: two more closed rules. So it’s kind of this whole hearing is kind of pointless because, again, the process is going to be the most restrictive that it can be. 9:40 Rep. Tim Walberg (MI): As you know, Title X is the only domestic federal program that provides grants for family-planning services. Grants go directly to states and non-governmental organizations, which then distribute money among healthcare providers. Over half of the grantees are state and local governmental agencies, which serve as intermediaries to distribute funding to subgrantees. Prior to this rule, states were free to direct their Title X funds to healthcare providers that did not participate in abortion. When states had this freedom, they were able to choose to invest in women’s health care instead of abortion. The new rule blocks states from restricting grants to potential recipients for reasons other than the ability to provide Title X services. Under this rule, states are prevented from establishing criteria that would eliminate abortion providers from receiving Title X grant money. Hearing: H.R. 372, the "Competitive Health Insurance Reform Act of 2017", House of Representatives Judiciary Committee, February 16, 2017. Timestamps & Transcripts 10:15 Rep. John Conyers (MI): I am pleased that the subcommittee’s first hearing of this new Congress is on H.R. 372, the Competitive Health Insurance Reform Act of 2017, which repeals the antitrust exemption in the McCarran-Ferguson Act for the health insurance business. For many years I’ve advocated for such a repeal, so I’m heartened to see the bipartisan nature of the support for this position. 11:50 Rep. John Conyers (MI): Congress passed McCarran-Ferguson Act in response to a 1944 Supreme Court decision, finding that antitrust laws applied to the business of insurance, like everything else. Both insurance companies and the states expressed concern about that decision. Insurance companies worried that it would jeopardize certain collective practices like joint-rate setting and a pooling of historical data, and the states were concerned about losing their authority to regulate and tax the business of insurance. To address these concerns, McCarran-Ferguson provided the federal antitrust laws apply to the business of insurance only to the extent that it is not regulated by state law, which has resulted in a broad antitrust exemption. Industry and state revenue concerns, rather than the key goals of protecting competition and consumers, were the primary drivers of the Act. In passing McCarran-Ferguson, Congress, however, initially intended to provide only a temporary exemption and, unfortunately, gave little to consideration to ensuring competition. 26:15 Rep. Austin Scott (GA): Be definition, health care and health insurance are not the same thing. But when one insurance company controls such significant portions of the cash flow of all of the providers in a region, no provider can stay in business without a contract with that carrier. Therefore, the insurance company gets to determine who is and who is not able to provide health care: sign a contract with a competing carrier, and we’ll cancel your contract. Accept the lower reimbursement, or we’ll cancel your contract. It’s closer to extortion than negotiation. Hearing: Legislative Proposals to Improve Health Care Coverage, House Committee on Education and Workforce, March 1, 2017. Witnesses Allison Klausner: American Benefits Council, which represents Fortune 500 companies Lydia Mitts: Associate Director of Affordability at Families USA, a consumer advocate org. Jay Ritchie: Executive VP of Toko Marine HCC-Stop Loss Group & Chairman of the Self-Insurance Institute of America Jon Hurst: President of the Retailers Association of Massachusetts Timestamps & Transcripts 25:50 Rep. Virginia Foxx (NC): Ultimately, they are fighting to maintain government control—government control over the kind of health insurance you can buy, government control over the kind of health insurance employers can and cannot offer workers, government control over the doctors you can see and the doctors you can’t see, and government control over certain healthcare benefits that many individuals may not need. Yet despite the cost and pain inflicted on so many Americans by Obamacare, the answer for some is still more government control. 47:35 Lydia Mitts: The second bill I would like to speak to is the Small Business Health Fairness Act. This bill would exempt association health plans from adhering to critical state and federal requirements for small-group coverage. These requirements have benefited small employers and their workers alike. They include protections that prevent plans from charging small employers exorbitantly higher premiums because their employees have poor health, are older, or are disproportionately women. They also include requirements that plans cover comprehensive benefits that meet the needs of a diverse workforce. By allowing association health plans to ignore these key protections, this bill would increase premiums and threaten stable access to comprehensive coverage for many small employers and their workers. Employers with a young workforce that is in pristine health may be able to get lower premiums. However, the rest of small businesses would see coverage become less affordable, whether they sought it through an association or the existing small-group market. On top of this, employees move to association plans would be at risk of facing skimpier coverage that doesn’t cover the care they need. 1:41:20 Rep. Suzanne Bonamici (OR): Ms. Mitts, the ACA included, as we know, unprecedented new consumer protections for patients, such as eliminating annual and lifetime limits, preventing insurers from dropping people when they get sick, charging women higher premiums. What will happen to these protections in association health plans? Lydia Mitts: Under the bill put forth to you today, those association health plans would no longer have to comply with so many of those rating protections that have been a huge benefit to many small businesses that prior before the Affordable Care Act actually had a really hard time finding affordable coverage for their employees because they employed employees who actually had healthcare needs, who were maybe older, and the market didn’t work for them before. And so we would move back to a situation where we’d have a segmented market, and people who are healthy, in pristine health, could move into an association health plan. I think the thing that’s important to keep in mind is that that doesn’t mean that association health plan would always be there and work for that small employer. If their workforce got older, claims went up, they might find that that association health plan charges them more, and it’s not a viable option for them anymore. Bonamici: Can you address—I know there’ve been some solvency concerns about some of the association health plans. Can you address that concern as well? Mitts: Yeah, there’s historically been concerns about association health plans not having adequate solvency funds. They have leaner, less rigid requirements than typical health insurance coverage. Partially state oversight was added to that to help address some of these problems, bigger problems, where they were just under ERISA. And when an association plan goes insolvent, their employers and their workers are still left with all of those unpaid medical claims and then on the hook for them. And if the plans are not under state jurisdiction, they won’t be able to benefit from state guaranty funds that help pay those claims, so they’ll be left on the hook for them. Hearing: H.R. 1215 Hearing-Part 1, House Committee on the Judiciary, February 28, 2017. Timestamps & Transcripts 44:20 Rep. Steve King (IA): One of the drivers of higher healthcare spending is defensive medicine. It’s a very real phenomenon confirmed by countless studies in which healthcare workers conduct many additional costly tests and procedures with no medical value that are charged to the federal taxpayers and to other consumers simply to avoid excessive litigation costs. 45:25 Rep. Steve King (IA): They include the following: a bedside sonogram with an “official sonogram” because it’s easier to defend yourself to a jury if you’ve ordered the second sonogram; a CT scan for every child who bumped his head, or her head, to rule out things that can be diagnosed just fine by observation; x-rays that do not guide treatment such as for a simple broken arm; or CT scans for suspected appendicitis that has been perfectly well diagnosed without it. In fact, I have an orthopedic surgeon who has said to me that when he has a knee injury, 97% of the tests that he orders are protection from malpractice. He knows what he’s going to operate on before he actually starts the surgery. 51:55 Steve Cohen: And if we want to make health care cheaper, which we should, and make it more affordable, we ought to have a single-payer system. That would make it more affordable. And if that’s the nexus that makes this law applicable for the federal government to usurp the states, and the Chairman said that the nexus was that it makes things cheaper and anything makes health care cheaper is so important that we need to take it away from the states, well, if you’re concerned about cost, you should be for a single-payer system, and that would make it cheaper and take profits away from insurance companies that right now are paying for ads to get people to buy drugs and making immense profits and having their executives draw salaries in the areas of 40 and 50 million dollars. This bill takes away from people who are hurt by medical malpractice in ways that are artificial and wrong, and we should not be on the side of those people who commit medical malpractice and cause injuries to others. With all of that said, I respectfully suggest that the agenda we’re following is not the agenda of the American people at the present time, and it’s the agenda of the American Medical Association, who’s here today, and this is the bill du jour. Hearing: Tom Price, HHS Fiscal Year 2018 Budget Request, Senate Finance Committee, June 8, 2017. Timestamps & Transcripts 44:37 Sen. Tom Carper (DE): And I like those ideas. I studied a little bit of economics at Ohio State as navy ROTC midshipman. I like market forces. I like trying to harness market forces and make them work. You came up with a good idea in 1993, and I just wish to heck that you would work with us to try to make sure that those good ideas have a chance of working. And the reason why the marketplaces are failing in places, like you mentioned Ohio in your statement, Mr. Chairman, the reason why they’re not working, we’ve basically undermined the individual mandate so that people will know if they really have to get coverage. Young people aren’t. We’ve taken off the training wheels, so to stabilize the marketplaces and insurance companies. They lost their shirts in 2014 because of it. They lost less money in 2015. Got better. They raised their premiums, they raised their copays, they raised their deductibles, and they did better in it. And tells that rather than the marketplaces being a death spiral at the end of 2016, they’re actually recovering, until a new administration came in and said, well, we’re not sure if we’re going to enforce the individual mandate, and, by the way, we don’t know for sure whether they’re going to extend the cost-sharing arrangements. That provides unpredictable lack of certainty for the insurance companies. What do they do? They say, we’re going to raise our premiums more. What you’re destabilizing, the very idea that these guys came up with 24 years ago. Sen. Orrin Hatch (UT): Well, if I could just interrupt for a second. Those were ideas that were against—it was part of the anti-Hillary care bill, and it— Carper: They were good ideas. Tom Price: Well— Carper: And I commend you for them. If my life depended on telling what Hillary care did, I couldn’t tell you. But I know what your bill did, and, frankly, there were good ideas, and now we’re undermining undercutting them. Why? Dr. Price, why? Price: Senator, I appreciate the observation. I would add to that that there are significant challenges out there, and there were so before this administration started. In your state alone, premiums were up 108% before this administration started. In your state alone, there were fewer insurance companies offering coverage on the exchange before this administration started. So what we’re trying to do is to address especially that individual and small-group market that is seeing significant increases in premiums, increases in deduct— Carper: What are you doing? What are you doing to doing? How are you stabilizing the marketplaces? Price: Well, we— Carper: Just give us some ideas. The three Rs. What are you doing on those? Reinsurance, risk adjustment, risk corridors. What are you doing there? Price: We passed it—or we put in place a market-stabilization rule earlier this year that identified the special enrollment periods and the grace periods to make certain that they were more workable for both individuals and for insurance companies. We allowed the states greater flexibility in determining what a qualified health plan was, to try to provide greater stability for the market. We put out word to all governors across this nation on both 1115 and 1332 waivers and suggestions regarding what they can do to allow for greater market stabilization in their states, and we look forward to working with you and other senators to try to make certain that all those individuals, not just in the individual and small-group market but every single American has the opportunity to gain access to the kind of coverage that works for them and their families. Sen. Mazie Hirono designated February 3rd as "National Wear Red Day." This is what she wore. Music Presented in This Episode Intro & Exit: Tired of Being Lied To by David Ippolito (found on Music Alley by mevio) Cover Art Design by Only Child Imaginations