iLoveBenefits: Industry News Blog

Independent Payment Advisory Board will be triggered for the first time

July 2015, implementation of the Independent Payment Advisory Board will be triggered for the first time in just two years, based on projections included in the annual report issued by Medicare’s trustees. That controversial ACA panel would be required to recommend cuts if Medicare exceeds spending growth thresholds. Conservatives have pilloried the board as potentially a means to ration care for seniors, and the House voted earlier this year to repeal it.

States with the lowest uninsured rates . . . some impressive results

10 States With Lowest Uninsured Rates Post-ACA
While the uninsured rate has dropped to a record low of 13.4% nationwide, according to Gallup figures, rates differ dramatically across states. Here are the top 10 states with the best uninsured rates in the aftermath of health care reform implementation, according to Wallethub.READ MORE »

Is ACA having an effect health spending

The August ‘Variety Issue’ of Health Affairs features an article by David Dranove of Northwestern University and co-authors entitled Health Spending Slowdown Is Mostly Due To Economic Factors, Not Structural Change In The Health Care Sector, which finds about 70 percent of the slowdown is due to broader economic conditions, rather than structural changes brought on by the Affordable Care Act.

August 11, 2014 | Categories: Cost,Health Reform Law,healthcare | Tags: , , , | Comments (0)

Health Spending by Consumers is Rising

From Employee Benefits News:

[The health law] is prompting [consumers] to spend more at the doctor’s office and pharmacy. Consumer spending climbed by $20.4 billion at an annualized rate adjusted for inflation in February, and $13 billion of the increase came from outlays on health services spurred by the Affordable Care Act of 2010, according to Commerce Department data.

The Urban Institute in Washington estimated this month that about 5.4 million people have gained insurance since January. That could be unleashing pent-up demand for medical procedures that are boosting out-of-pocket household spending on co-payments and prescriptions. Those who enrolled in more comprehensive insurance to meet Obamacare requirements may also be spending on newly-covered services.

Read more here:


The estimated cost of ACA to large employers

Cost of the Affordable Care Act to Large Employers


The total cost of ACA to all large U.S. employers  2014   to 2023

$151 to $186 billion

Cost per employee, 2014 to 2023

$4,800 to $5,900

Cost per large employer, 2014 to 2023

$163 to $200 million

Percentage increase in employer-provided health care costs   from ACA

4.3% in 2016

5.1% in 2018

8.4% in 2023

Notes: Large U.S. employers have 10,000 or more employees

Source: American Health Policy Institute

SGR and the Individual Mandate

House Republicans say they want to tie SGR repeal legislation to a delay in the ACA’s mandate that individuals purchase health insurance. The SGR repeal was previously bipartisan, but this latest GOP proposal is likely DOA in the Democrat controlled Senate.

Meanwhile, the Obama administration admitted Thursday they don’t know how many of the nearly 4 million who purchased insurance so far under the ACA were previously uninsured. However, a couple of independent surveys say the number is an underwhelming one in 10.

For those who don’t participate the important question is why not

A new study estimates
that 25% of all potential enrollees will choose to participate in the first
year of the health insurance exchange, and 35% of the 17 million people
eligible for tax credits in 2014 will buy coverage in an exchange.

“State-by-State Estimates of the Number of People Eligible for Premium Tax
Credits Under the Affordable Care Act ,” The Henry J. Kaiser Foundation,
Issue Brief, November 5, 2013,

News about Health Insurance Marketplaces

According to a survey conducted October 9–27, 2013:

  • 60%      of potentially eligible adults are aware of the new health insurance      marketplaces in their state
  • 17%      visited the health insurance marketplace in October to shop for a health      plan, either online, by phone, in person, or by mail
  • 21%      of visitors were ages 19 to 29
  • 21%      of visitors enrolled in a health plan
  • 37%      of those who did not enroll in a health plan through the marketplace cited      technical difficulties as a reason

Source: “Americans’ Experiences in the Health Insurance Marketplaces: Results from the First Month,” The Commonwealth Fund, November 4, 2013,

This is what Health Exchanges can be . . .

Instead of focusing on the issues and challenges that some exchanges are experiencing, if America understood the success of the California Exchange they would begin to grasp the promise of what can be. . .

Thousands of Consumers Apply for Health Insurance through New Covered California Marketplace

First Week of Open Enrollment Reveals Strong Demand for Coverage; Nearly 1 Million Unique Visits to Website; Service Center Calls Surge

SACRAMENTO, Calif. — Covered California™ received tens of thousands of enrollment  applications during the first week consumers could officially apply for health  insurance at the agency’s online marketplace, as well as those newly eligible  for Medi-Cal coverage.  “We’ve started strong,” said Executive Director Peter V.  Lee. “The amount of interest and number of applications we’ve received in the  first week underscores the demand among Californians for quality, affordable  health care.”

Website    and Call Center Weekly Report: Oct.1-5
Service    volumes
Unique    visits to 987,440
Call volume 59,003
Average    wait time 15:08    *
Average    handling time 16:48
Applications 43,616
Partially    completed 27,305
Applications    completed with household eligibility determined 16,311
Number    of Californians determined eligible for coverage 28,699
Small    Business Health Options Program businesses registered as of 10/8/2013 430
*Average    wait time was reduced to less than four minutes by Friday, 10/4/2013.

For the initial week of operations, reflecting Tuesday  through Saturday (Oct. 1-5), Covered California’s website,, had 987,440 unique visits.  Online, 16,311 households completed their eligibility process and were  determined eligible for subsidies, Medi-Cal or to enroll in an individual  private plan. These household applications contained 28,699 individuals who  completed eligibility determination. An additional 27,305 households had  partially completed their online application.

At Covered California Service Centers, 59,003 calls were  logged over the five-day period. “It’s just the beginning, but these numbers are truly  exciting and encouraging,” Lee said. Consumers were equally excited about being  able to enroll online in Covered California health insurance plans that provide  quality and value, and uniform benefits, without worry about pre-existing  conditions.

Paul Torrigino of Sacramento enrolled in a Bronze plan for  about a dollar per month and said, “Oh my gosh, the insurance has been going up  for the last few years like crazy. All our money was going to pay for medical  insurance.”

In San Diego, the Gedankens are receiving premium  assistance of $1,300 a month on their Silver plan — roughly half the cost  they’re paying now.

And Aura Lee Sanchez from Sacramento said when she enrolled,  “It felt fantastic to finally get coverage!”

“With almost three months to enroll for coverage effective  Jan. 1, the fact that thousands of Californians and hundreds of our small  businesses are stepping forward in our first week is a testament to the need  for the Affordable Care Act,” said Peter Lee.

Subsequent weekly statistics will be based on a Sunday-through-Saturday  schedule. Total enrollment for October will be released in November.

“Covered California is committed to sharing information and  will continue to report weekly on the numbers of visits to our website and the  number of consumer calls to our Service Centers,” Lee said.

About Covered California

Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California was charged with creating a new health insurance marketplace in which individuals and small businesses can get access to affordable health insurance plans. With coverage starting in 2014, Covered California will help individuals determine whether they are eligible for premium assistance that will be available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses will be able to purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.

Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the Governor and the Legislature. For more information on Covered California, please visit

Health Exchanges: If they think the first day was busy . . . wait until the final days

If you know a Benefits Director, you would have expected this. A launch of any significant changes in health plans draws huge traffic. This was huge. But they haven’t seen anything yet. Wait until the last week… those last few days will seen an avalanche of visitors.


ACA website records 4.7M visitors on first day, HHS says
HHS said Wednesday that it logged 4.7 million visitors to, the primary website for Affordable Care Act enrollment, during the first 24 hours of the law’s new health insurance exchanges. The site remained slow on Wednesday after technical problems plagued its initial launch on Tuesday. “While this overwhelming interest is continuing to cause wait times, there will be continuing improvements in the coming hours and days,” HHS spokeswoman Joanne Peters said. The Hill/Healthwatch blog (10/2)

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