Healthcare reform

John Lamb on helping employees that have reached the tipping point on health care spending.

Third biggest U.S. health insurer says the share of health care premiums it spends on patient care rose to 84.1% from 80.7% a year earlier. The insurer finished 2012 with 18.2 million members in its medical plans, an increase of 64,000 over the third quarter.

The IRS and HHS released new regulations Wednesday for the individual mandate portion of PPACA. The proposed regulations shed new light on the process the agencies will take in determining which individuals are subject to the mandate or whether they’re exempt, and whether their insurance coverage is sufficient.

Employees can receive government tax credits to buy insurance for their families if the coverage their employers offer would cost more than 9.5% of their income, the IRS said Wednesday in final regulations. However, that calculation will be based on the cost of single coverage, not family coverage, which is more expensive and would give more people access to the credits.

Oklahoma opposed a request by the U.S. that a judge dismiss the state’s lawsuit challenging President Obama’s 2010 health-care reform legislation.

State exchanges top Americans’ wish list for what they would like the government to set as 2013 health care priorities.

Howard County, Md., will become the first municipality to establish a nonprofit, member-run health co-op to sell individual and small group plans through the insurance exchanges — a move some say could undercut competitors by 30%.

UnitedHealth Group Inc. and other U.S. health insurers will soon have company in Maryland: a nonprofit started by a county government that plans to sell coverage at rates as much as 30% lower than competitors.

With the 113th Congress up and running and the president’s policy schedule filling up by the day, the Kaiser Family Foundation and Harvard School of Public Health polled Americans last week on what they would like the government to set as top health care priorities for the year.

As the health insurance exchange marketplace continues to expand, industry trailblazers and benefits experts are weighing in on what it takes for employers to succeed within this relatively new health care model.

Consulting firm announced Thursday the launch of a private benefits exchange developed by Benefitfocus, available to employers with at least 100 employees.

Mercer announced Thursday that it has launched a private benefits exchange developed by Benefitfocus and available to employers with at least 100 employees.

Spending on hospital visits, medications and other care grew 3.9% to $2.7 trillion in 2011, matching the slowest growth in 52 years of recordkeeping, according to federal data released this week. Before the 2007 recession, growth was close to 8%.

Most employees believe that their employer offers them the best health plan they could, and that they might be at a loss to ensure the same on their own, according to the Employee Benefit Research Institute.

Conditional approval from federal government allows Idaho, New Mexico, Nevada and Utah to move forward in creating state-run health insurance exchanges to comply with health care reform.

Medical insurance markets crafted by four U.S. Republican governors won conditional approval by the Obama administration as the federal government nudges states toward full implementation of the landmark health-care overhaul.

Experts from Mercer offer up a priority list for benefits providers in 2013. The first one: Prepping for 2014.

Insurance Reform

EBA Contributor Barry Cohn is being kept busy with questions about MLR reimbursements, with clients wondering what to do or asking how much they would be receiving.

Pediatric dental and orthodontic coverage could see significant changes under health care reform, particularly in terms of reimbursement. Evelyn Ireland, the executive director of the National Association of Dental Plans, talks about regulations that might or might not have people smiling.