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Repeal and Replace: "Watering" Down Ten Essential Benefits? PDF Print E-mail
Written by Ellen Breslow   
Sunday, 26 February 2017 00:00
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It’s abundantly clear that it is going to take time to repeal and/or replace the Affordable Care Act. And, despite the fact that the republican draft would sunset the ten essential benefits in 2019, it would require a change in the law and therefore 60 votes in the Senate to eliminate these provisions entirely. While it may be nearly impossible to throw out this provision without the necessary votes, perhaps these benefits can be diluted to reduce the costs of plans so that they remain close to employer sponsored health plans and therefore compliant. Put simply, diluting is easier to do than outright changing the law.


One benefit that the Republicans have discussed is preventive and wellness services and chronic disease management. Under the ten essential benefits provision, these services are covered without cost sharing. The thought is that several of these benefits could be trimmed to shrink costs. Among the proposed benefits to be limited is the requirement that birth control be provided without an out-of-pocket cost to women.

Also on the block for limitations of benefits are mental health and substance abuse disorders, prescription drugs, and pregnancy, maternity and newborn care. Within these, and really most all of the ten essential benefits, is room for paring back services without garnering the 60 votes in the Senate.

In addition, Obamacare requires that “rehabilitative and habilitative services and devices” be covered. Many employer plans don’t include habilitative services, which help people with developmental disabilities learn and improve functional skills. Although federal officials have issued regulations that define habilitative services and set limits for covered service visits, given the fact that all employer plans don’t include this benefit may allow for changes in this provision.


As we have seen repealing and replacing a 2000+ page piece of legislation is no easy task. Although these seem like small steps, it may be the way the ACA is dismantled.



Last Updated on Sunday, 26 February 2017 11:35
Repeal, Replace: Too Many Options, Too Little Concensus PDF Print E-mail
Written by Ellen Breslow   
Thursday, 09 February 2017 00:00
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It’s clear that Republicans want to get the Obamacare repeal headed in the right direction. There’s one big problem, however. Too many different competing plans have been introduced to replace the law.


Several plans have been presented or are expected, however none appear to have the necessary support to achieve Congressional approval. And it’s unlikely that any of plans would convince the public that it should replace Obamacare.  That’s a sad state of affairs given that Republicans have been trying to abolish the ACA for six years.

How to repeal and replace seems to be a question. There’s no agreement on what can be done through the budget reconciliation process, and when it comes to dismantling the entire law—this year, next year, who knows? It’s clear that Republicans want to find a solution that the whole party can get behind, but as of now, this hasn’t happened.

Instead of finding broad support for a single bill, there are a number of alternatives. Senators Cassidy’s (R-La.) and Susan Collins’ (R-Maine) plan would give states autonomy in creating their own health care plans, including keeping Obamacare. Senator Rand Paul’s (R-Ky.) bill would by and large repeal the ACA with little replacement. In addition, the House Freedom Caucus wants to introduce its own bill similar to Senator Paul’s.

Will it be possible for Republicans to pass a comprehensive health care plan after repealing the ACA? Hard to say. Some Senators are saying no; they believe that they will have to pass legislation piece by piece, while at the same time adding replacement language into a repeal bill. Then, of course, changes would need to be made to garner Democratic support in the Senate.

These are just the beginnings of what is to come. In addition to the Senate’s proposals, House Republicans are preparing new legislation to be released as early as next week that would start the repeal and replace process in the House. President Trump is expected to release a proposal also. Having to develop a concensus agreement between these entities adds to the complexity.

This will take time. More time than anyone thought.





Last Updated on Thursday, 09 February 2017 13:40
HealthCare.gov Enrollment: It Can Be A Simple Choice PDF Print E-mail
Written by Ellen Breslow   
Wednesday, 26 October 2016 00:00
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Although it seems as if many insurers are leaving the health insurance exchange marketplace and premiums are likely to rise for many in 2017, there is some brightness set for Obamacare. There will be a new, attractive option available to many consumers beginning in November. In an attempt to make plan selection easier, the federal government is encouraging insurers to offer “simple choice” plans. What’s simple and appealing about these plans is that they are standardized and cover basic services without a deductible.


These new standardized plans will hopefully help eliminate much of the confusion that consumers experience when trying to make comparisons among the various plans offered on the marketplace. The government is providing guidelines to insurers for simple plans at each of the bronze, silver and gold levels, in addition to three more silver plan options for people who qualify for cost-sharing reductions based on income.

The beauty of these simple plans is that the deductibles and annual limits on out-of-pocket spending will be consistent among the plans, as will many of the consumer payments for services. For many specific services, participants will have flat dollar copayments up front for services, rather than having to meet a deductible before the plan will contribute to the cost. Under the standardized simple silver plan, copayments would be $30 for a visit to a primary care doctor, $65 for a visit to a specialist, $15 for a generic drug, $50 for a preferred brand-name drug and $100 for a nonpreferred brand name drug. Consumers may be responsible for up to 40 percent of the cost of specialty drugs, including certain high cost medications for cancer, rheumatoid arthritis and multiple sclerosis.

Insurers generally dislike standardized plans and are not required to offer these plans on the federal exchange. Standardized plans already exist in some of the state run exchanges, however the insurers aren’t obligated to offer them there either. Many insurers believe that these plans can complicate comparisons and that without some differentiation, it may be no easier for individuals to select from among yet another plan choice. These simple plans may also harm those individuals with conditions for whom standardized plans would not be the best alternative.

Open enrollment is upon us. If you’re purchasing health insurance from the federal marketplace, look for the simple plans in your state. It may make sense for you and your family.






Last Updated on Wednesday, 26 October 2016 10:33
Trumpcare: What is it and When Will We See it? PDF Print E-mail
Written by Ellen Breslow   
Monday, 14 November 2016 00:00
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Maybe later than you think and it’s evolving.  President-elect Trump has promised that he’ll ask Congress to repeal the Affordable Care Act on Day One of his administration. Can he really do that on Day One? Even with a Republican House and Senate is that possible?

Not exactly. Not much is likely to change in 2017. The ACA is a complicated law with many moving parts. If the Republicans attempt outright to repeal the law, the Democrats have enough votes to filibuster that move. The Congress may opt to use the budget procedure called reconciliation that allows revenue-related changes, for example eliminating premium tax credits, with a simple majority vote. That process, however, could take months. So if you’re shopping for health insurance on an exchange, stay the course.

No final decisions have been made about what stays and what goes. In an interview on “Sixty Minutes”, President-elect Trump indicated that he would like to keep some provisions of the ACA. Specifically, he mentioned the ability for parents to cover adult children under their health insurance until age 26 and keep the system by which people with pre-existing conditions cannot be denied coverage. Trump did not elaborate on how these provisions would be maintained.

Congressional Republicans have given a general idea of some parts of the ACA that may be repealed. Some of these include the individual mandate whereby IRS fines are imposed for not obtaining coverage, mandates on employers to cover workers and limits on what insurers can charge older consumers. Other provisions, such as healthcare.gov and other online exchanges may be also be repealed.


The stays and goes of the ACA are fluid. Keep track of your own healthcare and stay in touch.






Last Updated on Monday, 14 November 2016 10:27
Silver Sneakers: More Than Just A Fashion Statement PDF Print E-mail
Written by Ellen Breslow   
Friday, 14 October 2016 00:00
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Actually, they are more than what you may be wearing. SilverSneakers are fitness programs for seniors provided by more than 70 health plans across the country. And while SilverSneakers often include health club memberships, fitness for seniors should focus on physical activity which may or may not involve a gym.

Sadly, problems with mobility among seniors is widespread. About 17 percent of seniors age 65 or older can’t walk even one-quarter of a mile, and another 28 percent have difficulty doing so.

That said, getting physical activity on a regular basis can enable older people to recover strength and flexibility and become less likely to develop long-term disability, new research published in the Annals of Internal Medicine shows. This research comes from a study of people with high risk of mobility issues:  men and women age 70 to 89 who were sedentary, had some difficulty with daily activities but were still able to walk a quarter mile without assistance.

The goal of this study was to have participants meet the government’s recommended standard of 150 minutes of moderate physical activity per week and sustain that level over time. Results confirmed the exceptional benefit of physical activity which has been shown in previous studies to lower an individual’s risk of heart disease, cognitive impairment, diabetes, depression and some cancers.

The good news for seniors is that it’s never too late to begin physical activity. What’s important is the emphasis on movement and not necessarily “exercise”. Older adults may identify exercise with younger people, however the physical activity in general is the critical component. A simple walk in the park or neighborhood can make a big difference.


If a participant is new to fitness, start slow. An older person may not be able to walk a quarter mile the first day, but every little bit helps. There is no need to try to do everything at once; smaller, achievable goals are better as a beginning. And, perhaps most essential, is that an individual make a plan or schedule and stick to it.

For additional information, contact EAB HealthWorks.


Last Updated on Friday, 14 October 2016 11:31
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