Category Archives: Health Care

A Fatter Butt Equals a Skinnier Wallet: Why Workplace Wellness Programs Discriminate Against the Obese and Violate Federal Employment Law

Source: Steven C. Sizemore, Wyoming Law Review, 2011
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This comment examines the complicated nature of obesity in America to ascertain whether workplace wellness programs requiring the disclosure of legally protected genetic information discriminate against the obese and violate federal employment law. To accomplish this, the background section discusses the facts behind America’s alleged obesity epidemic in an attempt to address some of the societal issues underpinning America’s growing concern with obesity and the workplace wellness program solution. Following a discussion of the relevant sections of the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA), this comment analyzes whether the ADA and GINA permit employers to provide discounts to the non-obese which results in charging the obese more for the same insurance benefits. This comment concludes Patient Protection and Affordable Care Act’s (PPACA) sanction of workplace wellness programs discriminates against the obese and violates the ADA and GINA by unequally allocating health insurance benefits among employees and requiring the disclosure of statutorily protected genetic information.

While workplace wellness programs provide a multitude of benefits for employers and their employees, ultimately such programs discriminate against the obese through the unequal distribution of health insurance premiums and violate federal employment law by compelling the disclosure of legally protected information. As a result, PPACA’s endorsement of workplace wellness through awarding grants to implement workplace wellness programs discriminates against the obese and violates federal employment law.

The Impact of PPACA on Employment-Based Health Coverage of Adult Children to Age 26

Source: Paul Fronstin, Employee Benefit Research Institute, EBRI Notes, Vol. 33, No. 1, January 2012

From the press release:
The new federal insurance law has increased the health insurance coverage of adult children between 2009 and 2011…

…To determine whether the coverage mandate had an effect, EBRI examined data from two U.S. Census Bureau surveys (the Current Population Survey, CPS, and the Survey of Income and Program
Participation, or SIPP), as well as from the National Health Interview Survey (NHIS) by the Centers for Disease Control.

The data indicated:
– The percentage of persons ages 19‒ 25 with employment-based coverage as a dependent increased from 24.7 percent in 2009 to 27.7 percent in 2010, according to the CPS.
– The percentage of individuals ages 19‒ 25 with employment-based health coverage as a dependent averaged 26.9 percent during January ‒ September 2010, and increased to an average 27.1 percent during October and November, per SIPP.
– The percentage with private insurance increased from 51 percent to 55.8 percent, and the percentage uninsured fell from 33.9 percent during 2010 to 28.8 percent during the first half of 2011 among those ages 19 ‒ 25, according to data from the NHIS.

Performing Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2011-2012

Source: Martha Heberlein, Tricia Brooks, and Jocelyn Guyer, Samantha Artiga and Jessica Stephens, Kaiser Commission on Medicaid and the Uninsured, Publication Number: 8272, January 2012

From the summary:
The annual 50-state survey of Medicaid and CHIP eligibility rules, enrollment and renewal procedures and cost sharing practices, conducted by the Kaiser Commission on Medicaid and the Uninsured with the Georgetown University Center for Children and Families, found that, despite continued fiscal pressures on states, eligibility policies remained stable in nearly all state Medicaid and Children’s Health Insurance Programs during 2011. Moreover, many states used technology to increase program efficiency and streamline enrollment. The “maintenance of eligibility” requirement in the Affordable Care Act (ACA) played a key role in preserving coverage levels. Without it, more states likely would have limited eligibility or tightened enrollment procedures.

Growth In US Health Spending Remained Slow In 2010; Health Share Of Gross Domestic Product Was Unchanged From 2009

Source: Anne B. Martin, David Lassman, Benjamin Washington, Aaron Catlin and the National Health Expenditure Accounts Team, Health Affairs, Vol. 31 no.1, 2012
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From the abstract:
Medical goods and services are generally viewed as necessities. Even so, the latest recession had a dramatic effect on their utilization. US health spending grew more slowly in 2009 and 2010–at rates of 3.8 percent and 3.9 percent, respectively — than in any other years during the fifty-one-year history of the National Health Expenditure Accounts. In 2010 extraordinarily slow growth in the use and intensity of services led to slower growth in spending for personal health care. The rates of growth in overall U S gross domestic product (GDP) and in health spending began to converge in 2010. As a result, the health spending share of GDP stabilized at 17.9 percent.

Medicaid Spending

Source: Debra Miller, Council of State Governments, January 18, 2012

Per capita health care spending and Medicaid spending per enrollee vary widely by state. According to 2009 data, the highest Medicaid spending state, Alaska, spent more than twice the lowest spending state, California. State spending for Medicaid continues to grow, consuming one third of the Missouri state budget, but just 7 percent of the Wyoming state budget in 2010. Regional and state data are provided in this brief on per capita health spending, Medicaid spending, and Medicaid enrollment.
See also:
National Analysis
– Regional Analysis: Midwest, East, South, West

2012 Progress Report: States Are Implementing Health Reform

Source: White House, January 18, 2012

In the nearly two years since President Obama signed the Affordable Care Act into law, all States have taken some action to implement health reform. For example, forty-four States are participating in the new premium rate review system where insurers must justify the rationale for any double-digit insurance premium increase. And 28 States and the District of Columbia are on their way toward establishing their own Affordable Insurance Exchange – an essential component of the law.

Affordable Insurance Exchanges are one-stop marketplaces where consumers can choose a private health insurance plan that fits their health needs. Starting in 2014, they will offer to the public the same kinds of insurance choices members of Congress will have. Exchanges will select health plans qualified to offer coverage; facilitate consumer assistance, shopping and enrollment; and coordinate eligibility for the Exchange and potential premium assistance.

Why Do State Disability Application Rates Vary Over Time?

Source: Norma B. Coe, Kelly Haverstick, Alicia H. Munnell, and Anthony Webb, IB#12-2, January 2012

From the abstract:
Social Security Disability Insurance (SSDI) applications and benefit receipts vary greatly by state, which has led to concerns about potential inconsistencies in the way that states apply disability standards. An earlier brief concluded that more than 70 percent of the variation across states in SSDI application rates is explained by state health, demographic, and employment characteristics; state policies and politics explain very little. Another concern has been the growth in the SSDI program over time. This brief uses the same data as the earlier analysis to answer a related question: How much of the trends in SSDI application rates within states can be explained by the different factors?
See also:
Working paper

Long-Term Services and Supports Opportunities in the Affordable Care Act

Source: Sarah Barth, Julie Klebonis, and Nancy Archibald, Center for Health Care Strategies, Technical Assistance Brief, December 2011

States now have more tools available to rebalance the provision of long-term services and supports towards more home- and community-based services and away from institutionally based care. In addition to the Money Follows the Person demonstration program, the Affordable Care Act created the Balancing Incentive Payments program, the state plan Community First
Choice Options program, and the modified Home- and Community-Based State Plan option (1915(i)). Selecting the appropriate program(s) to implement is made complicated by the sometimes overlapping and differing requirements of these options.

This technical assistance brief describes the different LTSS program options available to states with particular emphasis on their budget impacts;
application processes; and requirements for participant eligibility, care coordination, and data reporting. It also discusses the ways in which the different options for providing LTSS interact with each other and with existing state LTSS structures.

Federally-Facilitated Exchanges and the Continuum of State Options: Report from the Study Panel on Health Insurance Exchanges Created Under the Patient Protection and Affordable Care Act

Source: Deborah Bachrach and Patricia Boozang, National Academy of Social Insurance, December 2011

From the Robert Wood Johnson Foundation summary:
This report explores three ways that states can comply with the Affordable Care Act requirement of establishing a health insurance exchange in their state: (1) establishing one on their own; (2) defaulting to a federal exchange; or (3) creating a hybrid exchange.

On behalf of the National Academy of Social Insurance, the authors evaluated the considerations and eventual implications associated with each option to help states determine which model may work best for the unique needs of their residents.

Health Insurance for Active and Retired City Employees: Asheville, Denver, and Oklahoma City

Source: Robert L. Clark, Melinda Sandler Morrill, and Stephanie Riche, Center for State and Local Government Excellence, Issue Brief, September 2011

From the summary:
Public and private employers face the same challenge: how to control the continuing growth in health care costs? A new issue brief from the Center for State and Local Government Excellence examines how three city governments — Asheville, Denver, and Oklahoma City – have responded to rising health care costs.

All three cities use a range of strategies including:
Wellness programs
Chronic disease management
Employee clinics
Cost shifting to employees
Plan design changes
Trust fund

Although all three cities offer retiree health care benefits and require retirees who are eligible for Medicare to enroll, only one city has begun to prefund retiree health obligations. The other two cities pay for retiree health on a pay-as-you-go basis, typical of American local governments.

With an aging workforce and a growing ratio of retirees to active workers, governments recognize they cannot be complacent about a benefit as important – and costly – as health insurance. This brief sheds light on some of the strategies that show promise.