Category Archives: Health Care

Does retiree health insurance encourage early retirement?

Source: Steven Nyce, Sylvester J. Schieber, John B. Shoven, Sita Nataraj Slavov, David A. Wise, Journal of Public Economics, Volume 104, August 2013
(subscription required)

From the abstract:
The strong link between health insurance and employment in the United States may cause workers to delay retirement until they become eligible for Medicare at age 65. However, some employers extend health insurance benefits to their retirees, and individuals who are eligible for such retiree health benefits need not wait until age 65 to retire with group health coverage. We investigate the impact of retiree health insurance on early retirement using employee-level data from 54 diverse firms that are clients of Towers Watson, a leading benefits consulting firm. We find that retiree health coverage has its strongest effects at ages 62 through 64. Coverage that includes an employer contribution is associated with a 6.3 percentage point (36.2%) increase in the probability of turnover at age 62, a 7.7 percentage point (48.8%) increase in the probability of turnover at age 63, and a 5.5 percentage point (38.0%) increase in the probability of turnover at age 64. Conditional on working at age 57, such coverage reduces the expected retirement age by almost three months and reduces the total number of person-years worked between ages 58 and 64 by 5.6%.

Staffing Industry Compliance with the Employer Shared Responsibility (aka Pay-or-Play) Provisions of the Affordable Care Act: Five Questions

Source: Alden J. Bianchi and Edward A. Lenz, Employee Relations Law Journal, Vol. 39 no. 2, Autumn 2013
(subscription required)

From the abstract:
The authors discuss five high-level questions that firms in the “general staffing” space, that is, those whose core (or only) business is assignment of temporary and contract workers, face as the struggle to comply with employer shared responsibility under the Patient Protection and Affordable Care Act.

The Evolving Role and Value of Libraries and Librarians in Health Care

Source: Julia F. Sollenberger, Robert G. Holloway Jr., Journal of the American Medical Association, Viewpoint, Vol. 310 No. 12, September 25, 2013
(subscription required)

From the abstract:
Changes in medical information and technology are revolutionizing health care. As clinicians try to incorporate research into practice through comparative effectiveness research and decision support, they increasingly depend on technology to bring evidence to the bedside to improve quality and patient outcomes. Integrating current information into the processes of shared decision making and continuous learning supports the application of evidence in clinical decision making. Health sciences libraries and librarians have an increasingly important role in providing that information to clinicians as well as to patients and their families….

Everything You Need to Know About the Affordable Care Act

Source: Stateline, Featured Collection, September 23, 2013

The Affordable Care Act is one of the most far-reaching laws in American history and is likely to affect almost all Americans in one way or another. It is also one of the most complicated laws, with repercussions that were little understood or appreciated at the time Congress passed it in 2010.

Three years after its passage—and almost 18 months after it was largely upheld by the U.S. Supreme Court—it remains the subject of enormous division in the country, with many Republicans still hoping to stop it.

These Stateline stories help explain developments in the leadup to the Jan. 1 implementation of the most sweeping provisions of the law: the expansion of Medicaid eligibility (or not, in states that said “no” to expansion) and benefits for those who buy insurance on the new health insurance exchanges. Those exchanges open for business Oct. 1.

Costs and Benefits of Providing Transition-related Health Care Coverage in Employee Health Benefits Plans: Findings from a Survey of Employers

Source: Jody L. Herman, Williams Institute, September 2013

From the press release:
Employers report zero or very low costs and yet substantial benefits, for them and their employees alike, when they provide transition-related health care coverage in their employee health benefit plans, according to a new study by Jody L. Herman, Williams Institute Manager of Transgender Research. The report, Costs and Benefits of Providing Transition-related Health Care Coverage in Employee Health Benefits Plans: Findings from a Survey of Employers, released today, finds that a majority of employers reported that they would encourage other employers to add the coverage, and none would advise against it….

…Thirty-four employers participated in a survey to describe their transition-inclusive health benefits plans, how much these plans have cost them, and what, if any, benefits they receive from providing their transition-inclusive plans. Key findings from the survey include:

• Eighty-five percent (85%) of the 26 employers that provided information on costs of adding coverage to their existing health benefits plans reported no additional costs to add the coverage.
• Two-thirds of the 21 employers that provided information on actual costs from employee utilization of the coverage reported zero actual costs due to utilization.
• Based on the experiences of surveyed employers, we would predict that 1 out of 10,000 employees (among employers with 1,000 to 10,000 employees) and 1 out of 20,000 employees (among employers with 10,000 to 50,000 employees) will utilize transition-related health benefits annually when they are available.
• The type, number, and cost of services accessed by individuals will vary, yet as described above, the costs of these benefits, if any, are very low, as is the utilization of the benefit….

Income, Poverty, and Health Insurance Coverage in the United States: 2012

Source: Carmen DeNavas-Walt, Bernadette D. Proctor, Jessica C. Smith, U.S. Census Bureau, Current Population Report, P60-24 September 2013

This report presents data on income, poverty, and health insurance coverage in the United States based on information collected in the 2013 and earlier Current Population Survey Annual Social and Economic Supplements (CPS ASEC) conducted by the U.S. Census Bureau.

Summary of findings:
• Real median household income in 2012 was not statistically different from the 2011 median income.
• The poverty rate in 2012 was not statistically different from 2011.
• The percentage of people without health insurance decreased between 2011 and 2012, while the number of uninsured in 2012 was not statistically different from 2011.

Outcome Based Incentives: How the PPACA Revolutionized Wellness

Source: Amanda Cuda, HR News, Vol. 79 no. 9, September 2013
(subscription required)

These programs are part of the changing world of employee health care. Employers, particularly in the public sector, are no longer focusing just on paying for workers’ medical visits and care, but also on keeping them from getting sick in the first place. It’s a movement that’s been growing for a while as more employers realize the potential benefits of taking an extra interest in their workers’ well-being. Many of these programs are just a few years old, and employers are still waiting to see what kind of impact they’ll make, both on their employees’ health and on their own bottom line. But even those who haven’t seen overwhelming evidence of lower health care costs and more robust employees say the programs seem to be worthwhile.

The Strategy That Will Fix Health Care

Source: Michael Porter and Thomas Lee, Harvard Business Review, Vol. 91 no. 10, October 2013
(subscription required)

In health care, the days of business as usual are over. Around the world, every health care system is struggling with rising costs and uneven quality despite the hard work of well-intentioned, well-trained clinicians. Health care leaders and policy makers have tried countless incremental fixes—attacking fraud, reducing errors, enforcing practice guidelines, making patients better “consumers,” implementing electronic medical records—but none have had much impact.

It’s time for a fundamentally new strategy.

At its core is maximizing value for patients: that is, achieving the best outcomes at the lowest cost. We must move away from a supply-driven health care system organized around what physicians do and toward a patient-centered system organized around what patients need. We must shift the focus from the volume and profitability of services provided—physician visits, hospitalizations, procedures, and tests—to the patient outcomes achieved. And we must replace today’s fragmented system, in which every local provider offers a full range of services, with a system in which services for particular medical conditions are concentrated in health-delivery organizations and in the right locations to deliver high-value care….

…The transformation to value-based health care is well under way. Some organizations are still at the stage of pilots and initiatives in individual practice areas. Other organizations, such as the Cleveland Clinic and Germany’s Schön Klinik, have undertaken large-scale changes involving multiple components of the value agenda. The result has been striking improvements in outcomes and efficiency, and growth in market share.

There is no longer any doubt about how to increase the value of care. The question is, which organizations will lead the way and how quickly can others follow? The challenge of becoming a value-based organization should not be underestimated, given the entrenched interests and practices of many decades. This transformation must come from within. Only physicians and provider organizations can put in place the set of interdependent steps needed to improve value, because ultimately value is determined by how medicine is practiced. Yet every other stakeholder in the health care system has a role to play. Patients, health plans, employers, and suppliers can hasten the transformation—and all will benefit greatly from doing so….

Potential Employer Penalties Under the Patient Protection and Affordable Care Act (ACA)

Source: Janemarie Mulvey, Congressional Research Service, CRS Report for Congress, R41159, July 22, 2013

On Tuesday July 2, 2013, the Obama Administration posted a blog on employer requirements and the Patient Protection and Affordable Care Act (ACA, P.L. 111-148), as amended. Based on the White House blog, the administration (1) plans to revamp employer reporting requirements, and therefore suspend employer reporting requirements for 2014, and (2) because employer payments are dependent on the reporting requirements, no payments will be collected in 2014. The Administration noted that these changes were in response to employers’ concerns about the reporting requirement.

On July 17, 2013, H.R. 2667, the Authority for Mandate Delay Act, passed the House. H.R. 2667 would delay by one year the applicable effective date for the employer requirements, employer penalties, and related reporting requirements specified under ACA.

This report provides information on the statutory requirements and the proposed regulations issued to implement these statutory requirements in December 2012. This report does not yet reflect the proposed Administration changes. The report will be fully updated once additional information becomes available…