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House G.O.P. Leaders Outline Plan to Replace Obama Health Care Act
By ROBERT PEAR and THOMAS KAPLAN

WASHINGTON — House Republican leaders on Thursday presented their rank-and-file members with the outlines of their plan to replace the Affordable Care Act, leaning heavily on tax credits to finance individual insurance purchases and sharply reducing federal payments to the 31 states that have expanded Medicaid eligibility.

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In the Spotlight… Or the Crosshairs? Healthcare Discussion.
By: Ron Peck, Esq.

Yesterday we presented a webinar regarding issues that pop up when employers don’t act with consistency between their plan, handbook, behavior, and law.  We talked about situations where the employer is responsible (by contract) but stop-loss won’t reimburse; because the employer obligates themselves to do something that their plan doesn’t allow.  This is bad for the employer, but more importantly, every time an employer is bankrupt by an issue like this, it’s a black eye for our industry. This is a time of political upheaval, and the powers that be are scrambling to find a replacement for the status quo.  If self-funding is linked to these types of issues, conflict, and loss, we will not be the future of health benefits in America.  That’s bad for us, bad for healthcare, and bad for Americans.

How expensive are knee replacements in the 20 largest US cities?
By Laura Dyrda

Total knee replacement surgery price varies by geographic region.

The total price includes hospital services, physician services and anesthesia, according to Healthcare Blue Book. The hospital services assume a four day admission and the physician fee is for the procedure and routine postoperative care. The anesthesia price assumes average surgery time of 2 1/2 hours.

Here are the prices for the 20 largest cities based on population from the 2010 U.S. Census.

CMS projects next decade of health expenditures: 5 takeaways
By Ayla Ellison

National health spending is expected to grow at an average annual rate of 5.6 percent from 2016 through 2025, with expenditures projected to hit $5.5 trillion in 2025, according to new estimates from CMS’ Office of the Actuary published Wednesday in Health Affairs.

Although congressional Republicans are working on a plan to repeal and replace the ACA, it isn’t possible to determine the impact of potential policy changes on health spending and health insurance at this time. Therefore, the national health expenditure projections are constructed using current law and do not assume potential legislative changes over the projection period.

Here are five takeaways from the CMS report.

Top Miscues Employers Make When It Comes To Their Health Plans ... And What We All Can Do To Become Health Plan Heroes
Employers who self-fund their health plan act as a traditional employer, a plan sponsor, and a plan administrator. Juggling this many roles, conflicts and contradictions are bound to happen. For instance, an  employee handbook’s handling of disability leave may conflict with the health plan document as it relates to employment and plan coverage.

Thanks for joining The Phia Group’s legal team on February 15, 2017, as they discussed top miscues employers make when it comes to their health  plans, and what we all can do to become health plan heroes; rescuing employers who have blurred the lines, and will without our help soon be stuck between a rock and a hard place.

Click Here to Download Full Webinar
Click Here to Download Audio
Click Here to Download Slides

First Proposed ACA Rule Changes
By: Jen McCormick, Esq.

Today we got our first new proposed ACA rule changes from the Trump Administration.  One of the proposals was to decrease the open enrollment window for individuals to sign up on the insurance exchanges.  Specifically, the window which is currently November 1 to January 31 would instead be November 1 to December 15.  The thought, it seems, is that this will limit an insurers exposure from individuals only signing up once they get sick… if there is a shorter window. Hold on for the ride because I imagine this will be the first of many revisions to ACA as we know it today.

IRS loosening enforcement of ObamaCare mandate
By Peter Sullivan

The IRS says it will not reject tax forms from people who fail to answer whether they had health insurance, a sign of loosening up on enforcement of ObamaCare’s individual mandate.

Tax forms ask people whether they had health coverage in the previous year to determine whether they need to pay a financial penalty under ObamaCare’s mandate to have coverage.

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A Canadian Pays Cash for Care
In spite of the fact that I did not use insurance at all, we can still take my personal experience as a case study about the benefits of real-time payment for medical care. As I see it, there are three major wins to reflect on: 1) no complicated claims process (for anyone); 2) peace of mind that I settled my ‘financial responsibility’ immediately; and 3) I saved money.

I suppose in a parallel universe, and we all know this old racket, I could have presented with a health insurance card and the hospital would have agreed to bill my insurer directly, and the claim would have been paid and processed eventually, but how would I know? What does this cost, is the price fair?  What if there was an issue of coverage? A coding problem? Request for medical records? Error with repricing? What if the provider gets tired of waiting for payment? As one observer put it, in describing our current claim process “a horse-and-buggy in a world contemplating driver-less cars, the healthcare industry’s consumer billing and payment system is an inefficient antique.”

Humana Plans to Pull Out of Obamacare’s Insurance Exchanges
By REED ABELSON

Humana announced on Tuesday that it would no longer offer health insurance coverage in the state marketplaces created under the federal health care law, becoming the first major insurer to cast a no-confidence vote over selling individual plans on the public exchanges for 2018.

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Land of 10,000 Stories: Cop and Homeless Veteran
wkyc.com

CLEVELAND – Big medical bills are a problem for many Americans.
But few services deliver a bigger surprise hit than a life-saving ride on an air ambulance.
Here in Northeast Ohio, we found dozens of court battles with one of the nation’s largest private, for-profit air ambulance companies.
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