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Mercer

While I spend most of my work days helping large employers with their health benefit programs, this past week I wore my Mercer health reform leader hat at my own personal version of health policy summer camp in Washington. I spent two days with the American Benefits Council’s policy board, took some meetings on Capitol Hill, and visited with Julie Rovner and Julie Appleby at KAISER Health News. 

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Earlier this week, we hosted a Mercer Select Briefing and asked participants to ponder changes they might make to their health benefits if the ACA’s employer mandate were fully or partially repealed. Of the 175 employers taking the poll, relatively few anticipate making any particular change. The largest number of respondents – 21% – said they would be likely to set higher employee contributions for individual coverage than currently permitted under the affordability requirement. Given that many employers have added lower-cost plans since the ACA was signed, most don’t have an issue with affordable contributions. Just 19% said they would be likely to resume a 40-hour work-week requirement for eligibility (rather than the 30-hour requirement under the ACA) and the same percentage said they would likely revisit lifetime benefit dollar limits. Fewer than one in ten employers thought they might impose pre-existing condition limitations, and almost none said they were likely to require more than a 90-day waiting period for benefits. 

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The anxiously awaited CBO score of the AHCA – reflecting the last round of changes made to the bill before it was passed – was released yesterday afternoon. The nonpartisan scorekeeping office forecast the AHCA would cut the federal deficit by $119 billion over the next 10 years, down from $150 billion in the prior score. From a process perspective, the bill still easily passed the test to save at least $2 billion to qualify for consideration under a reconciliation process that is filibuster-proof by requiring only 51 votes in the Senate, not the typical 60-vote threshold.

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While working women continue to earn less money than their male counterparts, the gap is narrowing when it comes to health benefits. Three years ago, we used data from Mercer’s National Survey of Employer-Sponsored Health Plans to examine the difference in benefits between large employers with workforces that are 65% female or more to those with workforces that are 65% male or more. Just under half of the mostly female companies are in health care and a quarter are in the services sector, while mostly male companies are found predominately in the manufacturing industry (52%). The percentage of employees in collective bargaining agreements has remained about the same for the two groups (13% for companies with mostly female employees and 15% for companies with mostly male employees). One workforce statistic has seen some movement since 2013, when the average salary for mostly female companies was about $10,000 less than when the workforce is mostly male; data from our 2016 survey shows the difference is now over $15,000. That’s right – the gap in the average salaries of companies with mostly female vs. mostly male workers has only gotten wider.

 

The health benefits at organizations with predominantly female workforces continue to be less generous than in those with predominantly male workforces. In addition, the employee contributions for these less generous plans are higher than those for the richer benefits offered to employees at mostly male companies. For coverage in a PPO, the most common type of medical plan, the monthly contribution for family coverage is 17% higher ($484 for mostly female companies and $415 for mostly male companies), which is down from a 31% difference in 2013.

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Republican senators will continue discussions this week on revisions to legislation narrowly approved by the House -– the American Health Care Act – to repeal and replace much of the Affordable Care Act (ACA). Passing a bill out of the Senate may be an even tougher fight for Republicans, who can’t afford more than two defections.

 

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Earlier this week we learned that the CBO will release their “score” of the AHCA the week of May 22. This revised projection will reflect the most recent changes to the bill – allowing states to opt-out of certain provisions including essential health benefits, aspects of community rating and changes to age banding ratios as well as $8 billion in funding to help states that choose to waive the ACA's community rating for individuals who don't have continuous coverage.

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The vote to pass the AHCA in the House – a first step on the road to repealing the ACA – has raised questions about how employers might respond if the ACA requirements affecting employer-sponsored plans were to be lifted. One way to approach that question is to look at how employer plans changed – and how they didn’t change – under the ACA. We went back to past Mercer National Survey of Employer-Sponsored Health Plans databases to find out.

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Well, it happened. House Republicans got the votes to send the AHCA on to the Senate. The bill will face tough challenges in the Senate, so this is far from a done deal. For now, it is business as usual under the ACA.

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House Republican leaders are working to win the votes needed to pass a revised version of their health care reform bill, the American Health Care Act (AHCA), that aims to lower health insurance premiums for some individuals by letting states obtain waivers to opt out of the Affordable Care Act's (ACA) essential health benefits, community rating, and age banding requirements.

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It has been a month since the American Health Care Act was pulled because House Republicans lacked the votes to advance it to the Senate. Here’s a run-down of all that has happened since then, including our perspective on what it means to employers.

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After their failed attempt to pass ACA repeal and replace legislation, President Trump and House Speaker Ryan indicated that they were “moving on” to other legislative priorities. On Tuesday, we learned that Republicans have restarted their conversations about healthcare. On Wednesday, Bloomberg reported the GOP was discussing a new vote as early as next week.

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A couple of weeks ago (feels like ages) we launched a brief survey to find out where employers stood on specific provisions in the House GOP repeal-and replace-bill, the American Health Care Act (AHCA). We closed the survey on Thursday with more than 900 responses.  As I was reviewing the results on Friday, the bill was apparently dying -- but now House leaders and President Trump are signaling that it may be revived. Either way, the health reform debate is far from over, and many of the provisions introduced in the AHCA will likely remain part of the discussion.

 

The survey asked health benefit professionals how key provisions would affect their organization’s health benefit program, employees, and business success -- as opposed to how they might affect the individual market or people without access to employer-sponsored health insurance. They could also respond that the provision would not affect their organization one way or the other. 

 

HSA changes, repeal of employer mandate seen as positive

We didn’t ask for an overall opinion of the bill, but employers’ reactions to individual provisions added up to a less-than-ringing endorsement. To start with what they liked: 66% said that liberalizing HSA rules -- such as allowing higher contributions -- would have a positive effect on their organizations. That’s in the ballpark of the percentage of large employers nationally that offer HSA-eligible plans (53% in 2016). If you don’t offer an HSA-eligible plan and don’t intend to, or if you do offer one but none of your employees are likely to hit the maximum account contribution, you might not believe this provision would have much of an impact, like 29% of our respondents. 

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