Playing your cards right to win at health care reform

From the August 2009 issue of Ceridian Connection.

What you can do now to help boost employee benefits, cut health care costs
and plan for year-end 2009

The nation's health care reform legislation cards have been dealt. While Congress retreats for a month-long August recess, it's anyone's guess what hand will turn up when they return in September. But that doesn't mean that HR and benefits managers need to gamble this year when it comes to open enrollment. There are, in fact, still some very safe bets.

While members of Congress return home for recess, life goes on for employers as they seek ways to manage climbing health care costs, which, according to Towers Perrin's annual Health Care Cost Survey, rose on average by 6 percent in 2009. Although that growth rate remains on par with previous years, employers and their workers still faced record-high costs this year. No matter what legislation is ultimately passed by Congress, the way businesses must think about health care has changed.

As an estimated 100 million Americans enter open enrollment season this fall, companies must now take a hard look at the health of their employees and what they can do to drive down costs. And whether health care reform happens later rather than sooner, employers must make smarter moves now. This means playing their two most valuable trump cards -- medical reimbursement benefits such as Flexible Spending Accounts (FSAs) and wellness and prevention programs -- in efforts to further curb rising health expenditures.

Be well advised
Health and wellness programs are often one of the first employee benefits to be cut or forgotten within an organization during challenging times. However, with costs continuing to rise, improving the health and wellness of employees makes sense -- and saves dollars. Even Congress seems to think so.

"When you look at health care reform ideas, wellness and prevention are prominent," explains Eric Snyder, senior product manager for Ceridian LifeWorks. "One proposal that has attracted a lot of interest is the Healthy Workforce Act of 2009, authored by Senator Tom Harkin. If enacted, employers could receive a significant tax credit to help pay for the cost of their wellness programs."

Under Harkin's proposed plan, employer's wellness programs would qualify for tax credits if they include at least three of the following four best practices:
  • Health awareness activities (health education seminars and/or health screenings)
  • Employee engagement opportunities (wellness committees, etc.)
  • Behavioral change programs (tobacco cessation, weight management, stress reduction)
  • Supportive environment (incentive programs to encourage participation in wellness activities, etc.)

Ceridian is already designing a corporate wellness program to meet all of the requirements of the Healthy Workforce Act. Organizations that adopt this wellness program will achieve the substantial benefits of Ceridian's health management program, including reduction in health care costs and increased productivity, even if it is not a federal mandate," says Shannon Rickert, Health & Wellness product manager at Ceridian.

FSAs: Good-bye to a good buy?
Much has occurred during the unpredictable legislative journey to reform America's health care system, including the need to help save FSAs. For a time, it seemed as if we could breathe a collective sigh of relief -- the danger of eliminating or curtailing the tax-saving advantages of FSAs appeared to have passed.

But that changed. Congressional committees are once again targeting FSAs as a way to pay for a portion of the estimated $1 trillion health care reform price tag. Ideas under the proposals include eliminating the use of FSA dollars to pay for over-the-counter (OTC) medicines and a cap on FSA contributions.

"Despite these ongoing health care reform efforts, open enrollment this year should be 'business as usual'," says Tony Meredith, an FSA product manager for Ceridian Benefits Services. "Nobody knows what the final health care reform package will include or when it will be passed. But we do know that FSAs are still a valuable cost-cutting tool this enrollment season, offering significant savings for both employers and their employees."

Thirty-five million Americans have FSAs. More than 85 percent of large employers offer FSAs, providing a means to save as much as a third in taxes on certain everyday medical expenses for most of the nation's unionized workforce and most public employees.

Proposals that significantly alter the tax savings of FSA and other medical reimbursement accounts -- such as Health Savings Accounts (HSAs) and Health Reimbursement Arrangements (HRAs) -- would adversely affect businesses and their employees, many of whom are already struggling in a weakened economy.

"Any legislation that prohibits the use of FSA dollars for OTC medications amounts to a tax increase on consumers and discourages them from using medicines for prevention, treatment and the relief of symptoms," said Bart Valdez, general manager of Ceridian Benefits Services. "Likewise, capping or curtailing the tax savings provided through FSAs will only makes it more difficult for working families to pay for their ever-rising out-of-pocket medical costs."

Ceridian is taking part in the ongoing discussions around these issues and has joined forces with prominent law groups and others throughout the industry to oppose these measures. To gin up the grassroots effort, Valdez, on behalf of Ceridian Benefit Services, was quoted recently in Roll Call, the newspaper of Capitol Hill, regarding a two-page letter Ceridian sent to its customers informing them of the Congressional activity on FSAs.

"We urge you to contact members of Congress and ask them to preserve the tax-saving advantages of Health Care FSAs," Valdez said in the article.

Comprehensive health care reform legislation will not likely be carved into stone any time in the near future. Even if legislation is passed in October, as President Obama wants to make happen, it's likely many of the changes will take time to be implemented, even years.

As this year's open enrollment approaches, employees should be encouraged to take full advantage of today's FSAs and other tax-deferred plans, including HSAs and HRAs. Employers also can increase the odds of achieving high-quality, cost-effective health care by encouraging employees to make the most of their organization's health and wellness programs.

Learn more about Ceridian's FSAs and wellness programs.
Four of a kind: A look at health care reform consensus issues
A number of issues continue to challenge the White House and Congress as they try to achieve a shared goal of accessible, affordable coverage for all Americans. A consensus has formed around four issues in particular, which makes them potential key elements in any final health care reform bill.

Ceridian's executive consultant in Washington, D.C., Jim O'Connell, sums up his findings on the following issues. View O'Connell's comprehensive update on pending health care reform legislation.

  1. Insurance market reform: According to the National Business Group on Health (NBGH), the legislation recently approved by the House Committee on Energy & Commerce, HR 3200, would guarantee insurance coverage and renewal of coverage with no annual or lifetime limits or preexisting condition exclusions. It would prohibit insurers from charging higher rates based on health status or gender. Under the proposed bills, the federal government, in cooperation with the states, would take a more aggressive stance in regulating the underwriting practices of health insurance carriers -- long a barrier to insurance coverage for many Americans.
  2. Creation of a health insurance exchange: Modeled after the Commonwealth of Massachusetts' "Connector," the exchange favored by most members of Congress would replace today's individual insurance market with a new entity that would bring insurance carriers, uninsured individuals and small businesses together in a single health insurance cooperative. At the exchange, the uninsured would be able to choose among several health benefit packages mandated to be offered by competing private insurance companies at group plan premiums. The federal or state governments would regulate the practices of participating insurance providers, who would want to gain access to 47 million new customers, to make sure they offered the most competitive rates and plan options within the exchange.
  3. Subsidies for lower income households: To make the exchange even more attractive, the legislation would provide premium subsidies to lower income individuals and families to make coverage more affordable. There is broad agreement among Republicans and Democrats that achieving the goal of affordable coverage for all Americans will require substantial new federal government subsidies for lower income households -- delivered either through refundable tax credits or direct payments. Nevertheless, there is now a consensus that achieving "universal coverage," as the goal is termed, requires a broad program of financial subsidies to help people afford health coverage.
  4. Support for wellness and prevention. According to the NBGH, each of the proposed bills, as well as the White House, would support a new national program aimed at disease prevention and wellness. The NBGH favors changing the Internal Revenue Service definition of qualified medical expense for purposes of tax deductions to include health and wellness expenses. Other bills would provide for a special employer tax credit for costs of employee wellness programs, establish a national wellness research strategy at the National Institutes of Health (NIH), tax sugar-sweetened beverages, require insurers and employer plans to provide incentives for wellness programs; and factor tobacco use into federal subsidies.
For now, health care reform remains a moving target. Ceridian recommends these sites to help you stay on top of the latest legislative and policy changes:
Roll Call
Kaiser Family Foundation
Cable News Network
HealthReform.gov





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