health coverage

Health insurance giant Empire pulls out of NYC’s controversial Medicare plan for retired city workers

Billie S. Dickenson July 29, 2022

A major insurance company has pulled out of a deal to administer New York City’s new Medicare Advantage Plan — the latest setback in the city’s effort to shift roughly 250,000 retired municipal workers onto the controversial health coverage.

Empire BlueCross BlueShield, one of the country’s largest health insurance providers, notified Mayor Adams’ office that it’s not going to help roll out the Advantage plan after the city failed to provide a start date and benefit specifics as requested by July 15, the company said in a statement Tuesday.

“This timeline was important because delaying any further would not give retirees enough time to fully understand their options, benefits, and coverage in advance of open enrollment,” the statement read. “Given the level of uncertainty at this time, we informed the city that (Empire) is not able to participate.”

In light of Empire’s withdrawal, City Hall spokesman Jonah Allon said Adams’ administration is on the hunt for a new provider.

“We remain committed to moving forward with the program and are exploring alternative options,” Allon said.

New York City Mayor Eric Adams (Shawn Inglima/for New York Daily News)

Empire’s exit is the latest hiccup in the Adams administration’s push to implement the Advantage plan, which is supposed to save the city hundreds of millions of taxpayer dollars annually thanks to the partnership with a private insurance provider.

First proposed by former Mayor Bill de Blasio, the plan was supposed to go into effect earlier this year with Adams’ blessing.

But Manhattan Supreme Court Justice Lyle Frank blocked the plan, ruling in March that it was illegal because it contained a provision that would slap a $191 monthly penalty on retirees who opted to keep their current traditional Medicare instead of getting automatically enrolled in the Advantage plan for free.

The Adams administration is appealing Frank’s ruling. City Hall confirmed Tuesday that the appeal is ongoing.

Frank’s decision was the result of a lawsuit filed by the NYC Organization of Public Service Retirees, which has argued the Advantage plan would water down health coverage for the city’s tens of thousands of retirees, including by instituting complicated pre-authorization requirements for certain medical procedures and treatments.

FILE - In this May 14, 2019, file photo signage on the outside of the corporate headquarters building of health insurance company Anthem is shown in Indianapolis. (Michael Conroy/AP)

Marianne Pizzitola, the organization’s president, said she has for months asked City Hall for an opportunity to discuss the matter with Adams — and that she finally got a meeting scheduled with the mayor for this past Monday.

However, late Sunday, Pizzitola said she got word from City Hall that Adams could no longer meet after finding out the city remains in litigation with her group.

Pizzitola, a retired FDNY EMT, said she wishes Adams would take time to hear from her and the thousands of other former city workers who have pleaded with him to scrap the Advantage plan and let them stay on traditional Medicare.

“I really wish that he would just listen,” she said.

New Study: Employer-Sponsored Health Insurance Produces +47% Return on Investment for American Businesses

Billie S. Dickenson June 30, 2022

Washington, D.C. — Employers in the United States this year will earn an average return on investment (ROI) of 47% from their employer-sponsored health insurance (ESI) programs, according to a new study from Avalere Health. This means for every dollar spent on ESI, employers get back $1.47 in financial benefits. The analysis from the health data firm finds that the average ROI is projected to grow to 52% in 2026, and that businesses that invest more in their ESI programs tend have a higher ROI. 

While providing employees high quality health insurance is the right thing to do for workers, the report shows how it makes business sense. Avalere attributes the direct financial return for employers to lower direct medical costs, increased productivity, lower recruitment costs, stronger retention, lower short- and long-term disability costs, as well as tax benefits. More than 155 million Americans currently get their health insurance through ESI.  

The study was commissioned by the U.S. Chamber of Commerce on behalf of the Protecting Americans’ Coverage Together (PACT) campaign. PACT members, including the U.S. Chamber of Commerce, Business Roundtable, The National Association of Manufacturers, Council for Affordable Health Coverage, and Vermeer Corporation, represent leading employer voices focused on strengthening the employer-sponsored insurance (ESI) system and protecting the coverage and benefits that American families depend on for their health.  

The report from Avalere looks across industries at trends that drive ROI higher and lower. Avalere highlights the manufacturing industry as an example, finding American manufacturers see an ROI of 42% on their ESI programs.  

“Employee-sponsored health insurance is a win-win for employers and employees,” said Katie Mahoney, Vice President of Health Policy at the U.S. Chamber of Commerce. “We know employees place a high value on quality health insurance in the workplace, and now we have more evidence that employers benefit significantly from investing in these programs as well. Employer-provided coverage is the backbone of the American health care system, and this report reinforces that any reforms should build off this model that is good for workers and companies alike.”  

“Improving productivity and wellness make America more competitive and prosperous,” said Joel White, President of the Council for Affordable Health Coverage. “While employers offer health coverage to improve the health and welfare of their employees, employees and their families benefit significantly. This study shows that Congress and the Administration must work to expand job-based coverage, not weaken it. 

“Manufacturers are in the business of innovating and delivering best-in-class products to their customers,” said Robyn Boerstling, Vice President, Infrastructure, Innovation and Human Resources Policy at the National Association of Manufacturers. “That philosophy extends to the benefits provided to their employees, and this report further validates that offering comprehensive and innovative health benefits is not only the right thing to do but also critical to attracting and retaining the best talent. We are proud that approximately 99% of NAM member companies offer health benefits to employees, and working Americans understand the value and competitiveness of employer-sponsored health care.”  

“As an employer, knowing who we are caring for and the communities they come from gives us the advantage of providing access to quality, affordable care to our team and their families,” said Vermeer Corporation. “It is an incredibly important part of how we care for our people.” 

The study, which examined employers with 100 or more employees, defined ROI as “the monetary value of benefit for each dollar employers invest in healthcare coverage. Investment in ESI may include health insurance premiums, wellness programs, direct medical expenses, administrative costs associated with processing medical claims, and other costs associated with providing health insurance. Avalere calculated the ROI derived from ESI by dividing the total employer benefits by the total costs of providing ESI.”  

The full report including methodology can be found here.

# # # 

Millions could lose health coverage if premium subsidies expire later this year, officials say

Billie S. Dickenson June 23, 2022

Absent Congressional action, many consumers will see health-coverage costs skyrocket next year, Biden administration officials warned Wednesday. 

The American Rescue Plan, signed into law in March 2021, temporarily expanded premium tax credits available to consumers signing up for health coverage through the Affordable Care Act marketplaces. Those expanded tax credits are set to expire at the end of this year, and extending them would require Congressional legislation. 

“Time is of the essence,” Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services, said on a call with reporters Wednesday. As this fall’s open enrollment for 2023 marketplace coverage draws near, “we want to make sure that people know the subsidies will be in place,” she said. 

A record 14.5 million people signed up for coverage through the marketplaces during the open enrollment period that ended in January. The average monthly 2022 premium for HealthCare.gov enrollees was $111. Without the additional tax credits provided by the American Rescue Plan, that average monthly cost would have been 53% higher, according to the Department of Health and Human Services. 

If Congress does not act, more than 10 million people will see their premium tax credits reduced or lose them entirely, according to federal estimates, and about 3 million people could lose their health insurance. 

If lawmakers were to act by midsummer, marketplaces and insurers would have time to prepare for the 2023 open enrollment period, which starts in November, according to a recent report from the Urban Institute. The process of setting rates for 2023 plans has already begun.   

Congressional action later in the year could generate confusion as people are signing up for 2023 coverage, Brooks-LaSure said. “Of course we will pivot as quickly as we need to,” she said. But if action comes in the middle of open enrollment, it “would be so difficult for people to understand what was happening.” 

In addition to boosting premium tax credits for people who were previously eligible for subsidies, the American Rescue Plan expanded eligibility to people who were previously ineligible because their income was greater than 400% of the federal poverty level. An additional 2.8 million consumers received premium tax credits in 2022, compared with 2021, according to federal data. 

Without the American Rescue Plan’s enhanced premium tax credits, the average monthly 2022 premium in some states would have been roughly double what it is now. Among states that use the federal marketplace platform, the average 2022 monthly premium in Wyoming would have been 132% higher, according to federal data, while South Dakota average premiums would have been 95% higher.  

You may have missed

What Motivates People to Seek Help From a Snoring Specialist?

Billie S. Dickenson December 28, 2022

US health insurers raise rates to match increase in usage

Billie S. Dickenson July 31, 2022

A Retirement Journey: Health Insurance Issues

Billie S. Dickenson July 30, 2022

Health insurance giant Empire pulls out of NYC’s controversial Medicare plan for retired city workers

Billie S. Dickenson July 29, 2022

How to avoid a tax surprise from marketplace health coverage

Billie S. Dickenson July 27, 2022