Debate Heats Up Over "Skinny" Obamacare Plans with No Hospitalization Benefit

This is from Jay Hancock at Kaiser Health News:

Lance Shnider is confident Obamacare regulators knew exactly what they were doing when they created an online calculator that gives a green light to new employer coverage without hospital benefits. 

“There’s not a glitch in this system,” said Shnider, president of Voluntary Benefits Agency, an Ohio firm working with some 100 employers to implement such plans. “This is the way the calculator was designed.” 

Timothy Jost is pretty sure the whole thing was a mistake. 

“There’s got to be a problem with the calculator,” said Jost, a law professor at Washington and Lee University and health-benefits authority. Letting employers avoid health-law penalties by offering plans without hospital benefits “is certainly not what Congress intended,” he said. 

As companies prepare to offer medical coverage for 2015, debate has grown over government software that critics say can trap workers in inadequate plans while barring them from subsidies to buy fuller coverage on their own. 

At the center of contention is the calculator — an online spreadsheet to certify whether plans meet the Affordable Care Act’s toughest standard for large employers, the “minimum value” test for adequate benefits. 

The software is used by large, self-insured employers that pay their own medical claims but often outsource the plan design and administration. Offering a calculator-certified plan shields employers from penalties of up to $3,120 per worker next year. 

Many insurance professionals were surprised to learn from a recent Kaiser Health News story that the calculator approves plans lacking hospital benefits and that numerous large, low-wage employers are considering them. 

Although insurance sold to individuals and small businesses through the health law’s marketplaces is required to include expensive hospital benefits, plans from large, self-insured employers are not. 

Many policy experts, however, believed it would be impossible for coverage without hospitalization to pass the minimum-value standard, which requires insurance to pay for at least 60 percent of the expected costs of a typical plan. 

And because calculator-approved coverage at work bars people from buying subsidized policies in the marketplaces that do offer hospital benefits, consumer advocates see such plans as doubly flawed. 

Kaiser Health News asked the Obama administration multiple times to respond to criticism that the calculator is inaccurate, but no one would comment. 

Calculator-tested plans lacking hospital benefits can cost half the price of similar coverage that includes them. 

While they don’t include inpatient care, the plans offer rich coverage of doctor visits, drugs and even emergency-room treatment with low out-of-pocket costs. 

Who will offer such insurance? Large, well-paying employers that have traditionally covered hospitalization are likely to keep doing so, said industry representatives.... 

But companies that haven’t offered substantial medical coverage in the past — and that will be penalized next year for the first time if they don’t meet health-law standards — are very interested, benefits advisors say. 

They include retailers, hoteliers, restaurants and other businesses with high worker turnover and lower pay. Temporary staffing agencies are especially keen on calculator-tested plans with no hospital coverage. 

Benefits administrators offering the insurance say it makes sense not only for employers trying to comply with the law at low cost but for workers who typically have had little if any job-based health insurance....  

Such plans come with deductibles as low as zero for doctor visits and prescriptions and co-pays of only a few dollars, they say. Emergency-room visits cost members in the $250 or $400 range, depending on the plan. 

By contrast, health-law-approved insurance with inpatient benefits often includes deductibles — what members pay for all kinds of care before the insurance kicks in — of $6,000 or more.... 

Concerned for their reputations, larger administrators are wary of managing benefits without hospitalization, even if they do pass the calculator. 

“Our self-funded customers hand out insurance cards to their employees with Blue Cross all over it,” said Michael Bertaut, health care economist at BlueCross BlueShield of Louisiana, which has no plans to handle such coverage. “Do we really want someone to present that card at a hospital and get turned away?” 

There are two health-law coverage standards that large employers must meet to avoid paying a penalty. 

One, for “minimum essential coverage,” merely requires some kind of employer medical plan, no matter how thin, with a potential penalty next year of up to $2,080 per worker. Many low-wage employers are meeting that target with “skinny” plans that cover preventive care and not much else, say brokers and consultants. 

The calculator tests the health law’s second, more exacting standard — to offer a “minimum value” plan at affordable cost to workers. Failure to do so triggers the second penalty, of up to $3,120 per worker. 

The argument over the calculator is whether plans carving out such a large chunk of benefits — hospitalization — can mathematically cover 60 percent of expected costs of a standard plan. 

They probably can’t, Jost said. The fact that the calculator gives similar, passing scores to plans with hospital benefits and plans costing half as much without hospital benefits suggests that it’s flawed, he said. Plans with similar scores should have similar costs, he said. 

On the other hand, others ask, why did the administration make a calculator that allows designers to leave out inpatient coverage? Why didn’t the law and regulations require hospital coverage for self-insured employers — as they do for commercial plans sold through online marketplaces? 

“The law and calculator were purposely designed as they are!” Fred Hunt, past president of the Society of Professional Benefit Administrators, said in an email widely circulated among insurance pros. “No ‘glitch’ or unintended loophole.” 

“That’s baloney,” said Robert Laszewski, a consultant to large insurers and a critic of the health law. “Nobody said we’re going to have health plans out there that don’t cover hospitalization. That was never the intention… I think they just screwed up.”

  

Obamacare Nightmare for Low Income Families: Why Many Kids Lose Their Pediatrician After One Month

In Summary

• Persons eligible for Medicaid (Medi-Cal in California) are, by federal law, removed from Covered California and automatically enrolled.  
• Most adults are eligible for Medicaid at or below 138 percent of the federal poverty level.  
• Most children are eligible for Medicaid at or below 266 percent of the federal poverty level.  
• As children are born or a family's income drops, children are forced onto Medicaid while mom and dad remain on Covered California. 
• This creates a complex web of differing health plans within the family while worsening doctor access for the children (fewer providers see new Medicaid patients).   

I was on the Armstrong and Getty Radio Program this morning discussing this article.  You can hear that audio here:

You can hear that entire hour of Armstrong and Getty here.  All Armstrong and Getty podcasts available here.

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I have fielded more than a handful of inquiries from frustrated and angry parents over the byzantine run-around many receive from the interplay between Covered California (California's Obamacare Exchange), Medi-Cal (or Medicaid, the insurance program for low income persons in the Golden State) and the Children's Health Insurance Program (or "CHIP," a program for low income kids whose families make too much money to qualify for Medi-Cal in four different counties of California).

This topic arose again last week when I visited a client in California's central valley.  This client is a large group of doctors contracting with a major medical conglomerate.  They are troubled by a new phenomenon they are seeing more of for lower income families.

Expecting mothers on Covered California come in to have a baby and once that baby is born, the baby is covered under the mother's policy for the first month.  After that, the child moves onto their own plan.  However, a fair number of these children are no longer eligible for Covered California after that first month and are shuttled over to Medi-Cal.  That creates a problem in many cases because Medi-Cal generally reimburses less than Covered California.  Many providers only accept a limited quota of Medi-Cal patients.  And most of those quotas are filled with Obamacare's recent expansion of Medi-Cal eligibility from 100 percent to 138 percent of the federal poverty level.

The problem is exacerbated because it is easier for kids to qualify for Medi-Cal than it is for adults.  Furthermore, if an individual is eligible for Medi-Cal, federal law does not allow that person to purchase subsidized insurance in an Exchange.  The all knowing and benevolent government has decided that if an adult's income is below 138% he must have society's lowest grade of healthcare - Medicaid. Medicaid is so bad that a recent study found that having it was worse than having no coverage at all.

Medi-Cal Qualification for Adults:

And if a the child's family income is below 266 percent of the federal poverty level, that child is also forced onto Medicaid (1).  In at least one county, a child can get CHIP coverage at up to 416% of the federal poverty level (2).  There are no exceptions for getting subsidized Obamacare plans when your income falls below these levels.  The only way out at that point is to pay full premium for a private or Obamacare plan.  And that is simply not an economic possibility. (3) 

Adding to the bureaucratic nightmare many families face, "it is common for different members of the same family or tax household to be eligible for different programs.  In some cases, both parents could be eligible for tax credits through Covered California, while the children are eligible for Medi-Cal" according to California's Department of Healthcare Services site.  It goes on to state that:

[i]n other cases, one parent may be eligible for Covered California without subsidies because they have access to affordable coverage through their job, while their spouse is eligible for premium assistance tax credits through Covered California and the children are eligible for Medi-Cal.

The mind-numbing ordeal that results utterly stupefies.  Imagine an expecting couple making something between 139% and 265% of the federal poverty level (or $27,312 and $52,826 for a family of three). If Dad works for an employer that offers him affordable healthcare (meaning it costs him less than 9.5% of their household income) he is ineligible for any premium assistance in Covered California and makes too much for Medi-Cal.  So he would enroll in his employer's plan.  His wife works for a small company where healthcare is not offered.  So she is on Covered California getting a taxpayer subsidy to help with the premium.  (Also note that if their income is less than 250 percent of the federal poverty level they qualify for a different subsidy to help them pay copays and deductibles.)  When the child is born she is automatically added to the mother's plan for the first 30 days.  This means that the child's pediatrician would be on the same insurer and in the same network as mom.

However, after the bureaucracy's central planners get involved and evaluate the situation, they will realize that the child is to be transitioned to over to Medi-Cal based on the family income of 129 to 265 percent of the federal poverty level. And often times, a pediatrician that was accepting new Covered California patients may not be accepting new Medi-Cal patients since Medi-Cal reimburses at such low levels - even lower than Covered California.

Generally speaking, healthcare reimbursements are best from employer insurance plans, second best from Medicare (insurance for the elderly), third best from the Obamacare Exchange plans and worst from Medicaid/Medi-Cal. Most doctors accept (or are in network with) private plans and Medicare. Covered California's networks often offer as little as half of those providers and Medi-Cal has even fewer doctors accepting new patients.

The government likes to spin this by illuminating the high percentage of providers who accept Medi-Cal.  And that may be true.  However what is also true is that the overwhelming majority of doctors accepting Medi-Cal have a low quota of patients they can accept from Medi-Cal and then they shut their doors. To do otherwise would bankrupt them as Medi-Cal often pays less than a provider's raw cost for a procedure or treatment.

Turning back to our hypothetical family of three we see that the child may now lose his pediatrician after the first 30 days expire.  This has become a common enough problem for families that my client is convening a special session in order to explore the possibility of altering their policies to offer a longer grace period for treating such children.  But even after medical groups make such an allowance; the solution is only temporary.  They cannot afford to take all of these kids in at lower reimbursements and eventually this family will have three different insurance programs for its three different members.

Then, imagine the consternation arising when one of the parents is offered a pay raise changing the math on mother and child's eligibility. Not to worry, there will be bevy of DMV-esque employees there to line them up and offer their heart-felt assistance.

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Notes:

1.  266% of federal poverty level (FPL) for Kids is $52,826 per year for a family of three.

2.  California has a separate CHIP program in four counties that covers children up to 322% of the FPL in three of the counties and 416% of the FPL in one of the counties.

3.  I've received a number of questions from people who want know to why the government does not allow a family who is willing to make the sacrifice and buy up from an almost entirely subsidized Medicaid enrollment to a partially subsidized Obamacare plan so that they can consolidate family members onto one plan and procure a more robust provider network.  It seems abundantly practical and reasonable to most that a family who is willing for forego cable TV, keep a car for 10 years, and live more frugally in order to buy better healthcare should be permitted to do so.  I completely agree with that logic.  Yet, there appear to be at least three reasons the government does not want to allow this.

• First, because of the lower reimbursements to doctors and smaller provider networks, Medicaid plans are less expensive on a macro-economic level than the partially subsidized PPACA Exchange plans.  This is the most sound rationale for the federal law disallowing subsidized "buy-ups."  Or as a doctor client of mine succinctly put it, "it makes it easier to screw doctors." 

• Second, allowing some families to "buy-up" undercuts Obamacare supports' claims that the Medicaid expansion was ever necessary and creates a political difficulty for those wanting to further expand Medicaid.  It leads to the question - if some people can save and buy an Obamacare plan, why can't others?  And if they can't because they chose to have a different lifestyle, why should we subsidize them? 

• And third, for those who might be inclined to ascribe a more cynical motive to the situation, persons on Medicaid (almost wholly government funded) are more dependent on government largesse than persons enrolled in Obamacare (partially government funded).  A more thorough domestication of the population better ensures re-election and the maintenance of power. 

  

ObamaCare Vs. Home Care

This is from Jed Graham at Investor's Business Daily:

Virginia Kennon is the rock who has lifted up her family's spirits in difficult times. 

Until this month, she worked 54-hour weeks caring for her sister with cerebral palsy and her ailing 85-year-old mother. 

For Kennon, this $8-an-hour job has been a labor of love, as it would be for no one else, and in that sense she is irreplaceable. But lately she's feared that she might have to be replaced. 

Kennon's employer in Deming, N.M., recently began notifying caregivers that it's capping their hours at 29 per week, just below the 30-hour threshold at which ObamaCare requires companies to make affordable coverage available to most full-time workers or else pay a fine. ... 

Government data suggest that home care workers have been hit especially hard amid new [Obamacare] regulations. The average workweek clocked by non supervisors has sunk from 28 hours per week to a record-low 26.7 hours since the start of 2013. 

It's no coincidence that IBD's list of 450 employers who have systematically cut work hours to avoid ObamaCare employer mandate liability includes more than a few companies engaged in caring for the elderly and disabled. 

These are just examples that have been documented, but the real list is likely far, far longer: A group of assisted living centers in North Carolina; a Home Instead senior care franchise in Michigan; the Friendship Community group home, Firstaff Nursing Services and Lori's Angels home care, all in Pennsylvania; the Area Agency on Aging of Western Arkansas, which cut hours for 500 home health aides and drivers to 28 per week; and the Visiting Nurse Association (VNA) of El Paso. 

El Paso's ex-Democratic Mayor Joe Wardy told IBD last year that as CEO of financially troubled VNA, he was compelled to cut hours for 330 caregivers working 30 or more hours a week "because there is no margin in the reimbursement (from Medicaid) for any type of benefits."
The consequences, he said, were "disastrous" for employees, patients and the nonprofit itself, which has since closed. ...

 

The Federal Government Has No Clue If Obamacare Has Increased or Decreased the Number of Uninsured

Two of the bureaucracy's central planning agencies have come up with different answers as to the number of uninsured in America.  Surprising nobody, the Administration chose to hype the report that shed the best light on it despite the fact that it is the less reliable sampling. 

Here is a portion of an outstanding story from Joseph Antos at AEI: 

This week’s double-barreled release of government statistics on health insurance coverage leaves us with only one question: How many Americans are insured because of Obamacare? Remarkably, the two highly regarded government surveys released this week do not even agree whether the number of uninsured increased or decreased. The survey that received a great deal of attention said there were 3.8 million fewer uninsured. The other, which was hardly noticed, found that there were 1.3 million more uninsured. 

The Centers for Disease Control (CDC) reported preliminary results on the expansion of health insurance coverage. Its National Health Interview Survey(NHIS) interviewed 27,000 people in the first three months of this year. The survey estimates that the number of uninsured dropped by 3.8 million since 2013. That represents a 1.3 percentage point decline in the uninsured rate, from 14.4 percent last year to 13.1 percent early this year. 

Estimates from an even larger survey of the uninsured from the nation’s premier statistical agency, the Census Bureau, were released a few hours later. The Census Bureau has been collecting information on health insurance for decades based on the Current Population Survey (CPS). Data were collected from a sample of 68,000 households in February, March, and April of 2014. That survey found that 42 million—13.4 percent of the population—were uninsured in 2013. Interesting, but last year’s uninsured rate tells us nothing about how much the Affordable Care Act (ACA) expanded health insurance coverage this year. 

A day after the two main reports were issued, the CDC quietly placed another table on its website. The new table compares estimates from the NHIS and the CPS for the early months of 2014. It reports the NHIS result that 13.1 percent of the population lacked health insurance when they were interviewed in the January through March time period of 2014. But it also reports the CPS estimate that 13.8 percent were uninsured during the February through April interview period. 

The difference in levels estimated by the two surveys is due to differences in data collection methods and time periods, sampling error, nonresponse rates, and date processing that the CDC says leads to minor differences in estimates. That suggests that the trend in the uninsured rate measured by the CPS should be similar to that measured by the NHIS. It isn’t. 

The NHIS estimates a decrease in the uninsured of 1.3 percentage points, but the larger CPS shows an increase of 0.4 percentage points from last year to early this year. One survey says there were 3.8 million fewer uninsured Americans, while the other says there were 1.3 million more. 

What’s going on? 

It is no accident that the administration released CDC’s estimates early on September 16 followed shortly by the Census Bureau’s routine report on last year’s insurance coverage, delaying the comparable Census estimates to the next day. Good news about coverage gains drowned out the Census report. The high reliability of the NHIS was front and center in the press coverage. The contradictory evidence from Census was buried. 

Although the NHIS is a highly reliable survey, the CPS is even more reliable. Its sample is 150 percent larger than that of the NHIS, which means that its estimates have significantly lower statistical variance. If the NHIS is the gold standard, then the CPS must be the platinum standard. 

In fact, the CPS questionnaire has been substantially improved this year with the addition of new questions that do a better job of identifying both the type of insurance people have and the months they are covered. The previous version of the survey asked if the respondent had health insurance at any time during the last year. The current version asks if the respondent has coverage at the time of the interview as well as questions that directly ask about any specific months during the previous year of noncoverage. By asking about current coverage, the CPS can now be used to make the same comparisons over time as the NHIS. ...

 

Your Employees Don't Trust You or Your Insurer's Advice on Health and Wellness, Anyway

From Dina Overland at Fierce Healthcare; Hat tip to Benefits Link:

Many wellness programs could be doomed to fail based on a recent survey finding that most consumers don't trust their insurers or employers as a source of health and wellness. 

Based on more than 1,000 consumers participating in a survey from health optimization company Welltok, just 8 percent rely on their health insurers as a source of health and wellness. And just 10 percent rely on employers. 

That's why simply creating and implementing wellness programs isn't enough for insurers and employers to help consumers maintain a healthful lifestyle and avoid getting sick. ...

 

Obamacare's Economic Lesson to Hospitals: Cut Charity Care and Take More Emergency Room Visits

John R Graham has summarized a particularly perverse side-effect of Obamacare: hospitals are cutting charity care while encouraging greater use of the emergency room.  Remember when we were told that the Patient Protection and Affordable Care Act would encourage exactly the opposite?  Well it is not.  It is making this problem worse and it is doing so nationwide. 

Now that millions more have an insurance card, they are not dissuaded from using the emergency room.  In fact, they prefer it because waiting four to eight hours is much better that four to eight weeks.  Some medical groups are now even taking emergency room appointments. 

Meanwhile, the most unwelcome are those who still don't have coverage. Obamacare led to a reduction in federal charity care support.  The result is a disaster for the provision of affordable, quality healthcare.  

Head over to the NCPA and see John's post.  

  

CFOs: Raising the Federal Minimum Wage Would be a Mistake that could Cause Massive Layoffs and Job Freezes

This is from Jason DeBruyn at the Nashville Business Journal, hat tip to Iris Dorbian at CFO.com: 

The campaign led by President Barack Obama to raise the minimum wage is not getting much support from CFOs, as many claim it would hurt their businesses more than help them.

According to results from the September Duke University/CFO Business Outlook Survey, top financial executives contend that an increase in the minimum wage, if high enough, would lead to layoffs and hiring freezes.

The current minimum wage is $7.25, although it’s higher in some states. 

Though many CFOs said they wouldn’t have an issue if the minimum hourly wage increased to $8.75, anything near $10 or over would give them serious concern. In fact, nearly half (46%) of those surveyed at companies affected by the minimum wage said they would lay off employees if the minimum wage increased to $15 an hour. 

Also, 35% of respondents from the affected companies said employment growth at their firms would be limited if the wage was $8.75. That percentage nearly doubles when the minimum wage is set at $15. 

Further, almost 20% of the participants from the affected companies admitted that they would “reduce employee benefits or increase product prices if the minimum wage were increased to $8.75” while a little more than 40% would do the same if the minimum wage was $15. ...

   

Four Must-Haves For Learning New Information

In order to learn, research points to four must-haves for embedding new ideas.

1. Attention has to be very high; multitasking dramatically reduces recall. The chemical processes to encode memories only activate when we’re very focused. 
2. People need to generate their own mental maps around new ideas. They can’t just watch or listen; effort is central. 
3. Emotions need to be high; we only remember things we feel strongly about.
4. We grow our memories, so spacing out learning is critical. 

These four elements — attention, generation, emotion and spacing — form the optimal learning environment.  This level of learning is necessary for people to recall ideas before we even get to the question of how to build habits.

Source: The Brain at Work by David Rock at Chief Learning Officer.

Your Gut Bacteria May Be Deliberately Lying to You as Part of the Eternal Microscopic War Going on in Your Body

This is from Fruzsina Eordogh at Motherboard: 

... Within the human digestive system lives a massive ecosystem of bacteria, known as gut flora or the gut microbiota, and recent research suggests that these microbes can manipulate your brain into eating unhealthy things and even into feeling stressed and depressed. This is all part of the schemes bacteria use to optimize their environment for themselves.  

In a recent meta-analysis published in the journal BioEssays, researchers from UC San Francisco, Arizona State University, and the University of New Mexico concluded that these microbiota can influence their host's eating patterns through the vagus nerve. The vagus nerve is a nerve that extends from the brain to the gut, and microbiota love playing with it.  

"Microbes have the capacity to manipulate behavior and mood through altering the neural signals in the vagus nerve, changing taste receptors, producing toxins to make us feel bad, and releasing chemical rewards to make us feel good," said senior author Athena Aktipis in a statement. The researchers behind the current study looked at 120 different papers and research articles on gut flora published between 1981 and 2013 to come to their conclusions. ... 

To give you an idea as to how they can overpower and trick your body, remember that microbiota cells outnumber human cells 100 to one in your gut (though they're much, much smaller). These manipulative bacteria can make their hosts crave unhealthy foods rich in sugar and fat and are therefore thought to contribute to obesity. As if that wasn’t bad enough, it turns out some of our gut flora is linked to the growth of tumors and may be responsible for some stomach cancers, and possibly other types of cancer. 

Gut flora manipulate their host's eating patterns in order to survive and propagate, but also to wipe out their microbial competitors next-door. The gut is a battleground for these bacteria, and manipulating a host's brain into eating certain foods is their primary weapon. 

Sometimes they’ll even endanger the host by making them eat harmful foods. Research has found that people whose gut flora weren’t particularly diverse—meaning one bacteria managed to kill off the other types through brain manipulation—were more likely to be obese.
The paper stresses that gut flora is not solely responsible for obesity, though it did find some research to suggest microbiota might be contagious, including the bacteria that causes overeating. 

So why shouldn’t we nuke these bacteria in our gut with a bunch of antibiotics right away? Well, these microbiota perform important functions like “nutrient harvesting and immune development,” the paper explains, i.e. they serve us vitamins and minerals and build up our immune systems in return for living inside us. These microbiota also help the host digest certain foods. People in Japan have a special type of bacteria that helps them digest seaweed, and children in Africa whose diet includes consuming sorghum, a grass, have bacteria that helps them digest cellulose. 

But fortunately, everyone's microbiome is easy to manipulate via relatively simple changes in eating habits. 

If you’re worried about your microbiota composition, know that changing it through diet can take anywhere from a couple of minutes, which is how often the microbiota in your gut evolve, to 24 hours, which is how long it takes the gut flora to restructure itself once dietary changes have taken place. Changing the bacteria in your gut can potentially help change your eating habits, and vice versa. 

“Because microbiota are easily manipulatable by prebiotics, probiotics, antibiotics, fecal transplants, and dietary changes, altering our microbiota offers a tractable approach to otherwise intractable problems of obesity and unhealthy eating,” wrote the authors in a statement. ...
  

Poll: Now Most Californians Have a Negative Opinion of Obamacare. Most Also Favor Government Price Controls on Premium

A recent survey by the Public Policy Institute of California addressed voter sentiment on Obamacare as well as Proposition 45 (government price controls on health insurance premiums). Insurers in the Golden State already face a mind boggling bureaucratic morass making California one of the most difficult states in which to conduct business. I suspect that price controls on premium will be enough for a few carriers to leave the state altogether.

This is from Christopher Cadelago at the Sacramento Bee:

The Affordable Care Act continues to divide Californians, who remain skeptical four years after its passage despite the state’s relatively smooth launch in which more than 1.2 million people enrolled in health insurance coverage. 

A new survey released late Tuesday found some 42 percent of state residents generally view the law favorably, while 46 percent harbor unfavorable opinions. Support is down somewhat since May, before a wave of targeted TV ads began in a handful of competitive congressional districts. 

Democrats view the law positively while an overwhelming majority of Republicans (80 percent) see it unfavorably. Of the 1 in 5 Californians who say that they were aided by the law, 31 percent say that it allowed them or a family member to obtain or retain health care.  Meanwhile, of the 1 in 5 who said they have been harmed by the law, more than half reported it led to higher costs while about 20 percent say it made it more difficult to get coverage. ...

48 percent back Proposition 45, a measure that would give the state’s elected insurance commissioner the authority to regulate health insurance rates. Some 38 percent are opposed and 14 percent are undecided....

 

   

Read more he: http://www.sacbee.com/2014/09/23/6730622/poll-obamacare-support-sliding.html#storylink=cpy

30,000 Californians Face Dropped Obamacare Coverage and Delays. 64% of Callers Don't Get Through When They Call

From the Los Angeles Times:

California's health insurance exchange is vowing to fix enrollment delays and dropped coverage for about 30,000 consumers before the next sign-up period this fall. 

Covered California said it failed to promptly send insurance applications for 20,000 people to health plans recently, causing delays and confusion over their coverage. 

Another group of up to 10,000 people have had their insurance coverage canceled prematurely because they were deemed eligible for Medi-Cal based on a check of their income, officials said. 

The exchange said the private insurance should remain in place until coverage kicks in under Medi-Cal, the state's Medicaid program for lower-income residents. 

"There have been some cases of individuals where the wires got crossed and people were removed from Covered California before Medi-Cal was live," said Peter Lee, executive director of Covered California. "It's been a limited number of cases, but it's still a concern." 

At the same time, Covered California has been contacting nearly 100,000 households that risked losing coverage if they didn't provide proof of citizenship or legal residency. 

Covered California said it has cleared half of that list and about 50,000 households must still provide verification. Their coverage under the Affordable Care Act will be canceled Oct. 31 if they fail to provide the proper documentation. 

That verification effort, in particular, has taken a toll on the state's customer service, according to the exchange. 

Less than 1% of callers reached the exchange within 30 seconds last month; the state's goal is an 80% response rate in half a minute. 

Sixty-four percent of people abandoned their call entirely. ... 

 

IRS Q & A on Required Employer Reporting of Offers of Health Insurance Coverage to Employees (PPACA, Section 6056)

The IRS has updated its guidance on this topic.  Information reporting under section 6056 is voluntary for calendar year 2014. Reporting is first required in early 2016 with respect to calendar year 2015. For more information, see question 2.

• Basics of Employer Reporting: Questions 1-4
• Who is Required to Report: Questions 5-8
• Methods of Reporting: Questions 9-13
• What Information Must ALE Members Report: Questions 14-16
• How and When to Report the Required Information: Questions 17-25

Basics of Employer Reporting

1. What are the information reporting requirements for employers relating to offers of health insurance coverage under employer-sponsored plans?

The Affordable Care Act added section 6056 to the Internal Revenue Code, which requires applicable large employers to file information returns with the IRS and provide statements to their full-time employees about the health insurance coverage the employer offered. (For a definition of applicable large employer, see question 5, below.)

Under the regulations implementing section 6056, an applicable large employer may be a single entity or may consist of a group of related entities (such as parent and subsidiary or other affiliated entities). In either case, these reporting requirements apply to each separate entity and each separate entity is referred to as an applicable large employer member (ALE member). See question 7 for more information about the treatment of related entities.

The IRS will use the information provided on the information return to administer the employer shared responsibility provisions of section 4980H. The IRS and the employees of an ALE member will use the information provided as part of the determination of whether an employee is eligible for the premium tax credit under section 36B.

ALE members that sponsor self-insured group health plans also are required to report information under section 6055 about the health coverage they provide (See our section 6055 FAQs). Those ALE members that sponsor self-insured group health plans file with the IRS and furnish to employees the information required under sections 6055 and 6056 on a single form. The IRS and individuals will use the information provided under section 6055 to administer or to show compliance with the individual shared responsibility provisions of section 5000A.

2. When do the information reporting requirements go into effect?

The information reporting requirements under section 6056 are first effective for coverage offered (or not offered) in 2015. An ALE member must file information returns with the IRS and furnish statements to employees beginning in 2016, to report information about its offers of health coverage to its full-time employees for calendar year 2015.

Notice 2013-45 provides transition relief for 2014 from the section 6056 reporting requirements and the section 6055 reporting requirements for health coverage providers and, thus, the section 4980H employer shared responsibility provisions as well. Accordingly, neither the reporting requirements nor the employer shared responsibility provisions apply for 2014. The transition relief applies to all ALE members including for-profit, non-profit, and government entity employers. However, in preparation for the application of the employer shared responsibility provisions beginning in 2015, employers and other affected entities may comply voluntarily for 2014 with the information reporting provisions and are encouraged to maintain or expand coverage in 2014. Returns filed voluntarily will have no impact on the tax liability of the employer. For more information about voluntary filing in 2015, including the requirements for filing electronic returns, see IRS.gov.

3. Is relief available from penalties for incomplete or incorrect returns filed or statements furnished to employees in 2016 for coverage offered (or not offered) in calendar year 2015?

Yes. In implementing new information reporting requirements, short-term relief from reporting penalties frequently is provided. This relief generally allows additional time to develop appropriate procedures for collection of data and compliance with the new reporting requirements. Accordingly, the IRS will not impose penalties under sections 6721 and 6722 on ALE members that can show that they have made good faith efforts to comply with the information reporting requirements. Specifically, relief is provided from penalties under sections 6721 and 6722 for returns and statements filed and furnished in 2016 to report offers of coverage in 2015 for incorrect or incomplete information reported on the return or statement. No relief is provided in the case of ALE members that cannot show a good faith effort to comply with the information reporting requirements or that fail to timely file an information return or furnish a statement. However, consistent with existing information reporting rules, ALE members that fail to timely meet the requirements still may be eligible for penalty relief if the IRS determines that the standards for reasonable cause under section 6724 are satisfied. See question 24 for more information about penalties under sections 6721 and 6722.

4. Where is more detailed information available about these reporting requirements?

The regulations under section 6056 provide further guidance on the information reporting requirements for applicable large employers, and the regulations under section 6055 provide guidance on the information reporting requirements for insurers and other health coverage providers. Regulations on the employer shared responsibility provisions under section 4980Hprovide guidance on determining applicable large employer status and determining full-time employee status, including defining and providing rules for calculating hours of service. ...  

Click here for entire Q & A.  

 

Two New Section 125 Qualifying Events Permit Eased Access to Subsidized PPACA Exchange Plans

Background

Under the current section 125 change in status rules, a cafeteria plan may not allow an employee to revoke an election under the group health plan during a period of coverage solely to enroll in a Qualified Health Plan through a Marketplace (an Obamacare "Exchange").  For an individual enrolled through a cafeteria plan in a group health plan with a calendar plan year, the employee may continue his or her coverage under the plan for the remainder of the plan year and then immediately begin coverage under an Exchange plan. However, an individual enrolled through a cafeteria plan in a group health plan with a noncalendar plan year might not be able to synchronize the change in coverage to avoid an overlapping period of coverage or a period without coverage because the open enrollment period rules for Exchanges do not permit the purchase of coverage other than at the Exchange's fall open enrollment.

Also, under current Treasury regulations, a cafeteria plan may allow an employee to revoke an election under a group health plan during a period of coverage and to make a new election that corresponds with special enrollment rights only with respect to enrollment in another group health plan; not to enrollment in an Exchange. However, in the case of an event such as a birth or marriage, it may be more advantageous for some individuals to enroll themselves and their families in an Exchange rather than to add family members to an employer’s group health plan. To permit access to government subsidies and Exchanges in these cases, the new rules permit a group's cafeteria plan to allow a participating employee to revoke an election in order to obtain coverage through an Exchange. 

New Guidance

An employer cafeteria plan may now allow an employee to drop coverage under its group health plan (other than a health FSA) provided both of the following conditions are met:

Conditions for revocation due to reduction in hours of service:

1. The employee has been in an employment status under which the employee was reasonably expected to average at least 30 hours of service per week and there is a change in that employee’s status so that the employee will reasonably be expected to average less than 30 hours of service per week after the change, even if that reduction does not result in the employee ceasing to be eligible under the group health plan; and
2. The revocation of the election of coverage under the group health plan corresponds to the intended enrollment of the employee, and any related individuals who cease coverage due to the revocation, in another plan that provides minimum essential coverage with the new coverage effective no later than the first day of the second month following the month that includes the date the original coverage is revoked.

An employer may rely on the reasonable representation of an employee who is reasonably expected to have an average of less than 30 hours of service per week for future periods that the employee (and dependents) have enrolled or intend to enroll in another plan that provides minimum essential coverage for new coverage that is effective no later than the first day of the second month following the month that includes the date the original coverage is revoked.

Conditions for revocation due to enrollment in a Qualified Health Plan:

1. The employee is eligible for a Special Enrollment Period to enroll in an Exchange pursuant to guidance issued by the Department of Health and Human Services and any other applicable guidance, or the employee seeks to enroll in an Exchange plan during the Exchange's annual open enrollment period; and
2. The revocation of the election of coverage under the group health plan corresponds to the intended enrollment of the employee and any related individuals who cease coverage due to the revocation in an Exchange for new coverage that is effective beginning no later than the day immediately following the last day of the original coverage that is revoked.

An employer may rely on the reasonable representation of an employee who has an enrollment opportunity in an Exchange that the employee and related individuals have enrolled or intend to enroll in such Exchange for new coverage that is effective beginning no later than the day immediately following the last day of the original coverage that is revoked.

Effective Date. Plan Amendment Required.

These new changes are effective on September 18, 2014.

To allow these new permitted election changes, a group's cafeteria plan must be amended to provide for such changes. The amendment must be adopted on or before the last day of the plan year in which the elections are sought, and may be effective retroactively to the first day of that plan year, so long as the employer informs participants of the amendment.

Source: Additional Permitted Election Changes for Health Coverage under § 125 Cafeteria Plans, Notice 2014-55.

See also:

• IRS to Amend Cafeteria Plan Regulations to Facilitate Enrollment in Marketplace Coverage, Proskauer.  
• IRS Notice 2014-55 Gets the Employer Shared Responsibility Rules to Play Nice with the Rules Governing Mid-Year Cafeteria Plan Elections, Among Others, Minz Levin.

   

Artificial Sweeteners May Disrupt Body’s Ability to Regulate Blood Sugar

This is from Kenneth Chang at the NY Times: 

Artificial sweeteners may disrupt the body’s ability to regulate blood sugar, causing metabolic changes that can be a precursor to diabetes, researchers are reporting. ... 

[In a recent study] scientists performed a multitude of experiments, mostly on mice, to back up their assertion that the sweeteners alter the microbiome, the population of bacteria that is in the digestive system. 

The different mix of microbes, the researchers contend, changes the metabolism of glucose, causing levels to rise higher after eating and to decline more slowly than they otherwise would. 

The findings by Dr. Elinav and his collaborators in Israel, including Eran Segal, a professor of computer science and applied mathematics at Weizmann, are being published Wednesday by the journal Nature. ... 

Previous studies on the health effects of artificial sweeteners have come to conflicting and confusing findings. Some found that they were associated with weight loss; others found the exact opposite, that people who drank diet soda actually weighed more. 

Some found a correlation between artificial sweeteners and diabetes, but those findings were not entirely convincing: Those who switch to the products may already be overweight and prone to the disease. ... 

In the initial set of experiments, the scientists added saccharin (the sweetener in the pink packets of Sweet’N Low), sucralose (the yellow packets of Splenda) or aspartame (the blue packets of Equal) to the drinking water of 10-week-old mice. Other mice drank plain water or water supplemented with glucose or with ordinary table sugar. After a week, there was little change in the mice that drank water or sugar water, but the group getting artificial sweeteners developed marked intolerance to glucose. 

Glucose intolerance, in which the body is less able to cope with large amounts of sugar, can lead to more serious illnesses like metabolic syndrome and Type 2 diabetes. 

When the researchers treated the mice with antibiotics, killing much of the bacteria in the digestive system, the glucose intolerance went away. 

At present, the scientists cannot explain how the sweeteners affect the bacteria or why the three different molecules of saccharin, aspartame and sucralose result in similar changes in the glucose metabolism. 

To further test their hypothesis that the change in glucose metabolism was caused by a change in bacteria, they performed another series of experiments, this time focusing just on saccharin. They took intestinal bacteria from mice who had drank saccharin-laced water and injected them in mice that had never been exposed any saccharin. Those mice developed the same glucose intolerance. 

And DNA sequencing showed that saccharin had markedly changed the variety of bacteria in the guts of the mice that consumed it. ... 

Finally, they recruited seven volunteers who normally did not use artificial sweeteners and over six days gave them the maximum amount of saccharin recommended by the United States Food and Drug Administration. In four of the seven, blood-sugar levels were disrupted in the same way as in mice. ... 

[The study also suggested that] probiotics — medicines consisting of live bacteria — could be used to shift gut bacteria to a population that reversed the glucose intolerance....

 

Study: Before Obamacare People Had Access to Higher Quality and More Prevalent Health Plans

From the Daily Caller as summarized by NCPA:

The Daily Caller reports that health insurance policies for individuals were of higher quality prior to the Affordable Care Act. The claim comes from a study issued by the National Center for Public Policy Research, which analyzed health insurance plans across 10 major cities both prior to and after the Affordable Care Act. 

According to the study:

• Pre-Obamacare plans actually had more comprehensive health care coverage than plans offered in the exchanges. This was the case for both age sets analyzed: 27-year-old individuals as well as 57-year-olds.

• Last year, before the Affordable Care Act was in force, young adults had access to an average 33 health plans in their area with premiums that were lower than Obamacare, as well as lower or equal deductibles and lower out-of-pocket costs.

• For older Americans, there were an average of 10 insurance policies in each area that had premiums and deductibles cheaper than the exchange plans offered in 2014.

... The study also cited a recent survey from the Kaiser Family Foundation, which found that one-third of the enrollees who switched to exchange plans considered their plans "not so good" or "poor."

Sources: Sarah Hurtubise, "Study: Pre-Obamacare Health Insurance Was Better Quality Than Exchange Plans," Daily Caller, September 15, 2014. And The National Center for Policy Analysis.  

  

Wellness Programs Save Money By Penalizing Unhealthy Employees - Not Making Them Healthier

The following in an excerpt of what originally appeared on The Upshot (copyright 2014, The New York Times Company) and is coauthored by Austin Frakt and Aaron Carroll:

... Wellness programs have grown into a $6 billion industry because employers believe [they actually work]. In fact, asked which programs are most effective at reducing costs, more firms picked wellness programs than any other approach. The Kaiser survey found that 71 percent of all firms think such programs are “very” or “somewhat” effective, compared with only 47 percent for greater employee cost sharing or 33 percent for tighter networks. (Recent research on public employee plans in Massachusetts found that tighter networks were associated with large savings.) 

What research exists on wellness programs does not support this optimism. This is, in part, because most studies of wellness programs are of poor quality, using weak methods that suggest that wellness programs are associated with lower savings, but don’t prove causation. Or they consider only short-term effects that aren’t likely to be sustained. Many such studies are written by the wellness industry itself. More rigorous studies tend to find that wellness programs don’t save money and, with few exceptions, do not appreciably improve health. This is often because additional health screenings built into the programs encourage overuse of unnecessary care, pushing spending higher without improving health. 

However, this doesn’t mean that employers aren’t right, in a way. Wellness programs can achieve cost savings — for employers — by shifting higher costs of care onto workers. In particular, workers who don’t meet the demands and goals of wellness programs (whether by not participating at all, or by failing to meet benchmarks like a reduction in body mass index) end up paying more. Financial incentives to get healthier sometimes simply become financial penalties on workers who resist participation or who aren’t as fit. Some believe this can be a form of discrimination. 

The Affordable Care Act encourages this approach. It raises the legal limit on penalties that employers can charge for health-contingent wellness programs to 30 percent of total premium costs. Employers can also charge tobacco users up to 50 percent more in premiums. Needless to say, this strikes some people as unfair and has led to objections by workers at some organizations, as well as lawsuits. 

Another way that wellness programs can help employers is by putting a more palatable gloss on other changes in health coverage. For instance, workers might complain if a company tries to reduce costs through higher cost sharing or narrower networks that limit doctor and hospital choice. But if these are quietly phased in at the same time as a wellness program that’s marketed as helping people become healthier, a company might be able to achieve those cost reductions with less grumbling. ...

 

While PPACA Nudges Us Towards a Part-Time Economy; California Marches Us Off The Plank At Gunpoint

This is from Jed Graham at Investor's Business Daily:  

Diners don't want sandwich-makers sneezing on their turkey, so there's an obvious logic to California's new law mandating three paid days of sick leave. 

But as California piles up the costs of employing low-wage workers with paid sick leave and a higher minimum wage, employers also face another large cost spike via ObamaCare. 

From June 2014 — just before California bumped up the minimum wage from $8 to $9 an hour — to January 2016 (when the minimum wage hits $10), the cost of employing a 40-hour-per-week minimum-wage worker could rise as much as $4.82, or 56%, to $13.43 an hour, an IBD analysis finds. 

That includes $2.15 in more wages and Social Security and Medicare taxes; an additional 13 cents for sick leave; and a potential ObamaCare penalty equivalent to $2.54 an hour in wages. 

Fewer Jobs, Hours 

One big risk is that industries employing a primarily low-wage workforce will hire less. That's the prediction of the Congressional Budget Office, which has said the combination of ObamaCare's employer mandate penalties and a hike in the minimum wage to the $10 range would cause more job loss than a higher mandated wage by itself as employers find it more cost-effective to replace workers with technology. 

The other risk is that employers will keep workers' hours below 30 per week — full time under ObamaCare — to dodge a big part of these new costs. 

Restricting workers to 29 hours per work would avoid ObamaCare employer penalties and limit the compensation increase to a still-hefty $2.32 an hour, or 27%. 

Interestingly, Bureau of Labor Statistics data show that big minimum-wage hikes have been passed in four of the five states seeing the biggest year-over-year drop in the average workweek among leisure and hospitality workers. 

Inhospitable Wage 

... Evidence of an ObamaCare impact in depressing the workweek is piling up. In private industries paying up to $14.50 an hour, rank-and-file workers are clocking the shortest workweek on record, just 27.3 hours. 

Further, the number of workers clocking hours just above the 30-hour-per-week mark has plunged relative to those with workweeks just below it. 

The employer penalty for each full-time worker who receives ObamaCare exchange subsidies in 2015 will be $3,120. Penalties are assessed based on the work hours during a measurement period in 2014, so employers have had an incentive to act in advance to limit liability by reducing work hours.

Because the fine is nondeductible, it is the equivalent of $5,132 in deductible wages for a company facing a combined 39.2% state and federal tax rate. 

That breaks down to $2.47 per hour for a 40-hour-per-week, year-round worker, and the penalty is on track to rise at least an additional 3.2% in 2016. ...

    

Companies Reducing Subsidies for Dependent Coverage, Eliminating Some Spouses & Adding Per-Person Pricing

According to a recent survey of 1,234 employers:

• 22% have already reduced their subsidies for covered dependents. 

• An additional 50% expect to cut back over the next five years.

• 10% of the respondents have eliminated coverage for spouses with access to other coverage.  

• 49% more are looking at doing that within five years.

• Companies adopting a “unitized” pricing approach, where employee contributions to health benefits are on a per-person basis (rather than a single rate for all family sizes), may expand from 5% now to 52% in five years. 

Source: CFO.com, Sept. 12, 2014. By David McCann.  

  

Government Regulation Cuts Productivity in Half

Source: The Mercatus Center at George Mason University.

See also: The National Center for Policy Analysis Summary.

The Safety Hammock: Consumers Paid 48% of Healthcare Costs in 1960. They Pay 11% This Year

Ten years ago, the government was paying for 39% of all health care spending, but that share has only risen. Obamacare is part of this increase:

• In 2014 alone, federal health care spending is projected to increase by 14.7%, rising faster than the growth of private health care spending for the next decade.
• With states expanding their Medicaid programs to take advantage of federal funding under the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) projects Medicaid spending to rise by 18.4% in 2014.

Notably, Obamacare will only further decrease the amount of direct, out-of-pocket health care spending in the country. While consumers paid 48 percent of health care costs out of pocket in 1960, they will pay just 11 percent out of pocket this year.

Source: National Center for Policy Analysis.  

  

ObamaCare Scorecard Now Includes 450 Employers with More Than 100 School Districts Cutting Workers and Hours

From Jed Graham at Investor's Business Daily: 

ObamaCare's impact on jobs is hotly debated by politicians and economists. Critics say the Affordable Care Act gives businesses an incentive to cut workers' hours below the 30-hour-per-week threshold at which the employer mandate to provide health insurance kicks in. White House economists dismiss such evidence as anecdotal, but BLS data show that the workweek in low-wage sectors sank to a record low in July — just before the Obama administration delayed enforcement of the employer mandate until 2015.

In an example of excellent journalism, IBD has researched, complied and maintains a list of employer job actions with strong proof that ObamaCare's employer mandate is behind cuts to work hours or staff.  The latest edition of that list is up to 450.  Click here to see full list.  

  

PPACA's Impact on the U.S. Workweek

This is from Jed Graham at Investor's Business Daily:

... Bureau of Labor Statistics data show the average workweek among providers of home care for the elderly and disabled has shrunk to a record low 26.9 hours for non-supervisors, down from 28 hours in December 2012.

Among all private industries where pay averages about $14.50 or less for 30 million rank-and-file workers, the workweek has shrunk to 27.3 hours, undercutting the prior record low at the depth of the recession, an IBD analysis has found.

In the 19 months through June, these private low-wage industries added, on net, 972,000 non-supervisors clocking just 17.7 hours a week.

Meanwhile, the number of workers clocking 31 to 34 hours per week — just above ObamaCare's threshold — has sunk to a record low relative to the ranks clocking just below 30 hours, Current Population Survey data show.

In short, something is seriously depressing the work hours of modest earners and all the evidence points to ObamaCare as an important factor. ...

 

California Now Mandates Paid Sick Leave for Employees. Law Takes Effect July 1, 2015.

Governor Brown signed legislation on September 10th mandating paid sick leave for employees in the Golden State  The law will take effect on July 1, 2015 and requires employers to provide up to three days of annual paid sick leave to workers, who would accrue the time off at a minimum rate of one hour per 30 hours worked. The law applies to employers of all sizes and covers full-time, part-time and temporary employees, permitting them to take leave as early as their 90th day of employment. 

Link to statutory text.

The following is from Charles Thompson and Hera Arsen at Ogletree Deakins:

California employers need to know the following about the legislation:

1. The bill would enact a new law entitled the “Healthy Workplaces, Healthy Families Act of 2014” and would amend California Labor Code 2810.5.
2. Beginning July 1, 2015, California employees will accrue one hour of paid sick leave for every 30 hours worked.
3. Employees can begin using their paid sick days on the 90th day of their employment for their own health condition, a family member’s health condition, and if the employee is a victim of domestic assault, sexual violence, and/or stalking.
4. The legislation defines “family member” to include spouse, registered domestic partner, grandparent, grandchild, and sibling. Because grandparent, grandchild, and siblings are not family members under the California Family Rights Act, the legislation expands the types of family members for which an employee can take protected leave.
5. Employers can limit an employee’s use of paid sick days to 24 hours or 3 days in each year of employment.
6. Employers are not required to pay out accrued unused sick leave at time of termination.
7. Employers cannot discriminate or retaliate against employees who request and/or use paid sick days. An employer that takes an adverse employment action against an employee who uses or requests leave is presumed to have retaliated against the employee.
8. The bill imposes posting, notice, and record-keeping obligations on employers.
9. The bill assigns enforcement authority to the California Labor Commissioner.
10. Employers that violate the law will face administrative fines. The bill also authorizes the Labor Commissioner or the Attorney General to recover civil penalties, attorneys’ fees, costs, and interest against violating employers, as well as to reinstate employees.
11. The bill exempts employees covered by collective bargaining agreements if those agreements meet certain requirements, including providing for paid leave and binding arbitration.

... Because many California employers already provide at least three days of paid time off that employees can use for sick leave for themselves and others, the legislation will impose administrative burdens on those employers without providing their employees with any additional days off. Employers will have to comply with notice and record-keeping burdens and integrate the law with their own paid time off policies, Labor Code section 233 (“kin care”), family medical leave, and all the other protected leaves that California provides employees. ...

According to Douglas J. Farmer, a shareholder in the San Francisco office of Ogletree Deakins:

Many California employers that currently have paid sick leave policies believe that the new legislation will not impact them. In fact, every employer with a paid sick leave policy will now have to review their policies to ensure they meet the minimum requirements of the law. Many paid sick leave policies, for example, exclude part-time, temporary, and seasonal employees from paid sick leave benefits. The new law provides no such limitation and will place employers with such limited policies squarely in violation of the law. Similarly, paid sick leave policies that meet the requirements of California Labor Code section 233, the state's ‘kin care’ law, will likely also fall short of compliance. The legislation extends the employee’s right to use paid sick leave benefits to care for a broader range of family members than section 233, including grandparents, grandchildren, and siblings. Employers in San Francisco and San Diego, which have their own unique paid sick leave ordinances, will have the unenviable task of integrating their policies at both the state and local levels.

And the below is from Susan Schoenfeld at BLR:  

The Healthy Workplaces, Healthy Families Act of 2014 (the Act) requires that covered employers provide up to three days of paid sick leave per year for diagnosis, care, or treatment of an existing health condition of, or preventive care for, an employee or an employee’s family member. The Act also requires that paid sick leave be provided to eligible employees who are victims of domestic violence, sexual assault, or stalking.

Here are the basics:

Covered family members include children, parents, spouses, registered domestic partners, grandparents and grandchildren, and siblings. Covered children include biological, adopted, or foster children, stepchild, a legal ward, or a child to whom the employee stands in loco parentis. The definition of a child is applicable regardless of age or dependency status.
Covered parents include biological, adoptive, or foster parents, stepparents, or legal guardians of an employee or the employee’s spouse or registered domestic partner, or a person who stood in loco parentis when the employee was a minor child.

Eligibility 

In order to be eligible for paid sick leave, an employee must have worked within the state for 30 or more days within a year from the commencement of employment. An employee will be entitled to use accrued paid sick days beginning on the 90th day of employment, after which day the employee may use paid sick days as they are accrued. 

Notice

Employers must provide employees with written notice that sets forth the amount of paid sick leave available, or paid time off leave an employer provides in lieu of sick leave, for use on either the employee’s itemized wage statement or in a separate writing provided on the designated pay date with the employee’s payment of wages.

At the time of hiring, an employer must provide each employee a written notice, in the language the employer normally uses to communicate employment-related information to the employee, containing (among other information) that the employee:

• May accrue and use sick leave;
• Has a right to request and use accrued paid sick leave;
• May not be terminated or retaliated against for using or requesting the use of accrued paid sick leave;
• And, has the right to file a complaint against an employer who retaliates. ...

If the need for paid sick leave is foreseeable, the employee must provide reasonable advance notification.

If the need for paid sick leave is unforeseeable, the employee must provide notice of the need for the leave as soon as practicable. ... 

Employers with paid sick leave policies in place

An employer is not required to provide additional paid sick days pursuant to the Act if the employer has a paid leave policy or paid time off policy in place and the employer makes an amount of leave that may be used for the same purposes and under the same conditions as specified in the Act.

In order to meet the Act’s threshold requirements, the employer’s policy must either satisfy the accrual, carry over, and use requirements of the Act—or provide no less than 24 hours or three days of paid sick leave, or equivalent paid leave or paid time off—for employee use for each year of employment or calendar year or 12-month basis. No accrual or carry over is required if the full amount of leave is received at the beginning of each year. ...

Penalties 

If the Labor Commissioner determines that a violation of the Act has occurred, he or she may order any appropriate relief, including reinstatement, backpay, the payment of sick days unlawfully withheld, and the payment of an additional sum in the form of an administrative penalty to an employee or other person whose rights under this Act were violated. Penalties range from $50 to a $4,000 aggregate cap. 

An employer will not be assessed any penalty or liquidated damages due to an isolated and unintentional payroll error or written notice error that is a clerical or an inadvertent mistake regarding the accrual or available use of paid sick leave. In determining whether the employer’s actions were isolated and unintentional, a fact finder may consider whether the employer—prior to an alleged violation—has adopted and is in compliance with a set of policies, procedures, and practices that fully comply with the Act. 

Exclusions 

Specific industries and employee groups are excluded from the requirements of the paid sick leave Act. Those excluded from the Act’s coverage include:

• Collective bargaining agreements (CBAs). An employee covered by a valid CBA is not covered by the Act if the agreement expressly provides for the wages, hours of work, and working conditions of employees, and expressly provides for paid sick days or a paid leave or paid time off policy that permits the use of sick days for those employees. The CBA must also provide for final and binding arbitration of disputes concerning the application of paid sick days provisions, premium wage rates for all overtime hours worked, and regular hourly rate of pay of not less than 30 percent more than the state minimum wage rate.

• Construction industry/CBAs. An employee in the construction industry covered by a valid CBA is not entitled to paid sick leave under the Act if the CBA expressly provides for the wages, hours of work, and working conditions of employees, premium wage rates for all overtime hours worked, and regular hourly pay of not less than 30 percent more than the state minimum wage rate, and the agreement either was entered into before January 1, 2015, or expressly waives the requirements of the Act in clear and unambiguous terms.

• Providers of in-home supportive services

• Individuals employed by an air carrier. Flight deck or cabin crew members are subject to the provisions of Title II of the federal Railway Labor Act (45 U.S.C. 181 et seq.), provided that the individuals are provided with compensated time off equal to or exceeding the amount provided by the Healthy Workplaces, Healthy Families Act of 2014. ...

See also:

• California Employers May Get Ill Over California’s New Mandatory Paid Sick Leave Law | Employment Matters Blog; and

• The Epidemic Continues: California Enacts Statewide Paid Sick Leave Law, by Michelle Barrett Falconer and Pam Salgado of Littler. 

• Q & A on California's New Paid Sick Leave from Ogletree Deakins.  

  

How Standing Might Be The Best Anti-ageing Technique

From Sarah Knapton at the Telegraph:

... [A] reduction in sitting hours is of greater importance than an increase in exercise time for elderly risk individuals." ... 

Telomeres stop chromosomes from fraying, clumping together and "scrambling" genetic code.
... The study, published in the British Medical Journal, revealed that although people who did more exercise tended to be healthier, the most important factor was how much time they spent sitting down. 

Scientists found that the less time a person spent sitting, the longer their telomeres, and the greater their chance of living longer....

 

Univ. of Chicago Econ Professor: The Myth of ObamaCare's Affordability

In summary: 

• Americans will work fewer hours less productively under the perverse disincentives of PPACA 
• Society has to make sacrifices in order to deliver healthcare to more people
• Workers and production are taken away from other industries to beef up healthcare 

The following is from Casey Mulligan writing in the Wall Street Journal.  His entire post is certainly worth the time to read.  Here is an excerpt:

... Although the ACA helps specific populations by giving them a bigger slice of the economic pie, the law diminishes the pie itself.  It reduces the amount that Americans work, and it makes their work less productive. This slows growth in both personal income and gross domestic product. 

In further expanding the frontiers of redistribution, the ACA reduces the benefits of employment for both employers and employees. Employers that don't provide health insurance are either subject to large penalties based on the number and types of employees that they have, or are threatened with enormous penalties when they get the opportunity to expand their business. About a quarter of the nation's employees, more than 35 million men and women, currently work for employers that don't offer health insurance. These tend to be small and midsize businesses with employees who already make less than the average American worker. The result of penalizing businesses for hiring and expanding is going to be less hiring and expanding. 

Another sixth of the nation's employees—almost 25 million people—are in a full-time position that makes them ineligible for the law's new and generous assistance with health-insurance premiums and cost sharing. They are ineligible for subsidies simply because they are working full time and thereby eligible for their employers' coverage. Because the only ways for them to get the new assistance is to move to part-time status, find an employer that doesn't offer coverage, or stop working, we can expect millions of workers to make one or more of those adjustments. 

Most people wouldn't give up working merely to qualify for a few thousand dollars in assistance. But it is a mistake to assume that nobody is affected by subsidies, because there are people who aren't particularly happy with working, planning to leave their job anyway, or otherwise on the fence between working and not working. A new subsidy is enough to push them over the edge.... 

The law has effects that extend well beyond the employment rate and the average length of the workweek. People, businesses and entire sectors will jockey to reduce their new tax burdens or enhance their subsidies. Their adjustments to the new incentives will make our economy less productive and stifle wage growth, even among workers who have no direct contact with the law's penalties and subsidies. 

The "29er" phenomenon is a good example of how the law harms productivity. Because ACA's "employer mandate" requires firms with 50 or more full-time workers to offer health plans to employees who work more than 30 hours a week, many employers and employees have adopted 29-hour work schedules. This is not the most productive way to arrange the workplace, but it allows employers to avoid the mandate and its penalties....

... [T]his ... exacerbates the societal problem that the economy cannot expand its health sector without giving up something else of value.... The ACA as a whole will have the nation working fewer hours, and working those hours less productively. 

I estimate that the ACA's long-term impact will include about: 

• 3% less weekly employment, 

• 3% fewer aggregate work hours, 

• 2% less GDP and 

• 2% less labor income. 

These effects will be visible and obvious by 2017, if not before. The employment and hours estimates are based on the combined amount of the law's new taxes and disincentives and on historical research on the aggregate effects of each dollar of taxation. The GDP and income estimates reflect lower amounts of labor as well as the law's effects on the productivity of each hour of labor. ...