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Appetizers for the insurance increases story

By - Last modified: April 11, 2013 at 8:59 AM
Heather Stauffer
Heather Stauffer

I have a story coming out in tomorrow's paper that is, in a word, weighty.

It is also long.

Even with all that, though, I found myself with a couple of loose ends afterward — things I gleaned along the way that didn't quite fit, but I wanted to include. So I'm going to serve those up now, as appetizers. (Be sure to catch the main course, too!)

The first is a question: Why is self-insurance projected to become more popular under the Patient Protection and Affordable Care Act? The answers are that self-insured plans will not be required to meet minimum essential benefits standards; they will evade the Health Insurance Tax that has been described as one of the biggest taxes in the PPACA; and they are by nature shielded from the rating band restrictions that are expected to increase costs for fully-insured groups that are relatively young and healthy. This is a good read on the subject.

The self-insurance difference is so vital that I've seen some descriptions of it as a "loophole" in PPACA. I asked Matthew Scott, senior vice president of Pittsburgh-based HDH Group's Lemoyne office, if that has inspired efforts to close said loophole.

"There are certain states that have considered putting a floor on stop-loss insurance levels," Scott said. "I haven't seen those gain any traction."

The second is — well, this headline pretty much says it:

"Insurers see way to dodge federal healthcare law next year: A little-known loophole in President Obama's landmark legislation enables health insurers to extend existing policies for nearly all of 2014."

And this story by the New York Times is about how the National Association of Insurance Commissioners is analyzing steps that states can take to "mitigate expected premium increases."

The third is that I've been wondering how big a deal it is for businesses to figure out how many full-time-equivalent employees they have and how to proceed on that knowledge. Eric N. Athey, attorney and co-chair of labor and employment at McNees Wallace & Nurick LLC, told me this: It's big.

Athey also told me that, contrary to common misperception, the lookback provision of the employer mandate that will use all or part of 2013 to determine 2014 eligibility applies only to variable-hour employees.

"Many employers seem to think that this whole lookback applies to all their employees," Athey said. "It really doesn't. In many industries, hourly employees work a relatively fixed schedule."

The fourth is also from Athey, who reminded me that the feds are still "cranking out regulations at a rate that you wouldn't believe." Furthermore, he said, they're doing things like putting proposed regulations on one subject "in the preamble to proposed regulation that's entirely different" — and then when it was not well-received, issuing a correction to said badly placed proposal.


In closing, do you remember the Healthier Vending Fair that was supposed to happen in Lancaster on March 25? Snow nixed those plans, and it was rescheduled for April 12. Same time, same place.

Heather Stauffer covers Lancaster County, nonprofits and health care. Have a tip or question for her? Email her at You can also follow her on Twitter, @StaufferCPBJ.

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