Making health care decisions is what bosses do

“I don’t always make my employees’ health care decisions for them, but when I do, I only do it for women.”

Thus says the photo posted by Pennsylvania-based Women’s Law Project. There’s a caption, too: “Bosses shouldn’t be able to impose their religious beliefs on their employees. #NotMyBossBusiness”

The thing is, bosses usually do make employees’ health care decisions for them, regardless of gender. More than half of non-elderly Americans have employment-based health insurance, in which the employee’s only decisions are typically whether to opt into the plan and then whether to seek treatment in or out of network. Carrier, network, deductible, prescription plan and more: These are all decisions companies make, even if workers shoulder a substantial share of the cost (as is becoming increasingly common).

I am now going to go two ways with this.

The first is that the photo implies that bosses are actually keeping employees from getting contraceptives, a misconception that is apparently pandemic. They’re not — and that’s not just because, as part of the Internet has been shouting, “You can go out and buy any birth control you want for yourself with your own money, nothing is stopping you from doing that.” (I trust that you’ve also heard the retort, which is along the lines of, “But you might not be able to afford that and they aren’t taking anything away from the men and that’s not fair and, hey, their investment portfolio says they’re hypocrites.” And that’s as far as I’m going to follow the argument.)

Under the ruling, women employed by objecting companies can still get not only whatever contraceptives they want, but for free. And I quote: “The Court assumes that the interest in guaranteeing cost-free access to the four challenged contraceptive methods is a compelling governmental interest.”

I’m going to quote again, because I’ve seen so many stories get this wrong: “The effect of the HHS-created accommodation on the women employed by Hobby Lobby and the other companies involved in these cases would be precisely zero. Under that accommodation, these women would still be entitled to all FDA-approved contraceptives without cost sharing.”

Got that? The court said only that employers with religious objections to particular contraceptives shouldn’t have to pay for them. It didn’t mandate how women are to be given that full and free access, but it prominently cited the current nonprofit accommodation as a possibility. In that model, an objecting employer fills out a form that goes to the insurer and then the insurer has to cover the cost of whatever contraceptives the employer excluded.

If that strikes you as splitting hairs — as it does me, frankly — then just wait until I get to the part where I explain that some nonprofits are protesting that filling out that form constitutes a violation of their rights, and that on July 3 the Supreme Court issued an injunction saying that while that litigation proceeds, Wheaton College doesn’t have to fill out that form.

The issue, of course, isn’t the filling out of the form so much as it is the triggering of the accommodation. But the court’s Wheaton injunction makes it clear that although it gave the college a reprieve from the form, it is still considering the accommodation triggered. And although it says, “this order should not be construed as an expression of the Court’s views on the merits,” I haven’t come across anything indicating that the justices are likely to turn around and decide that employees shouldn’t have full and free access through some accommodation or another.

So then, the Conestoga and Hobby Lobby ruling doesn’t really change access to contraceptives at all — it just shifts who pays for it directly. And I say “directly,” because we all know that if complying with the accommodation hits insurers in the wallet, they will find a way to pass on the costs. And I wonder how many people who rejoiced at the ruling would have had the same reaction if they really understood it.

Now, for the second — and much shorter — way I’m going to go with this. I need you to forget about the contraceptive issue for the moment and focus on the more general truth that your boss makes a lot of health care decisions for you. Do you think that’s the way it should be? I know that it’s the way it is, and that the tax benefits of the arrangement probably explain why it hasn’t ever drawn much protest from employees — but really. Particularly now that Obamacare has put the underwriting ban in place, does it make any sense for the government to incentivize a system that gives employers so much control over their employees’ lives?

And now, as you consider that rabble-rousing question, I am going to take this opportunity to make an observation about the whole contraceptive mandate situation that I’ve been eager to share ever since it occurred to me. Here goes:

Given that, historically, the contraception conversation in our country has been so strongly associated with the Catholic church, how remarkable is it that this whole episode, if you will, is so dominated by non-Catholics? I mean, the Little Sisters of the Poor did have their day in the headlines, but that was about it. Who would have thought?

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This is both a quick read and a helpful explanation: “Fluctuating Premiums Could Push Exchange Enrollees to Switch Plans.”

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Not quite in our area, I know, but the numbers in this Independence Blue Cross report on its ACO are interesting. The model “has been embraced by more than 90 percent of the health care delivery systems in the region,” and half of the hospitals participating successfully reduced their medical costs, with nearly 90 percent lowering hospital readmission rates (average reduction: 16 percent), and the potential performance-based incentive dollars for doctors and hospitals is “expected to approach $150 million in 2014.”

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In the latest installment of online patient portal news, 65,000 patients have enrolled in MyWellSpan so far, according to a news release.

And in other WellSpan news, “WellSpan Pharmacy at WellSpan York Hospital recently implemented a program where patients can get their medications filled and delivered to them in their room before they are discharged.” The pharmacy is filling about 900 to 1,000 prescriptions per month for about 400 inpatients, according to a news release, and early feedback on the program is good.

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There’s a very nice ribbon-cutting photo to go with this caption posted by Highmark, but in this case the words pretty much say it all.

“We’ve cut the ribbon and officially kicked off a three-year $45 million collaborative initiative and investment in information technology in Pennsylvania. Together with Computer Aid, Inc, we’ve hired 30 Harrisburg University students to work on an IT project for United Concordia Dental. The partnership gives students excellent real-life experience, mentoring opportunities, and provides a pipeline for potentially hiring these students once they graduate.”

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Have you heard that Verizon is targeting self-insured employers and integrated delivery networks for its Virtual Visits telehealth program?

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You might be interested to know that CMS released something titled “Medicare and Medicaid Programs; Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction; Part II.”

In response, the Pennsylvania Medical Society, the American Medical Association and many other medical organizations sent A Letter of Extreme Disappointment.

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If you missed the news about the new voluntary prescription guidelines, you can catch up here.

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And finally, I thought you might appreciate this news release. Please note that it was dated July 15, 2014, which is not “on the heels” of any open enrollment deadline I know of. Domain to Be Auctioned by Interactive Media Ventures

Domain Name Poised to Become One of the Year’s Top Sellers

ATLANTA – On the heels of the Affordable Care Act’s deadline for open enrollment, Interactive Media Ventures announced today that the domain is available for sale. First registered in 1998, the domain name has huge potential for anyone in the healthcare niche.

“ has amazingly high recall power in the lucrative healthcare industry,” said John Souza, founder of Interactive Media Ventures. “It is arguably one of the most valuable domain names on the internet at present.”

A Google search of the term “healthcare plans” returns nearly 300 million results, compared to 22.5 million results for the term “Obamacare.” Additionally, there are nearly 100 million video results for the search term, beating even some of the world’s most searched pop stars including Lady Gaga and Justin Bieber, with 14 million and 21.6 million respectively.

Google Trends shows the term “healthcare plans” has grown almost 100 percent since December 2007. Based on this data, and recent healthcare legislation, is future-proofed and primed for viral growth.

“This is an ideal opportunity for either an industry leader looking to expand their portfolio and bolster their position in the marketplace, or an agile start-up or challenger brand seeking a huge competitive advantage,” said Souza.

Along with the domain name, the purchaser will also receive the corresponding Facebook page, which has already attracted more than 2,000 Likes since its December 2013 launch.

Bids for the domain will be accepted via, a leading marketplace for buying and selling domain names. Payment will only be accepted via, a leading third party site that protects buyers and sellers from online fraud.

For additional information or to contact the seller directly, visit

Heather Stauffer

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