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Health care reform provisions moving forward for now


Michelle Hicks

Michelle Hicks

As new Republican leaders in the U.S. House of Representatives threaten a vote to repeal health care reform, several provisions of the 2010 Patient Protection and Affordable Care Act are moving forward this month – provisions that will impact employer-provided health insurance.

Employers should provide clear communication to employees about certain provisions, especially those that impact out-of-pocket expenses. If you invest time and some resources to help employees understand these changes, it can provide tangible and intangible benefits to your organization.

In a very practical way, when you demonstrate your concern for employee understanding, you build trust with your workforce. Not only do you prevent distractions that can arise from misunderstandings, but when employees are clear about the proper use of their health benefits, they save themselves and your company money.

One of the changes that promises to be most confusing for employees is the restriction on flexible spending accounts. Effective as of Jan. 1, employees cannot be reimbursed by their FSA for over-the-counter drugs, unless they have a prescription from a doctor. So, if you have an employee with allergies, she may have gotten used to using her FSA debit card to pay for her Claritin, especially when it became available over the counter a few years back.

She can’t do this anymore, unless she has a doctor’s prescription. The only exception is for insulin.

However, what is really complicating about this change is that it doesn’t apply to non-medication medical reimbursements. So, employees can still be reimbursed for bandages or contact lens solution.

A less confusing change, but one important for maintaining a healthy workforce, is the requirement of 100 percent coverage for preventive services. These services include cholesterol screenings, blood pressure tests, diabetes tests, annual physicals, obesity counseling and tobacco-cessation programs. If you are an employer with a population that could use more of these screenings to nudge your workforce toward a healthier lifestyle, this change should be promoted.

Small employers may benefit from federal grants to help them begin wellness programs. Organizations with fewer than 100 employees may qualify for some of the $200 million set aside for this purpose. The grants can be used to pay for programs that promote good nutrition, stop tobacco use, encourage physical fitness and manage stress.

Provisions that started taking place in 2010, but most commonly were implemented for calendar-year plans on Jan. 1, 2011, include adult children being allowed to remain on their parents’ policies until age 26 and insurers no longer being able to drop policy holders if they become sick.

Other health care reform provisions, not necessarily related to employer-provided plans, are also moving forward. Some of those items include filling in the Medicare prescription drug “donut hole” and that Medicare will now provide seniors with free screenings for cancer and other diseases. You will also notice in 2011 that chain restaurants with 20 or more locations will be required to post calories on menus, menu boards and drive-through signs. The Food and Drug Administration is finalizing those provisions now.

In the meantime, a House vote is scheduled for early January to repeal the health care reform law in its entirety. House leaders site concerns that the law has failed to lower health costs as promised. And, a lawsuit challenging the constitutionality of the act will also move forward to higher court review. On Dec. 13, a Virginia federal court declared the provision to require all Americans to purchase health insurance unconstitutional, but the rest of the provisions were allowed to move forward, awaiting higher court reviews.

Michelle Hicks is a communications consultant with Buck Consultants. Contact her at michelle.hicks@buckconsultants.com.

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One comment

  1. If you’re eating at Taco bell, Denny’s, Fridays, Friendly’s, etc. then you don’t give a damn about calories in the first place. The best dieting is to simply eat right and exercise.