Health Reform Polls Are Inconsistent and Confusing. Should We Still Pay Attention?

Which one of the below scenarios is most true?

A.) The Affordable Care Act is an increasingly unpopular law among U.S. residents.

B.) The ACA is a wildly popular law, with many provisions garnering overwhelming approval.
C.) U.S. residents know very little about the ACA.

"A" is a good answer, given that a Gallup poll released late last month found that 52% of respondents disapprove of the law, while 44% support it. A similar poll by Gallup last year found that 45% of respondents disapproved of the law and 48% approved.

"B" is also a good option. Polls from the last three years have consistently shown that while many U.S. residents dislike the ACA itself, they overwhelmingly favor most of its provisions.

Most recently, the Kaiser Family Foundation's March 2013 tracking poll found that respondents favored all but one of the law's major provisions and more than half of those garnered support greater than 70%. And no surprise, the individual mandate was the least popular provision. Meanwhile, aReuters/Ipsos poll conducted in the days before the Supreme Court upheld the ACA last summer found that "strong majorities" favored most of the provisions in the law. Even more surprising, the poll found that most provisions were popular even among respondents who identified as Republicans.

There's also a convincing argument for choosing "C." Another Gallup poll released just a few weeks ago found that more than four in 10 uninsured U.S. residents are not aware that they will be required to purchase health insurance beginning Jan. 1 under the ACA's individual mandate.

Given those arguments, the answer might very well be: "D.) All of the above." The seemingly ambiguous and incongruous results from polls measuring reaction to the ACA brings up a valid question: Why should we pay attention to them?

No Reason To 'Throw Away' Polls

Ambiguity is no reason to "throw away the polls," Julie Phelan, senior research analyst at Langer Research Associates, tells California Healthline. In fact, Phelan says the results might not be as "logically inconsistent" as they seem at first glance. Phelan's firm conducts research for ABC andBloomberg News, among other clients.

"If you look at the provisions that people support overwhelmingly, they're things ... with no cost," Phelan says, adding, "If you ask, 'Do you support allowing children to stay on their parent's insurance plans until they're 26,' people will say, 'Of course -- How's that going to hurt me?'"

Cost comes into play with the individual mandate. "That's why you see the disconnect between what people say about the law overall -- they think of the ACA as the individual mandate," she says.

Phelan also discounts the notion that U.S. residents know little about the law. She notes that many people learn about the law in "brief snippets" from the news or a pundit. As a result, the way many U.S. residents "think or know about the Affordable Care Act is different than ... policy wonks think and know about the ACA."

Despite Confusion, Wisdom in the Results

Polling experts say that despite the confusion, there is wisdom in the results.

Mollyann Brodie -- senior vice president for executive operations and director of public opinion and survey research for the Kaiser Family Foundation, which produces a series of tracking polls on the ACA -- notes that public opinion on the law has been "unbelievably stable" since it was enacted. "If you look at the data from the beginning, Democrats have liked this law from the beginning, they still do. Republicans have not liked it from the beginning, they still don't," she says.

Although there has been a slight uptick in the law's unpopularity, Brodie notes much of that change has been because many independents are shifting from a favorable view of the law to what she calls a "don't know position," where perhaps the lack of clarity surrounding the ACA has caused them to view the law less favorably.

Brodie says that consistency shows the public is still viewing the law through a political context, as opposed to from a policy perspective. She adds, "If you didn't have all this public polling data, we wouldn't even understand the extent to which this law, at least in its most nebulous, big-term way, is being viewed only through a partisan lens."

Clarity Might Be Wait-and-See

Will polling on the ACA ever become clearer?

Brodie predicts that public opinion on the law might become more definitive once U.S. residents start viewing the law through a consumer lens. She says there are plenty of "legitimate questions" surrounding the law that have not yet been answered -- such as whether the law makes health care more affordable, if people are gaining access to coverage, and whether emergency department visits are being prevented, among other things -- both because partisanship has clouded people's views of the law and many of the law's provisions have not yet taken effect.

How will we know if those things are happening?

Brodie says there is only one way: "We'll have to keep tracking people's opinions."

Weekly Roundup

Here's a look at what else is making news in the world of health reform.

Hospitals drop out of pilot program: In her "Health Reform Watch" column in the Washington Post's "Wonkblog," Sarah Kliff examines why some hospitals are dropping out of the ACA's Pioneer Accountable Care Organization. Kliff features Austin-based Seton Health Alliance, which "invested millions moving to a value-based system," only to abruptly quit the program and switch to another federal program with "a bit more flexibility."

Amid delays, an acceleration: In a Kaiser Health News/Washington Post collaboration, Jordan Rau examines the acceleration of an Affordable Care Act program that ties a portion of physicians' Medicare reimbursements to the quality of their care.

Laughing toward enrollment: In Reuters, Roberta Rampton reports on a White House effort to recruit the comedy website "Funny or Die" to help promote the ACA. Senior administration officials think the site can help encourage young, healthy individuals to enroll in the ACA's health insurance exchanges, which experts say is key to the success of the law.

by Anthony Wilson, California Healthline Contributing Editor

An Attractive Alternative For Employers Seeking More Control

Self funding could be the right solution for you and for clients who are making benefit decisions a midst health care reform. But it can be a challenge to present self-funding to employers who are not familiar with this approach. It is important to demonstrate how self-insurance can help the employer control the plan design and the financial impact of providing health coverage. the added flexibility in plan design, exemptions from state-mandates, and the increased control that comes with owning all claims data and reporting. The number of private sector employees in self-funded plans has increased nearly 20% over the past decade, according to a recent study by the Employee Benefit Research Institute. In 2011, self-funded plans covered 58.5% of private sector employees. Self-funding has become even more attractive due to Affordable Care Act (ACA) regulations, which could increase costs for fully insured plans with increased fees and additional assessments.


Which Groups Should Consider Self-Funding? 

Since not all groups are good candidates for self-funding, it’s important to recognize the appropriate attributes. The group should have a steady employee population, more than 100 employees, and stable claim experience. If little or no claim data is available, another good indicator would be consistently low renewal increases or increases below 10% year-over-year. Fully insured coverage remains the best option for smaller groups with a known large-claim participant (more than $500,000 in claims per year) unless that risk improves. Many stop-loss carriers will laser (set a higher coverage level) for a known large claimant in the first year of coverage and then provide non-laser renewals, which is important information to determine upfront. Self-funding can be a solid alternative when a group wants one health plan for its multi-state locations. But, in order to self-fund properly, the group must be able to handle the cash flow fluctuations that come with paying its own claims. And the group needs to be willing to commit to selffunding long enough to see its positive effects, which is about three years. There are some important considerations when transitioning to self-funding. The group must not only select a plan design or designs, but also the network and claim administrator as well as cost containment and wellness programs.


The Added Protection of Stop-Loss Coverage

As reinsurance for self-funding, stoploss insurance is designed to pay for catastrophic claims that exceed the employer’s pre-determined level of risk tolerance. Stop-loss insurance can help address the employer’s concern about the financial exposure of the self-funded plan. Coverage is always tied to an individual’s medical claims (known as “specific coverage”). High-dollar claims from individual employees drive the majority of a group’s claims variation. Employers use stop loss to protect against large, unforeseen claims. The employer’s stop-loss contract identifies the level of claims spending that will occur before stop-loss coverage begins to reimburse claims (known as the “attachment point.”) Aggregate stop-loss coverage can be added to protect the employer from large claims. This coverage pays claims, in aggregate, once a specified level has been reached. Specific and aggregate coverage can be implemented together for broad coverage. Various riders and options can further protect the employer, including advance funding, gap less or bridge renewals, and two-year rate caps. These programs allow you to tailor coverage to the employer’s risk tolerance. To help protect the employer, brokers should look for a stop-loss carrier that has an unlimited maximum and coverage that mirrors the underlying plan of insurance. 

The Impact of Health Care Reform 

Beginning in 2014, health care reform mandates will assess the following fees affecting fully insured groups, self-funded groups, and individuals in the exchange: a Patient Centered Outcomes Research Institute fee, a reinsurance fee, a health insurance tax, and an exchange fee. Self-funded plans are expected to experience the least impact. The assessable taxes vary by coverage type, by year, and by other factors, creating new complexities for plan advisors, group decision makers, administrators, and brokers. As your groups turn to you for guidance in this new world of health benefit coverage, help them understand their options. Self-insurance can be an excellent solution for a variety of employers, especially those that want to gain more control of their benefit program in times of uncertainty and change. As you work to determine the best solution for each client, know the group’s options, conditions, and suitability because being informed is the most important part of the decision-making process for brokers and their groups.


by. Sharon Aquino and Stephen Miller

What hasn't changed for employers in 2014?

by. Keith R. McMurdy

In a move that was generally applauded by employers, the Obama administration announced last week that it would delay implementation of the employer health coverage mandate under the Affordable Care Act until January 1, 2015. The good news is that this gives employers another year to prepare for the so-called pay-or-play mandate that requires employers with at least 50 full-time-equivalent employees to offer affordable health coverage to those who work at least 30 hours a week. The bad news is that it remains unclear what compliance still means for employers.

While the employer mandate is suspended, a variety of key provisions that go into effect on January 1, 2014 remain in play. Subject to any future adjustments, plans are still obligated to comply with a number of specific changes. These include:

• Waiting periods cannot exceed 90 days

• Caps on annual out-of-pocket maximums and elimination of lifetime and annual limits

• Revised Summary of Benefits and Coverage notices and a required notice of availability of exchanges

• Excise taxes and fees, such as the PCORI fee and the reinsurance program fee

While we are awaiting further guidance, and any additional changes, plan sponsors should continue to take the necessary steps to make sure their plans are in compliance. Even though the pay-or-play mandate is suspended, plan sponsors could still be found to have non-compliant plans and face penalties around the ACA. So while you might be able to postpone changes relating to eligibility and affordability, you still have to revise your plan to make sure it complies. This delay only effects who you might have to offer coverage to, not the nature of the coverage that will ultimately be offered.

So employers as plan sponsors should take this delay as an opportunity to focus on making their plans 100% compliant. Consider 2014 a “measurement” year where you can implement those employment structures you might have already discussed to make sure your part-time and full-time employees are clearly defined. Consider this a brief reprieve and not an excuse to ignore ACA completely. Employers might have been given some breathing room on the final due date, but the project still has to be completed.

Join on August 1st at The Grande Colonial hotel for a complimentary luncheon on self-funded benefit plans and navigating HCR.  Click Here for Details

5 things that have not changed due to the ACA delay...

ACA has been delayed until 2015.  However, let's look at what did not change:


1. The Affordable Care Act (ACA) is still alive and well.

2. The mandates driving premium increases are still in place.

3. The individual mandate to have coverage in 2014 or pay a tax penalty is still in place.

4. The individual exchanges are still projected to be operational in 2014.

5. The “Pay or Play” is still here. Since the administration postponed the implementation, they now have 12 more months to strengthen their resolve, plug all the loopholes and prepare for stringent enforcement.  The impact of the ACA-driven rate increases will still arrive on schedule; the core issues have not changed. 

Join on August 1st at The Grande Colonial hotel for a complimentary luncheon on self-funded benefit plans and navigating HCR.  Click Here for Details

Administration Delays Health Law Requirement For Large Employers To Provide Coverage

Obama Administration Announcement

During a presentation at the Independent Insurance Agents of Texas Annual Conference in Dallas Texas last week one of the key points I made was, “We should expect political volatility to further confuse an already complex environment”. I guess I was right. This decision by the Obama Administration pushes back the “Pay or Play” mandate 12 months. At a practical level this is a welcome change. However, we should not let this generate a false sense of security. Let's look at what did not change.

1. The ACA is still alive and well.

2. The mandates driving premium increases are still in place

3. The individual mandate to have coverage in 2014 or pay a tax penalty is still in place.

4. The individual exchanges are still projected to be operational in 2014.

5. The “pay or play” is still here. Since the administration postponed the implementation they now have 12 more months to strengthen their resolve, plug all the loopholes and prepare for stringent enforcement.

Allied National’s Funding Advantage product for small employers remains a very desirable solution for the small employer. Don’t become complacent The impact of the ACA driven rate increases will still arrive on schedule. The core issues have not changed.