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Monday, 16 December 2019 08:30

Benefit Topics to Watch

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At Fall River we’re always keeping our eyes on hot topics in the benefits world. As 2019 closes out, we are bringing you news on three potential developments: legislation preventing surprise hospital bills, the Texas v U.S. court case regarding the validity of the ACA, and the potential for a paid parental leave policy for federal workers. 

Surprise Billing

Believe it or not, Democrats and Republicans can agree on something: they hate surprise medical bills! Congress is close to passing a bill that would protect Americans from receiving large surprise bills mostly generated from emergency room or hospital visits. To read more about the nature of surprise billing, please see our past blog article

Members under a Colorado fully insured medical plan are protected under the Hold Harmless bill and all emergency room charges should be billed and paid as in-network. However, sometimes the claims systems do not catch this and may pay the claim incorrectly, thereby leaving members unsure of what to do when the bills start arriving in the mail.

According to recent news, there is bipartisan agreement that furthers member protections against this practice. Under the proposal, “Doctors who provide care that is out-of-network for a patient’s insurance will automatically be paid the median price of in-network doctors in the area. For certain large claims, doctors will be allowed to appeal to an outside arbitrator for reconsideration. Hospitals that treat patients in medical emergencies and air ambulances would get similar treatment, ”according to the New York Times.

Federal lawmakers are hopeful that progress will be made on passing mutually agreed-upon legislation by the end of year.

Texas v U.S. court case

While no decision has been made yet regarding the Texas v U.S. court case involving the constitutionality of the Affordable Care Act (ACA), some believe we may still have a ruling from the Fifth Circuit by the end of this year.

This case began in 2018, where 20 states sued the federal government declaring the ACA unconstitutional and citing the individual mandate as a violation of rights. In December 2018, the trial court ruled to invalidate the ACA, which was immediately followed by an appeal. In early 2019, two states withdrew from the case, and in July the Court of Appeals heard oral arguments.

If the court decides the ACA must be overturned in its entirety, the Kaiser Family Foundation explains that most Americans will be affected in some way given that provisions for pre-existing conditions, subsidies, coverage to age 26, and free preventive care all stemmed from the ACA. Other potential rulings from the Fifth Court are to uphold the ACA, strike down only the mandate, or strike down the mandate and other provisions from the mandate.

More to come on this one.

Trump’s Space Force Compromise on Parental Leave for Federal Workers

Democratic lawmakers and the White House have potentially struck a deal that would give the federal workforce a paid 12-week parental leave benefit in exchange for the creation of a Space Force or essentially a sixth branch of the U.S. military. This program, at least for federal workers, would put the U.S. on par with other developed countries when it comes to parental leave. 

Some lawmakers are concerned about the overall cost of a generous parental leave benefit. According to the Washington Post, “Cost estimates for the deal vary from $3.3 billion over five years to the same amount over 10 years, and Democrats cautioned over the weekend that the Congressional Budget Office has not yet issued a definitive analysis.”

This potential victory for federal workers could ramp up the pressure on employers to implement paid parental leave policies to compete for American workers. The Washington Post estimates that one-fourth of private companies currently offer paid parental leave, and we would anticipate that number to increase if approved for the federal workforce.

We will continue to watch the progression of these initiatives through the end of 2019 and beyond. If you have any questions about these proposals and how they might affect your members or your employer, please contact us.

Read 1151 times Last modified on Friday, 11 September 2020 15:49