The Payroll Treatment Of Health Insurance

The Iron triangle for healthcare consists of cost, quality, and access; these three characteristics when balanced create great healthcare. Managed Care Organizations combine the three to offer consumers with care that is appropriate for their individual needs. Our book describes managed care organizations as “the cost management of healthcare services by controlling who the consumer sees and how much the service cost” (Basics of the U.S Healthcare System, Niles). Taking a look at the history prior to the Health Maintenance Organization Act of 1973 (HMO ACT of 1973) the implementation has been significant in balancing cost, and quality control. Before this Act was signed in to law by President Nixon healthcare costs were determined by fee for service. A fee for service or indemnity plan is a plan that allows the provider to determine the cost of service, this fee for service plan caused for healthcare costs to increase rapidly. An example of this would be going to the doctor with neck pain, being told to stretch then receiving a bill for 25,000 dollars. As could be understood the cost of healthcare had became a problem.

A health insurance plan pays for medical care only after the insured has first paid $500 out of pocket on an annual basis. The $500 annual cost is called

The National Federation of Independent Business (NFIB) agrees that the cost of health insurance is a high ranking concern for business owners. Every year, they conduct a study to see what the top general concerns facing small business owners. From the beginning of the fiscal year of 1986 to the present, every year has concluded that the cost of health insurance is the top burden facing small business owners in America. (Wade, Holly Pg 24, table 5). Another important factor to consider are lost capacity due to employee illnesses or unemployment. Brad Plumer of the Washington post recently did an interesting study to determine the amount of money lost due to inactivity at the workplace. Including businesses in both the public and private sectors, Plumer estimates that over $1.8 trillion dollars per year in lost productivity at the workplace. While the Post acknowledged the idea of lost productivity is not a clear science and can be overvalued this is nonetheless a huge amount of money wasted each year.

In 1954, Congress passed legislation allowing employers to provide health insurance benefits to employees on a tax-free basis (Sih and Singh 99). This legal provision marked the beginning of the rapidly expanding health care costs still apparent today due to the major incentives provided by the government to obtain employer-based health coverage. The overwhelming popularity of employer-based health insurance has led to a serious market inefficiency resulting from the system of third-party payment. As individuals rely on their insurance companies to pay for their medical expenses, this provides

Employers should offer affordable( employee premium less than 9.5% of employee’s wages) and of minimum value( employers must pay at least 60% of insurance cost) healthcare benefits to their employees depending on factors like number of FTE, number of employees receiving premium tax credits and other complex measurements to calculate the amounts. Employers should also notify employees by written about State exchanges, and advise them that if an employee decides to purchase a health Plan through an exchange, they may lose the employers’

A series of events has recently occurred to cause the passage of PPACA. Economics are explicitly linked to health care. In the United States, health care coverage is provided primarily through an employer-based system. This system began in the depression era when pay was federally frozen. Companies, in an attempt to lure scarce workers, used benefits packages including health care as bait. Described as a “uniquely American” “private social security” health care system, the employer-sponsored system is the “cornerstone” of United States health care system (Blumenthal, 2006). This system has left many un- or under-insured. Blumenthal states (2006), “The United States’ dependence on employer-sponsored insurance means that the protection of its citizens against the costs of illness depends directly on the ability of private businesses to manage and absorb health care expenses that have defied all efforts to contain them.” Recently, economic downturn and the need to reduce expenses to better compete on the global market has caused many companies to both reduce their insurance benefits package and their work force causing many to lose their health care coverage. The employer-based system merged with the economic downturn, unaffordable health care costs for businesses, and

The National Federation of Independent Business (NFIB) has repeatedly stated that the cost of health insurance is a high ranking concern for small business owners. Every year they conduct a study to see what the top general concerns facing small business owners. In each fiscal year since 1986 the cost of health insurance has been shown to be the top burden facing small business owners in America. (Wade, Holly Pg 24, table 5). Another important factor to consider are business which suffer from lost capacity due to employee illnesses or unemployment cost. Brad Plumer of the Washington Post recently conducted a study to determine the amount of money lost due to inactivity at the workplace. Including businesses in both the public and private sectors, Plumer estimates that over $1.8 trillion dollars per year in wasted each year as a result of lost productivity at the workplace (Plumer, Brad). While Mr. Plumer acknowledged the idea of lost productivity is not a clear science and can be overvalued this is nonetheless a huge amount of money wasted each year.

At last, the law gave new alternatives and motivating forces to help states rebalance their Medicaid long haul mind programs for group based administrations and backings as opposed to institutional care. All in all, these arrangements have quickened Medicaid advancement effectively in progress in numerous states. Also improved with the ACA besides Medicaid, is Medicare. The Affordable Care Act incorporates a progression of Medicare changes that will create billions of dollars in reserve funds for Medicare and fortify the care Medicare recipients get. The new law secures ensured benefits for all Medicare recipients, and gives new advantages and administrations to seniors on Medicare that will help keep seniors solid. The law likewise incorporates arrangements that will enhance the nature of care, create and advance new models of care conveyance, suitably value administrations, modernize our wellbeing framework, and battle waste, extortion, and mishandle. A big topic that is affected from ACA is businesses. The Patient Protection and Affordable Care Act -- otherwise known as Obamacare -- is putting such a small dent in the profits of U.S. companies that many refer to its impact as 'not material' or 'not significant. Even after a provision went into effect this year requiring companies with 50 or more full-time workers to provide coverage, and after more workers are choosing to enroll in existing company coverage because of another requirement that all Americans get

“a) Contracts that explicitly detail the responsibilities of employers as purchasers with insurance, managed care, and hospitals and physician groups as suppliers, b) Information to support the management of purchasing activities, c) Quality management to drive continuous improvement in the process of healthcare purchasing and in the delivery of healthcare services, d) Incentives to encourage and reward consumers, and e) Education to assist employees become better healthcare consumers” (p. 352).

Small employers with employees of heterogeneous income levels will have strong incentives to offer coverage that is either “unaffordable” or fails to provide “minimum value” in order to preserve availability of government subsidies for their low-income

Under the new health care reform law over 47 million women will have access to women’s services with no out of pocket costs for preventative and wellness services (Obamacare, 2013). The low-income individuals will have the opportunity of getting health insurance coverage through the state exchange, Medicare, or Medicaid; however some states have opted out of the Medicaid expansion in which some low-income individuals will not be eligible. Seniors and other individuals eligible for Medicare will see expanding benefits and coverage options; however there will be decreases in home health payments and hospital coverage as well. Obamacare will require businesses with over 50 full-time employees to provide affordable health insurance coverage to its employees however small businesses with 25 employees or less will receive federal tax credits to help offset the costs that a small business will face to encourage these businesses to provide health coverage to

Interest groups included, insurance companies, medical associations such as AMA and HIAA, small businesses, and unions. Insurance companies were fearful that they would be spending more money and losing a profit since they would have to cover the extra expenses of normally not covered services. Small business owners were very nervous that it would cost them more and possibly put them out of business. It would require, “that employers would have to pay 80 percent of premiums; few small employers understood that this obligation was limited to a share of payroll, ranging from 3.2 to 7.9 percent, depending on the size and average wage of a firm (Starr, 1995).” Unions wanted there to be a guarantee if coverage and not a high tax on what they

The probable impact of the Cadillac tax is causing employers to reassess the health care plans they offer their employees and reconsider their role in providing health care benefits to their employees in the future. Currently, this excise tax is proving to be a catalyst for change. However, regional differences in the cost of healthcare and unrelenting medical inflation is going to make the ability for employers to continually reduce benefit costs in an attempt to avoid the tax extremely

Many employees must designate a health plan through their employer. These days, as HMOs (health maintenance organizations) and managed care plans continue to proliferate, that means a choice between bad and worse. As employees line up in the lunch-room for a process called open enrollment, they may be surprised to learn that managed care rates have gone up — again. The mirage that managed care is cheaper care is finally fading. And, for the first time in years, employees may also have the promise of free choice in medicine in the form of a new method of financing health care. Consumers are already aware of horror stories involving HMOs, but cheap rates persuaded many that managed care is less expensive. Recent

Most health care analyst believes that health benefits provided by employers are provided as part of the overall compensation paid to workers. Because of the rising cost of the health care benefits, employers’ shares of