Updates from Portico Leaders Shaping the ELCA Health Plan
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July 8, 2013, from Steve — Large Employer Requirement Delayed One Year
Another delay announcement as we move closer to implementation of key parts of the health care reform law.
On July 8, 2013, the Obama administration delayed for one year implementation of the requirement that any employer with 50 or more workers must provide health insurance starting in 2014 or pay a $2,000 fine for each uninsured worker.
Of course, this requirement and delay have little impact on ELCA sponsoring organizations. Most ELCA congregations are small employers, and the ELCA Philosophy of Benefits has always encouraged all church organizations to provide their rostered leaders and other employees with health care benefits to support their well-being and ability to serve.
While health care reform implementation in the state exchanges continues to evolve, ELCA employers and plan members can be confident that we will be ready for the fall. Portico will announce the details of its new 2014 health benefit options in mid-August. Our Open Enrollment process will begin for employers in September and plan members in November.
June 12, 2013, from Brad — Interpreting the ELCA’s “Gold” Recommendation
As I’ve matured into my 60’s, I’m increasingly aware of situations where the new and the familiar collide. But I’m pleased to discover that, instead of fighting change, I’m more able to identify and celebrate both the traditional and the new. It helps to recognize “productive tension” – where the new and the familiar are used together to achieve a larger purpose.
Let’s take the ELCA’s response to health care reform. On April 6, the ELCA Church Council, as the board of directors of the ELCA, took two actions that I think illustrate “productive tension” – in this case, letting the realities of a marketplace changed by health care reform achieve a larger purpose.
- The Church Council strongly endorsed Portico’s new 2014 health plan strategy. This strategy involves developing four options similar to what we expect the health insurance exchanges to offer for 2014, while preserving our wellness focus and supporting the call process of a national faith community.
- The Church Council instructed Portico to design one of the four options to be similar to our current ELCA-Primary benefits, what people are calling the “Gold” option, and recommended that ELCA employers offer and pay for this familiar option.
So, how do these actions fit together? How could the Church Council unanimously support a new four-option approach and, at the same time, recommend the option most similar to what we have today? From my perspective, the Church Council’s actions reflect a desire to achieve a larger purpose, to sustain and enhance ELCA ministry over both the short term and the long term.
First, the Church Council could not ignore that the health insurance marketplace is changing. By endorsing the Portico four-option strategy, it affirmed that a viable ELCA-sponsored health plan is critical if healthy rostered leaders and lay churchworkers are to support this church’s ministry over the long term.
- By remaining competitive with the marketplace, we’re more likely to keep a diverse mixture of health risks, which is fundamental to the viability of our plan over the long term.
- Plus, an ELCA health plan, even with four options, will continue to support the call process over time. About 40% of changes in call involve plan members relocating to a different state. This is a much easier transition if you can keep your existing health benefits.
The Church Council also recognized that, in the swirl of changing times, the current plan design offers great value to employers and plan members. Their decision to recommend the so-called “Gold” option is a way to create short-term stability in a sea of change.
- Staying with the recommended option gives employers and plan members a chance to see how the 2014 health insurance marketplace shakes out.
- The recommendation invites ELCA employers to pause before selecting a lower priced option and consider benefits in the context of total compensation – a particular concern for clergy who are generally compensated well below others with comparable education. With this issue in mind, some synods have already discussed and, in some cases, are taking steps to adopt benefit guidelines incorporating the Church Council’s recommendation.
The Church Council has not said the other three plan design options are inappropriate. Nor has it prohibited employers from choosing one of the three new options. The Church Council recognizes that it may be appropriate for an employer to choose one of the three new options if it is in the best interest of the plan members. This decision should come after a period of mutual discernment.
In the end, I think the Church Council found a way to take the tension caused by change and uncertainty and make it productive for the sake of ministry – in both the short term and long term. This is a worthy goal indeed.
Feb. 24, 2013, from Steve — Employers, no need to worry about meeting the government’s March 1, 2013 deadline for providing notices to employees about health coverage available through the exchanges. If you attended Portico’s webinar in November, we speculated that there was a possibility for the date to be delayed. We were right! In late January, the Department of Labor announced this date will be postponed until “late summer or fall of 2013.”
Once the government provides more guidance, Portico will create a model notice to assist our employers and help distribute it to ELCA health plan members. While meeting this government requirement is ultimately each employer’s responsibility, our sponsoring congregations and synod offices won’t need to create the notice on their own.
Read the government’s FAQ for more about this date change
Nov. 26, 2012, from Brad — Thanks to everyone who attended our Nov. 15 webinar. If you weren’t able to attend our live broadcast, I invite you to watch the recording (30:51) at your convenience.
Oct. 24, 2012, from Brad — Health care reform news has been relatively quiet over the last few months, but that will soon change. If you’re wondering what’s next for health care reform, the answer largely depends on the outcomes of the Nov. 6 elections — less than two weeks away. With that in mind, we invite you to a post-election webinar on Nov. 15. Please plan to join us to learn about the possible implications of the election results on the ELCA health plan. We’ll also share our plans for helping you understand and prepare for changes coming next year.
Oct. 15, 2012, from Brad — If you’re an ELCA-Primary health plan member, you recently received some information through the mail about your 2013 health benefits. Included in the mailing were two documents mandated by health care reform legislation: a multiple-page Summary of Benefits and Coverage, and a Glossary of Health Coverage and Medical Terms. All group health plans are now required to create these documents according to specifics defined by the federal government. They’re intended to help individuals compare health plans. We hope you found these documents useful. As always, we’ll provide more details about using your 2013 health benefits toward the end of the year.
Aug. 15, 2012, from Brad — In last month's webinar, I suggested that one way to prepare for 2014 is to monitor the building of your state’s health insurance exchange. As of Aug. 1, 16 states have established an exchange, seven have decided not to create one, and the rest are somewhere in the middle. Do you know where your state falls in this spectrum?
Different things are happening around the country, but one thing is the same for all states. They all have a Nov.16 deadline to submit their exchange plans to the U.S. Department of Health and Human Services. Unless this deadline changes, it essentially gives states the next three months to determine (if they haven't already) whether they'll implement a health insurance exchange or let the federal government assume responsibility.
I frequently visit the Kaiser Family Foundation website for objective analysis of health care reform-related activities. One of the tools it offers is an at-a-glance map of state action related to exchanges. I recommend this as a great place to keep tabs on what's happening in your state. As long as you're there, take a look at “The States” button near the top of the page for more details.
If you’re like many of the people I’ve talked to, you may still feel a little unclear about what an exchange is. The Kaiser Family Foundation offers a nice definition of a health insurance exchange, too.
See the map of state actions
See definition of health insurance exchange
July 16, 2012, from Brad — Thanks to all of you who joined me and my colleague, David Delahanty from Towers Watson, for our July 10 webinar discussing the U.S. Supreme Court’s decision and what it could mean for the ELCA health plan. I appreciated your participation and so many thoughtful questions, many of which I will plan to address here in the future. If you were unable to attend the live broadcast, I invite you to listen to the webinar recording (34:45) at your convenience.
June 21, 2012, from Brad — Well, here we are in June, awaiting the Supreme Court’s decision on several aspects of the Patient Protection and Affordable Care Act. The Supreme Court will rule on four features of the law, three of which address the requirement that all U.S. taxpayers have health insurance — i.e., the individual mandate.
The Supreme Court has several steps to walk through to determine the constitutionality of the individual mandate and its impact on the rest of the health care reform law — including whether it can even make that determination now, or if the ruling has to wait until 2015.
The Supreme Court’s decision should help to clear up some things. But several other factors continue to cloud the long-term picture: the outcome of congressional and presidential elections later this year, the availability of funding, states’ preparedness to manage health insurance exchanges, and as-yet unpublished regulations.
What are the potential implications of the Supreme Court’s decision for ELCA health plan members and sponsoring employers? It is far from clear, but here are my thoughts:
- If the Act is declared constitutional, then it’s full speed ahead implementing reforms. Efforts by the states to implement health insurance exchanges will proceed at a rapid pace. Additional regulations will be published to help clarify issues.
- If the individual mandate is declared unconstitutional but severable from the rest of the Act, the impact will affect the health insurance exchanges. The individual mandate cushions insurance carriers participating in the exchanges by offsetting the potential adverse selection created when individual underwriting, pre-existing condition exclusions, and lifetime maximums go away. Losing the requirement that all individuals must have health insurance would likely cause insurers to find alternative ways to protect their risk pool or raise premiums.
- If the entire Act is declared unconstitutional, it’s hard for me to believe that health care and the health insurance industry will simply go back to 2009. The cost control and wellness genies are out of the proverbial bottle.
In the midst of the known and unknown, Portico is not sitting still. We are called to meet the needs of both plan members and employers. This means offering a benefits program that aligns with industry best practices, offers fairness and protection, and supports the call process of this church. Regardless of what the Supreme Court determines this month, we plan to deliver the following in the future:
- A health plan for ELCA rostered leaders and lay church workers
- Competitive plan designs
- Tools to help ELCA employers make decisions
- Communication about what’s coming
About 10 months ago, I began the process of raising awareness among the ELCA’s leaders as to the implications of the Patient Protection and Affordable Care Act. My message then was that big changes are coming. I still believe changes are coming, and they will come no matter how the Supreme Court rules.
Jan. 5, 2012, from Brad — In November 2011, I and several Portico Benefit Services staffers attended the annual meeting of the Church Benefits Association (CBA). Meetings like this are a great opportunity for us to gather and discuss common benefit issues affecting clergy and church workers with representatives of other major denominational benefit plans.
I spent the bulk of my time attending sessions about health care — three sessions were devoted solely to identifying and understanding the likely impact of health care reform on our health plans.
While health care reform isn’t front page news right now, the Patient Protection and Affordable Care Act (PPACA) is the “law of the land,” and implementation continues at the federal and state levels.
2012 will be a pivotal year for health care reform. The U.S. Supreme Court will hear, and rule, (likely in June) on the constitutionality of key provisions including the individual mandate to purchase health insurance. And elections for national offices will be held in November. No one knows for sure what the outcome of either of these events will be, but we at Portico Benefit Services have to assume the present law will remain in effect until we know otherwise.
So how is Portico preparing for health care reform-related changes as we head into 2012?
- We’re continuing to learn as much as possible by working with our colleagues at other church plans. By sharing ideas, we are more efficient, our ideas are more robust, and we have more potential to educate national leaders about the benefits of church plans and the unique needs of clergy and lay memberships.
- We’re working with outside consultants to help identify and shape potential, feasible post-2014 health plan options. In 2014, health insurance exchanges will come on board at the state and federal level, and government subsidies will be available for qualifying individuals who purchase health coverage in an exchange.
- We’re communicating to ELCA leaders about the potential changes that health care reform is likely to bring. We have met with the Lutheran Center Administrative Team, the Conference of Bishops, and the Church Council. In January and February 2012, we intend to offer webinars for synod staffs to help provide a better understanding of what we are likely to encounter in 2014.
- We’re facilitating a discussion among church leaders regarding the ELCA Philosophy of Benefits. The new health care law provides an opportunity to revisit how ELCA employers provide health care protection for employees fairly in a changing landscape.
With all that’s going on, our analysis suggests we will continue to have a health plan in 2014 and beyond. What will it look like? Stay tuned.