Compliance Corner: Podcasts

In this episode, Suzanne Spradley and Chase Cannon dig in to a trending topic, particularly for self-insured plans: reference-based pricing (RBP). Suzanne begins with a description of RPB, including an example to help illustrate how it works. Next, Suzanne explains the process and the pros and cons of RBP, which leads to a discussion on pricing and billing, including balance billing to unsuspecting plan participants. Suzanne outlines employer considerations when implementing an RBP design, including several issues with respect to the ACA and out-of-pocket maximums, and lessons learned from litigation relating to RBP strategies (including one case that made it to court with over $300K in claims at stake). The two close by discussing related ERISA fiduciary issues and administrative practicalities for employers to consider when adopting an RBP design.

In this episode, Chase Cannon and Suzanne Spradley look at a few ACA topics that are a bit up in the air. The first is the health insurance tax (HIT), a tax on health insurance carriers that has been on and off moratorium the past few years, but is coming back into effect for 2020. Chase breaks down the HIT, its impact on health insurance rates and on employers and employees, and whether Congress might add a moratorium for 2020 or repeal the HIT entirely. The second is the Cadillac Tax, a tax on plans that provide richer benefits. Chase and Suzanne discuss the potential issues and burdens associated with the Cadillac tax, why it was enacted, and whether the Senate might follow the House’s lead on repealing it. The third is Texas vs. the U.S., the lawsuit challenging the constitutionality of the ACA’s individual mandate. Chase breaks down the lawsuit, the validity of the arguments on either side, and gives a prognosis on how and when the Fifth Circuit might rule on the case. The two close the podcast by looking to the case’s potential impact on the 2020 elections.

In this episode, Suzanne Spradley and Chase Cannon examine one argument that is put forth by proponents of a single payer system — that because Medicare is purportedly more administratively efficient, that a single payer system in the U.S. would reap huge savings and reduce overall health care costs. Suzanne breaks down the estimated administrative costs of Medicare (claimed 2% of total costs) versus private insurance (claimed 12% to 15% of total costs), and the reports upon which they’re based. Suzanne explores whether comparing administrative costs versus total costs is the best method, and how a per-beneficiary comparison might be more meaningful. Suzanne and Chase discuss some of the costs that shouldn’t be included in an administrative costs comparison, including profits and taxes. The two wrap the episode with a discussion on how some administrative costs actually reap huge benefits, and why administrative costs may not impact overall health care costs — ultimately concluding that the current comparison and claims on single payer administrative cost savings may not be all they’re cracked up to be.

In this podcast, Beth Allen and Chase Cannon discuss the Setting Every Community Up for Retirement Enhancement (SECURE) Act. Beth highlights the last major retirement legislation that's passed and briefly discusses what has taken place to bring the SECURE Act to this point. That discussion leads into a conversation about what all the SECURE Act entails, including what the act would mean for retirement plan participants, plan sponsors, and industry organizations. They end with a discussion of where the bill is now and what could happen next.

In this episode, Chase Cannon and Carol Wood, in her podcast debut, discuss updates and considerations regarding state family and medical leave laws. The two discuss leave protections that have been enacted in new states in the past few years, as well as states that previously had such laws and protections in place. Chase outlines, at a high level, some of the differences in duration of leave, benefits, and family members for whom an employee can take leave (including domestic partners, who employers often forget about). Chase and Carol wrap up the discussion by outlining several key points employers should consider when developing their employee leave policies, with a focus on the benefits considerations.

In this episode, Suzanne Spradley and Lauren Fischer discuss criminal enforcement actions by the DOL and IRS involving employee benefit plans. Specifically, the two discuss the latest development in the action involving The Total Financial Group, Inc., which promoted the Classic 105 program. Suzanne and Lauren then discuss other enforcement actions involving an HRA administrator, an internal employee benefit administrator and a program that sought to carve-out high claimants from a self-insured plan.

In this episode, Suzanne Spradley and Jill Brooking discuss surprise medical bills and what laws have been enacted or proposed at the state and federal level. The two address situations in which surprise medical bills occur, the two ways that the individual is financially impacted, polling and claims data concerning the extent of this issue, and which states are taking a comprehensive approach to resolving this issue for fully insured plans in their states. Suzanne and Jill then discuss recent proposals by three bipartisan groups in the Senate.

Continuing discussion of single-payer system proposals, Suzanne Spradley and Chase Cannon review the recent report from the Congressional Budget Office (CBO) on a single-payer system in the US. Suzanne starts off by describing the purpose of the report and some high-level takeaways, including that the report does not specifically address funding of a single-payer system (one of the major challenges in establishing a single-payer system). Suzanne and Chase discuss the report’s findings on the administration of a single-payer system (state- versus federally-run), the types of benefits and cost-sharing, eligibility for single-payer plans, and the potential roles of private insurance (including employer-sponsored coverage) alongside a single payer (in a multi-payer system). Suzanne wraps things up by discussing the report’s take on approaches to setting provider rates, and some of the conclusions reached by the report.

In the fifth part of the single-payer system mini-series, Chase Cannon and Suzanne Spradley look at single-payer systems at the state level, specifically reviewing Vermont’s failed attempt at establishing a single-payer system. Chase walks through the political environment leading up to the passage of the state’s single-payer bill, the proposed plan, and the events that transpired in the years following the passage of the bill. Chase and Suzanne walk through several of the factors that prevented Vermont from implementing their single-payer proposal. They’ll cover funding, tax increases and exemptions, barriers to purported savings, and public education. The two close with a discussion on how Vermont’s struggles might impact single-payer efforts on both the state and federal level moving forward.