Compliance Corner: Podcasts

In this episode, Chase Cannon and Suzanne Spradley break down last week’s D.C. district court ruling that invalidates the DOL’s 2018 rules on association health plans (AHPs, which are also considered multiple employer welfare arrangements, or MEWAs). Chase gives a high level outline of the original and 2018 DOL AHP rules, and how the two differ. Suzanne and Chase discuss the lawsuit filed by a coalition states – led by New York and Massachusetts – and the arguments presented: That the DOL went beyond its authority be expanding access to AHPs through a loosening of ERISA’s rules on commonality of interest, primary purpose, and working owner participation. The two analyze the court’s reasoning in concluding that the 2018 rules are invalid as a regulatory overreach in conflict with ERISA’s statutory design. Chase and Suzanne prognosticate on next steps in the challenge and lawsuit, and what it all means for AHPs.

In the third part of this mini-series on single-payer systems, Suzanne Spradley and Chase Cannon focus on the challenges of funding a single-payer system, with a focus on the single-payer proposal put forth by Senator Bernie Sanders. Suzanne explains that the Sanders plan is a comprehensive first-dollar government-financed health insurance plan for all Americans, and is therefore very expensive. Suzanne outlines the taxes that would have to be raised and to what extent, and discusses studies that outline the total amounts of tax increases for both individuals and businesses. Suzanne and Chase discuss the different purported savings and efficiencies under the Sanders proposal, and how various studies dispute them. The two address different aspects of current inefficiencies in US-run programs, including waste, fraud and abuse in the current Medicare system. The two conclude that funding a single-payer system in any form will be a huge challenge; one that will be extremely difficult, if not impossible, to overcome for those that support such a system.

Chase Cannon and Suzanne Spradley focus on the parts of the US system that are working well, focusing on the employer-sponsored group health insurance market. Chase orates a brief history of the employer-based insurance model, including why employer groups were originally (and still today) the ideal group market target for insurance companies. Chase explains that between 180 and 185 million people (or 55 to 60 percent of the US population) are currently covered through an employer group health plan; the vast majority of whom are happy with their plan and benefits. Chase and Suzanne outline the importance of employer engagement in employee’s health care benefit coverage, and how the employer market has seen lower cost increases than the individual market. Chase describes the built-in incentives for employers and carriers to develop innovative plan design and cost-saving strategies, and how the private market (as compared to the government) is better suited to stoke the embers of further innovation. The two conclude that the employer model is working well: It’s a stable system that has lower premium rate increases, less adverse selection, more incentives for innovation, and that already covers the majority of US citizens. The better approach is to develop fixes for the more problematic individual market.

In this episode, Suzanne Spradley and Chase Cannon announce a three-part mini-series aimed at better understanding the challenges facing a single payer system (sometimes called “Medicare for All”) in the US. In the first part, Suzanne re-sets the discussion on single payer systems and describes some of the different arrangements and titles that fall under that general term. Suzanne describes the challenges facing different single payer systems in the UK and in Canada, including information on wait times and quality of care outlined in recent studies. Chase and Suzanne discuss funding of single payer systems, and how single payer systems generally result in higher taxation across the board. Suzanne finishes with a description of the challenges facing the Veterans Affairs (VA) program, which is a version of a government-run health care system right here in the US. The two outline the next two parts to the mini-series: part two will focus on parts of the US system that are working, including the employer-sponsored group health insurance market, and part three will dig deeper into the financing and funding of some of the proposals thrown around in US political debates.

In this episode, Jill Brooking joins Chase Cannon to discuss the impact the government shutdown may have on employer group health plans, particularly for governmental contractors, whose employees may be out of work due to the shutdown. Jill breaks down the benefits issues employers should look at for employees that are out of work or on furlough as a result of the shutdown, including plan eligibility terms and carrier (or stop-loss) contracts, and the risks in covering employees outside the plan’s eligibility terms. Jill describes how the ACA’s employer mandate may impact an employer’s offer of coverage, depending on whether the employer is using measurement/stability periods for employees. Jill also discusses premium payment options for employers and employees during an unpaid leave of absence, and at what point COBRA comes into play. Lastly, Jill and Chase discuss what should happen when – if ever – the government shutdown ends, including collecting premiums in arrears and the rehire rules under both Section 125 and the ACA’s employer mandate.

In this episode, Suzanne and Chase review the recent district court ruling that the individual mandate is unconstitutional and, as a result, the entire ACA is invalid. While the ACA remains in place pending appeal, Suzanne outlines the basis for the case, the reason why intervening states had to step in for the DOJ, and why the individual mandate may or may not be “inseverable” from the rest of the ACA. Suzanne gives a basic overview of civil procedure and appeals, and describes the process by which the case here will be appealed. Suzanne and Chase also discuss a bit of constitutional law and the balance of powers — the limitations on courts as they interpret and decide the constitutionality of legislation passed by Congress. The two close with important points on employer obligations while the case is appealed and the potential political fallout with a split Congress and the looming 2020 elections.

In this episode, Suzanne and Chase review the Office of Civil Rights (OCR, a subdivision of HHS) list of HIPAA violation settlements that occurred in 2018. To lead off, though, Chase breaks down the purpose of the HIPAA privacy and security rules, and what the basic HIPAA requirements are for employers. Suzanne and Chase then discuss several OCR investigations of employer HIPAA violations that eventually led to settlements. Chase breaks down HIPAA violations resulting from several situations. First: a doctor’s response to media inquiries regarding a patient’s complaint. Second: a hospital group that developed policies and procedures, but failed to implement them and later experienced a breach when unencrypted USB drives were lost and an unencrypted computer was stolen. Third: a document retention company that left a box of files containing sensitive information in an unlocked truck in its parking lot. The final case involves hospitals that failed to obtain authorization from patients while filming a TV mini-series. Chase and Suzanne close with a discussion of HIPAA compliance learning points for employers and their group health plans.

In this episode, Suzanne and Jill discuss year-end considerations for employer plan sponsors. Many employers are currently in or have just completed their open enrollment process. Jill and Suzanne answer the question of whether an employer should accept enrollment requests after open enrollment has ended. They also remind employers about which notices need to be distributed, including the frequently forgotten COBRA Initial Notice for employees and spouses who newly enroll during open enrollment. Lastly, they discuss how employers should prepare for upcoming reporting obligations.

In this episode, Suzanne and Chase look at the benefits compliance environment since the midterm elections. The two start off with a recap of election results and then immediately dive into the impact a divided Congress could have on the ACA. There could be bi-partisan support on simplified reporting and on repeal of the Cadillac tax. The two also discuss the Texas v. United States case involving the Republican challenge to the constitutionality of the ACA in consideration of the 2019 repeal of the ACA’s individual mandate and assess how a divided Congress might react to a loss of protections for those with pre-existing conditions. Chase outlines issues to consider post-election on prescription drug prices, medical tourism, the issues of a single-payer system (sometimes referred to as “Medicare for All”) and Medicaid expansion (and how that might interact with the employer group market). The two close with post-election impact on the court challenge of the DOL’s association health plan regulations.