One of the most common pay-determining techniques could now put your company in legal danger.
The 9th U.S. Circuit Court of Appeals just unanimously ruled that pay differences based on prior salaries are inherently discriminatory under the Equal Pay Act because those past salaries stemmed from gender bias.
The ruling was handed down in Rizo v. Fresno County Office of Education, a lawsuit in which a teacher claimed she was paid thousands of dollars less than her male colleagues. ...
Not counting the money spent on state and federal exchanges, the federal government spent $341 billion from 2014 through 2016 on subsidizing individual coverage so that people would buy it.
All this spending managed to increase private coverage by just 1.7 million people, slightly less than half of the natural increase in the civilian labor force. That’s $200,000 per person. The feds could have saved money by closing the exchanges and giving people who qualified for subsidies a check for $50,000 for each of the three years. Those people could then have paid $20,000 for their own unsubsidized policy and used the rest to either cover their out-of-pocket costs or buy a nice used car.
Many people assume that the U.S. health care system is primarily supported by private dollars, such as insurance premiums from employer-based coverage, said Gerald Kominski, director of the UCLA Center for Health Policy Research and the study’s lead author.
But that’s no longer the case, at least in California — mostly because of its massive expansion of Medi-Cal, the state’s version of Medicaid, he said.
“There’s this myth that we have a mostly privately funded health care system, but we’re approaching a point in which almost three quarters of this system is funded by public money,” Kominski said. “Now a question to ask ourselves is: when do we reach the tipping point and say ‘this is essentially a public system?’” - California Healthline.Meanwhile, as we put a bow on the first quarter of 2018, the insurance carrier community is busy funneling another message to investors on Wall Street: business is good!
UnitedHealth Group’s 2018 1st Quarterly Earnings Advanced 28.27%; Surpassed Expectations
Cigna came out with adjusted earnings per share of $4.11, beating the Zacks Consensus Estimate of $3.37. Earnings also grew 48% year over year. Better-than-expected earnings were primarily driven by revenue growth.
Health insurer Aetna Inc.’s AET first-quarter 2018 earnings of $3.19 per share beat the Zacks Consensus Estimate of $2.97 by 7.4%. Moreover, the bottom line improved 17.7% from the prior-year quarter.
Anthem reported a better-than-expected quarterly profit on in 2018 Q1 as
- it kept a tight leash on patient payouts, prompting the health insurer to raise its full-year profit forecast
Health insurer Centene's profit more than doubles in Q1 of 2018. Centene owns the popular California insurer Health Net and focuses primarily on taxpayer funded health plans such as Medicare and Medicaid.
- The company said it was prioritizing investments throughout 2018 on infrastructure that can quickly respond to the evolving needs of its customers - a sign it may continue to steer clear of major acquisitions
Kaiser Permanente sees record revenue growth in 2017. The not-for-profit Oakland, Calif.-based system, which includes Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, saw its operating revenue jump by $8.1 billion in 2017, a 12.5% boost, mostly thanks to its massive health plan. Operating revenue was $72.7 billion in 2017, compared with $64.6 billion in 2016.
Anthem's first-quarter earnings shot up 30 percent, and the Blue Cross-Blue Shield insurer hiked its 2018 forecast, as a drop in medical expenses bolstered its performance.
The nation's second-largest health insurer joined rival UnitedHealth Group Inc. in topping analyst expectations for the quarter and hiking its 2018 forecast.
Anthem said Wednesday that it now expects 2018 adjusted earnings to be greater than $15.30 per share after saying in January that they would exceed $15 per share.
The new estimate tops the average analyst forecast for $15.13 per share, according to FactSet.
In the first quarter, Anthem saw its largest expense, medical costs, fall 3 percent to $17.05 billion. New CEO Gail Boudreaux attributed that drop in part to the insurer's push to create "value based care models" across its markets. ...
Backed by labor and consumer groups, a California lawmaker unveiled a proposal Monday calling for the state to set health care prices in the commercial insurance market.
Supporters of the legislation, called the Health Care Price Relief Act, say California has made major strides in expanding health insurance coverage, but recent changes haven’t addressed the cost increases squeezing too many families.
To remedy this, Assembly Bill 3087 calls for an independent, nine-member state commission to set health care reimbursements for hospitals, doctors and other providers in the private-insurance market serving employers and individuals.
The bill faces formidable opposition from physician groups and hospitals.
“No state in America has ever attempted such an unproven policy of inflexible, government-managed price caps across every health care service,” Ted Mazer, president of the California Medical Association, said in a statement.
At a press conference Monday, Assembly member Ash Kalra (D-San Jose) and other sponsors of the bill said the commission would use Medicare reimbursements as a benchmark and then factor in providers’ operating costs, geography and a reasonable amount of profit to establish rates. More details on the legislation are expected during committee hearings.
The belief that some workplace wellness programs are worth the money hit a snag recently when researchers at University of Illinois at Urbana-Champaign released a study that found such programs show “limited evidence” that they actually work.
According to the researchers, such programs cover more than 50-million workers and are intended to reduce medical spending, increase productivity and improve well-being, but they found workplace-health programs such as health or fitness assessments, weight-control programs or disease-management classes, among others, don’t result in happier, healthier employees, medical cost reduction, lower absenteeism or higher productivity.
The trio of researchers—Damon Jones of the University of Chicago, and David Molitor and Julian Reif of the University of Illinois at Urbana-Champaign—created and deployed a comprehensive workplace wellness program study for a large employer, the University of Illinois. Employees were randomly assigned program eligibility and financial incentives individually. All told, about 5,000 (56 percent) of eligible employees participated.
Essentially, the study found zero benefits from this specific workplace wellness program in its first year. Health costs, sick days, productivity and even gym visits remained static. According to Reif, assistant professor of finance and economics at the University of Illinois Urbana-Champaign, the research sought to determine the causal impact of the program on health and employment outcomes. While 39 outcomes showed no improvement, two were positive: Workers who joined the wellness program did become likelier to be screened for health issues, and they thought their employer put a high priority on employee health. ...
Attorney Richard Grossman represents a group of 1,500 health plans in a class-action suit against Sacramento-based Sutter Health, alleging that the industry giant has been illegally overcharging patients for more than a decade. The case is being closely watched by policymakers across the country as hospital consolidation increases and prices continue to rise. Last November, it was discovered that Sutter destroyed 10 years of records after the lawsuit was filed. SN&R publisher Jeff vonKaenel visited Grossman in his San Francisco office for an interview.
What is significant about this lawsuit?
This case is extraordinarily important, because it’s a documented fact that the cost of hospital health care in Northern California exceeds the cost for the same health care in Southern California by 30 to 40 percent. When I learned that that was the case and examined what was likely to be behind it, I determined that there is no explanation for that kind of price disparity other than anti-competitive behavior that restrains price competition here and allows hospital providers to increase their prices without discipline. The discipline that we all accept and rely upon to keep prices low and quality high. And that’s competition in our marketplace.
Without that competition, there is no reason for competitors to keep their prices at the lowest possible rates and no reason for them to increase their quality. With competition, they have tremendous incentive to do what our economic system requires, which is provide the best quality at the lowest possible price and, if you fail to do so, you do so at your peril.
Who are you representing in this case?
As of last August, I represent all self-funded health plans—employers that pay for the health care of their employees directly without purchasing insurance to cover those costs. That’s how half of the individuals in Northern California—for that matter, across the country—obtain their health care coverage.
What are you alleging in the lawsuit that Sutter did to allow their health care costs to go up 30 to 40 percent?The full interview is absolutely worth reading and can be found here.
Sutter’s anti-competitive conduct is extremely treacherous. What they did was they entered into anti-competitive and illegal contracts with all of the major health insurance companies that provide health care coverage in Northern California. And those contracts require the following: One, that if you utilize one Sutter Health provider, one of their hospitals or one of their medical practices across the state, you must utilize all of them in your network. And if you fail to do that, you will pay a huge pricing penalty.
... Plaintiff’s son, who suffers from a permanent and debilitating neurological condition, was hospitalized for four months in 2013. As an employee of Atlas Industries, Inc., plaintiff participated in a group medical plan that covered his son’s medical expenses. Atlas’s plan was partially self-insured, and the company paid approximately $250,000 for the son’s care.
Seven months later, plaintiff did not call Atlas or report to work for three consecutive days after he had been released to work following a medical leave. Atlas’s handbook provided that any employee absent for three consecutive days without permission would be automatically fired. After plaintiff’s third no-call/no-show day, his supervisor fired him.
Plaintiff sued, alleging that the company had fired him because of his son’s medical expenses, and thus that the company was liable for both retaliation and interference under ERISA. In support, plaintiff pointed to evidence that (1) Atlas had expressed concerns about “skyrocket[ing]” medical costs in employee notices; (2) an Atlas Vice President had told him in 2013 that he hoped his son would be released soon because the medical costs were getting expensive for the company; and (3) an Atlas human resources director showed another employee the son’s medical expenses and said that large payments were causing the company’s health insurance costs to rise.
While the district court entered summary judgment for Atlas, the Sixth Circuit reversed, finding that there was enough evidence of interference or retaliation to deny summary judgment. Specifically, while the supervisor who fired plaintiff did not know about the son’s medical expenses, the Sixth Circuit found significant that the Vice President and director who commented about medical expenses played a role in the decision. Also, plaintiff contended that Atlas had tried to contact other employees before firing them under the no-call/no-show policy, but did not do the same for him. ...
