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Employers and Health Reform

by Barbara J. Zabawa, posted Thursday, May 26, 2011

On Thursday, May 19, I presented to the Residential Services Association of Wisconsin. As has been typical lately, I spoke about health reform, including Accountable Care Organizations and the legal challenges to the Affordable Care Act (ACA).
The audience included smaller employers who operated group homes for individuals with disabilities. Although they were intrigued by the idea of Accountable Care Organizations, what they were more concerned about was the impact of the ACA on their ability to survive as a business. I discussed Wisconsin’s Health Insurance Exchange ideas, the individual mandate and expectation that everyone have health insurance under the ACA. The audience was worried that, as small employers, they would not be able to afford to provide health insurance to their employees as the ACA requires them to do.
Because of limited time, I was not able to explore each facet of the ACA to help the audience understand its total impact on them; however, this blog might help answer some of the questions that were not addressed in full. Included in this blog is a summary from the Congressional Research Service regarding employer penalties under the ACA. According to Page 1 of the summary, which references §§ 1513 and 10106 of the ACA, only “large employers” are subject to the penalty. A large employer is defined as having “at least 50 full-time employees during the preceding calendar year.” “Full-time employees” are defined as those working 30 or more hours per week.
Also included is a PowerPoint presentation I gave in January 2011 to the Society of Human Resource Managers. This presentation provides examples on how an employer might calculate the penalty for not offering health insurance to its employees.
As one can see on slides 45-48, the employer does not pay a penalty for the first 30 employees who do not receive health coverage through their employer. The penalty is calculated after the employer exceeds the 30 employee threshold.
As a result, small employers (those with fewer than 50 employees) would not be subject to a penalty if they failed to offer “minimum essential benefits” to their employees. In 2014, those employees could obtain health insurance through the Insurance Exchange. As one can also see from the attached slides, it is not clear what Wisconsin’s Insurance Exchange will look like in 2014.


Accountable Care Organizations: Will They Live Up To The Hype?

by Barbara J. Zabawa, posted Tuesday, May 17, 2011

On Thursday, May 11, 2011, I had the pleasure of talking to the Wisconsin Medical Group Management Association about Accountable Care Organizations (ACO). It was truly a pleasure to discuss what I believe to be the future of health care delivery. I answered the question: “Will ACOs live up to the hype?,” in the affirmative. I believe that ACOs offer a sensible way of providing care in light of the forthcoming changes from the Patient Protection and Affordable Care Act, should the U.S. Supreme Court find the Act constitutional.
Regardless of the U.S. Supreme Court’s forthcoming decision, however, I believe the ACO movement is still worth health care stakeholder consideration.
During the presentation I described the current landscape of negotiations between providers and payers, and informed the audience as to how ACOs and other parts of the Affordable Care Act will ease the current tensions and help these stakeholders work toward the common goal of providing patient-centered care. Because insurers will have less flexibility in increasing premiums, insurers will not be as willing to accommodate provider cost increases. Therefore, providers and payers will be forced to find alternative ways to work with one another. I believe an attractive option is through the ACO vehicle.
The ACO holds the promise of delivering appropriate, seamless care to patients. The ACO concept embodies the other, much less-discussed piece to the Affordable Care Act that strives to improve health care quality and efficiency.
I invite you to look at my presentation materials on ACOs. I am certain there will be more blog postings on this topic soon.


In re Helen E.F.: Good Intentions Gone Wrong?

by Barbara J. Zabawa, posted Monday, May 16, 2011

“One way to measure the greatness of our society is to look at how we treat our weakest members, such as our growing population of people afflicted with Alzheimer’s.” That is a quote from a recent Wisconsin Court of Appeals decision that, although well-intended, may ultimately harm patients suffering from Alzheimer’s disease and related dementia disorders. On April 27, 2011, the Wisconsin Court of Appeals issued an opinion concluding that people suffering from dementia and Alzheimer’s disease should not be subject to Chapter 51 commitments because such conditions are not “treatable.”  In re Helen E.F., 2010 AP 2061 (Ct. App. April 27, 2011). In that case, Helen E.F., an 85-year-old woman with Alzheimer’s dementia, was committed to St. Agnes Hospital pursuant to Wis. Stat. ch. 51 because of her disruptive behavior. Id. at ¶ 9. Three days later, a court commissioner conducted a probable cause hearing on the ch. 51 petition. Id. at ¶ 6. The court commissioner concluded that there was insufficient probable cause to proceed. Id. At that point, the ch. 51 proceeding was converted to a Wis. Stat. ch. 55 protective placement action and a 30-day temporary guardianship was issued. Id. Read more...


ABA Fights Implementation of the FTC's "Red Flag" Rules

by Christian D. Lavers, posted Monday, August 31, 2009

On Thursday, August 27, the American Bar Association filed suit against the Federal Trade Commission to prevent application of the FTC's new proposed "Red Flag" rules to lawyers and law firms (See the complaint at www.abanet.org/media/nosearch/1). The "Red Flag" Rules require that any business or entity that acts as a "creditor" create a policy and procedure to help prevent identity theft—even if the business is only acting as a creditor by billing for goods and services after the services are rendered or the goods are provided.
The FTC has had numerous problems in its attempted implementation of the rule, and recently postponed enforcement of the rule to November 1—its third such postponement. The problems have related to the incredible breadth of the rule, and its application to virtually every business and industry in existence.  The American Medical Association has also been a vocal critic of the rule as applied to doctors, (see www.ama-assn.org/ama/no-index/physician-resources/red-flags-rule.shtml), though they have not gone so far as to file a lawsuit.
While identity theft is a growing problem and needs to be addressed, the current version of the "Red Flag" Rules creates almost as many problems as it attempts to fix. Stay tuned for updates...