What Obamacare Really Means If You Get Insurance Through Work

2013-09-24 18:16:47 healthday

The Obama administration’s sweeping health reform law known as the Affordable Care Act goes well beyond helping America’s uninsured. It also affects roughly 159 million workers and family members who now have job-based health coverage.

If you have an employer-sponsored health plan, you satisfy the law’s “individual mandate” that requires most people to have health coverage or pay a fine. And because of the health reform law, sometimes known as “Obamacare,” your job-based health plan may include new insurance protections and benefits.

Beginning in 2014, for instance, the reform package prohibits employer-sponsored health plans from excluding people from coverage based on pre-existing health conditions.

It also makes larger employers responsible for offering medical coverage. Beginning Jan. 1, 2015, businesses with more than 50 workers must offer health insurance to full-time workers and dependents or pay penalties. The Obama administration recently delayed the “play-or-pay” mandate, originally set to take effect Jan. 1, 2014, to give employers more time to work through federal rules and reporting requirements.

The health reform law also creates several new insurance protections and benefits for people with job-based coverage. For example, if your health plan had a lifetime limit on health benefits, that’s history. And annual limits will be banned completely in 2014.

“Some employer plans had lifetime coverage limits, usually capping out at $1 million, but some were as low as $750,000,” said Dr. Alan Spiro, executive vice president and chief medical officer of Accolade Inc., a Plymouth Meeting, Pa.-based company that helps employees and their families navigate the health-care system. “These limits often spelled financial ruin for families during catastrophic medical events,” he added.

Also, if you have an adult child under age 26 and your employer health plan offers coverage for dependents, the plan must allow your son or daughter to enroll. Spiro called that “a huge blessing for families” with young adult children. “In this difficult economy, many college graduates were struggling to find employment and losing benefits simultaneously,” he said.

The law also requires most employer health plans to offer certain preventive services at no cost to the employee.

“Hopefully, that’s an incentive that gets a couple of us couch potatoes to the doctor,” said Bill Kaiser, area vice president of sales and marketing for the benefits consulting firm Gallagher Benefit Services.

The law also encourages workplace wellness programs that promote healthy behaviors. You can earn rewards (or face penalties) based on whether you achieve certain results, like lowering your cholesterol, or participate in specific wellness activities. Effective Jan. 1, 2014, the law allows employers to boost rewards and penalties (such as premium discounts or surcharges) to 30 percent of the total plan premium, up from 20 percent.

Law already bringing changes to insurance options

But the law is also prompting changes — some intended, some unintended — to employer health plans and employment practices, analysts say.

“The ACA (Affordable Care Act) is hastening difficult decisions employers have to make with how they provide health care to their employees,” said Kaiser.

For instance, one in five employers has boosted employees’ share of health plan premiums, while one in four intends to do so over the next year, according to the International Foundation of Employee Benefit Plans’ (IFEBP) 2013 employer survey. And one in three employers is increasing employees’ share of dependent coverage costs, the survey also found.

Scrambling to offset rising health expenses, many employers are getting aggressive. Employees can expect higher premiums, steeper out-of-pocket costs and a continuing migration to high-deductible health plans, among other cost-shifting measures.

“An employer might have to make certain decisions to contain costs, and this is not necessarily only a result of the Affordable Care Act” but the upward trend in health-care costs, explained Mandy Bartoshesky, area senior vice president and compliance counsel in the Philadelphia office of Gallagher Benefit Services, a provider of employee benefits consulting services.

The Affordable Care Act is “shaking things up,” added Kevin Flynn, president of Philadelphia-based HealthCare Advocates, which helps consumers resolve health insurance problems. “I think at the end of the day, everybody’s going to be paying more,” he said.

The IFEBP survey also estimates that about 16 percent of employers are trimming worker hours to part-time status so fewer employees will qualify for health-plan benefits.

Beginning in 2015, large employers — those with at least 50 full-time workers — must provide health insurance to employees who log an average of 30 or more hours a week or pay penalties. But some employers are cutting worker hours below the 30-hour threshold, or considering doing so, to avoid the expense of providing health coverage.

A study published earlier this year by the University of California, Berkeley Center for Labor Research and Education found that 2.3 million workers nationwide — particularly retail and restaurant workers — are at risk of losing hours as a result of the new law.

Recent media reports suggest those industries aren’t alone in trimming worker hours. School districts, universities and local governments are also limiting staff hours, citing the anticipated financial strain of providing health benefits.

It’s an unintended consequence of the law that union leaders, including the International Brotherhood of Teamsters, see as a threat to worker pay and health benefits. In a letter to Democratic leaders in Congress in July, they warned that without a fix, the Affordable Care Act will “destroy the foundation of the 40-hour work week that is the backbone of the American middle class.”

A growing number of midsize and large employers — 25 percent in 2014 and 44 percent in 2015 — are also saying they’re likely to discontinue health coverage for Medicare-eligible retirees, a new Towers Watson & Co. survey found.

And if your employer offers a particularly attractive yet pricey health benefit, the Affordable Care Act may spell the beginning of the end of that coverage.

Starting in 2018, the law imposes a steep tax on employer plans with premiums exceeding $10,200 for an individual and $27,500 for a family — plans that are typically offered to high-wage earners. (In contrast, average annual premiums for employer-sponsored coverage are $5,615 for single coverage and $15,745 for a family, according to the Kaiser Family Foundation and Health Research & Educational Trust.)

About 17 percent of employers are redesigning their high-cost plans to avoid this so-called “Cadillac tax,” while 40 percent are considering it, according to the IFEBP survey.

Employer-based plans on the decline

Job-based health insurance has a long history in the United States. Companies provide health benefits to recruit and retain qualified workers. It’s the way the majority of Americans under the age of 65 get health insurance.

Yet employer-based coverage has dropped off in recent years. The percentage of Americans receiving health insurance on the job or through a family member’s job slipped from 69.7 percent in 2000 to 59.5 percent in 2011, according to a report by the Robert Wood Johnson Foundation.

The economy is partly to blame, with fewer people in the job market overall, according to the report. Staggering increases in health insurance premiums also contributed to the decline, resulting in fewer employers offering coverage and fewer employees accepting it.

The big unknown is whether Obamacare will force some companies to exit the health benefits business. On that point, there is significant debate.

The latest Congressional Budget Office estimates suggest that as many as 7 million people will lose job-based coverage by 2017 as a result of the Affordable Care Act.

Experts say smaller companies that employ 50 or more workers and currently provide health insurance may drop coverage because it would be cheaper to pay fines than maintain coverage for all of their workers.

Most large employers (with more than 1,000 employees) remain committed to providing health benefits for the next five years, according to an employer survey by Towers Watson/National Business Group on Health. But just 26 percent are confident that they will be offering health-care benefits a decade from now.

Meanwhile, a number of large employers are eyeing private health insurance exchanges as a way to continue providing job-based coverage while controlling spending on health benefits. Much like the public exchanges under the Affordable Care Act, private exchanges represent a new way for employees and families to shop for group health coverage and other benefits. Instead of offering a limited number of health plans, the employer would give workers a set amount of money to buy their own coverage.

Kaiser, who works in Gallagher Benefit Services’ Mount Laurel, N.J., office, anticipates a slow migration toward private exchanges.

“I don’t think it’s going to be a mass disruption of employer-sponsored plans where they all go, ‘I’m out of the game,'” he said.

More information

The University of California, Berkeley Labor Center, has summarized provisions of the Affordable Care Act affecting employer-sponsored insurance.

To read part one of the series, how to navigate the new health insurance exchanges, click here.

To read a part-one story on the potential impact on young adults, click here.

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4 Healthy Summer Breakfasts to Beat the Heat

2013-08-19 17:57:12 eatingwell

By Lisa D’Agrosa, August 19, 2013 – 1:33pm

4 Healthy Summer Breakfasts to Beat the Heat

I eat breakfast every day regardless of the time of year—breakfast provides me with a much-needed morning energy boost and keeps me focused. And research shows that regular breakfast eaters weigh less and have an easier time keeping weight off. (Who doesn’t love that?)

In the cooler months, I almost always eat a hearty, healthy bowl of oatmeal. But in the heat of summer the last thing I want is a steaming-hot breakfast. Luckily, there are plenty of refreshing breakfast options to help me beat the heat and start my day right. Here are my 4 favorite breakfast ideas to stay healthy and cool all summer long.

Banana-Cocoa Soy Smoothie1. Smoothies: We don’t get into the triple-digit temperatures very often in Vermont, but it definitely gets hot enough to whip up a frozen treat in the morning. EatingWell’s Banana-Cocoa Soy Smoothie gives you a tasty reason to wake up in the morning. The creamy combination of frozen bananas and chocolate is balanced nicely by the protein-packed soymilk and tofu (I promise you can’t taste it).

Tutti-Frutti Muesli2. Cold Oatmeal: I don’t give up on oats entirely over the summer; I just eat them cold! It might sound strange—but don’t knock it till you try it. My favorite recipe, Tutti-Frutti Muesli, mixes oats, fruit and yogurt for a refreshing and super-quick breakfast. This tasty breakfast is also nutritionally balanced with oats providing healthy whole grains, yogurt adding protein and calcium, and the fruit contributing essential vitamins, minerals and fiber.

Fruit & Yogurt Parfait with Lisa's Granola3. Fruit & Yogurt Parfait: I love how quick and nutritious this breakfast is. Yogurt is rich in probiotics, healthy bacteria that help your digestive system. I use 1 cup of whatever fruit I have on hand (some favorites are strawberries and peaches) and 1 cup of plain nonfat Greek yogurt as a base. I top my parfait with a serving of my favorite homemade granola and am left with a satisfying treat rich in protein, calcium, whole grains and fruit.

Almond-Honey Power Bars4. Homemade Power Bars: I don’t know about you, but long days in the summer make it hard for me to get to bed at a decent hour. (I want to soak up the sun while I can!) Those late nights mean that my morning alarm always seems to go off a tad too early. When I’m pressed for time in the morning I grab one of EatingWell’s Almond-Honey Power Bars to go. These portable breakfast bars are packed with nuts, seeds, whole grains and fruit so I know I’m not falling short on nutrients—even when I’m short on time. Almond butter makes these bars taste fantastic and provides heart-healthy fat, which helps give this breakfast real staying power.

What’s your favorite breakfast to eat when it’s hot outside? Tell us what you think below.

TAGS: Lisa D’Agrosa, Health Blog, Breakfast, Diet, Nutrition, Weight loss

Lisa D'Agrosa

Lisa D’Agrosa is EatingWell’s Associate Nutrition Editor. She earned her master’s degree in Nutrition Communication from the Friedman School of Nutrition Science and Policy at Tufts University and attended the dietetic internship program at Massachusetts General Hospital to become a registered dietitian.

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Honey, You've Gained a Little Weight!

2013-08-07 13:30:14 medlineplus-health-news

The last thing anyone wants to hear is, “honey, you’ve gained a little weight.”

Now a new study suggests a diet discussion with your significant other can lead to dangerous behavior, including fasting, taking diet pills and using laxatives. Researchers surveyed more than two thousand adults between the ages of 20 and 31 who were in relationships.

All were asked about their eating habits and whether their partner diets, or encourages them to diet. Almost half of the participants said their significant other pushed them to diet, and their encouragement was often viewed as critical versus supportive.

Women who said they were frequently encouraged to diet by their significant other engaged in binge eating at nearly double the rate of those who said they were never asked to loose a few.

Overall, more than 40% of the people surveyed had used extreme diet tactics in the past year, 51% of women and almost 30% of men.

The takeaway for couples, according to the researchers, Try encouraging exercise and positive communication about health versus looks when it comes to this weighty issue.

I’m Dr. Cindy Haines of HealthDay TV, with the news that can keep you and your loved ones safe, healthy, and happy.

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It’s Too Damn Hot! How to Chill Out in This Heat

2013-07-18 19:46:40 olivia-cho

It seems that no part of the U.S. has been spared from blistering weather this week. The Northeast topped out with temperatures nearing 100 degrees, Arizona’s Death Valley recorded a whopping 120 degree high, and three cities in the typically cooler Great Lakes region (Milwaukee, Detroit and Chicago) experienced temperatures in the mid-90s, the hottest of the season. It’s not just uncomfortable — too being too hot for long can cause heatstroke, according to the Mayo Clinic. Here’s how to stay cool and healthy when it’s hot:

Turn on your A/C

The Center for Disease Control and Prevention (CDC) lists air conditioning as the number one protective factor against heat-related illnesses — the best way to stay cool is to crank up the cold air. If you don’t air conditioning, hang out in a public place that does, like the mall, museum or movie theater. Many big cities, like New York and Chicago, have set up cooling centers for those who have no access to air conditioning. Call your local health department for more information.

Stay hydrated

When it’s this hot, you have to drink water — and lots of it. The New York City Office of Emergency Management (DOHMH) recommends drinking plenty of liquid, even if you don’t feel thirsty. And while one beer probably won’t put you at risk for heatstroke, it’s generally best to avoid alcohol and other dehydrating beverages containing caffeine or sugar. If you really don’t like water, try a sports drink like Gatorade to replace the salt you’re bound to sweat out.

Eat something light

You can cool down your diet, too. Shira Lenchewski, R.D., founder of the Work+Play Method™ recommends water-based foods like cucumbers and melons, smoothies and frozen raspberries or blueberries for a quick, chilly snack. Instead of an ice cream fix, she suggests frozen yogurt as a healthier alternative (her favorite are Yasso Greek yogurt bars).

While the average American consumes enough salt to replace what’s lost via sweating, it’s important for those who exercise rigorously (especially outdoors) to boost their sodium intake right now. For example, Lenchewski recommends a serving of salted almonds and coconut water, which has less sugar than sports drinks. As a rule of thumb, don’t eat heavy foods to remain as comfortable as possible during sweltering summer days, Lenchewski says. “I recommend using this heat wave as an excuse to make more no-cook meals, with more raw produce to retain water content,” she says.

Wear looser clothes

To stay cool in hot weather it’s best to wear light-colored, loose-fitting clothes in a breathable fabric, according to the DOHMH. Exercise clothes are your best bet, as many are made for the express purpose of drawing the sweat off your skin. Wear sunscreen and a hat to protect your face and head from the blistering sun.

Take precautions outside

When you need to be outdoors stay in the shade and out of the direct sun as much as possible, advises the DOHMH. Avoid any strenuous activity except in the cooler morning hours before 7:00 a.m. or after sunset. Once you return inside, take a cold shower or bath to cool down. If you work outside, drink water every 15 minutes, take breaks inside an air-conditioned area and watch for signs of heatstroke in you and your colleagues.

Symptoms of heatstroke:

When a body is unable to cool itself down, you’re susceptible to heatstroke is the most serious and deadly of heat illness. The most common symptoms are nausea, dizziness, trouble breathing, headache, flushed skin a racing heart rate, according to the Mayo Clinic. If you or someone you know experience any of these signs, find a cool place to rest, drink plenty of water and get to the hospital ASAP!

Olivia Cho is a producer for iVillage. You can find her on Google+ and Twitter

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How to use your shades, blinds and curtains to beat the heat

2013-07-16 18:14:59 consumer-reports

Air conditioning is blissful during the summer but running it non-stop during a heat wave will have you cursing when you get your utility bill. Fortunately, clever use of blinds, curtains and other window treatments can help keep your house cool and your bills in check. The Department of Energy reports that smart management of window coverings can reduce heat gain by up to 77 percent. And as a bonus these same practices can reduce heat loss in the winter. Here are some energy-saving suggestions from the DOE that’ll pay off immediately.

Awnings. Window awnings can reduce solar heat gain by up to 65 percent on south-facing windows and 77 percent on west-facing windows, according to the DOE. For best results choose awnings in light colors that reflect more sunlight. In the winter, you can roll up retractable awnings to let the sun warm up your house.

Curtains and drapes. On summer days, keep your curtains closed, especially on windows that get direct sunlight. The ability of curtains and drapes to reduce heat gain depends on fabric type (closed or open weave) and color. Studies show that medium-colored draperies with white-plastic backings can reduce heat gain by 33 percent, according to the DOE. Hang the curtains as close to the window as possible. For maximum effect, install a cornice at the top of the draperies, seal the draperies at the sides and overlap them in the middle using Velcro or tape.

Shades. When properly installed, window shades are one of the simplest and most effective ways to save energy but they need to be drawn all day to work. Mount them as close to the glass as possible within the window frame, creating a sealed space. Reversible shades that are white on one side and dark on the other can be switched with the seasons with the white side reflecting the sun in the summer and the dark side absorbing it in the winter. Quilted roller shades and Roman shades with several layers of fiber batting act as both insulation and an air barrier and are more effective than other soft window treatments.

Blinds. Because of the horizontal slats, it’s difficult to control heat loss through interior window blinds, although they do offer some flexibility. Unlike shades, you can adjust the slats to control light and ventilation. When completely closed, highly reflective blinds can reduce heat gain by around 45 percent, says the DOE. They can also be adjusted to block and reflect direct sunlight onto a light-colored ceiling, which diffuses the light without much heat or glare.

Reflective films. Window films are best for homes in regions with long cooling seasons. Silver, mirror-like films typically are more effective than colored, more transparent films and east- and west-facing windows benefit most because of their greater potential for heat gain. Keep in mind that reflective films are tricky to clean and impair outside visibility.

Best Buy air conditioners
If these old-fashioned tricks don’t help you beat the heat, consider buying a new, more energy-efficient air conditioner and run it in energy-saver mode. The Kenmore 70051 is our Best Buy among small air conditioners. Despite its bargain price of $190, the 43-pound unit offers great cooling power. The Sharp AF-S85RX, $200, sold at Costco is a Best Buy in mid-sized air conditioners. It has a digital display, built-in timer, auto-fan speed and a five-year warranty. Two large air conditioners that we named Best Buys include the Frigidaire FRA106CV1 and the LG LW1210ER, both $320. Both were aces at keeping a room comfortable and continued to operate under brownout conditions. For more choices go to our air conditioners’ ratings, which include 15 top air conditioner picks.

—Izabela Rutkowski

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