Other Areas of Outsourcing include Temporary Staffing (for projects or temp-to-perm) and also printing & shipping.

With waivers being given to multiple carriers, another health reform requirement is being moved back a year because of complexity and challenges facing businesses and the IRS alike. W-2 reporting requirements that were initially supposed to be put in place in 2010, then pushed back to 2011, are now being presented to businesses as “optional” for 2011.

According to the IRS website reporting the cost of coverage for an employer-sponsored group health plan will not be mandatory on W-2 forms issued for 2011. An employer will not be treated as failing to meet the requirements of this bill for 2011 and will not be subject to any penalties for failure to meet such requirements.

Microsoft and Wal-Mart Turning to Consumer Directed Health Care

CNN Money reported this week that Wal-Mart is moving to a

Health Reimbursement Arrangement (HRA) along with adjustment in their retirement benefits to help the employee with out of pocket expenses and plan for the future. This past week, Microsoft shared with their employees that they would be going to a Health Savings Account plans as the primary coverage by 2013 for their health insurance benefits. These are two major business giants who are not waiting for the government to solve their problems.

Wal-Mart will be offering a health insurance plan that will have an HRA component to it where the company will give the employee the first $1000 to go towards medical reimbursable services. This process put more responsibility into the hands of the employee to make decisions on doctor visits and prescriptions purchased. With an HRA, the employer controls the dollars provided to the employee. If the employee doesn’t use services, the employer does not pay out.

Microsoft, on the other hand, is incentivizing employees to move toward the HSA through contribution over the next two years. Many companies who have rich health insurance plans find that providing money which goes toward retirement to be an excellent way to nurture satisfaction among employees. Additionally, the versatility to use that money to reimburse for medical expenses (tax free) has been well received by their employees. Both programs give more control to employers as well as employees, while the HSA gives the employee funds to take with them if they leave the company like an IRA. HRAs and HSAs are becoming essential for businesses because of the proven savings that they are able to achieve without taking away employee benefits.

Many feel that health reform should have included more focus of individual control of health care funds. It looks like businesses like Wal-Mart and Microsoft are taking matters into their own hands to make that happen and will be better off for it. Should our government reconsider the direction they are taking U.S health care?  Saving money and lowering cost, what a concept.

Just a little over 6 months after the bill was passed,  HHS and the White House gave a break to McDonald’s and those carriers that had HIPPA compliant medical plans by granting them waivers on their limited medical benefit plans. With elections around the corner and frustration from businesses, the “reality” of health reform bill that was rushed through Congress has hit the White House administration and Health and Human Services (HHS) hard.

Is this a glimpse into the future of things to come for all directly affected by the new legislation?  Carriers like Cigna and Aetna, with their limited medical plans, received waivers along with McDonalds.

Carriers and businesses aren’t the only ones seeking waivers due to the Medical Loss Ratio (MLR) requirements in the health reform legislation, Florida also requested last week to have a waiver for the state because of the disruption to the insurance carriers in the “Florida market place”, following request by Maine and Iowa for the same reasons. In fact Maine had only one individual health insurance provider on the individual side. The MLR would have affected the carrier to the point of going out of business.

Here’s a question, could the health reform implode?  Can it survive the scrutiny and be able to maintain any validity going forward? I had an opportunity to go to the National Health Care Reform Conference in Los Angeles, recently and speak to Michael Gibbons, Chairman of National Restaurant Association and Neil Trautwein, VP and Employee Benefit Policy Counsel, National Retail Federation who were on a panel discussion. Both men shared their frustration of what their industries could be facing ahead.

Michael Gibbons provided a scenario of where a restaurant chain with 5000 employees will have to pay $40 to $50 million in health care benefits that they don’t provide now for their employees to be compliant in 2014 when the mandates go into effect. This was around 50% of the payroll this particular restaurant chain pays each year for their employees. He said it would be cheaper to not provide benefits and pay the $4.5 million in penalty. It may be the only way for them to keep their doors open.

One of the questions that came up was, had the restaurant and retail industry looked into a

defined contribution benefit program instead of having a group health insurance plan? The concept had not crossed their mind. There was a promise that all options were on the table as this “train of mandates and regulations leave the station of common sense and heads towards the city of Chaos.”

When the Health Care Reform bill was signed into law back in March, there was a promise that the new laws would help those 47 million (currently 50.2 million) without health insurance, get it. Even though there is question as to how many of the millions without health care will get onto a health insurance plan, there is an even bigger question that remains as to how these additional millions will get the health care they need – along with the rest of us – with the shortage of doctors.

We also know that in the health care reform bill, $155 billion dollars had to get cut from Medicare over the next 10 years. Doctors will take the brunt of this impact, so with the pressure of requirements to meet more patients and the cuts in Medicare reimbursements bigger emphasis will be placed on helping fill the gap with Nurse Practitioners and Physician Assistants.

I had a meeting back in May with a medical group about their concerns with health care reform. The all-physician group talked about going to cash-only business, sending in physician assistants for routine visits and routine illness or even getting out of their profession all together. Health care reform, as it states now, will stand to greatly lower the financial reimbursement paid out for care for someone on Medicare. I predict, as do many others, that nurse practitioners are coming in and beginning to fill the roles doctors used to fill. While nurse practitioners were once considered to be in a much lower medical class than doctors, today they are responsible more than ever for filling in the gaps. Already delivering babies, counseling patients with heart disease or diabetes and carrying for cancer patients – these men and women find themselves truly stepping up to the challenge. It is true that there is no substitute for education and experience, but the argument to make here is that nurses will still be required to operate within the limits of their field, not trying to fill the role of physician.

Value Added Process facilities, or VAP facilities such as Minute Clinic are becoming more and more well-known, employing nurse practitioners, physicians assistants, and even some physicians are starting to fill these roles as they try to get away from red tape and the pressure of all the laws being put into place. The statistics, as they are now, show that nurse practitioners already exist at a 4:1 ratio with physicians, and I believe those numbers will rise as people start to seek treatment in more creative and innovative ways.

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