President Trump highlights healthcare in State of the Union

Health care has long been a priority for the Trump administration, and the President used his State of the Union speech this week to highlight his priorities when it comes to improving health and bringing down costs for consumers.

Ahead of the speech, the Trump administration released its plan to curb drug prices for Americans, especially those under 65. His plan proposes eliminating the legal protections that allow pharmacy benefit managers to accept rebates from drug companies for brand-name drugs. Rebates would instead be credited to patients when they fill their prescriptions at the pharmacy.

These after-the-fact discounts are seen by many as one of the driving factors pushing up the list price of drugs. President Trump focused on the struggle this can cause, as many Americans are increasingly responsible for paying larger portions of these prices.

He also called for more transparency in general in the healthcare industry, asserting that if  hospitals, drug companies and insurers had to “disclose real prices,” consumers would have more information that would foster more competition.

“It is unacceptable that Americans pay vastly more than people in other countries for the exact same drugs, often made in the exact same place. This is wrong, this is unfair, and together we will stop it. We will stop it fast. I am asking the Congress to pass legislation that finally takes on the problem of global freeloading and delivers fairness and price transparency for American patients.”

There is bipartisan support in Congress for legislation to bring down drug prices and to improve healthcare pricing overall, but any bill would likely face strong opposition from lobbyists from pharmacy benefit managers, pharmaceutical companies and insurers.

Complicating the issue as well is the current climate in Washington with the divided government. It is still unclear if Congress will be able to work with the President on key issues like these, while so much time and energy is being spent on other subjects, like border security and the government budget.

President Trump went on to talk about his hopes for increased funding for research on treatments for childhood cancer and a cure for HIV and AIDS in the United States within the next 10 years. He called on Democrats and Republicans to pass his budget, which seeks additional funding for the National Institute of Health for both initiatives.

Both priorities are largely seen as an outreach to Democrats and as issues the country could unify around. No specific legislation outside of the budget proposals have been released.

Overall, President Trump’s State of the Union address covered a wide range of topics but his focus on these initiatives shows healthcare remains a priority for the administration.

It will be a game of watch-and-see as Trump’s own campaign for reelection becomes increasingly underway. He may want to tout a big legislative win regarding healthcare on the campaign trail, especially as efforts to “repeal and replace” the Affordable Care Act were unsuccessful early in his presidency.

 

ClaimLinx saves small businesses $4.5M on health care in 2018

Insurance consultant finds innovative solutions to reclaim dollars for employers

BOSTON, Dec. 31, 2018 /PRNewswire/ — Health insurance consultant and agency ClaimLinx saved small business owners a total of $4.5 million on benefit costs in 2018 using its unique strategy for purchasing insurance.

For more than 15 years, ClaimLinx has been pioneering ways of saving small businesses money on benefits. In 2018, the company reached new records of savings for employers, cutting costs by 20 percent or more within the first year of a business starting its program and keeping renewal rates below 5 percent in following years.

Tom Quigley, National Benefit Consultant, said partnering with ClaimLinx is simply about the numbers.

“It all comes down to a math problem,” he said. “Do you want to pay more to an insurance company, or do you want to keep more in your pocket?”

The trick is ClaimLinx combines two types of insurance: traditional coverage from a major carrier and self-funded reimbursement coverage from the employer.

First, ClaimLinx helps companies choose a high deductible health plan from a major carrier, which includes access to a wide provider network and a stop-loss in case of high medical costs from an employee.

Then, ClaimLinx customizes a medical expense reimbursement plan funded by the employer to return benefits employees need, such as copays and a lower deductible.

The resulting plan saves business owners thousands of dollars per employee because they are paying only for services rendered, rather than prefunding major carriers’ bottom line.

In 2018, insurance companies reported strong growth, already amassing an estimated $47 billion in global profit by the end of the second quarter, according to analysis of company documents by Axios media company. 

Where these premium funds end up can be a mystery for employers, but not so with ClaimLinx. The self-funded plan enables employers to track utilization, a useful tool for the future when cutting unnecessary or misused benefits.

Christy Quigley, President of ClaimLinx, wonders how small businesses continue to afford high healthcare costs. Average premium rates for a family plan from a major carrier reached $19,616 in 2018, according to the Kaiser Family Foundation Employer Health Benefits Survey.

“As a small business owner myself, I don’t know how companies keep up with premium rates without finding a solution like ours,” she said.

Contact: Whitney Faber, (617) 892-4655
wfaber@claimlinx.com
www.claimlinx.com

View published release here

ClaimLinx reclaims thousands of dollars for consumers

Business pioneers strategy for employers to pay less for company health plan

CINCINNATI, Dec. 20, 2018 /PRNewswire/ — As health plan premiums rise nationally, so too do insurance companies’ earnings, but one local business has found a way to return some of those would-be profits to consumers.

ClaimLinx is a consultant, insurance agency and third-party administrator specializing in an alternative strategy for purchasing health insurance that saves companies money while delivering quality benefits.

Nationally, insurance companies reported strong growth in 2018, amassing an estimated $47 billion of global profit by the end of the second quarter, according to an analysis of company documents by Axios media company.

Not all of that money is being funneled into improving care or services. Insurance companies spend only 80 percent of funds collected in plan premiums on actual medical care, as required by the Affordable Care Act.

Packed into those huge premium bills are charges for administration, marketing and company profits for share-holders. That’s thousands of dollars each year being given to insurance companies instead of being spent on what workers really need: quality medical care.

Tom Quigley, National Benefit Consultant at ClaimLinx, says buying traditional health plans leaves a lot of money on the table, an especially difficult prospect for small businesses where profit margins are slim.

“It’s really a shame, because people are really just giving all this money away to health insurance companies without even realizing it.” 

So ClaimLinx abandons traditional methods of purchasing health insurance. Instead, it shows clients how to combine a high deductible plan from a major carrier with a self-funded medical expense reimbursement plan. 

The plan with a major carrier offers a wide physicians network with discounts for services and a stop loss in case of high medical costs. The medical expense reimbursement plan offers the ability to add a lower deductible and better cost-sharing measure for services, like copays.

Christy Quigley, President of ClaimLinx, compares this strategy to other types of coverage.

“People have car insurance, but they don’t buy it for $40 oil changes. Imagine how expensive it would be if it did. We use the same concept for health insurance.” 

This two-prong strategy allows small businesses to restore some of its health care dollars to its employees by delivering better benefits at a much lower price. 

Contact: Whitney Faber, (617) 892-4655
wfaber@claimlinx.com
www.claimlinx.com

View the published release

Insurance agency maintains low premium rates for clients

Health benefits consultant finds a solution for rising insurance costs

NORTH CONWAY, N.H., Dec. 19, 2018 /PRNewswire/ — While many health insurance agencies are delivering sour news to employers about rate increases or the prospect of cutting benefits, ClaimLinx is delivering low rates for quality health plans to all of its clients.

Premiums for employer-sponsored health plans for 2019 increased by an average of five percent nationally reaching a staggering average rate of $19,616 for a family plan, according to the 2018 Kaiser Family Foundation Employer Health Benefits Survey.

However, ClaimLinx insurance agents were able to keep its clients’ rate increases below the national average using its unique strategy for purchasing benefits. What’s more is employers using ClaimLinx’s methods pay substantially less overall because they save 20 percent or more within the first year of implementation.

National Benefit Consultant, Tom Quigley, said his team of insurance agents and consultants is willing to do anything to keep plan costs low.

“It’s all about the numbers, but you have to be creative or you’re going to end up paying more,” he said.

For this reason, partnering with ClaimLinx can be a substantial step to taking back control of a company’s benefits, especially important for small businesses where margins are thin and rate increases can be crippling.

Over the past 10 years, premiums have increased twice as fast as wages so that while insurance costs on average 55 percent more, workers earn only 26 percent more to pay for it. When both employer and employee are being squeezed, savings become significant for both.

ClaimLinx specializes in guiding business owners through the insurance market as a full-service consultant, insurance agency and third-party administrator to help them purchase the best, most affordable health plan.

Their solution combines traditional high deductible insurance plans with a customized self-funded medical expense reimbursement plan. The resulting plan enables employers to offer top-notch benefits at a much lower cost.

The company’s founders pioneered the solution more than 10 years ago, when they first saw rates climbing. President and Owner, Christy Quigley, said since then they have been refining their strategy for delivering quality benefits at a low price.

“We really just want to help people save money on their health insurance,” she said. “It’s as simple as that.”

Contact: Whitney Faber, (617) 892-4655
wfaber@claimlinx.com
www.claimlinx.com

View the published release

Another lawsuit aims to take down the Affordable Care Act

A federal judge in Texas heard arguments Wednesday in a case aimed at doing what the Republican Congress has not yet been able to do — dismantle the Affordable Care Act.

The suit hinges on the change to the individual mandate as a part of the tax overhaul President Trump signed into law in December, which zeroed out the requirement that most Americans have health insurance or pay a fine.

The GOP plaintiffs also sought a “preliminary injunction” of the law, which would mean the law would be suspended while the case is decided. The judge has not made a decision on the injunction yet.

Judge Reed O’Connor, a conservative jurist appointed by George W. Bush, heard arguments from GOP plaintiffs, the Justice Department and 17 Democratic attorneys general, with the bulk of his questions going to the defendants of the law.

The lead Democrat arguing the case, California attorney general Xavier Becerra, cautioned against ending the law, even temporarily, as it “would wreak havoc in our health care system.”

The case was filed in February by 18 GOP attorneys general and two GOP governors. They argue the Supreme Court upheld the individual mandate in 2012 as a part of Congress’s authority to tax. Now that the mandate carries no penalty, it can no longer be justified as a tax and should be struck down. And without the mandate, the rest of the law crumbles, including the law’s arguably most popular requirement, that insurers must cover people with pre-existing conditions at no extra cost.

Legal scholars across the political divide believe this is a weak argument, but the case could be the first to go before the more conservative Supreme Court.

Although the Trump administration is technically the defendant in the case, the administration announced in June it would not defend the law. The Justice Department wrote in its filing with the case that it did not think the entire law needed to be eliminated, but it did agree the protections for preexisting conditions should be eliminated January 1, 2019, when the tax penalty goes away.

Filing a case that could put protections for those with pre-existing conditions at risk has already had some political fallout for Republicans, as Democratic candidates have started using it in their campaigns for Congress.

In response, a group of 10 Republican senators introduced legislations last month that prohibits insurance companies from denying coverage or charging more for a pre-existing condition. Democrats point out that the new legislation would not require insurer’s plans to cover treatment for those illnesses, as the Affordable Care Act currently does.

What all of this means is that this is once again a wait-and-see moment for the Affordable Care Act, a daunting concept with open enrollment and an election quickly approaching.