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Showing posts with label health care reform. Show all posts
Showing posts with label health care reform. Show all posts

Tuesday, September 28, 2010

HEALTHCARE IN BUSINESS: Am I Losing Good Employees Because of Benefit Choices?

Healthcare In Business with Ruth Lycke


As a small business owner and employer we are often saddled with the challenges that large businesses employ human relations departments for. You can be faced with the mounting pressures of the day to day financials of business, coupled with the endless rules and regulations regarding employees and employee benefits.
  • What is legally required?
  • What is important about "leave" benefits?
  • How does the healthcare law affect what must I do?
  • What will happen to healthcare benefits in the future?
The law requires you to cover certain costs of so called benefits. Depending on the state(s) where your business has employees these “benefits” can differ. Due to the potential complexity, we will limit what is talked about here.


Legally required benefits include:

  • Social Security Taxes — Every employer must pay social security at the same rate paid by their employees.
  • Unemployment Insurance — If you have employees, you are required to pay unemployment insurance taxes under certain conditions.
  • Workers Compensation Insurance — Businesses with employees are required to carry Workers’ Compensation Insurance coverage through a commercial carrier, on a self-insured basis, or through your state’s Worker’s Compensation Insurance program.
  • Disability Insurance — If your employees work in California, Hawaii, New Jersey, New York, Puerto Rico or Rhode Island, you will have to provide a partial wage replacement insurance coverage to eligible employees for non-work-related sickness or injury. (The term “eligible employees” is used because the requirement varies by state, employee work hours, employee(s) location(s) and employee type. Part-time workers are often excluded from these requirements.)
For your information all benefits are regulated by state and/or federal law.


Important “leave” benefits:

  • The Family Medical Leave Act, which applies to private employers with 50 or more employees and to all public employers.
  • COBRA benefits, which provide former employees, retirees, spouses, former spouses and dependant children the right to temporary continuation of health coverage at group rates. (NOTE: You may be required to provide COBRA to an employee that has been terminated or laid off.)

What effect has the healthcare law had on what you are providing?


The initial changes of the healthcare law began to take effect on Sept. 23, 2010, six months after the health-reform bill was signed into law and these include:

The preservation of job-based coverage: for employees who get health insurance through work, coverage’s should remain the same. Certain consumer protections are supposed to go into action including:
  • Lifetime caps on coverage are banned (Insurers will have to adopt new procedures allowing appeals of coverage denials.)
  • According to the new Patient's Bill of Rights insurers can no longer:
    • Cancel your coverage if you become sick
    • Set lifetime limits on coverage
    • Put annual dollar limits on coverage (this is phased in over 3 years)
    • Deny coverage to children under age 19 who have pre-existing conditions
    • Impose barriers to and/or refuse to pay for emergency care (even outside the insurer's network.)
  • Young adults can stay on their parents' insurance plans until age 26.
  • High Risk: Individuals who have been uninsured for six months and have a pre-existing medical condition (can apply for coverage through new high-risk pools being set up in each state) *This will last until 2014 when insurers cannot discriminate on the basis of health status.
  • Starting in 2010, businesses with up to 25 workers and average wages per worker up to $50,000 per year can get tax credits to offset the cost of insuring their employees.

What about the future:

  • Beginning in 2011
    • States will be responsible for enhanced review of health-insurance company rate increase requests. (insurers will have to spend 80 to 85 cents out of every premium dollar on medical care)
  • Beginning in 2014
    • Insurance marketplaces (exchanges) will be based in each state.
    • Private insurers will offer coverage options for individuals and small businesses in the exchanges. They will have to take all people that apply.
    • Subsidies, the largest part of the reform law in terms of cost,
      • tax credits to offset the costs of premiums and out-of-pocket expenses for individuals and families who meet income qualifications
    • Incentives to buy health insurance
      • Those who don't have insurance have to pay a penalty when they file their federal taxes. (Despite what you may have heard or read, no one will go to jail if they don't buy health insurance. More than 20 states are currently contesting the "individual mandate" in the federal law. Years will pass before a final decision is made and it will probably end up in the hands of the Supreme Court.)
  • Beginning in 2018
    • The new law expands the so called “safety net health-insurance program” to a projected 13 million more people, on top of the 50 million people it already serves. States can choose to start the expansion early, in 2011, with federal dollars paying the full cost. My question is this, where will the money come from to pay for it? All states have to provide the expanded coverage beginning in 2014.

Complicated isn’t it! The biggest question that remains unanswered is how much will this cost the employer and how well will the changes be integrated. The fact remains that the “employers” burden has and will continue to increase and you will have to weigh heavily the cost of “benefits” for each employee and may have to scale back as a result.

I doubt in this economy where there is so much unused talent you are loosing anyone but it is clear that the days of simple employee management have gone. We are entering a new era of not only “managed care” but micro-managed employment. If you are a small and emerging enterprise you will want to think long and hard about outsourcing HR duties until you can afford to bring them in-house. Benefits will have to be paid and will be expected by the best employees, your choices will determine how many you can afford, what state(s) you operate in, what is required by law, and what you need to supply to remain competitive.


For more information, please visit Ruth's TNNWC Bio.



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Thursday, September 23, 2010

HEALTHCARE IN BUSINESS: Healthcare Accessibility - Is It Still Available?

Healthcare In Business with Ruth Lycke


Last month we talked about cost shifting and how much a company and employees can bear. This month we’ll endeavor to answer the question, “Is medical healthcare accessibility still available?”
  • Time to get care
  • Number of people insured
  • British healthcare exposed
  • Canadian wait times
  • Number of physicians
  • Nursing profession shortages
  • Costs relating to accessibility

Lets start by taking into consideration the time it takes to make an appointment when needing to see a specialist. Would you believe 4 months? According to the Fraser Institute the average wait time to go from a general practitioner to a specialist was 17.3 weeks in 2008 before adding 47.3 million people to the insurance rolls with the healthcare bill passed in 2010. That’s up from 11.9 weeks in 1997 and with healthcare passage it is now projected to get worse.

In the UK they must see you within 4 hours of your calling so when they are backed up they simply stop answering the phone. Great solution, right? In Canada the average wait time to see a physician in an ER varies from 10 to 25 hours. Now consider that in the US there are over 119.5 million ER visits annually and that is expanding. Over 25% of all US based physicians are from foreign countries with limited time to practice in the US before returning to their country of origin. In spending countless hours researching physician forecasts and projected shortages I am amazed that the only conclusion they arrive at is, there is no single accepted approach to forecasting physician requirements. They all seem to attempt to identify the current and emerging trends. The fact that they try not to disclose is that there are fewer numbers of physicians entering the workforce in the US and increasing number retiring and leaving practice. Combine that with the growing 8.1% RN vacancy rate and there are definite problems looming for healthcare accessibility.

If you take a look at the following chart you will see the winners in bold black and the losers in bold red. It is amazing to see that we as a nation lose in 5 out of 8 categories and only win in one. Where we pay the most and expect to have the best care and life expectancy we actually loose. It is no wonder that emerging and small businesses are caught in a quandary trying to anticipate costs while their employees are trying desperately to gage the benefits that they really have.

Country

Life expectancy

Infant mortality rate

Physicians per 1000 people

Nurses per 1000 people

Per capita expenditure on health (USD)

Healthcare costs as a percent of GDP

% of government revenue spent on health

% of health costs paid by government

Australia

81.4

4.2

2.8

9.7

3,137

8.7

17.7

67.7

Canada

81.3

4.5

2.2

9.0

3,895

10.1

16.7

69.8

France

81.0

4.0

3.4

7.7

3,601

11.0

14.2

79.0

Germany

79.8

3.8

3.5

9.9

3,588

10.4

17.6

76.9

Japan

82.6

2.6

2.1

9.4

2,581

8.1

16.8

81.3

Sweden

81.0

2.5

3.6

10.8

3,323

9.1

13.6

81.7

UK

79.1

4.8

2.5

10.0

2,992

8.4

15.8

81.7

US

78.1

6.9

2.4

10.6

7,290

16.0

18.5

45.4



In meeting with HR department heads of small, medium, and even large businesses we continually see that they are being challenged to consider accessibility as a factor within benefits offered and guidelines they must meet.

Now an increasing number of patients are being seen in ER’s to cut wait times in clinics. With an increasing number of physicians entering retirement or choosing to leave healthcare practice because of new laws, seeking to change the rules of in-network care versus out of network is a valid consideration and choice. Knowing that there are options that can increase your available options, accessibility, and outcome is worth the time it takes a small or large business owner or an HR staffer to have a third party evaluate the access of current costs, offerings, and options.


For more information, please visit Ruth's TNNWC Bio.



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Monday, February 08, 2010

THE POINT: “Anyone can buy a truck.” No, Mr. President, they can’t.

The Point with Brenda Krueger Huffman


When I saw the television evening news clip of President Obama at the Boston rally urging voters to vote for Martha Coakley on January 17 with his statement “Anyone can buy a truck.”, my first reaction was “No, Mr. President, they can’t.” My first thoughts were: Not only can many not buy a truck right now, but many are having a hard time for the first time in their lives just paying for food and their house payment. Many can’t believe they are facing car repossession, a foreclosure, or even a personal bankruptcy due to a prolonged unemployment rate of officially 10% to a reality rate of 17%; or they can’t believe their business revenue has been down 30% or more for over a year.

Many have seen a doubling and tripling of their credit card interest rate and minimum payments (with little notice) levied by the same banks bailed out by taxpayers even though they have been good customers. And we watched Congress congratulate itself for “credit card reform” legislation enacted last year with enough time before implementation in the legislation for banks to drive up rates and increase payment amounts prior to enactment. We are all seeing a general economic job growth checkmate brought on by uncertain business costs (taxes, health care cost, energy costs) and a government viewed by wary investors as unfriendly to business and profit.

I felt this truck talking point, that was no doubt thought of as clever in the intent of mocking the populous appeal of Scott Brown by the speech writers that wrote it, actually revealed a not so clever absence of being relatable to one or more out of every five Americans struggling and wishing they were in a stable enough financial position to buy a truck. In fact, even those with jobs or a surviving small business would have a hard time buying a truck right now, because bank loans are hard to come by for those without a 700+ FICO score or for those who have any other debt. And given the credit card interest and payment acceleration games going on the last several months, many are now behind on payments or have given up which has ruined their once excellent credit score.

The majority of these same now financially unstable people were quite stable even one or two years ago and generally through most of their lives up until now. These people are not looking for a government bailout – they want an appropriate job again, an end to usury credit card interest rates, an end to unfair credit and insurance practices, and a government that sees uplifting the down economy as priority one. They don’t want deficient spending that will impact the next 50 years in stifling higher tax rates for all – including the middle class - no matter what is promised now. They want the American Dream again for themselves and for their children and grandchildren.

As we all know, the Republican Scott Brown won the Massachusetts senate seat by a 5 point margin – shocking in the bluest of blue Democrat rule states. Actually, I don’t think President Obama’s truck comment or his stump appearance in general lost the race for Coakley. I don’t even think it was completely the health care debate in Washington that changed the seat to the Republican. Simply put, the Independent voters were the deciding factor in both the Scott Brown win in 2010 and the Barack Obama win in 2008. Many voters, even those that are registered Republican or Democrat, are actually more Independent voters in reality. In other words, the more partisan the politics have become in Washington, the more voters have been turned off to being affiliated with either major party. Voters will vote for the candidates they believe hear them and will be a vote in Congress that reflects their voice.

I am currently a registered Republican, but my views are more in line with being an Independent voter. It would benefit politicians wanting to keep their jobs this November and in 2012 to get to know the positions of the true Independent voters again. For example, I am more fiscally responsible than any true liberal. I am more socially tolerant than any true conservative. I can agree to disagree with someone on my political beliefs without name calling or personally demonizing them or their political party. I don’t like it when our elected politicians can not. I don’t expect every citizen or every politician I vote for to agree with me 100% to consider them a good person. I feel I exemplify the Independent voter.

I think it was voters of all parties that were tired of those in Washington not understanding and caring that their political antics and statements are affecting the economy that put Scott Brown in the Senate. Job growth is affected by Washington’s actions when the confidence of investors and banks to provide capital for job growth creation is lowered. When confidence is lowered, business owners are hesitant to increase any cost, especially their largest operating cost, which is usually adding new employees and thus their salaries and benefits. Voters realize that those in Washington are not personally and financially being affected by a hard economy as many of them, the voters, are. Voters resent that government is the largest growth sector especially in Washington D.C. itself. This fact is not a plus for Americans who know all government costs are paid for by taxes, and that all spending by Congress is increasing the national deficit.

It’s obvious to a majority of voters the $787 billion economic stimulus bill has not helped the economy and therefore them personally. It has not created real jobs, stopped lay-offs or slowed corporate or small business closings. It has not made the everyday lives of most Americans more financially stable. They can not simply go and buy that truck as the majority in Washington can, and those in Washington sadly don’t even realize the average American can’t. Voters are frustrated with those in Washington playing games with the language and real results of the stimulus spending “actually” creating permanent and real job growth.

Politicians play word games and political spin games while the unemployed continue to look for real jobs that have not been created. Voters wonder where billions of stimulus dollars were actually spent and for what. Voters raise their eyebrows when they hear each $45,000 per year job cost 8 to 10 times $45,000 to create it. Voters shake their heads when they hear seasonal jobs, part-time jobs, existing jobs, and a salary raise in an existing job are used in the figures to calculate the sum of new jobs created.

Voters can’t continue to borrow more money when loaded with debt. They can’t vote themselves a debt ceiling increase or avoid the consequence of personal pain for being in debt. Voters have personal consequences for not being able to pay their current bills that affect them today. And these consequences may continue to personally affect them for years to come. They get fired if they don’t do a good job. They don’t do one thing and say another and then casually spin it away in front of media cameras. They don’t meet behind closed doors and then say how transparent they are. They don’t consider raising taxes in a struggling business climate as a solution to the rising debt problem. They don’t ignore excessive spending as a root cause of rising debt.

I am not a “right-wing pro-greed, pro-war, corporate loving Republican conservative” or a “left-wing big government is the answer to everything, redistribution, nanny-state Democrat liberal”. I am not an evil, greedy capitalist at all costs. I am not an “everyone deserves the same outcome no matter the output” non-capitalist either. Like most Independent voters, I am sick of extremes. I do not like labels being placed on people or political parties. I am an independent thinker, and I do not think “party” when voting. I have voted for both Democrats and Republicans throughout my life. I vote for the candidate I like and for who has the best ideas for solutions to our country’s challenges.

I respect our founding fathers and our constitution. I am proud of America. I understand America is not perfect. I acknowledge mistakes have been made at times. (I was furious with President Bush and his administration for the failure to act effectively in the wake of the Katrina disaster.) But I also know America is the first country to give aid globally, and Americans are the most generous people in the world. I know “freedom” is not just a word to Americans. Freedom and national security are the first elements in our ability to pursue happiness.

I know government has a given role in America. But, I also know government can be a deterrent to its citizens and their prosperity when it exceeds its given role. Like most Independent voters, I believe in the free-market, yet I don’t believe insurance companies should be allowed to set their own profit agendas that include the practices of denying policy availability to those that have ever been sick or cutting off benefits to those policy holders that do get sick. I believe there is a need for health insurance reform, but I don’t want the government to take over health care or to mandate its purchase. I believe tort reform and interstate competition should be a part of any health care reform discussion as well as honesty to the American taxpayers in the true cost of the proposed reform. I don’t want the cost to break the backs of businesses leading to more unemployment and to taxpayers leading to more personal pain consequences.

I have never been about color or ethnicity. I celebrate the diversity that makes America interesting and strong. I don’t believe any business or company is too big to fail. I don’t believe the government should pick winners and losers in our economy. I don’t believe the government should use the tax code or exemptions to favor one group of citizens over another. I believe in a helping hand safety net to help lift someone to more stable ground, but I don’t believe in the deliberate use of government programs and policies for a redistribution political philosophy. You don’t lift some up by pulling others down. You also don’t ignore those that need a helping hand. But, you don’t offer that helping hand by having government take over a free market segment – any free market segment.

Independent voters are tired of the arrogance of both the Republicans and Democrats in the House and Senate. They are tired of the political rhetoric regarding the struggling middle class without job creation being the number one priority of Congress. They are tired of discussions on health care, cap and trade, and card check even being considered before working to stabilize the economy and affect real job creation which can only be accomplished by free market understanding and expansion. It can not be affected by government expansion which is in reality only taxpayer cost and risk expansion. It can only be affected by creating an economic environment in which confidence in private growth reward outweighs private growth risk. I am not an economist or in the financial industry, but I do have some sense of what has worked historically and what has not. I see what has worked in other countries and what has not.

I feel I have what many regular voters have, which is common sense. What I do know is you stop spending when you have no more money. What I do know is you don’t openly insult, talk down to, or ignore those you represent and their concerns and wishes. I believe this is why Scott Brown won the senate seat. He tapped into what the independent and common sense voters know, and he gave them confidence that he would represent their concerns and wishes in Washington.

He was smart to present himself as his own man and not a party man. He connected well with the independent thinkers and voters no matter the party affiliation they had if any. He drove a truck and didn’t give up when he was 30 points down in the polls a month before the election. He spoke with his voters - not at them or down to them. He listened to voters. He asked for their vote, and he made the voters feel like he deserved it. He assured them he wanted to go to Washington to get things done for them, and not to become a part of any political machine at their peril.

I realized the “truck” Obama used in his comment was really a symbol to me - a symbol of all that is the “American Dream” to many. That’s what Americans want – to be financially stable and to have the opportunity to provide for their families with dignity and pride. They want to be able to afford health care for their family and not have to fight with an insurance company for continued coverage if they get sick. But, they don’t want health care reform laden with excessive government intervention and new taxes. They don’t want new taxes levied on everyone except for those that are politically favored because of campaign contributions and lobbyist. They don’t want any bill completely being written behind closed doors and being rubber stamped by party affiliation without being read by Congress. They want to work hard and to pay their fair share of taxes, but they do not want to be penalized by business-killing tax rates and demonizing rhetoric by their own government for being successful through hard work. The majority of successful American business owners and workers are honest and fair - they want this acknowledged. They want those that aren’t to be appropriately prosecuted and companies that aren’t to be allowed to fail.

Both the Republicans and Democrats in government at all levels need to relearn who they work for and reintroduce themselves to the needs and desires of their “people” as represented in “of the people, by the people, and for the people”. Members of Congress also need to reacquaint themselves with who they were meant to be in the American “people” equation.

It would be smart for members of Congress to hold town hall meetings with the goals of listening and learning. (Voters do not want town hall meetings to simply be another opportunity for political spin.) This would allow meaningful representation of their constituents and ensure that members of Congress understand voters are now more independent thinking than partisan. Voters are intelligent. They are more informed and engaged than ever. And, it wouldn’t hurt to give up the limousine and drive to those town hall meetings to meet the voters in a truck.


For more information, please visit Brenda's TNNW Bio.


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