Employers have been struggling to find the best way to provide affordable health benefits to their workers for many years now. One promising option, especially for those with smaller workforces, is to offer insurance through multiple employer welfare arrangements (MEWAs) and association health plans (AHPs).

The idea behind MEWAs is to bundle small groups into a larger community, thereby spreading risk over a larger and more diverse pool of covered individuals. It’s the same principle large employers benefit from by way of lower insurance premiums.  

If your small business is looking for cheaper healthcare options, MEWAs and association health plans may be good options for you to investigate.

What is a MEWA?

MEWA stands for multiple employer welfare arrangement, but is also sometimes referred to as a multiple employer trust (MET). MEWAs allow small employers to essentially team up to create a larger pool of employees to capitalize on the economies of scale that larger employers enjoy. This could mean as few as two employers in the group, or as many as deemed necessary to form a large enough employee pool.

Each employer gets a say in plan design, as well as plan offerings. If one employer has an older population who prefers more traditional plans, they can request such for their workforce. If another employer has a younger workforce for whom high deductible health plans would be more appealing, they could request more consumer-driven healthcare options for their employees. With these groups banded together, the premium costs should be lower than if each employer tried to get insurance on their own.

In the November 2016 general election, Arizona voters passed Proposition 206, which instituted an incremental increase in the state’s minimum wage, as well as mandated paid sick leave for all employees — not just full-time, but part-time, temporary, and seasonal workers as well. All HR professionals and business owners should be apprised to the changes this law will bring and what it means for themselves and their employees.

To assist with complying with the new law, we're providing you with sample paid sick leave policies, not only for employers with over 15 employees, but also for employers with under 15 employees. Feel fee to use these new sample policies in posters, updated employee handbooks, and wherever else you post your HR policies. Of course as always, you should consult with your legal council and benefits advisor to ensure accuracy and applicability to your business,*

Here's a recap of the new law.

Determined to pass health care legislation before the July 4th break, the Senate on Thursday night released a draft ACA replacement bill called the Better Care Reconciliation Act (BCRA). As of this morning, at least five Republican Senators have said they won’t vote for the bill. GOP Senate leaders can only afford to lose two members of their 52-senator caucus in order for the bill to pass. (The loss of two would require Vice President Pence to cast the tie breaking vote, assuming not a single Democrat supports the bill.)

While passage as the bill stands now seems dubious, Republicans and the White House see this as one of the last chances they have to pass healthcare legislation before they can move on to tax reform, so amendments are likely to win back some of these Senators. That process, however, could push the vote to after the July 4 break. Still, Majority Leader Mitch McConnell is a seasoned politician, and many pundits doubt he’d call for a vote before the recess if he didn’t have a few aces up his sleeve.

Let's look at several elements of the bill which are particularly pertinent to employers:

State lawmakers are currently reviewing a piece of legislation that could improve Arizona healthcare for a number of residents. Senate Bill 1441 seeks to solve a common Arizona healthcare problem: surprise medical bills from out-of-network physicians after receiving treatment or having surgery through in-network providers. It’s a frustrating (and confusing) situation, especially for those who have done their research beforehand to make sure all providers were covered by their insurance policy. How are people getting unexpected bills? And what will this legislation do about it?

The Arizona Healthcare Problem: Surprise Bills

In the state of Arizona, people seeing in-network doctors and utilizing in-network hospitals systems frequently receive surprise bills from out-of-network providers. It’s become a common Arizona healthcare narrative these days. If it hasn’t happened to you, you probably know someone who has encountered this issue in the past.

How does this happen? Well, it’s actually pretty complicated.

Let’s say you need surgery. You do your necessary diligence by researching the hospital, the surgeon, and the other doctors you know you’ll be in contact with. You make sure they’re all in-network so you’re minimizing the bills you receive after the fact. Everyone (including the hospital network) is covered. You should be all set, right?

Since the inauguration of a new president in January, healthcare legislation to replace the Affordable Care Act (ACA) has been a hot topic of conversation, not only among employers and healthcare providers, but many American citizens as well. Multiple rumors have been making their way down from Capitol Hill, but it appears as though we finally have some concrete ideas from House Republicans — even if they aren’t fully fleshed out in terms of finances. 

Regardless of what healthcare legislation is passed, it is largely expected that the employer mandate will be repealed, which will have some sort of effect on many American employers. Let’s take a look at the proposed healthcare legislation and other documents from the Department of Health and Human Services (HHS) to determine what employers might be able to expect from lawmakers in the coming months.

The New GOP Healthcare Bill

On Monday, March 6, 2017, House Republicans released what is being collectively referred to as the American Health Care Act (AHCA), which is intended to partially repeal, but also replace the ACA. As anyone might expect in a heated political climate, the proposed healthcare legislation has been met with mixed reviews.

The proposed bill would keep some of the popular components of the ACA, such as the provisions that prohibit insurance companies from denying coverage based on pre-existing conditions or capping the amount of benefits received in one year (or a lifetime). In addition, people would be allowed to remain on their parents’ health insurance plans up to age 26.

While pre-existing conditions would no longer be a reason insurance companies could deny coverage, they would be allowed to charge up to 30 percent more for enrollees who let their coverage lapse. Coverage lapses are common among those suffering from chronic illnesses or serious medical conditions because they are likely to miss work for an extended period of time. Since the Family Medical Leave Act (FMLA) only protects workers for 12 weeks, those receiving extensive treatments (such as chemotherapy) are some of the most commonly affected by lapses.

Americans are concerned about the future of their health care system—and for good reason. It's projected that we will spend 4.5 trillion dollars on health care in 2019 and five trillion by 2022.

According to a recent study from the Society for Human Resource Management, 79 percent of employers that provide health insurance are "very concerned" about rising health care costs. HR professionals know health care concerns go well beyond the effects on the organization's bottom line. Health care benefits play a critical role in recruitment, retention, employee morale, and productivity.

The healthcare debate hasn't been as tumultuous this election cycle as it has been in the past, but regardless of who sits in the Oval Office in January, there will be changes in employer sponsored healthcare. Here's what you need to know about potential legislative changes and employee health benefits.

The Democrats

Hillary Clinton:
After years of championing a single-payer system, Clinton shifted her stance to fully support the Affordable Care Act with a plan to extend current legislation. She has stated that building upon the Affordable Care Act is a more practical solution than instituting a single-payer system, but acknowledges flaws in the existing ACA. Notably, high deductibles and premiums. Her plan incorporates increased tax credits to offset high premiums and other out-of-pocket costs. She also plans to "fix" the "family glitch" so that families can make up the gap in costs between employer coverage and health care costs. Under Clinton's plan, little will change for employers but consumers can expect to see relief in the form of expanded public options and tax credits.

Should Vaping be Encouraged as a Smoking Cessation Tool?

A reader of last week’s blog post on vaping asked us if employers should actively promote e-cigarettes in their wellness programs as a smoking cessation tool. This is an excellent question. It’s admittedly tough to ascertain if e-cigarettes are going to be the next major health hazard or the most effective smoking cessation technique ever created. Unfortunately, there’s not a straightforward answer to this question, but we will attempt to answer it as best we can.

What is Vaping?

For the uninitiated, vaping is the act of inhaling atomized liquid, usually nicotine dissolved in propylene glycol plus flavoring and colors. The device used for this activity is called an e-cigarette; a battery-operated device, often shaped like a cigarette, which is designed to deliver nicotine in the form of an inhalable vapor rather than tobacco smoke.

E-cigarettes Remain a Dilemma for Employers

Electronic cigarettes, or vape pens, don’t contain tobacco and they don’t produce smoke, yet they do contain nicotine, and this has left insurers and employers in a quandary. Should “vapers”, as these people are commonly called, be categorized as smokers, and therefore be penalized with higher insurance rates?

The Categorization Quandary

Despite the growing popularity of vapers (they’ve gotten so popular that even icons like Leonardo DiCaprio are comfortable “vaping” in public), they present a somewhat troublesome gray area to insurance companies. This has left employers wondering if their employees who vape are considered smokers and if so, by whom.

Some businesses have weighed-in on the matter. According to the Wall Street Journal, Wal-Mart and UPS, for example, categorize vapers as smokers, and accordingly charge them higher insurance premiums. Cleveland Clinic, which refuses to hire smokers, similarly won't hire e-smokers, while CVS Caremark doesn't allow employees to use e-cigarettes at its corporate campuses. Starbucks bans e-cigarettes for employees and customers; and almost every state has enacted disparate legislation to regulate where e-cigarettes may and may not be used.