Breaking News: The Supreme Court Ruled 6-3 that Subsidies Were Legal

AAEAAQAAAAAAAAI8AAAAJDljN2E2ZWIzLWU2NWMtNDFjYi1hM2I0LTNhMmQ1N2FjODEwNwThe Affordable Care Act scored a major win today, as the Supreme Court ruled that subsidies used to purchase health insurance on the federally facilitated marketplace are legal. The 6-3 decision in King v. Burwell means that tax credits will continue to be valid in the 34 federally-facilitated marketplace (FFM) states. Millions of consumers will keep their legal HealthCare.Gov subsidies and the IRS will continue to be able to issue subsidies to those who buy plans on the federal website (HealthCare.Gov).

For more information on the ruling, please click here.

CVS to pay $1.9B for Target’s Pharmacy Business

635699795552685572-cvs-target615CVS Health is buying Target’s pharmacy business for $1.9 billion. Under the terms of the deal, Target’s 1,660 pharmacy locations will become CVS branded and will operate under the CVS name in Target stores.

Additionally, CVS said it planned to rebrand about 80 clinic locations previously operated by Target under the MinuteClinic name, adding that they would be part of its plan to operate 1,500 clinics by 2017.

This acquisition of Target’s pharmacy business, simply adds to the already dominant CVS Health. The deal with Target comes just less than a month after CVS agreed to acquire nursing-home pharmacy operator Omicare Inc. in a $12.7 billion transaction. CVS Health is already the nation’s largest dispenser of prescription drugs, the biggest operator of health care clinics, and the second-largest pharmacy-benefits manager.

For more information on this deal, please click here.

Ask Me Anything: Five Questions About Private Health Insurance Exchanges

Concept image of the six most common questions and answers on a signpost.What kind of resources are typically available to employees on private exchanges (i.e. call center, online tools)?
There are a number of resources available to employees including technology-driven decision support during open enrollment, as well as call centers, videos, avatars, and other marketing materials. Additionally, some private exchanges offer a call center with highly trained advisors to help employees learn about their employer’s specific health benefits as well as guide them through the choice of plans and the enrollment process.

In your experience, who typically leads the communication plan with employees and what part would the employer play in this regard?
This varies greatly depending on the exchange. It is important to pick an exchange that truly minimizes the employer involvement without minimizing your access to information. The exchanges and carriers should both be involved in the communication process.

Implementing a new benefits strategy, such as moving onto a private health insurance exchange, requires senior management to communicate clearly the benefits for both the employees and the organization. Employee communications should be designed to educate them about the transition to a private exchange.

What is the typical timeline for choosing a private exchange?
The timeline is generally four to six months, depending on how far along an employer is in developing its specific goals and objectives. Depending on the complexity of the employer’s needs, desire to customize, contract negotiation, and set-up time, a longer timeline may be necessary.  If the employer is conducting its own due diligence of exchanges, the selection process can be much longer than six months.

Can the employer remain self-funded in the private healthcare exchange?
Yes. Some private exchanges allow employers to choose the funding mechanism that best fits their needs and goals. The employer may choose between two different funding methods: fully insured or self-funded. For example, there are private exchange strategies that offer “fully-insured” group health plans. In a fully- insured model, the employer contracts with an insurance company, effectively shifting all of the health risks of its employees to the insurer.  Private exchanges may also be utilized to offer “self-insured” group health plans. This allows the employer to continue to manage the employees’ utilization of benefits. The employer, however, assumes responsibility for paying all medical and drug claims.

What is the effect of wellness & health management programs on a private exchange?
In theory, wellness and health management programs accessed through an exchange will generate similar positive impact as off an exchange. There are a few private exchange solutions that have effectively integrated wellness as part of their offering.

Have a question we didn’t cover in this edition of Ask Me Anything? E-mail your question to Jennifer Jones at I’ll answer five more of your questions about private exchanges soon.

KTP’s Barry Eyre Interviewed on IHC Radio

imagesKTP’s Barry Eyre, vice president of business development, was recently interviewed on the Institute for Healthcare Consumerism Radio Show. In this episode, Barry shared his knowledge of the private exchange market, including what he has seen and heard from employers who are exploring the private exchange option for their employee benefit strategy. He stressed that understanding the right questions to ask is critically important to making the best choices. With dozens of benefit advisors offering a private exchange option of their own, employers need to take this information with a grain of salt, he added.

Barry went on to explain that there are more important questions employers should be asking than simply “What are my exchange options? What are the exchanges that serve my industry type? What carriers are offered on the exchanges?  While these are good questions, employers might be better severed by first reflecting on what their benefits philosophy is and what they hope to accomplish by moving to an exchange.” During the program, Barry also touched upon: implementation timeline, resources found on private exchanges, and public and private exchange integration. He ended the interview with a final piece of advice to employers: “Understanding your needs (as an employer) is critical to being able to evaluate an exchange offering. Time spent upfront to understand your goals could help to eliminate a lot of potential vendors from consideration.”

For the full interview on IHC Radio, please click here.smIHC-Radio-Logo

Ask Me Anything: Five Questions About Private Health Insurance Exchanges “Jargon Edition”

jargon-freeWhat is a “Private Exchange Technology Platform?”

These are typically software companies that have developed, and in most cases, continue to refine proprietary technology that powers private health insurance exchanges. They may sell or lease the use of their software to other exchange vendors and sometimes may integrate it with other employee benefit services. They may also license users on a SaaS (software-as-a-service) basis, charge fees to those who wish to private label and co-brand the technology, and may even play the role of a “marketplace” for the purchase of employee and retiree group health plans. Many of these companies will work to add members to their own exchanges by working directly with employers or through brokers and consultants without a private label or co-brand arrangement.

What is a “Private Exchange marketplace?”

A private health insurance exchange “marketplace” is an organization set up to facilitate the purchase of health insurance and other employee benefits. The exchanges are similar to shopping malls with a broad variety of products and competitors. Marketplaces provide standardized health care plans and ancillary benefits, such as dental, vision, life, disability, accident, cancer, critical illness, hospital indemnity and other products, offered by different insurers.

Essentially, a marketplace is a “distribution channel.” These marketplaces are typically sponsored by insurance brokers, insurance carriers, industry associations and affinity groups, and benefit consultants who, in many cases, have paid a license fee to use the enrollment software, built and powered by a private exchange technology company.

What is a “single carrier exchange?”

Single-carrier exchanges are operated by a single insurance carrier. These exchanges carry the same definition as a ‘marketplace’ but are owned and offered by insurance carriers to employers and employees and retirees for the exclusive purchase of their own health insurance products. However, some insurers are considering offering another carrier’s specialty or ancillary products. Most single health carrier exchanges pay for the right to use technology software from PHIX technology companies.

What is a “multi-carrier exchange?”

A multi-carrier exchange is operated by a third party (not the insurance carrier or the employer), which, in most cases, is a broker or consultant. These exchanges contract with multiple insurance carriers for health and voluntary benefit plans. However, multi-carrier exchanges can come in many forms. For example, some are set up to compete for enrollment by offering multiple health plans and pricing structures, along with additional services. Others are “customized” exchanges in which plan designs are tailored specifically by the employer or the exchange.  In that example, the exchange may contract with multiple carriers but offer employers only one carrier per region. Additionally, in a customized exchange, an employer may choose to only offer one carrier from what’s available on the “product shelf” and then offer employees different plans from that one carrier.

What is is a health insurance exchange website operated by the federal government under the provisions of the Patient Protection and Affordable Care Act (also known as ACA, or ‘Obamacare’). This federal exchange facilitates the sale of private health insurance plans to residents of the United States and offers subsidies to those who earn less than four times the federal poverty line. The website also assists individuals who are eligible to sign up for Medicaid, and has a separate marketplace for small businesses.

Note: is designed to serve residents of the 36 states that have opted to not create their own state exchange. Fourteen states – Washington, Oregon, California, Nevada, Colorado, Minnesota, Kentucky, Maryland, New York, Vermont, Massachusetts, Rhode Island, Connecticut, and Hawaii –operate their own “state” exchange, with different websites. However, all state exchanges are considered “federal marketplaces” under the ACA.

Have a question we didn’t cover in this edition of Ask Me Anything? E-mail your question to Jennifer Jones at I’ll answer five more of your questions about private exchanges soon.

Catch Insights from KTP’s Barry Eyre on IHC Radio this Week!

smIHC-Radio-LogoOn Friday, June 5, KTP’s Barry Eyre, vice president of business development, will be interviewed on the IHC radio show. Barry will share his extensive knowledge of the private exchange market, including what he has seen and heard from employers who are exploring the private exchange option.

In this interview, Barry will help guide employers to the right set of considerations when exploring private exchange solutions. The show airs Friday (June 5th) at 11 a.m. (ET). Tune in here.

Poll: The Public’s View on the ACA


In October 2013, the Affordable Care Act kicked off to a rocky start.  The Kaiser Family Foundation Health Tracking Poll has tracked and reported American’s favorability rating towards the law since the bill was signed in 2010.  For years now, the foundation’s findings have shown the majority of adults look unfavorably towards healthcare reform. However, after its second year of enrollment, the ACA has surpassed expectations, enrolling upwards of 12 million people since its implementation.  Most importantly, for the first time in 29 months, April 2015 marks the first report of a favorable view from the public.

See the interactive Kaiser Family Foundation Health Tracking Poll Report here.