02/24/14 4:00pm
02/24/2014 4:00 PM
Stony Brook University Hospital Courtesy Photo

Stony Brook University Hospital Courtesy Photo

Stony Brook University Hospital is now taking one of the insurance options offered through the healthcare exchange.

On Feb. 14., hospital officials reached an agreement with Health Republic through their health insurance provider MagnaCare. Health Republic is one of eight options offered to residents in Suffolk County through the exchange.

The hospital is still in “active discussions” with several of the other providers on the exchange, working to come to an agreement “that is both beneficial for patients and fiscally responsible for Stony Brook and the insurance carrier,” according to a statement from the hospital.

“We are pleased to have been able to amend our existing agreement with MagnaCare to include in-network coverage for thousands of Long Islanders participating in the NY State of Health Plan Marketplace,” said Dr. L. Reuven Pasternak, chief executive officer at Stony Brook University Hospital, and vice president for Health Systems, Stony Brook Medicine.

“It supports New York State’s mission to offer affordable care to our patients in a manner that is consistent with Stony Brook’s core mission as the safety net provider for the area and source of specialized and unique care for populations at risk.”

As of last week, all three East End Hospitals — Peconic Bay Medical Center, Eastern Long Island Hospital and Southampton Hospital, all comprising the East End Health Alliance — were accepting six of the eight plans. Those included EmblemHealth, Empire Blue Cross, Oscar, United Healthcare and Affinity insurances, as well as Health Republic, a nonprofit alternative health plan.

For patients with out-of-network exchange options requiring care that only Stony Brook University Hospital can provide, Stony Brook will work with the patient’s exchange plan to try to reach an arrangement for payment, a hospital spokeswoman said.

Patients in need of this type of assistance should call Stony Brook University Hospital’s office of healthcare tele-services at (631) 444-4392.

10/25/13 7:00am
10/25/2013 7:00 AM

CARRIE MILLER PHOTO | ‘Cover yourself and protect your business,’ advised Alysia Doerbecker, senior district manager for ADP payroll services, at last Wednesday’s conference on health care and small businesses in Wading River.

As employers, employees and the unemployed across America continue to wrap their heads around new federal health insurance mandates – known to many simply as Obamacare — owners of local businesses, both large and small, were asking plenty of questions last week at a symposium designed to clue them in to the new rules and regulations and how it could affect their business models moving forward.

Experts at the event, “Taming Healthcare 2014,” gave a dose of advice to the business community Oct. 16 at the Inn & Spa at East Wind, offering tips for navigating the newly reformed health care system — which they described as a “moving target.”

Starting in 2015, businesses employing 50 or more full-time equivalent workers will be required to offer those employees affordable health insurance coverage or face penalty fees.

Andrew Mitchell, CEO of PBMC Health, delivered the keynote speech at the event – presented by the Riverhead Chamber of Commerce, the Riverhead Industrial Development Agency and Peconic Bay Medical Center. He said employers are required to offer an insurance plan that covers at least 60 percent of medical expenses, which is the same percentage covered by the lowest plan on the public health insurance marketplace. At the same time, the plan’s monthly premium must be no more than 9.5 percent of the employee’s household income – otherwise it is considered “unaffordable,” according to the reform law.

This means what is affordable to one employee may not be to another, which in turn means added paperwork and oversight for employers to ensure they are in compliance, said Alysia Doerbecker, senior district manager for ADP payroll services.

“There is a laundry list of information that you need to be prepared for,” Ms. Doerbecker said.

As a result, she said, a proficient human resources system to keep tabs on all the information could be vital.

Should a company slip up, it may be subject to penalties or open itself to a lawsuit, said John Hudson, president of True Benefit, LLC, an employee benefits brokerage and consulting firm.

After 90 days, new employees become eligible to join the company’s health care plan, should they offer one, Mr. Hudson said. “You better track [those] employee[s] accurately. If they should have been offered coverage, it’s going to come back to you as an employer from a lawsuit perspective.”

To enforce the new regulations, Michael Vigliotta, an attorney at The Law Offices of Thomas M. Volz, said the Internal Revenue Service is hiring more than 6,500 new employees to ensure businesses are in compliance.

Susan Flatley, manager of North Fork Radiology, which has 60 full-time employees, said she was expecting added oversight, “but not to the extent of what I heard here today.”

And for those considering not offering affordable care, “the penalties are larger than I had anticipated,” she said. The penalty is generally equal to $2,000 for each full-time employee, excluding the first 30 employees. Should an employee enroll in the marketplace and qualify for a government subsidy, additional fees could be incurred.

Bruce Talmage, owner of Talmage Agway in Riverhead, has about 17 full-time employees, which puts him in the small business category.

“It sounds like I am not required to provide a health plan, but I currently do, and I am trying to understand the rules,” Mr. Talmage said. He said many of his questions have to do with his ever-changing work force because the store gets busier during the spring and summer landscaping seasons.

Talmage wears an interesting couple of hats, as he’s also involved with the nonprofit Riverhead Volunteer Ambulance Corps, which has about 17 full-time employees. While the nonprofit has not offered health coverage in the past, he said they are looking into getting it.

As a small business, he is not required to offer health insurance, but there are tax incentives for small businesses that do so, according to the Small Business Assistance Program, a state-run nonprofit supporting affordable health insurance.

“If I do continue to offer one, does it have to be to every single employee? Is there a limit on the number of hours they work?” Mr. Talmage asked.

According to the law, as long as his work force does not exceed 50 full-time workers for more than 120 calendar days, he will still be considered a small business.

Raising even more questions for Talmage, the insurance plan he currently offers his employees will no longer be offered come Jan. 1, so it’s as if he is starting at square one, he said.

There are also unanswered questions on the health care provider side.

An estimated 57 million uninsured people stand to gain access to affordable health care, however there are already shortages of primary care physicians to provide it, said Dr. George Ruggierio, chief of family medicine and director of medical education at PBMC.

“Primary care physicians are already under strain. Who’s going to see these people?” Dr. Ruggierio said.

The U.S. Department of Health and Human Services estimates that the physician supply will increase by only 7 percent in the next 10 years, far less than the more than 36 percent increase in the patient population, according to the Association of American Medical Colleges.

“There are concerns across the board – the insurance industry, hospitals and doctors trying to deliver care,” Dr. Ruggierio said.

Unfortunately, not all of the questions are answered yet, said Randy Blum, a representative from United Healthcare – an insurance provider offering coverage on New York’s insurance exchange. “At this point nobody knows what’s going to happen.”

While much remains uncertain for health care providers, small business owners seeking the right plan and employees themselves, Lauren McKissick, owner of Prominent Swimming Pools Inc. of Calverton – which has just a handful of employees – said that either way, she believes offering health benefits is important to keeping loyal employees.

“You don’t want to lose good people over insurance issues,” she said. “But is it going to be more affordable to workers if we break off and no longer offer it?”

cmiller@timesreview.com

07/12/12 5:00am
07/12/2012 5:00 AM

LAUREL

Don’t kill health care bill

After much nervousness, we recently listened to Justice Roberts approve the Affordable Care Act.

Would it be OK to tell everyone to have health insurance or would this be a violation of the commerce clause? Well, with a thoughtful reversal he called the requirement a tax, which is OK.

The pundits howling and the attorneys flying one wild idea after another turned this into a serious brawl. The legalese and distortion of our language and the twisting of logic was outstanding. The Roberts opinion, however, is not in doubt and the Affordable Care Act is safe, at least for now.

However, I could not drive out of my mind the Shakespearean comment from Dick the Butcher in Henry the VI: “The first thing we do is kill all the lawyers”.

In spite of the lawyers, we now have a plan that we need to make work.

Our health results are not as good as many European countries’. We are behind on infant mortality and general longevity, while our costs are almost twice those of many European countries. If we are as smart and business savvy as we think, we should be able to reduce duplicate tests, institute early preventive care and cut the costs of downstream serious health issues.

We should be able to reduce ridiculously high medical malpractice insurance costs. We should be able to send patients to the right medical people where costs relate to the seriousness of treatment. We should be able to make paperwork a simple tracker and recorder of care, and not a major cost-driver.

Instead of promising to kill “Obamacare” on his first day in office, Mr. Romney, who installed an equivalent program in Massachusetts, should vow to demonstrate his vaunted business acumen and reduce the costs and make the program a winner for all those citizens in dire need.

Unfortunately, he does not care or is not smart enough to do it. Does it really matter which is the right description? I don’t think so.

Howard Meinke

MATTITUCK

Speak up, Mr. O

When Ronald Reagan took office in 1980, the federal tax on people making $212,000 was 70 percent. When the great Reagan left office in 1988, the tax rate was at 28.5 percent. Since then our country has been in a slow decline economically.

Obviously, trickle-down economics did not work. We must learn from this tax issue quickly. Right now, President Obama is worried about beating Mr. Romney in fundraising, when in fact he should be talking about a clear and concise message on tax reform. He has the bully pulpit.

People are starving for information and they will listen to the lies from the right when the president is so quiet. He needs to explain what Obamacare is all about. Many think that if they have health insurance it’s going to change into something else, not that it will remain the same.

Start naming bridges in need of repair again and again to engage the other party into explaining why they have shot down rebuilding our infrastructure again and again.

Tell everybody that you saved the auto industry. Say it loud and proud. Explain your plans for immigration reform, education reform, Wall Street regulations.

And for God’s sake call the Republicans what they are: obstructionists.

Edward Donohue

AQUEBOGUE

Can’t take it anymore

I awakened this morning to what should have been a beautiful day. The rain was ending, breaking the recent heat wave. Subsequently, I feel an aura of apprehension with regard to our present liberal course.

Since the Supreme Court has upheld it, we can kiss small business goodbye.

Unemployment, as a whole, is totally unacceptable. State, county and local municipalities seem to be in a layoff mode. Who feels the Sword of Damocles? The low man on the pole, the actual worker.

I also saw on TV news that this administration was paring back our military. I can only ask myself if we’ve gone totally out of our minds.

Higher fuel prices, coupled with the cost of just about everything, have consumed most of our retirement funds. In addition, our salaries just can’t cover our everyday living expenses.

Time is overdue for changes. We must send Randy Altschuler to Congress. I have the utmost confidence he will work for us. No more failed Obama policies rubber-stamped by Pelosi and Bishop.

The time is now for a positive change. The time has come to send Randy Altschuler to Washington.

Frederick Rogers

SOUTHOLD

Equality in doubt

Some readers have claimed that Mr. Bishop is serving the North Fork as equally as the South Fork.

The steady stream of noisy South Fork commuter copters crossing the North Fork in both directions casts some serious doubt upon this.

Bob Gazza

SOUTHOLD

Let the
voter beware

Business drives the economy by creating wealth. Government drains wealth by taxing that wealth to provide protection, regulation and those services business can’t or won’t provide.

Benja Schwartz wrote that government is the largest contributor to Long Island’s economy. Hardly. It may be the largest employer, but not contributor. You and I pay for government and it does not produce a profit. In fact, government takes on obligations it cannot presently afford and raises taxes to pay those future pensions and health care.

Mr. Katz urges young people to seek jobs allowing retirement in 25 years and “then let the government work for you.” You and I will pay for those benefits; the government has nothing we aren’t taxed to provide. To paraphrase the comic strip character Pogo, “We have met them and they are us!”

The world is in a period of very rapid change and few people recognize the change while it takes place. The pension and health care obligations of the past will change because you and I can’t afford to continue them.

Government pensions are based on expecting 8 percent investment returns and additional taxes to make up shortfalls. Who knows how to earn 8 percent in this economy? Each new tier (revision) of state pensions requires more of new employees and promises less because you and I can’t afford to make up the shortfall of past promises.

Don’t relive the past; prepare for the future. Don’t aim to share my wealth; aim to match my work ethic.

Mr. Schwartz concludes: “In other words, especially distrust those who tell you to just trust them.” He may not fully understand what he says, but I completely agree, and would emphasize that we not trust anyone making promises to deliver in the future.

Be very wary of those asking for your vote with a promise.

Gunther Geiss

SOUTHOLD

Keep your
eyes open

About letters to the editor, I think the editors should cast a wary eye when local writers get going on national politics.

Some of them are gaming the system by trying to get free publicity for their favorite candidates and their stands on various issues. Others make claims that are dubious and cite “facts” that are fuzzy.

For example, in the June 28 issue Howard Meinke says Republicans, and by extension Mitt Romney, who does not hold public office at this time, have “gutted federal and state budgets.”

But federal spending has increased almost 20 percent since 2008 and is projected to make a similar increase over the next five years. That doesn’t look like gutting to me. Perhaps Mr. Meinke’s definition of gutting is not getting everything you wanted.

I also would note that Democrats controlled both houses of Congress in the first two years of the Obama administration and still control the Senate. They still have considerable say on what goes on in Washington.

Writers on political issues should identify their political affiliations. I’ll bet Mr. Meinke is a card-carrying Democrat. Me? I’m a former Democrat turned independent, a “blank” as the politicians would say.

The Democrats are too beholden to special interest groups to make me happy.

Jack Abele