It’s no secret that, for years, health care costs have been on the rise, reflecting a massive burden for employers and employees alike.
According to the Kaiser Family Foundation, the average premium for employer-sponsored family coverage has increased approximately 54 percent since 2009. In 2019, the average annual premium for employer-sponsored health insurance was $7,188 for single coverage — a 4 percent increase over the prior year. For family coverage, the average premium rose 5 percent in 2019 to $20,576.
Now, in the wake of COVID-19, that cost could be exacerbated, as health plans look for ways to recoup the cost of mass testing and widespread treatment. For example, in New York, insurers originally sought a near-12 percent rate hike to health plans. The state government stepped in to quash that plan, instead opting for only a marginal hike, but that’s just for 2021. In 2022 and beyond, health care costs have the potential to soar.
Kathy Williams Chiang is an established business analytics practitioner with expertise in guided analytics, analytic data mart development and business planning. Prior to her current position as VP, business insights, at Wunderman Data Management, Chiang consulted with Aspirent on numerous analytic projects for several multi-national clients including IHG and Coca-Cola, among others. She has also worked for multi-national corporations including Telecommunications Systems of Trinidad and Tobago, Acuity Brands Lighting, BellSouth International and Portman Overseas. Chiang is experienced in designing and developing analytic tools and management dashboards that inform, matter anddrive action. She is highly skilled in data exploration, analysis, visualization and presentation and has developed solutions in telecom, hospitality and consumer products industries covering customer experience, marketing campaigns, revenue management and web analytics.
Andrew Roman Wells is the chief executive officer at Aspirent, a management-consulting firm focused on analytics. He has extensive experience building analytical solutions for a wide range of companies, from Fortune 500s to small non-profits. He is also co-author of "Monetizing Your Data: A Guide to Turning Data Into Profit-Driving Strategies and Solutions."
Maria T. Vullo was confirmed by the New York State Senate as Superintendent Financial Services on June 15, 2016. She was nominated for the position by Governor Andrew Cuomo. As Superintendent, she is responsible for protecting consumers and markets in New York State from fraud and financial crises, as well as reforming the regulation of financial services to keep pace with the industry’s rapid evolution.
Prior to joining DFS, Ms. Vullo was a litigation partner at Paul, Weiss, Rifkind, Wharton & Garrison LLP, where she led civil, criminal, and regulatory investigations before courts and governmental authorities across the country. Ms. Vullo also served as Executive Deputy Attorney General for Economic Justice Division in the Office of the New York State Attorney General, under then New York State Attorney General Cuomo. There she oversaw the Bureaus of Investor Protection, Antitrust, Real Estate Finance, Consumer Frauds and Internet, leading investigations across New York State to protect investors and consumers from fraud.
Over the course of her career, Ms. Vullo’s specific legal experience has included litigations and investigations involving the financial services sectors and fraud, real estate, health care, insurance, tax, consumer protection, bankruptcy, antitrust, and constitutional law.
An accomplished trial lawyer, Ms. Vullo has also argued before the U.S. Supreme Court, the U.S. Courts of Appeals for the Second, Ninth, and Tenth Circuits, and the New York State Appellate Division.
Ms. Vullo is a recognized leader in protecting women’s rights, including representing women raped by soldiers during the 1992-1995 Bosnian War – a case in which she secured a $745 million jury verdict for the plaintiffs. Her pro bono work also includes securing a $100 million jury verdict representing abortion providers whose lives had been threatened by an online “hit list” and numerous amicus curiae briefs to the U.S. Supreme Court in significant civil rights cases.
Ms. Vullo was twice nominated by the New York State Commission on Judicial Nomination as a candidate for Associate Judge of the Court of Appeals. She has been named a “New York Super Lawyer” by Super Lawyers Magazine and has been included in numerous leading lawyer lists published by the National Law Journal and other leading publications.
Ms. Vullo recently received the New York Women Making a Difference Award from Eleanor’s Legacy, the Humanitarian of the Year Award from the Interfaith Nutrition Network, and the Distinguished Corporate Citizen Award from A Better Balance, among many other awards and professional recognitions.
Ms. Vullo earned her J.D. from New York University School of Law, an M.P.A. from the New York University Wagner Graduate School of Public Service, and a B.A. from the College of Mount Saint Vincent. She clerked for the Hon. John A. MacKenzie, U.S. District Court, Eastern District of Virginia, following law school prior to entering private practice.
So, if an even bigger health care premium crunch is coming, is there any way for taxpayers to find some relief? Potentially.
Last year, President Donald Trump issued Executive Order 13877, which directed the Internal Revenue Service on how to treat certain types of health plan arrangements. This year, the IRS responded by issuing proposed regulations. These new regulations included guidance for two alternate health care strategies — direct primary care, or DPC, arrangements and health care sharing ministries, or HCSMs. Under the proposed regulations, amounts paid for DPC arrangements and HCSMs are treated as deductible medical expenses. And that just may be the key to unlocking the respite many taxpayers desperately need.
What are DPC arrangements and HCSMs?
Before ditching traditional health insurance plans, taxpayers first need to understand how DPC arrangements and HCSMs work. Because these arrangements can take on a variety of forms, they will need to inquire about specific eligibility requirements and any limitations on the types of health services covered.
Under DPC arrangements, a patient contracts with their doctor for the provision of typical primary care services (e.g., preventative care, annual checkups, laboratory tests, etc.). Fees are usually fixed and paid on an annual or monthly basis (a typical monthly fee for a DPC arrangement is around $100), and in some cases doctors may charge an additional visit fee when services are performed. Obviously, this would be far more affordable than traditional health plans; however, many patients that pursue DPC arrangements also enroll in a high-deductible health plan to cover visits to specialists, urgent care or hospitals.
HCSMs are organizations whose members share medical expenses in accordance with a common set of ethical or religious beliefs, thus creating a cost-burden sharing system. According to the Alliance of Health Care Sharing Ministries, 1.5 million Americans are active members of an HCSM, and to date, the Department of Health and Human Services has certified 108 HCSMs.
That doesn’t mean it’s a slam dunk option for everyone, though. Proposed regulations lay out some detailed criteria that a group has to meet to gain HCSM status. For example, the organization has to have been in existence at all times since Dec. 31, 1999, and medical expenses of its members must have been shared continuously and without interruption since at least that date. It also must conduct an annual audit that’s performed by an independent CPA firm in accordance with GAAP, and have that audit made available to the public upon request. But if an organization can check all those boxes, it raises some intriguing options for some taxpayers that may be looking to save money during these uncertain times.
The grey area
While some of these options may seem enticing, they won’t be ideal for every taxpayer. For example, it appears that the IRS suspects its definition of a DPC arrangement may be limiting. Therefore, the agency is requesting comments on whether to expand the definition to include contracts with nurse practitioners, clinical nurse specialists or physician assistants who provide primary care services. Also, the IRS is requesting comments on whether other medical arrangements that don’t meet the definition of direct primary care (e.g., dental care or certain specialty services) should be included.
Meanwhile, the biggest disadvantage of HCSMs is inconsistent health coverage. HCSMs aren’t required to cover pre-existing conditions, cap out-of-pocket expenses or cover essential health benefits. They also can impose annual and lifetime benefit caps. In addition, because they’re based on common ethical or religious beliefs, HCSMs may require their members to abstain from certain activities. For some, this may seem too restrictive.
What’s more, if a taxpayer wants to take advantage of a health savings account, taking part in a DPC arrangement would limit, or in an HCSM’s case, outright preclude an employee from contributing to that HSA, which can offer substantial tax benefits.
The jury’s out
As health care costs continue to soar, some taxpayers will undoubtedly want to consider health care alternatives, but tax pros will have to weigh all the pros and cons before suggesting an alternative. Depending on the taxpayer’s circumstances, a DPC arrangement or an HCSM could either be a great fit or a square peg in a round hole. Preparers can help determine which category — if any — is right for their clients.
