WASHINGTON (AP) — President Barack Obama says Dr. Vivek Murthy’s confirmation to serve as U.S. surgeon general will better position the nation to save lives abroad and protect Americans at home.

Obama says Murthy has a lifetime of public health experience dealing with diseases and health promotion that he’ll bring to the job. He says Murthy’s confirmation also helps the U.S. continue to combat Ebola in the U.S. and in West Africa. Obama says Murthy will start right away to ensure every American has necessary information to keep their families safe.

The Senate approved Murthy’s nomination late Monday despite longstanding opposition from some lawmakers over his public support for gun control. Murthy is a 37-year-old physician and Harvard Medical School instructor.

By Jay Hancock
Kaiser Health News
WASHINGTON, D.C. — For two decades Atlanta restaurant owner Jim Dunn offered a group health plan to his managers and helped pay for it. That ended Dec. 1, after the Affordable Care Act made him an offer he couldn’t refuse.

Health law subsidies for workers to buy their own coverage combined with years of rising costs in the company plan made dropping the plan an obvious — though not easy — choice.
“I had a lot of regrets going into it,” Dunn, who owns three Italian Oven restaurants in suburban Atlanta, said of his decision. “I don’t think I have as many now — only because I’ve seen the affordability factor for my managers improve.
Dunn and five managers are now covered under individual plans bought on healthcare.gov. How many other owners make the same decision will help set the future of small-business health insurance. Although the evidence so far is mixed, brokers expect more firms to follow in the next few years.

Companies like Dunn’s — those with fewer than 50 workers — provide medical coverage to roughly 20 million people. Unlike larger employers, they have no obligation under the health law to offer a plan. Now they often have good reason not to.

If employees qualify for government subsidies, like the managers who switched from Italian Oven’s corporate insurance to individual Obamacare coverage, everybody can win.

Owners don’t have to pay premiums, meaning they can give workers raises, invest in equipment or add to profits instead. And employee take-home pay can rise if subsidies — available even to families with middle-class incomes — are worth more than what a company was contributing.

Whether to cancel a company plan and let workers buy insurance on healthcare.gov or another online exchange “is something that I would say comes up in every conversation with a small-group” employer, said Adam Berkowitz, a consultant with Caravus, a benefits firm based in St. Louis.

“I just had another [small] business call in today and say, ‘You know, we can’t do it. We’re packing it in,’” said Roger Howell, head of Howell Benefit Services in Wilkes-Barre, Pa.

Anthem, the largest seller of small-business health insurance, lost almost 300,000 members in such plans — many more than expected — in the first nine months of the year. That was 15 percent of the enrollment. Many of those consumers are presumably switching to individual plans sold through exchanges, including those offered by Anthem, officials said.

Part of compensation

It’s far from clear, however, that most companies will take the same steps as Italian Oven.

Many small employers see health coverage as an essential piece of compensation. They note that premiums in company-sponsored plans are tax-deductible — for workers as well as employers — while the tax advantages of individual plans are limited.

“I feel like we have to have a medical plan in order to hire people and keep them employed,” said Dan Allen, head of a 15-worker engineering firm in Decatur, Ill. Allen Engineering renewed its Coventry Health Care plan for 2015 even though the premiums rose 21 percent, he said.

No other major insurer has reported cancellation of small-business plans at the same rate as Anthem.

“We didn’t see that,” said Rick Allegretti, vice president of marketing at Health Care Service Corp., operator of Blue Cross plans in five states, including Illinois and Texas. “We actually saw our [small-group] business grow slightly — mind you it’s probably a 10th of a percent.”

Businesses shifting workers into the individual exchanges tend to be the very smallest, employing a handful of people, said Skip Woody, a partner at Hill, Chesson & Woody, a North Carolina benefits firm. “Anything above 15, we haven’t had any dropping coverage,” he said.

Instead, many small companies are taking advantage of rules letting them maintain insurance bought before the health law took effect. President Barack Obama, who promised consumers they could keep coverage they liked, allowed carriers to extend noncompliant plans after facing fierce criticism over their imminent extinction.

Most, but not all, states approved the adjustment. Because older policies may lack features required by the health law and because their rates are often set according to employee health history, not community-wide costs, they can be less expensive than compliant plans, say brokers and consultants.

“I haven’t sold one of the new plans yet” to a small employer, said John Jaggi, an Illinois broker and consultant. Faced with price increases of as much as a third or more for new plans, all 40 or so of his small-business clients including Allen Engineering renewed older coverage for 2015, he said.

Heavy renewal of old plans plus workers shifting to individual coverage help explain why the health law’s online portal for new small-business plans has attracted only modest interest, analysts say.

‘The responsible thing’

For some companies there is logic to ending coverage altogether.

For Italian Oven’s Dunn, “it made sense to recommend that he drop coverage,” said Elena Merino, CEO of the Meridian Group, a benefits firm in Alpharetta, Ga. “It hurts me. But that was the responsible thing to tell him.”

Italian Oven employs the equivalent of about 30 people — less than the 50-worker threshold that would get it fined for not sponsoring insurance. The company does not offer coverage to servers and kitchen staff, but full-time managers have always had a plan.

All are eligible for tax credits to buy insurance on healthcare.gov, said Dunn. Next year, the subsidies are available for individuals with income of up to $46,680 and families of four with income of up to $95,400.

With subsidies factored in along with unrelated pay increases, the managers “are going to be saving money out of the deal” while getting coverage comparable to what they had before, Dunn said. “My managers actually got excited about it because they’re saving money on their health insurance.”

Brokers expect more small businesses to make the same move, especially after the ability to extend older, noncompliant plans expires between now and the end of 2017, depending on state policy. Allen, the engineering firm executive, is concerned premiums could rise even higher next year than they did for the 2015 renewal.

“If it’s up in the 25- to 30-percent increase [range] — I’ve heard as high as 40 — we’ll just have to drop it,” he said. “Turn everybody loose.”

 Jay Hancock is a reporter for Heartland Health Monitor, a news collaboration focusing on health issues and their impact in Missouri and Kansas.

TOPEKA, KAN. – Former Kansas City builder F. Jeffrey Miller has been sentenced to three years in federal prison for violating the terms of his release when he became involved in a new real estate scam, U.S. Attorney Barry Grissom announced in a media release on Monday.

Miller, 53, was sentenced to 72 months in federal prison in August 2012 after a jury convicted him of bank fraud, money laundering and criminal contempt. On Jan. 10, 2014, he entered supervised release.

In a 16-page order issued last month, U.S. District Judge Julie A. Robinson cited evidence that Miller lied to his probation officer about his involvement with his son, Brandon, in a company called Tri-States Holding, LLC (TSH). She cited “substantial evidence about the fraudulent practices and transactions” by the company.

During sentencing hearings, prosecutors submitted evidence that Miller began planning a new business while he was in prison. He formed the new company with his 23-year-old son, Brandon. Although Brandon Miller was represented as the owner, his father controlled the company. The Millers claimed to be in business to buy, refurbish and sell houses. In fact, Judge Robinson said in her order, the business was engaged in a “contract for deed scam.”

The company purchased more than 40 houses at Jackson County, Mo., tax sales and then advertised the houses for sale to low-income people in the urban core of Kansas City. The company advertised home ownership for just $500 down, sweat equity of no more than $2,000 in the form of cosmetic repairs including painting and clean up, and then monthly payments of $399. The buyers signed contracts for purchase prices in the $35,000 range.

Prosecutors presented evidence the company failed to complete promised repairs, performing shoddy repairs or virtually no repairs at all and then harassed and threatened buyers who ceased to make payments.

Judge Robinson ruled Miller violated four conditions of his supervised release by:

Controlling the new company even though he was prohibited from working in any capacity involving authority in financial matters.
Telling his probation officer that that he was a mere laborer at the new company when in fact he controlled the company.
Making false monthly reports to the probation office that he was not committing any federal crimes.
Making threats of bodily harm to a woman who purchased a house from the new company.
Grissom commended the Internal Revenue Service – Criminal Investigation and Assistant U.S. Attorney Richard Hathaway for their work on the case.

DETROIT (AP) — At least 42 people have died and 58 have been injured in crashes involving General Motors cars with defective ignition switches.

Attorney Kenneth Feinberg, who was hired by GM to compensate victims, updated the totals Monday.

Feinberg says he has received 251 death claims and 2,075 injury claims since August.

The fund so far has deemed a total of 100 claims eligible for compensation.

GM knew about faulty ignition switches in Chevrolet Cobalts and other small cars for more than a decade but didn’t recall them until February. The switches can slip out of the “on” position, which causes the cars to stall, knocks out power steering and turns off the air bags.

Feinberg will accept claims until Jan. 31.

SETH BORENSTEIN, AP Science Writer

WASHINGTON (AP) — Federal meteorologists say last month was only the globe’s seventh warmest November on record. That’s the first time since July that a month hasn’t broken the record for heat.

Still, National Oceanic and Atmospheric Administration climate monitoring chief Deke Arndt says after 11 months, 2014 is likely to break the annual heat record set in 2010. It was the hottest fall, September to November, on record.

If December is at least 0.76 degrees warmer than the 20th century average, then 2014 will set the global record. Since 2000, December has averaged 0.95 degrees warmer than that standard.

Arndt said the world’s oceans set a new monthly heat record in November, the seventh time in a row, making it more likely that 2014 will set the heat record.

TOPEKA, Kan. (AP) — Prosecutors say a man should be executed for kidnapping, raping and killing an 8-year-old Topeka girl, while the defense is calling for a life prison sentence.

The Topeka Capital-Journal reports that closing arguments were made Monday in the penalty phase of the trial for Billy Frank Davis Jr. The 31-year-old was convicted last week of 10 counts, including capital murder, in the May 2012 killing of Ahliyah Nachelle Irvin.

Defense attorney Mark Manna says imprisoning Davis for the rest of his life will protect the public.

Chief deputy district attorney Jacqie Spradling’s posted 30 photographs on a TV monitor depicting the battered child, her injuries and her blood smeared in the basement crime scene. Spradling says jurors will know what to do if they look at the images.

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TOPEKA, Kan. (AP) — Defense attorneys have finished making their case that a convicted murderer should be sentenced to life in prison and not executed for kidnaping, raping and killing an 8-year-old Topeka girl.

The Topeka Capital-Journal reports clinical psychologist June Cooley of Atlanta testified Monday that Billy Frank Davis Jr. has bipolar disorder with psychotic features and post-traumatic stress disorder. She says his symptoms worsened when he stopped using his prescription medication and began drinking alcohol and using cocaine.

Under cross-examination, Cooley acknowledged that Davis was dangerous.

Davis was convicted last week of 10 counts, including capital murder, in the May 2012 killing of Ahliyah Nachelle Irvin.

The defense rested its case after Cooley testified. Jurors will begin deliberating his sentence after the defense and prosecution make closing arguments.