Jared Kaltwasser

More small and midsized firms are opting for self-insured health plans, according to a new report.

 39% of private-sector establishments now have at least one plan that is self-insured, up from 28.5% in 1996. The number of employees enrolled in self-insured plans has increased from 58.2% to 60% between 2013 and 2015, the group said.

The results are based on data from the US Census Bureau’s Medical Expenditure Panel Survey Insurance Component.

Report author Paul Fronstin, director of EBRI’s Health Research and Education Program, said the findings “are consistent with the prediction that the ACA would cause more small and midsized employers to adopt self-insurance plans.”

The motivation appears to be cost savings. The Affordable Care Act’s passage in 2010 brought a spate of new mandates, fees, and taxes, thus driving up the cost of health coverage overall. However, self-insured plans aren’t subject to all of those mandates. For instance, self-insured plans aren’t required to include coverage for the ACA’s package of 10 “essential health benefits,” including pediatric oral and vision care. As a result of these and other factors, self-insurance is generally less expensive for employers.

However, self-insurance also carries a major risk. If a group’s health expenses exceed the amount paid in insurance premiums, the self-insured employer is stuck paying the extra costs. If an employer uses an outside commercial insurer, the insurer is on the hook for cost excesses. For this reason, self-insurance has traditionally been more common among large employers, since they have a larger pool of people paying into the insurance fund. Many self-insured firms purchase stop-loss insurance policies, which help cover costs if an employers’ health insurance claims exceed a pre-determined amount.

Notably, EBRI found some large employers are now turning away from self-insurance. The percentage of large employers choosing to self-insure dropped from 83.9% to 80.4%.

The shift toward self-insurance could have wider implications for the insurance market. A 2012 report from 

 noted that small employers with younger employees have a strong financial incentive to opt for self-insurance, since their employees’ health costs are likely to be lower. However, small employers with older employees would be more likely to stay in the commercial market, skewing the pool of commercial customers older and likely driving up premiums for everyone in the commercial market. 

Articles

The Affordable Care Act appears to be driving more small and midsized employers toward self-insurance. The change could impact costs for a wide swath of the public.

More Small, Medium Firms Choosing Self-Insurance

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These five stories were our most popular last week.

The DMD Top 5 for the Week Ending August 4

An Illinois man received a $675,000 settlement this week after his dentist allegedly dropped a dental file down 

 that the dentist seemed to be looking for something after the procedure, but the dentist downplayed the situation and 

“She told me when she found it she will be calling me,” 

pain in his abdomen. An X-ray revealed the presence of the file, and 

 filed a lawsuit, and this week his legal team announced a 

Journal of the American Dental Association

 found damage from swallowed dental objects can be minimized if caught and retrieved early. If the object isn’t located quickly, more serious consequences—even death&mdash;can occur. 

 of 78 swallowed object cases in Austria found 86% of the objects passed through the gastrointestinal tract spontaneously without complication. Eleven percent were removed with endoscopy, and 3% required surgery.

has not commented publicly on the settlement. A search of Illinois professional licensure database 

shows no record of disciplinary actions against the dentist.

A Chicago area man spent more than a month in the hospital after a dentist allegedly dropped a dental file down his throat. Now the man is receiving more than half-million dollars.

Illinois Man Gets $675,000 After Swallowing Dental File During Root Canal

Dental industry groups are working hard to tamp down public confusion after a widely circulated news report this week suggested that flossing is effectively useless.

Flossing suddenly became a hot topic of conversation Tuesday when the Associated Press (AP) published 

 asserting that flossing has little or no effect on gum disease. The AP based the claim on five studies from the past 11 years, each of which found little or weak evidence to support flossing.

The research is important because the government is required to offer a scientific basis for the federal dietary guidelines it issues every five years. The government has recommended daily flossing since 1979.

Last year, the AP filed a Freedom of Information Act request with the government seeking the scientific rationale behind the flossing recommendation. Instead of directly responding to the request, the government quietly removed the flossing recommendation from its 2016 version of the guidelines. When asked about the change, the government told the AP that there wasn’t a sufficient amount of research to justify flossing.

The AP’s report—under the headline “Medical Benefits of Dental Floss Unproven”—quickly boomeranged around social media, with major publications like 

However, dental organizations were unconvinced.

The American Dental Association (ADA) quickly responded with 

 calling interdental cleaners “an essential part” of oral health and affirming its recommendation that patients brush for two minutes twice a day with fluoride toothpaste and use an interdental cleaner like floss once per day.

“Cleaning between teeth removes plaque that can lead to cavities or gum disease from the areas where a toothbrush can’t reach,” the ADA said. “Interdental cleaning is proven to help remove debris between teeth that can contribute to plaque buildup.”

The ADA also noted that flossing’s effectiveness can be undermined by poor technique.

, the American Academy of Periodontology (AAP) said the studies cited by the AP are insufficient.

“Because the development of periodontal disease is slow in nature and because a variety of factors can impact its progression, studies that examine the efficacy of daily flossing are best conducted over a number of years and among a large population,” the AAP said. “Much of the current evidence does not utilize a large sample size or examine gum health over a significant amount of time.”

The AAP also said many of the studies didn’t measure inflammation or clinical attachment loss, which it says are the best markers of periodontal disease.

While both the ADA and the AAP were resolute on the importance of cleaning between your teeth, the ADA did offer one bit of wiggle room. Patients who don’t like flossing don’t have to use floss—they can also use other interdental cleaners, such as picks and water irrigation.

Despite a widely circulated report, dentists should continue to urge their patients to floss, according to the American Dental Association. 

Don't Believe the Hype: Dental Groups Say Flossing Still Essential

If you’re one of millions of Americans still paying off their federal student loans, the US Department of Education has a message for you: They want to be a better partner.

The Department of Education this week outlined a series of changes they say will improve the customer experience and protect borrowers against default and fraud. If the plan comes to fruition, it could eliminate some headaches for dentists with major student loan debt.

memo from US Secretary of Education Ted Mitchell

. The memo follows an executive order from President Barack Obama last year that established a “Bill of Rights” for student borrowers.

“This guidance has the power to strengthen our student loan servicing system by providing long-overdue improvements to servicing,” said Deputy Treasury Secretary Sarah Bloom Raskin, 

The changes fit into five broad categories:

• Developing economic incentives that encourage repayment, while eliminating fixed fees that the department believes serve as a disincentive for struggling borrowers.

• Improving oral and written communication with borrowers to provide accurate and actionable information, particularly for borrowers at a high risk of default.

• Streamlining and coordinating Department of Education communications to ensure adequate, timely, and consistent communications from the agency.

• Speeding up responses to inquiries and complaints and increasing transparency to solutions when problems occur. The agency also plans to increase accountability by better monitoring its servicing vendors.

• Disclosing more data to the public in order to boost transparency about the agency’s performance.

The changes are largely focused around reducing defaults and improving customer service when problems occur. It’s unclear what changes, if any, will be noticed by borrowers who aren’t at risk of default and don’t encounter problems repaying their loans.

However, the new framework could become a roadmap for other lenders, if federal regulators have their way. The student loan improvement plan was developed in coordination with the Consumer Finance Protection Bureau, which is charged with protecting consumers in their dealings with financial services firms.

“These servicing standards can help to increase accountability and improve the quality of information borrowers receive about their loans and the affordable repayment plans they are entitled to by law,” said Rich Cordray, the CFPB’s director, in the press release. “We will continue working to stamp out illegal practices and look forward to the implementation of these critical protections that all student loan borrowers deserve.”

The CFPB has been working with the Treasury Department to find borrowers who are eligibility for loan forgiveness due to disability. They’ve also launched a pilot program to find new approaches to helping delinquent borrowers.

In the meantime, the Education Department has set up an online portal to file complaints or report suspicious activity. The portal, called the Federal Student Aid Feedback System, 

The US Department of Education says it needs to do a better job of helping struggling borrowers and responding to customer complaints.

Department of Education Pledges to Improve Customer Service for Student Borrowers

Anyone who travels frequently has likely had the experience of running to catch a flight or get from one gate to another.

If a new company has its way, you won’t have to run anymore. You can drive.

 has developed what it’s billing as “the world’s first motorized, rideable carry-on smart luggage.” You read that right. It’s a carry-on bag that is equipped with wheels, a small motor, and handlebars for steering.

With a top speed of 8 miles per hour, the company says riding the bag is three times faster than walking. The bag comes with a battery that lasts for six miles or can charge your phone 10 times.

Will travelers actually want to use such a device? Apparently, yes. The company is funding its launch through crowdfunding. And while an earlier 

Kickstarter campaign fell short of its goal

 was at 89% of its $50,000 fundraising goal a day after the campaign went live.

The bag is the brainchild of Kevin O’Donnell and Boyd Bruner, two entrepreneurs from Chicago. Bruner is also the winner of the 2014 AMA Pro Road Racing Daytona 200.

"We created Modobag to revolutionize the way people travel and introduce one of the biggest updates to carry-on luggage since rolling suitcases were launched in the 1970s," said O'Donnell, the company’s CEO, 

A limited number of customers who pre-order the bag can get it for $995, a 30% discount off what will be the retail price, the company said. Though the price is higher than most luggage, it also comes with a feature that allows users to locate their bag using GPS, a tool that could come in handy if an airline loses your bag.

. There are some drawbacks. For one, the bag weighs in at 19 pounds. That might not be bad considering it contains a motor. However, it constitutes nearly half of the 

 most US airlines allow for a carry-on bag.

It’s also unclear whether travelers will even be allowed to use the bags. The company says its bag is approved by the Transportation Security Administration. However, when so-called “Hoverboards” became a popular item last year, airlines quickly banned the devices over fears their lithium ion batteries could start onboard fires.

So far, no major airline has commented on Modobags. 

A new startup has created a motorized suitcase, which can whisk travelers through airports at speeds three times faster than walking.

Luggage Startup Hopes Travelers Race to Buy Motoroized Suitcase

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Our weekly look at the past week's most popular stories.

The DMD Top 5 for the Week Ending July 22

With an election year just a few months away, much of the political debate has centered on a handful of billionaires who like to use their largesse to support political candidates of their liking.

However, most of the world’s billionaires aren’t involved in politics, and most aren’t household names. In fact, many billionaires live in unexpected places. For instance, 25 billionaires live in Shenzhen, China, a city not known to many Americans. Meanwhile, Delhi and Mumbai, India have a combined 50 billionaires.

, which each year tracks the wealthiest individuals in the world, used its data to compile a list of cities with the most billionaires.

Altogether, the magazine counted 1,826 billionaires in the world in 2015, an increase of 290 from 2014. Those billionaires had an aggregate wealth of more than $7 trillion.

Not surprisingly, Bill Gates was named the richest man in the world, with an estimated wealth of $79.2 billion. Carlos Slim Helu of Mexico held steady at No. 2, and the “Oracle of Omaha,” Warren Buffett, was in third place.

Notably, none of the richest three’s hometowns made it on the list of cities with the most billionaires.

So which cities did make the list? Below we present the eight cities with the most billionaires, according to 

The world's richest people are concentrated in some of the world's biggest cities. Which cities? The answers might surprise you.

The World's Richest People Are Concentrated in These 8 Cities

When an Ohio periodontist refused to hand over a patient’s dental records, the patient knew something was wrong.

The patient called the Geauga County Prosecutors Office, who quickly opened up a probe into the matter. Investigators found more than they bargained for.

Last week, prosecutors arrested Jeffrey Becker, DDS, on charges of practicing dentistry without a license and prescribing narcotics without a license.

As it turns out, the state dental board had already been watching Becker at the time the patient called the county prosecutor to complain about Becker’s refusal to turn over records.

Becker lost his license to practice dentistry in May after a variety of charges. 

 reported that the charges included refusing to undergo an assessment for alcohol and drug impairment.

It wasn’t the first time Becker has gotten into trouble with state regulators.

 reported that Becker had his Ohio license suspended in 2007, but was allowed to return to practice after signing a consent agreement. Meanwhile, the state of Wisconsin revoked Becker's license to practice there in 2013. 

Despite losing his license on May 18, officials allege Becker extracted a tooth in late May and prescribed medication to the patient.

Then, in June, prosecutors say Becker sedated a patient and delivered narcotics intravenously, even though he no longer had authorization to administer the drugs.

In mid-June, officials from the Ohio State Dental Board confronted Becker, who reportedly admitted to treating patients “because he cared about his patients and they were in pain, and he was trying to help them.”

A Geauga County investigator noted that before the drugs were involved, practicing without a license might have only been a misdemeanor. But the investigator told the Maple Leaf that the use of narcotics in those procedures brought the charges up to the level of a felony.

Meanwhile, patients might still have trouble getting access to their records. Prosecutors seized documents from Becker’s practice, but they did not take patient dental records. If patients want to access their records, prosecutors said they’ll have to contact Becker.

An Ohio periodontist kept practicing despite losing his license for the third time. He now faces drug charges.

Ohio Periodontist Faces Drug Charges After Practicing Without a License

Dental insurers are putting a major push behind a bill they say would expand consumers’ ability to shop around for dental coverage.

, was introduced last week by Kansas Republican Sen. Pat Roberts and Sen. Michael Bennet, a Colorado Democrat. It has been referred to the Senate Health, Education, Labor, and Pensions Committee.

The bill is dubbed the “Aligning Children’s Dental Coverage Act.” Proponents say it would clear up confusion about whether certain insurance customers can buy standalone dental coverage for their children.

Under the Affordable Care Act of 2010, health plans are required to offer coverage for pediatric dental care. Health insurance plans sold on state or federal healthcare exchanges can satisfy the requirement by incorporating dental coverage into the health plan, or by offering dental coverage as a standalone option.

However, the healthcare reform law isn’t clear about whether health insurers who sell coverage outside of the state and federal marketplaces have the same flexibility when it comes to meeting the pediatric dental coverage requirement. As a result, insurers and employers must navigate a range of state regulations and market conditions, which in some areas leave consumers with little or no choice of dental plans.

The “Aligning Children’s Dental Coverage Act” aims to fix the situation by allowing consumers to access the same dental care options regardless of where they get their health insurance.

"The Senate and House legislation offers a simple, but crucial solution to ensure that families across the nation continue to have the access they need and the choices they deserve in obtaining dental benefits," said Jason Daughn, vice president of government relations for Delta Dental Plans Association, in a press release.

Delta Dental said the change makes sense, since about 99% of Americans purchase their dental insurance separately from their health insurance. The legislation has the support of a number of business groups, including the American Supply Association, the Council for Affordable Health Coverage, the National Retail Federation, and the Small Business and Entrepreneurial Council.

 to a committee discussing the House version of the bill, a coalition of business groups (including those named above) said the current system is confusing and untenable.

“Without this clarification, small businesses must contend with the confusion of two differing standards for how dental coverage is offered

one inside and one outside the Marketplaces,” the groups wrote.

, was introduced in September but is still in committee.

Insurers say current law restricts the number of choices some consumers have when shopping for healthcare. 