Employers Eye Moving Sickest Workers To Insurance Exchanges

Originally posted May 7, 2014 by Jan Hancock on www.kaiserhealthnews.org.

Can corporations shift workers with high medical costs from the company health plan into online insurance exchanges created by the Affordable Care Act? Some employers are considering it, say benefits consultants.

"It's all over the marketplace," said Todd Yates, a managing partner at Hill, Chesson & Woody, a North Carolina benefits consulting firm. "Employers are inquiring about it and brokers and consultants are advocating for it."

Health spending is driven largely by patients with chronic illness such as diabetes or who undergo expensive procedures such as organ transplants. Since most big corporations are self-insured, shifting even one high-cost member out of the company plan could save the employer hundreds of thousands of dollars a year -- while increasing the cost of claims absorbed by the marketplace policy by a similar amount.

And the health law might not prohibit it, opening a door to potential erosion of employer-based coverage.

"Such an employer-dumping strategy can promote the interests of both employers and employees by shifting health care expenses on to the public at large," wrote two University of Minnesota law professors in a 2010 paper that basically predicted the present interest. The authors were Amy Monahan and Daniel Schwarcz.

It's unclear how many companies, if any, have moved sicker workers to exchange coverage, which became available only in January. But even a few high-risk patients could add millions of dollars in costs to those plans. The costs could be passed on to customers in the form of higher premiums and to taxpayers in the form of higher subsidy expense.

Here's how it might work. The employer shrinks the hospital and doctor network to make the company plan unattractive to those with chronic illness. Or, the employer raises co-payments for drugs needed by the chronically ill, also rendering the plan unattractive and perhaps nudging high-cost workers to examine other options.

At the same time, the employer offers to buy the targeted worker a high-benefit "platinum" plan in the marketplaces. The plan could cost $6,000 or more a year for an individual. But that's still far less than the $300,000 a year that, say, a hemophilia patient might cost the company.

The employer might also give the worker a raise to buy the policy directly.

The employer saves money. The employee gets better coverage. And the health law's marketplace plan --required to accept all applicants at a fixed price during open enrollment periods -- takes on the cost.

"The concept sounds to[o] easy to be true, but the ACA has set up the ability for employers and employees on a voluntary basis to choose a better plan in [the] Individual Marketplace and save a significant amount of money for both!" says promotional material from a company called Managed Exchange Solutions (MES).

"MES works with [the] reinsurer, insurance carrier and other health management organizations to determine [the] most likely candidates for the program."

Charlotte-based consultant Benefit Controls produced the Managed Exchange Solutions pitch last year but ultimately decided not to offer the strategy to its clients, said Matthew McQuide, a vice president with Benefit Controls.

"Though we believe it's legal" as long as employees agree to the change, "it's still gray," he said. "We just decided it wasn't something we wanted to promote."

Shifting high-risk workers out of employer plans is prohibited for other kinds of taxpayer-supported insurance.

For example, it's illegal to induce somebody who is working and over 65 to drop company coverage and rely entirely on the government Medicare program for seniors, said Amy Gordon, a benefits lawyer with McDermott Will & Emery. Similarly, employers who dumped high-cost patients into temporary high-risk pools established by the health law are required to repay those workers' claims to the pools.

"You would think there would be a similar type of provision under the Affordable Care Act" for plans sold through the marketplace portals, Gordon said. "But there currently is not."

Moving high-cost workers to a marketplace plan would not trigger penalties under the health law as long as an employer offered an affordable companywide plan with minimum coverage, experts said. (Workers cannot use tax credits to help pay exchange-plan premiums in such a case, either.)

Half a dozen benefits experts said they were unaware of specific instances of employers shifting high-cost workers to exchange plans. Spokespeople for AIDS United and the Hemophilia Federation of America, both advocating for patients with expensive, chronic conditions, said they didn't know of any, either.

But employers seem increasingly interested.

"I have gotten probably about half a dozen questions about it in the last month or so from our offices around the country," says Edward Fensholt, director of compliance for the Lockton Companies, a large insurance broker and benefits consultant. "They're passing on questions they're getting from their customers."

Such practices could raise concerns about discrimination, said Sabrina Corlette, project director at the Georgetown University Center on Health Insurance Reforms.

They could also cause resentment among employees who didn't get a similar deal, Fensholt said.

"We just don't think that's a good idea,” he said. "That needs to be kind of an under-the-radar deal, and under-the-radar deals never work," he said. Plus, he added, "it's bad public policy to push all these risks into the public exchange."

Hill, Chesson & Woody is not recommending it either.

"Anytime you want to have a conversation with an employee in a secretive, one-off manner, that's never a good idea," Yates said. "Something smells bad about that."


Measuring leaves of absence in concert with the ACA

Originally posted May 7, 2014 by Ed Bray, J.D. on https://ebn.benefitnews.com

I can unequivocally say that administering employee leaves of absence has been the most challenging responsibility of my HR career. Why? For every employee leave you must ensure that an orchestra of different people, laws, and systems play in perfect concert with each other.  Not an easy task when you consider the following:  trying to determine who and when employees are on leave; often abiding by multiple, complex leave laws; and dealing with HRIS tracking shortcomings (if you even have a tracking system).

OK, so what’s my point?  Thanks to the Affordable Care Act, many organizations’ leave of absence orchestras are going to need to start sounding like the London Symphony Orchestra in the next few months.

Organizations that are required to follow the shared responsibility (play or pay) rules that use the look-back measurement period to determine whether variable hour, seasonal, or part-time employees are eligible for employer health insurance benefits must ensure each employee’s average hours of service are calculated accurately for the initial and standard measurement periods.   A key component of the average hours of service calculation is the impact of any employee special unpaid leave (FMLA, leave under USERRA, and jury duty) during the respective measurement period.

The final regulations for the employer shared responsibility rules state that “special unpaid leave” may be defined as unpaid leave under the Family and Medical Leave Act of 1993, the Uniformed Services Employment and Reemployment Rights Act of 1994, or jury duty.  When calculating hours of service for a look-back measurement period, the employer must treat special unpaid leave in one of two ways:

▪       Determine the employee's average hours of service by excluding any periods of special unpaid leave during the measurement period and applying that average for the entire measurement period, or

▪       Impute hours of service during the periods of special unpaid leave at a rate equal to the average weekly hours of service for weeks that are not part of a period of special unpaid leave.

That said, it is critical that each employee’s average hours of service calculation accurately reflects any “special unpaid leave” as any employees that average under 30 hours of service per week or 130 hours of service per calendar month for the respective measurement period do not need to be offered employer-sponsored benefits.  Many employees not offered benefits will be significantly affected as they will be required to enroll in some form of minimum essential coverage or else face a penalty under the ACA individual mandate. In addition, they may feel their hours of service calculation is incorrect and call the Department of Labor to express their concerns.

I recommend organizations focus on making three key business decisions as they prepare for the shared responsibility rules, effective in 2015 for employers with 100 or more full-time employees, including full-time equivalents (FTEs), and in 2016 for some employers with 50-99 full-time employees, including FTEs (certain conditions apply):

▪       How to accurately track employee leaves of absence.

▪       How to handle unpaid state and company leaves of absence for purposes of the measurement period calculations.

▪       Determine which ACA “special unpaid leave” process to use.

Ensure accurate leave of absence tracking

First meet with executive management to make them aware of the shared responsibility rules and noncompliance penalties plus gain support for doing what is necessary to ensure accurate leave of absence tracking. This includes the following (at a minimum):

▪       Making managers and employees aware of the importance of communicating employee leaves of absence to the HR department as soon as they learn about or need them;

▪       Meeting with the IT department to see if they can: 1) accurately track leaves of absence; 2) track different types of leaves; and 3) provide reporting of such leaves during the initial and standard administrative periods. If not, develop a leave of absence tracking mechanism within the HR department.

Handling unpaid state and company leaves of absence for purposes of the measurement period calculations

The federal government has stated its position with regards to three special unpaid leaves, but what about state or company unpaid leaves of absence? How should they be treated under the look-back measurement period calculations?

Given the fact that there is legal uncertainty regarding the answer to this question and handling such a situation incorrectly could have significant ramifications for your organization, I recommend consulting legal counsel to determine the answer for your organization.

Determine which ACA special unpaid leave process to use

I recommend selecting the ACA special unpaid leave process that is going to be the least administratively challenging given all of the new responsibilities associated with the leave of absence tracking process. To date, I have seen more employers select the exclusion method.

So, start tuning up your leave-of-absence orchestra because the effective dates for the shared responsibility rules are right around the corner.


Protecting the next generation of workers with voluntary benefits

Originally posted May 1, 2014 by Andrea Davis on https://ebn.benefitnews.com

As the Affordable Care Act continues to make its presence felt, and as employers look for new ways to control their health care costs and shift more of the responsibility for benefit decision-making on to employees, the role of voluntary benefits is changing. Once viewed as a nice-to-have benefit, some say voluntary benefits should now be advertised and heavily promoted to employees as an important component in their overall portfolio of benefits.

“It’s part of a trend sweeping the industry,” says Chris Hill, CEO of Spotlite, an online enrollment technology company. “This level of [benefits] engagement has never really been required before.”

Rewind a few years to benefit plans with low deductibles and rich benefits and “these supplemental products [were] less relevant,” he says. “Now you’re asking employees to meet a $2,500 or $5,000 deductible and they have to understand how the [health savings account] or [flexible spending account] works with that and why an accident plan, for example, may be complementary to the high deductible plan.”

Millennials in particular can benefit from education about voluntary benefits. While they may view themselves as invincible, they actually have a lot to protect. “They’re not really thinking about all those what-ifs, but probably more than any other generation, they have something to protect,” says Alison Daily, second vice president of clinical and vocational services at The Standard. “They’re very highly educated. A third of them have four-year college degrees, but that comes with a big price tag for them. The average millennial has $29,000 in student loan debt alone.”

And yet millennials are either unaware of voluntary benefits or reluctant to purchase them. Sixty-nine percent of employees age 25-29 don’t own any voluntary benefits, while 71% of those under age 25 don’t own any voluntary products, according to statistics from Eastbridge Consulting Group. Among older age groups, 60% of 45-49-year-olds own some type of voluntary product.

Still, there’s evidence that millenials value voluntary benefits and that the availability of these products may increase employees’ loyalty to the company. According to MetLife’s 12th Annual U.S. Employee Benefit Trends Study, 86% of Generation Y value having benefits personalized to meet their individual circumstances and age.

The challenges of engaging this tech-savvy group are well-known. Millennials have high expectations when it comes to technology and the overall online purchasing process. This is a group that “sends thousands of text messages on a monthly basis,” says Hill. “You’ve got to compete for their limited attention span so those communications need to be highly relevant.”

But for all the talk about how different Millennials are from other generations, Daily believes good communication resonates with everyone, regardless of age. “I think that maybe one of the mistakes people make, or confusion they have, is that the millennials are very different from their non-millennial peers,” she says. “They’re probably not as different as we think.”

Awareness vs. purchase

Still, there are tactics employers can use to better engage millennials in their voluntary benefits, starting with separating the process in their own minds between initial education and purchase.

“You have the initial communication about benefits – what the benefits are, here’s why you should care,” says Hill. Employers should strive for “concise messaging that drives an action and the action you want to drive upfront is getting the employee to learn about what’s offered to them,” he says.

He encourages employers to actively look at email open rates to get a better understanding of subject lines that resonate with millennials. “Relevant information, relevant subject lines, relevant email layouts, relevant electronic communications are going to drive that action,” he says.

Once employers are past that initial awareness phase and on to open enrollment, “you’re adhering to those same principles – how are we going to capture the attention of the user?” says Hill. “Here we actually want to drive decision making about the products.”

It’s that second sale – the actual purchase of voluntary benefits – that gets tricky with millennials, believes Hill, because they tend to say: “I don’t want to call somebody about this product. I want all the information online so I can make a decision. I don’t want to meet with someone or fill out a piece of paper.”

But when it comes to benefits, millennials’ reliance on technology and self-service might be overstated. Face-to-face meetings are still important, even for this generation, says The Standard’s Daily. “I think sometimes [employers] may be thinking it’s got to be glitzy, that they’ve got to text [millennials] or something like that, but really just sitting down with a millennial and going over what these benefits mean … I think it’s the cornerstone to helping them make the right decision.”

The Eastbridge data appear to back up Daily’s assertion. When asked which of several ways they prefer to learn about voluntary benefits, just over half (55%) of employees representing a spectrum of ages chose “speaking with someone in person.” Twenty-one percent, meanwhile, chose “on my own.”

Daily also emphasizes employers shouldn’t feel they have to do all this communication on their own. In fact, she recommends they turn to their benefit brokers and carriers first, before starting any kind of communication program about voluntary. Another tactic, she says, is using peer-to-peer discussions.

“The millennial generation really values recommendations. If you think about looking for a new restaurant you think about Yelp, and the same thing applies to deciding to select disability coverage,” she says. “They’re going to look to their peers to help them make that decision, so having real stories about why colleagues chose to enroll in a benefit may be just what that millennial needs to make that decision to enroll.”

In addition, employers can leverage other successful communication campaigns. “Employers should really think about anything they’ve already done where they successfully communicated to employees and leverage that strategy,” says Daily. “I would look to the leaders of that event and say: ‘What did you do and why did it work?’ Employers may already have some of the skills and they just aren’t thinking about it in that way.”

And while it might seem like a no-brainer, an online enrollment system that facilitates a seamless shopping experience is important for millennials and all employees, for that matter. Not only that, but a mobile site that’s easy to navigate whether employees are using their laptop, iPhone, iPad or Android device.

“If I get an email from Amazon promoting a product I really want and I click on that email and then go on a wild goose chase to find that product, you’re going to lose users and buyers,” says Hill, who also cautions that all the benefit communication in the world is for naught if the buying experience isn’t simple. “If I do a great job communicating these benefits to millennials and then they have to go on to a system that looks like it was built in 1995, and the initial communications are very different than the actual purchase experience, we think that’s really bad. You’re going to lose millennials, who are used to things being easy.”

Among Spotlite’s clients, about 15% of employees use a mobile device to shop for benefits. As mobile devices and smartphones get more sophisticated and make inroads among older generations, Hill only expects this to grow. “Mobile is necessary. It’s something you have to have,” he says. “Enrollment needs to be easy for the end user. So you make it easy by offering it on a computer or a mobile device. It’s a necessary access point for individuals.”


2015 is just around the corner. Are you ready?

Originally posted April 30, 2014 by Dorothy Summers on https://ebn.benefitnews.com

Most of the political discussion surrounding the Affordable Care Act involves whether the law will be further delayed and/or repealed. While the government continues its in-fighting, the Obama Administration has pushed forward. In fact, in the first quarter of 2014, the government issued two significant pieces of final guidance related to implementing the major requirements of the law.

Employer mandate final regulations

The first piece of guidance was the employer mandate final regulations. These “play or pay” rules provide some clarity as well as a deadline for compliance. For large employers—businesses with 100 or more full-time and full-time equivalent employees—the deadline is January 1, 2015, or the month in which your health plans renews in 2015. While 2015 seems far off, the reality is that it is only eight short months from now.

Employers with between 50 and 99 full-time and FTE employees have a bit more breathing room—they have until 2016 to comply. Businesses with fewer than 50 full-time and FTE employees do not need to meet the play or pay requirements.

Information reporting

The second set of final regulations from the government addressed information reporting. These regulations include two separate types of reporting: to employees and to the government. The first reports must be completed using information collected in 2015 and then distributed to employees and the government in 2016. The government will issue a Form 1095 for this reporting.

While 2016 seems well into the future, the collection of required data must begin in January 2015. The reporting will be done on a calendar year basis regardless of whether your health plan operates on the calendar year.

So, are you ready to act on the government’s final guidance? Are you certain? To determine the answer, review your current plan against this checklist:

First, count your employees to determine if you are a large employer and subject to the employer mandate in 2015. If you qualify as a large employer in 2015, take the following steps:

▪   Determine whether health coverage is offered to at least 70% of your full-time employees and their dependents.

▪   Review whether the plan being offered to at least 70% of your full-time employees and their dependents provides minimum value by using one of the three available methods: the minimum value calculator; safe harbor checklists; or actuarial certification.

▪   Confirm the information provided from the fully insured carrier on the Summary of Benefits and Coverage.

▪   Assess the affordability of your lowest-cost single health coverage under one of the IRS’ affordability safe harbors using the W-2, rate of pay, or the federal poverty line.

▪   Provide required information regarding plan coverage and participation in accordance with information return requirements, and file the report in 2016 using 2015 data.

When the government announced last summer that it was delaying the employer mandate, many employers let out a sigh of relief. They relaxed. However, now it’s time to pick up the pace again. Before you know it, 2015 and 2016 will be here and the ACA will be an everyday reality for employers.


6 health care trends for 2014

Originally posted by EBA https://eba.benefitnews.com

2013 was a pinnacle year in health care with the opening of the Affordable Care Act’s health care exchanges. But what can we expect in 2014? EBA spoke with experts across the spectrum to find out.

1. Complying with the ACA

The Affordable Care Act will continue to have a lasting impact into 2014. With the employer mandate pushed off and the penalties delayed as well, brokers will spend most of 2014 making sure their clients are complaint for 2015, says Mark S. Gaunya, principal at Borislow Insurance.

2. Losing coverage

In addition to focusing on compliance in 2014, Gaunya believes that many people will be in for a big surprise on Jan. 1 when “millions wake up and can’t see their doctor.” Gaunya predicts that many people who had coverage will lose it — 110,000 alone in his home state of Massachusetts — and some won’t even realize it until they go to the doctor.

3. Health care eligibility issues

With the ACA and Windsor decision on DOMA, employment lawyer Keith R. McMurdy of Fox Rothschild LLP believes many plan sponsors in 2014 are going to have problems with plan eligibility definitions. “Lots of employers don't really remember that changing eligibility and participation requirements requires an update of plan documents, revisions to SPDs and summaries of material modification,” he says. “I think that as the year progresses between litigation and EBSA audits we are going to see a lot of plans that have conflicting language over how they are being administered. “Plan sponsors that don't do complete review of these eligibility rules are going to find themselves in a world of hurt,” he adds.

4. Uneven risk pool hurts carriers

Insurance carriers whose plans are sold through the exchanges will issue earnings reports much worse than average in 2014, predicts Thom Mangan, CEO of United Benefit Advisors, due to the failure to enroll the young and healthy. Mangan says that after that happens the federal government will offer “some financial assistance to insurance carriers but not enough to make them whole.”

5. A small rise in health care costs

In 2014, the medical cost trend is estimated to be 6.5% by PricewatehouseCoopers Health Research Institute — one full percentage point below 2013’s estimate. After accounting for benefit design changes, such as higher deductibles, the net growth rate will be 4.5% in 2014, pWc predicts.

6. A request to drop coverage

In 2014, individual employees will realize they can get individual health coverage for less than their employer's group health plan, says Rick Lindquist, president of Zane Benefits Inc. “As a result, employees will start asking their employers to drop coverage, which will cause the small businesses health insurance market to implode in favor of defined contribution health benefits,” he says.

 

 

 


Almost Half Of Workers Don’t Know What Impact Affordable Care Act Will Have On Them

Originally posted November 06, 2013 on https://www.insurancebroadcasting.com

Online resources cited as most reliable source of information about law

COLUMBIA, S.C.--(BUSINESS WIRE)--A survey conducted online by Harris Interactive on behalf of Colonial Life & Accident Insurance Company shows nearly half of American workers don’t feel knowledgeable about how the Affordable Care Act will impact them personally.

“Despite all the attention the Affordable Care Act has received in the past few years, nearly half of American workers still say they don’t know much about it”

In a poll of more than 1,000 U.S. employees (full-time and/or part-time)1, 47 percent of workers say they are not very knowledgeable or not at all knowledgeable about the impact the Affordable Care Act will have on them. Thirty-three percent say they’re not very knowledgeable about the law and its proposed personal impact, and 14 percent say they’re not at all knowledgeable.

“Despite all the attention the Affordable Care Act has received in the past few years, nearly half of American workers still say they don’t know much about it,” says Steve Bygott, assistant vice president of core market services at Colonial Life.

In other survey findings, 48 percent of workers say federal government websites are the most reliable source of information about the ACA and its personal impact on them. They rated internet or other online news sources as the next most reliable, cited by 44 percent of employees. Other sources viewed as reliable options include:

Their employers or HR departments

36 percent

Insurance company websites or literature

30 percent

TV news programs

25 percent

Printed magazines or newspapers

20 percent

Family or friends

18 percent

Other

8 percent

“Workers clearly need help understanding this law and its personal impact on them and their families,” says Bygott. “Because employers are viewed as one of the top three sources of reliable information on this topic, they have a tremendous opportunity to help their workers get the information they need when they communicate their benefits programs.”

Survey results were included as part of a white paper recently published by Colonial Life called “Beyond Health Care Reform.” The research paper outlines what employers should know about health care reform, employee benefits and the subsequent need for increased benefits education.

Survey Methodology

This survey was conducted online within the United States by Harris Interactive on behalf of Colonial Life from September 3-5, 2013 among 2,046 adults ages 18 and older, among whom 1,023 are employed full-time or part-time. This online survey is not based on a probability sample and therefore no estimate of theoretical sampling error can be calculated. For complete survey methodology, including weighting variables, please contact Jeanna Moffett at Colonial Life at JMoffett@ColonialLife.com.

1 Online survey conducted within the United States for Colonial Life & Accident Insurance Company by Harris Interactive, Sept. 3-5, 2013, among 2,046 U.S. adults age 18 and older, among whom 1,023 are employed full-time or part-time.


Cost of benefits, ACA compliance main concerns of midsized businesses

Originally posted by Andrea Davis on https://ebn.benefitnews.com

The cost of health coverage, the Affordable Care Act and the volume of government regulations are the top three concerns of midsized business owners and executives, according to a new survey from the ADP Research Institute.

Seventy percent of midsized businesses – those with between 50 and 999 employees – surveyed said their biggest challenge in 2013 is the cost of health coverage and benefits. ACA legislation  came in as the No. 2 concern, cited by 59%, a 16% increase over last year. And rounding out the top three list of concerns was the level and volume of government regulations, cited by 54%.

“What was a surprise to us was that midsized business owners’ level of confidence in their ability to comply with the laws and regulations doesn’t reflect reality,” says Jessica Saperstein, division vice president of strategy and business development at ADP.

For example, the survey finds that, overall, 83% of midsized businesses are confident they’re compliant with payroll tax laws and regulations, nearly one-third reported unintended expenses – fines, penalties or lawsuits – as a result of not being compliant.

“The majority say they’re confident but many of them are experiencing these fines and penalties,” says Saperstein. “On average, it’s about six times a year and the average cost of one of these penalties or fines is $90,000.”

Nearly two-thirds of benefits decision-makers at midsized companies are not confident they understand the ACA and what they need to do to be compliant. Ninety percent aren’t confident their employees understand the effects of the ACA on their benefits choices.

 


Employers up estimated costs of health care reform law

Original article from https://www.businessinsurance.com

By Jerry Geisel

Employers are upping their estimates of how much the health care reform law will increase costs, according to a Mercer L.L.C. survey released June 12.

Two years ago, 25% of employers thought that complying with the Patient Protection and Affordable Care Act would increase their health care plan costs by less than 1%. But now, just 9% of nearly 900 employers surveyed by Mercer expect a cost increase that small.

Similarly, 15% of employers in 2011 expected the health care reform law to increase costs by at least 5%. Now, 19% of employers expect cost increases of at least 5%. In addition, 21% are projecting 2014 health care reform law related cost increases of 1% to 2%, while 18% expect cost increases of 3% to 4%; 32% of respondents said they didn't know the cost impact.

Mercer executives said there are several reasons why more employers are increasing their cost estimates.

“As employers get closer to implementation, they have a better idea of how many additional employees will become eligible for coverage. Some that thought they would cut hours have changed their position on that,” Beth Umland, Mercer's director of research for health and benefits in New York, said in an email.

Under PPACA, employers will be liable for a $2,000-per-employee penalty if they do not provide coverage starting next year to full-time employees, or those working an average of 30 hours a week.

In addition, Ms. Umland said, some employers in 2011 didn't know about the various fees that the health care reform law imposes. For example, employers will have to pay a fee of $63 per health care plan participant in 2014 to fund a program that will partially reimburse health insurers for providing coverage to high-cost individuals. While there was some awareness of the Transitional Reinsurance Program, it wasn't until last year that regulators announced the size of the fee employers would have to pay.

Check out our HCR Central for FREE PPACA Downloads, FAQ's, and compliance news to help you and your company prepare for PPACA requirements that take effect later this year and in 2014.

 


Health Care Law Remains Deeply Divisive

Original article from https://triblive.com

By Dayton Daily News

David Peabody is apprehensive about the new health care law. Ericka Haverkos is hopeful about it.

These Ohio residents — one the owner of a small landscaping business in Columbus and the other a college student who works part time as a cashier — are emblematic of millions of Americans who next year will have to adapt to the most sweeping changes in the delivery of health care since the establishment of Medicare and Medicaid in 1965.

To Peabody, the law will impose steep costs on his company and force him to decide whether to insure his 65 workers or pay a fine to the federal government. To Haverkos, who says she has a learning disability, it could mean access to a doctor who could prescribe the medication she needs.

All across the nation, millions of people are facing the reality of a new era in health care. Signed into law in 2010 by President Obama and known as the Affordable Care Act, the law will extend health care coverage to more than 20 million of the 47 million Americans without insurance.

“For people who haven't been able to find affordable insurance, they are going to love it,” said Elise Gould, a health insurance analyst at the Economic Policy Institute, a left-leaning nonprofit organization in Washington.

The law's critics contend it's going to frustrate Americans with its complexities, new regulations and blizzard of fees and taxes that they claim will deal a major blow to a fragile economy still recovering from the 2008 financial crash.

When asked to describe how efficiently the law is being implemented, Thomas Miller, a health policy analyst at the conservative oriented American Enterprise Institute in Washington joked: “Coming along just fine. Steady as she goes right into the cliff. Don't mind that iceberg. The Titanic got past it.”

A Kaiser Family Foundation survey in April found that 49 percent of Americans lack the information to understand how the law works. More alarming to the Obama administration, a recent Wall Street Journal/NBC News poll showed that 49 percent of Americans believe the law is a bad idea while just 37 percent call it a good one.

The law extends coverage in two ways. It expands the eligibility for Medicaid, which provides health coverage to low-income people. For those making too much money to qualify for Medicaid, the law offers federal subsidies for families of four earning $33,000 to $94,000 a year so that they can buy their plans through exchanges operated by the federal government or their state.

“I do believe folks underestimated the enormity of this law,” said Kevin Kuhlman, a Washington lobbyist for the National Federation of Independent Businesses. “In order for it to be a success, not only does the government have a massive project ahead of it managing and operating these exchanges, but private businesses also will have to come along and make a lot of drastic changes.”

Haverkos, a student at the Columbus College of Art and Design, said she lost her health insurance more than two years ago when her mother's term on the state Board of Education ended. The health law lets adult children remain on their parents' health plan until age 26, but Haverkos said that's not an option for her.

She said her employer doesn't offer insurance to part-time employees like her. She said she has emergency coverage through the college. Under the law, her insurance through the college will be upgraded if she remains enrolled there.

Supporters of the health care law say people like Haverkos can get access to coverage because government subsidies make the coverage more affordable. Comprehensive coverage would help relieve the symptoms of her persistent allergies and, she said, give her security - a sense of comfort knowing that it's there.”

For some people, the subsidies would amount to considerable savings. According to the Kaiser Family Foundation, a single 45-year-old earning $28,735 a year would pay $5,733 a year in premiums under a typical plan. Using the ACA's graduated scale, which calls for more subsidies for lower-income people, that person would have $3,420 of the premium paid for by the government.

“Those people who have found it very difficult to have access to coverage will find it a good deal,” said Kenneth Thorpe, a one-time senior health official under former President Bill Clinton.

Others are scrambling to determine what the law will cost them.

Many small companies that have not been offering insurance will have to under the new law. That will force some into a choice between providing insurance for their workers or paying thousands of dollars in federal taxes.

The ACA will require a company with 50 or more full-time workers to provide insurance or pay a $2,000 per-person fine for every uninsured worker. The only exception is the first 30 workers in the company are excluded from the fine.

Peabody, who years ago took pride in covering the entire cost of his employees' health coverage, said he now has to calculate what he can afford.

Last year, his company paid $48,000 of the $119,000 in premiums charged by his insurer, with the workers picking up the rest.

Not all of his workers accept the company-provided insurance, Peabody said.

“A lot of people can't afford health insurance,” he said. “That's why they choose not to take it.”

Other businesses are facing similar choices. Jamie Richardson, vice president of White Castle, which has 406 hamburger shops across the country, said his company spent $36 million last year on health coverage for its 5,000 full-time workers. All told, the chain employs about 10,000 people.

Under the new law, White Castle must offer its full-time workers (or anyone working 30 hours or more a week) insurance within 90 days of their hire date. That's a change from current White Castle policy, which offers health insurance to workers six months after they are hired. The company could reduce the number of hours for some workers — as a few companies have said they would do — but the chain said it does not want to do that.

“If someone's full time, we want them to stay full time,” Richardson said. “We don't want people to lose benefits.” He did say the additional costs could mean fewer people are hired.

Opponents argue that adding 20 million into the health care system along with requirements for minimum federal coverage is likely to cause premiums to rise for everyone insured in the United States. By contrast, supporters say the new law will restrain the growth rate of health care because insured people will not be flooding emergency rooms for care.

Jennifer Tolbert, director of state health reform for the Kaiser Family Foundation, said the true costs of the new law will be difficult to calculate.

“For most people with employer-sponsored coverage, the cost of that coverage has been increasing over the past decade,” she said. Determining how much of those costs are due to general trends as opposed to the new law will be “hard to disentangle.”

 


HHS Issues Final Rule on SHOP Exchange Program

This content was originally published on the IFEBP.org website.

The Department of Health and Human Services (HHS) released a final rule implementing Affordable Care Act provisions relating to the Small Business Health Options Program (SHOP). This rule finalizes the amendments in the proposed rule of March 11, 2013, regarding triggering events and special enrollment periods. It implements a transitional policy regarding employees' choice of qualified health plans (QHPs) in the SHOP.

  • The final rule changes the special enrollment period from 60 days to 30 days in most instances.
  • If an employee or dependent becomes eligible for premium assistance under CHIP or loses eligibility for Medicaid or CHIP, the employee or dependent would have a 60-day special enrollment period to select a Qualified Health Plan.
  • There is a transitional rule regarding what QHPs an employer may choose to offer.

The regulations are effective July 1, 2013.

HHS also published a