ACA is coming, ACA is coming!

I may not be Paul Revere, but get ready because ACA is coming. Are you ready for the Affordable Care Act whose open enrollment starts October 1st and you must be enrolled in by March 2014?Stehtoscope

Probably not, eh? I just attended a panel discussion about ACA put on by Mainebiz. One thing is very clear to me and that is that ACA is not very clear to me. Here’s what I learned. I should say here is what I heard, whether I learned it correctly or not is still to be seen.

The panel was made up of four experts from Maine. Looking at this from 30,000 feet, this is what I understand so far. The Act is broken up into three different company sizes.

  1. Less than 5 employees, called Micro
  2. 5 to 49 employees, called Small
  3. 50 or more employees, called Large

The biggest impact on Maine businesses will be on those who do not offer insurance already. There are different rules for each size and you can find a flow chart to guide you through the determination of the number of qualifying employees you have, whether you offer the insurance through your company or you send your employees off to find their own through an exchange which you may subsidize a percentage of. Also, there are different levels of coverage you may offer your employees if you choose to offer coverage through the company. The differences are in the total cost to the employee. The healthier employees may choose higher deductibles and copays, while the less healthy employees may choose the opposite. The premium costs reflect which level you choose. You pay for your healthcare one place or another. Large companies (greater than 50 employees) must pay at least 60% of the costs of healthcare coverage.

In recent years company health coverage has migrated to healthy choices programs where the employee who is active about taking care of himself (herself) has advantages. So the programs were more of a take charge of your health and it’ll cost you less. You could choose how much you set aside for health savings accounts, less if you were healthy. Employees who were obese or smoked and suffered from numerous side effects of those conditions were more apt to spend more money on healthcare, thereby having to set aside more money in their health savings accounts.

The difficulty in the ACA will be in defining your company size, what coverage to offer, how to handle part time or temporary employees, seasonal hires and if you send your employees off to get their own coverage through an exchange, will you subsidize and for how much. For some, this will not be difficult if they fall within the middle of the spectrum. Companies that have 40+ employees will need to define exactly where they are and do their calculations carefully. There are more obstacles than I could take in a 2 hour session. It IS complex, but there is help available to help you get you through it. Stay tuned.

For now, the important thing to do is keep your head up, start digging into it (I’ve provided some references below) and become knowledgeable enough to discuss it with your insurance agent, accountant, attorney and consultant. As one panelist said, don’t plan your company around the ACA, adapt the ACA to work for your company. In the long run, it appears that it will put more people into coverage which down the road should reduce overall health care costs.

The one thing that was addressed lightly and I feel as Americans we need to pay closer attention to is taking charge of our health. We’ve become an entitled society where we expect to be taken care of. Just because employers “have always been in charge of providing health care as a benefit” should not make it an expectation. This ACT may be the start of providing options away from employers. There is an option for employees to purchase it on their own in the smaller size companies. Today, we look at healthcare as an expectation of how our employer takes care of us, not on how we take care of ourselves. It’s OUR health, why don’t we take care of it? I get really frustrated when I talk to an obese or smoking employee about his or her deteriorating health like it’s not their fault. Hello? Lose weight or stop smoking. I know, I know, easier said than done. Between weight related illnesses and smoking related health problems, we could reduce insurance costs tremendously for everyone by reducing or eliminating both of those habits. Prevention versus repair. Costs for health insurance should be directly related to how well you take care of yourself.

Here are some helpful links:

Maine Community Healthcare Options


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