BY KEN LITTLE
The Patient Protection and Affordable Health Care Act will have a wide-ranging impact on Americans.
That includes busines-owners and all employers, Andrea Bailey Powers told about 90 members of the Greene County Partnership on Thursday during a one-hour seminar at the General Morgan Inn.
Powers, a lawyer specializing in employee benefits with the Birmingham, Ala., office of Baker, Donelson, Bearman, Caldwell & Berkowitz, addressed key provisions of the act, and how it will affect employers and their group health insurance plans.
LAW SIGNED IN 2010
The landmark health reform legislation, widely known as the ACA, or simply as Obamacare, was passed by the 111th Congress and signed into law by President Barack Obama in March 2010.
It includes a lengthy list of health-related provisions that began taking effect in 2010 and will continu to be rolled out this year and in 2014.
According to the federal government, key provisions are intended to extend coverage to millions of uninsured Americans, to implement measures to lower health care costs and improve system efficiency, and to eliminate industry practices that include rescission and denial-of-coverage because of pre-existing conditions.
"The goal of the Affordable Care Act is universal coverage, and the goal is doing what they can to push employers into providing insurance for everybody," Powers said.
She said that specifics of the complex ACA may be modified as different phases go into effect.
"This is probably just the first step at trying to get (the) uninsured coverage," she said.
She urged employers to be proactive in taking steps to respond to ACA requirements that will be rolled out through 2014.
"It's very important we understand where we are," Powers told those attending the talk.
The seminar was sponsored by Takoma Regional Hospital and Rodefer Moss & Company, PLLC.
"Nearly everybody here is impacted by health care reform," Tom Ferguson, Partnership president and CEO, told participants in introducing Powers.
'KEEP PREMIUMS DOWN'
Powers said the goal of employers is to "keep premiums down and maximize coverage."
The law will have "a tremendous impact on smaller or mid-size companies," Powers said. "We have a very large percentage of businesses in this country that have less than 50 employees."
She offered a timeline of when different provisions of the ACA have gone into effect or will go into effect.
"In the past three years we have seen a progressive forward march in the implementation of the law," Powers said.
The "biggest hurdle" for businesses is shared-responsibility provisions of the ACA, she stated.
One provision that was to take effect this year requiring employers to inform employees of coverage options on state health insurance exchanges has been delayed.
Tennessee, like many other states with a Republican-majority state government, has declined to set up its own state insurance exchange, which is required by 2014.
In 2011, the law prohibited pre-existing exclusions for young people under age 19, and also extended adult child coverage to age 26.
By 2014, pre-existing-condition exclusions will be prohibited for all employees, Powers said.
'ESSENTIAL HEALTH BENEFITS'
"By 2014, employer plans can no longer have a lifetime or annual limit on health benefits," she explained.
That includes "essential health benefits," which she said is "an extraordinarily broad category."
The year 2014 will also bring a limit of a 90-day waiting period for eligible-employee health insurance coverage, an increased company discount for employees participating in wellness programs, and limits on deductibles and out-of-pocket maximums.
In 2014, employers will be required to provide full-time employees with "affordable minimum essential health coverage," Powers said.
The Transition Reinsurance Program is a three-year program that starts in 2014 and continues through 2016. It's intended to reimburse carriers in the individual market for high claims costs, Powers said.
The program is funded through fees paid by employers for self-insured plans, and paid by insurance-providers for insured plans, she said.
The fees will total $63 a year for each individual covered under a health care plan, Powers said.
Depending on the scope of the plans that companies offer to workers, another challenge arising from ACA will be "how as an employer to attract and retain talented and loyal employees," she said.
HOW 'TO COPE'
Powers offered advice on how employers can comply with provisions of the health care law in the most painless way.
It can be difficult for companies with 500 or less employees to adjust to all the new ACA requirements, Powers said.
"You can offer a plan that's affordable. You may have to subsidize it, but it's on the employee-only coverage," she said.
In the Southern states, the majority of employees will end up being eligible for federal subsidies because of lower income levels, Powers said.
Employers can also retain current plans.
"At the end of the day, you're not required to have the employee in the coverage. You just have to offer it," Powers said.
The ACA will also create "a record-keeping challenge" for companies, she said.
"They will require quite an eye for detail," Powers said.
Taking action now on the ACA will benefit employers later, she counseled.
"The sooner you jump on this, the better," Powers said. "This law has so many parts to it."