The Patient Protection and Affordable Care Act “is the biggest change we’re ever going to see in our lifetime,” the president of Anthem Blue Cross Blue Shield Ohio said Friday.
But many of the federal regulations that spell out just how that big change is going to unfold have not been published yet, said Erin Hoeflinger told members of the Dayton Area Chamber of Commerce at the Dayton Racquet Club.
“There’s still so many questions about health-care reform out there, and nobody knows the answers yet,” she said.
Though there is some question of how, or if, the law will proceed after the November elections, Anthem is moving forward to be ready to educate its customers “so people can really get a grip on what they need to do and what changes are moving forward,” Hoeflinger said.
Business owners are bracing for sweeping changes to health-care coverage, including new fees, penalties and taxes and new regulations, under the law, which requires most Americans to have health insurance starting in 2014.
But the complexity of the law makes it difficult to prepare, or even ask the right questions, said Phil Parker, president and CEO of the Dayton Area Chamber of Commerce.
“You don’t know what you don’t know,” he said. “It literally gives me a headache just thinking about the complexity of this law.”
Parker said he also worries the law could discourage business growth, if businesses decide not to add workers in order to avoid the cost of providing coverage.
“Could it actually slow companies down from making the decision to grow? We want to see small businesses grow into medium businesses and medium businesses grow into large businesses,” he said. “Does this inhibit growth? I think it does, because the employer doesn’t know what this could end up costing him.”
Businesses that employ more than 50 people will be required to offer affordable coverage or pay penalties. Employers will also have to collect a variety of data on workers, including seasonal workers, to make sure the coverage requirements are met. Individual workers will be required to purchase coverage, either through their employer or through insurance exchanges set up in each state, or they will also face penalties.
The law also provides tax credits and subsidies to small businesses and some individuals to help offset the cost of coverage. People who earn up to four times the federal poverty level will qualify for those credits and subsidies. In Ohio, about 60 percent of families will qualify for those credits, Hoeflinger said.
One key component of the new that will likely be “pretty disruptive” for small plans, she said is the community rating provision. Before the ACA, insurers could take into account how healthy a group of employees were and price plans accordingly. They could also deny coverage to individuals based on their health history. Now, insurers cannot deny coverage to anyone, and they cannot look at workers’ health status. Insurers will only be able to consider four items when pricing coverage:
- The number of people in the plan
- Their ages
- Where they live
- Whether or not they use tobacco
In Colorado and other states, the community rating provision has meant that some businesses with mostly healthy workers have paid “a little more,” she said, and some businesses with less healthy workers have paid “a little less.”
Some of the “easier” provisions of the law are already in effect, Hoeflinger said. “It’s going to get a little more complicated to navigate.”
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