Health
Care Reform: Are You Prepared?
The
United States Supreme Court largely upheld President Obama's health care law,
the Affordable Care Act in a mixed decision. The court's ruling, seen as one
of the most significant in decade, is a crucial milestone for the law,
allowing almost all of its far-reaching changes to roll forward. The decision
did significantly restrict one major portion of the law: the expansion of
Medicaid, the government health-insurance program for low-income and sick
people. The ruling gives states more flexibility not to expand their Medicaid
programs, without paying the same financial penalties that the law called for.
The
legislation for the Patient Protection and Affordable Care Act (PPACA) will
impose significant new responsibilities on employers, some of which are
already effective. While further guidance is expected on the application of
these requirements, the following provides a summary and timeline of key
provisions of the PPACA. As employers look ahead to the implementation of the
PPACA, CS Plus will be providing additional updates to provide clients with
compliance strategies in connection with various components of the new law.
Summary
of the Affordable Care Act
The
Affordable Care Act (umbrella term for the Patient Protection and Affordable
Care Act and the Health Care and Education Reconciliation Act of 2010) was
passed by Congress in March 2010 to overhaul the health care system, expand
affordable coverage, change insurance rules and create an online marketplace
(exchange) in each state for the individual and small group markets.
Most U.S. citizens and legal residents will be required to have health
insurance in 2014. Those without coverage would pay a tax penalty based on
household income to be phased-in starting in 2014. Federal subsidies will be
available to assist those who cannot afford to purchase coverage.
Large employers (50 or more full-time employees) will be required to
"pay or play" starting in 2014.
Qualifying small employers (no more than 25 employees) are eligible for a tax
credit for offering coverage beginning in 2010. The tax credit increases in
2014 if employers buy from the exchange, and then phases out in 2016.
How
Health Reform will Impact Businesses
The
Patient Protection and Affordable Care Act (PPACA) impacts businesses in
several ways - from the types of benefits offered under insurance plans, to
the ways employers conduct their businesses. Some provisions are already in
effect and more will be implemented over the next several years.
General
Impacts on Employer-Provided Coverage
There
are several mandates from the Patient Protection and Affordable Care Act
(PPACA) already in effect. View the Timeline
below for more information on timing of provisions.
Some of the key mandates are below.
Grandfathering
- "Grandfathering" allowed some plans to be exempt from some Health
Care Reform provisions.
Lifetime
Limits and Annual Limits
- Law prohibits imposing annual limits on Essential Health Benefits and any
lifetime dollar limits.
Medical
Loss Ratio (MLR) Reporting
- A Medical Loss Ratio or MLR is the percentage of premium dollars insurers
spend to provide covered medical services and improve the quality of health
care for their members.
No
Pre-Existing Conditions Exclusions
- As of September 2010 there are no pre-existing exclusions for children
under age 19. Beginning in 2014, this provision applies to everyone,
including adults.
Patient-centered
Outcomes Research Fee
- The Patient-Centered Outcomes Research Tax, also known as the Comparative
Effectiveness Research Fee, is a fee paid to the government to fund
Patient-Centered Outcomes Research Institute (PCORI) research.
Preventive
Services
- The Patient Protection and Affordable Care Act of 2010 (PPACA) requires
health plans to cover designated preventive services without any member cost
sharing.
Summary
of Benefits Coverage
- The Departments of Health and Human Services, Labor and Treasury recently
issued final regulations requiring health plans to provide a SBC and Uniform
Glossary that clearly explain benefits and coverage within a standardized
template with uniform language.
W-2
reporting
- PPACA contains a requirement for employers to report the cost of health
coverage under an employer sponsored group health plan on an employees W-2
form. The cost includes both the cost paid by the employer and contributions
from the employee.
Women's
Preventive Services
- The Patient Protection and Affordable Care Act (PPACA) requires health
plans to cover designated women's preventive services without cost sharing
for the member. Cost-sharing includes deductibles, copayments and
coinsurance. Some of the benefits and services outlined in the women's
preventive guidelines are already included within the existing PPACA
preventive services requirements.
Establishment
of Health Insurance Exchanges
On
April 12, 2012 Governor Andrew M. Cuomo issued an Executive Order to
establish a statewide Health Exchange. State-established health insurance
exchanges must begin to operate on January 1, 2014. The Exchanges are virtual
marketplaces that allow individuals and eligible employers to purchase health
insurance. Initially in 2014, only employers with up to100 employees can
purchase insurance for their employees through the Exchange. Prior to 2016,
states can limit the size to businesses with up to 50 employees. Beginning in
2017, states can allow employers with more than 100 employees to purchase health
insurance for their employees through the Exchange.
How
Does Health Care Reform Affect Small Businesses?
In
addition to the key provisions outlined, it's important to know that small
businesses already have an opportunity to qualify for:
Small
business tax credits
- In an effort to help small employers offer affordable coverage to their
employees, the Patient Protection and Affordable Care Act provides for tax
credits for qualified small employers. These credits began in 2010. The
credits increase in 2014, but are only available for coverage purchased on an
Exchange. The small group tax credit sunsets in 2016.
Timeline
It
will take several years for changes to be enacted and regulations written.
However it's important to begin to understand what will be happening in the
near future versus long term changes.
To
view a larger image of the timeline, CLICK HERE.
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