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By Wayne J. Taylor
| December 19, 2016
The drapes at the White House may change on Day One of the new White House administration, but—campaign promises aside—changing something as complicated, unwieldy, and enormous as the Affordable Care Act will be a little more challenging to alter overnight.
Come Inauguration Day, it will be business as usual for employers still trying to accommodate the mandate of the ACA, or Obamacare. As a practical matter, this means many will continue to struggle with managing the escalating costs of extending health care coverage to their employees.
“Repeal and replace” may eventually morph into a more reform-oriented agenda when it comes to addressing U.S. health care, as President-elect Trump has already signaled that certain components, like covering pre-existing conditions, are important. But until more details emerge, the road ahead is paved only with uncertainty.
“All we can tell our members right now is to sit tight,” says Christopher Geehern, executive vice president of Associated Industries of Massachusetts, which represents many of the Bay State’s small and medium-sized manufacturing companies.
“Continue filling out the required forms,” he says, “and don’t assume anything is going away until it actually does.”
Major change in 2017 seems unlikely
Health care plans for 2017 are being sold now through January 31, and many of them are scheduled to take effect on Jan. 1.
“It is difficult to imagine how a new administration could come in and undo plans that are already in place,” says Greta Johannson, the district director for the Small Business Administration in New Hampshire. “Most people are thinking that the current rules will be in place for 2017. We don’t know what’s going to happen in 2018, but we think we’re okay for now.”
“Okay for now” are hardly reassuring words for businesses wrestling with the headache-inducing provisions of the ACA.
The daunting reporting obligations under the act, the uneasiness around its potential for levying fines for failure to comply with it, the significant capital expenses of additional employee time, software purchases, and consulting contracts—these are some of the most common challenges faced by employers large and small.
Over the past several years, businesses have slowly begun to work through some of these administrative challenges. Many of the large payroll servicing companies have invested heavily in developing specialized ACA systems to help their clients with the complexities of tracking employee hours and determining their coverage eligibility.
“Technology has now worked out many of the bugs in the ACA’s administrative processes,” says Tony Cabana, vice president of the benefits division of Cross Insurance, which helps New England companies develop specific employee benefit programs.
And now for something completely different
Just as employers have begun to adapt to and manage Obamacare, even with all of its pain points, they know they shouldn’t get too comfortable given what Trump has said, especially since his pick for health secretary, Tom Price, has been one of the program’s fiercest critics.
Under the ACA, employers are required to provide their eligible employees with Form 1095C. It details the kinds of health care insurance available, and it’s cumbersome and expensive for employers to manage, one reason why the filing deadline for 2016 has been extended to March 1, 2017.
“There’s a great deal of frustration among employers,” says Geehern of Associated Industries of Massachusetts. “They know they have to complete these forms, but they also know that the ACA, if not altogether repealed, will at the very least undergo some substantial revisions.”
If the ACA were to be repealed, states would revert back to whatever existed there before. In the case of Massachusetts, that would be the law passed in 2006 by then-Governor Mitt Romney, the provisions and requirements of which were in many cases quite different. For example, “RomneyCare” required employers with 11 or more employees to provide health insurance; the ACA puts the bar at 50 or more. So reverting back to what existed before could mean that some small employers that were exempt under the ACA would be non-compliant if the Act were repealed.
On top of that, budgeting uncertainties could well arise for employers if there are changes to the ACA’s current rating factors for employee pools, which use criteria such as age, location, and tobacco use to determine premium levels.
“The sense of uncertainty among employers is pervasive right now,” AIM’s Geehern remarks, “and there’s nothing business dislikes more than uncertainty.”
If it ain’t broke…
Uncertainties aside, there are a number of the ACA’s provisions that businesses find quite valuable and would like to see survive any future changes to the law. Among the most popular, says Cross Insurance’s Cabana, are coverages for dependents up to age 26, pre-existing medical conditions, and preventive services such as annual physicals and well-baby doctor visits.
As revealed in recent post-election interviews, the Trump Administration appears to agree that some of the ACA’s provisions do make sense.
As usual, the devil is in the details.
And so far, no one—neither Republicans nor Democrats—has figured out how to design a system that both expands coverage and lowers costs.
“It’s going to be interesting to see how this all unwinds itself,” says Cabana. “Something’s definitely going to happen. It’s just a question of what it’s going to look like.”
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