Health care is about to get even more complicated

By Marty Carpenter, Contributor | Posted - Sep 5th, 2013 @ 8:06pm

SALT LAKE CITY — Over the past few weeks, I've had the opportunity to discuss the upcoming changes to health care with several experts as the Affordable Care Act (ACA) rolls into full effect. Through those discussions the one thing I have learned is that if you think health care is about to get simpler, you're in for a bit of a shock.

"I don't think health care was ever simple," says Terry Buckner, president and CEO of The Buckner Company, a health insurance broker. "Any time you have a transaction that involves an employee, their employer, their medical provider and a health insurance carrier, it's a complex transaction. Now you add on top of that the IRS to regulate it and some mandates by the federal government as to what your insurance should look like-- it certainly becomes complex."

I don't think health care was ever simple. Any time you have a transaction that involves an employee, their employer, their medical provider and a health insurance carrier, it's a complex transaction.

–- Terry Buckner, president and CEO, The Buckner Company

Many of Buckner's clients are still unclear about how the ACA will affect their business or if it has to affect their business at all.

"It absolutely impacts every business," says Buckner. He says large employers have mandates they now have to navigate while small businesses have varying requirements about when they have to provide coverage.

Buckner says navigating health care today without some help is as crazy as a large business trying to do its own taxes. "Right now—more than ever—the expertise is huge."

The wave of change

Though Pres. Obama signed the ACA into law more nearly three-and-a-half years ago, the most significant parts of the law go into effect Jan. 1, 2014. Next month, open enrollment into the program begins. This comes at a time when 42 percent of Americans still don't know the law was even passed, according to a poll by the Kaiser Foundation. That number jumps to over 50 percent for Americans ages 18-29. More than one in ten Americans — who presumably heard sound bites during the presidential campaign — but didn't pay much attention) think Congress has repealed the ACA.

Depending on whom you believe, the ACA is either the greatest thing since sliced bread or the end of civilization as we know it. I'm not here to argue for either side of that coin, but Greg Matis, senior counsel with SelectHealth, says, "it's probably somewhere in between."

He says there are five fundamental changes coming to health care:

1. Everyone qualifies for coverage

2. Everyone is required to have coverage

3. Some people get financial help

4. Coverage and costs are changing

5. There are new shopping choices

One of the biggest changes, according to Matis, isn't spelled out in the legislation; rather it comes from the market's reaction to ever-increasing costs. The shift from a fee-for-service to a fee-for-value model means your doctor is incentivized (i.e. paid) to keep you healthy, not just to treat you when you get sick. It's similar to encouraging you to change your car's oil every 3,000 miles instead of waiting for your engine to blow and having to pay more to replace it.

"This is a huge shift in the industry," says Matis. "It's born from a recognition that our current system is unsustainable, that we need to change how we provide and pay for care."

Navigating the regulation

One of the most famous (or infamous, again, depending on your point of view) aspects of the ACA is its heft. The final bill was over 2,700 pages long, but that's just the beginning of the headache for business. It's also filled with the ambiguous statement "The Secretary shall determine…" which appears 1,563 times. The bill also creates 180 boards and commissions.

That's a lot of regulation to keep track of and it increases the probability a business will misstep and end up in non-compliance. That lack of specificity likely also plays a role in the recent delays in various aspects of the implementation of the law.

"It's kind of cumbersome," says Blake Watkins of Gallagher Benefit Services. "It seems like there are more and more regulations a business has to deal with every day."

Watkins says even the general penalty in the bill is around $100 per day per employee. That can really add up pretty quickly.

It's kind of cumbersome. It seems like there are more and more regulations a business has to deal with every day.

–- Blake Watkins, Gallagher Benefit Services.

So is the shift in health care complicated because it is a big change that will take some time or does it take an already complicated system to a whole new level?

"I think it's more complicated," says Watkins.

Helping small business

While many larger businesses have been preparing for health care changes for the past few years, there is a lot of confusion among small business owners—those with fewer than 100 employees.

The Salt Lake Chamber has joined with the Utah Small Business Coalition to help clarify the situation at the 2nd Annual Utah Small Business Summit. That event will be held at the Salt Palace on Sept. 10 from 8 a.m. - 4 p.m. The summit will feature numerous sessions devoted to helping small businesses understand and take practical action as the ACA is implemented. In addition, a special section of our exhibitor gallery will feature health care brokers, insurers, providers and other health care vendors to answer all your questions about the ACA and health care reform. You can register here.

Marty Carpenter

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