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Panel helps businesses deal with healthcare reform

Numerous compliance requirements, combined with lack of details, make any decision-making complex

Posted: February 8, 2013 2:00 a.m.
Updated: February 8, 2013 2:00 a.m.

Brian Koegle of Poole & Shaffery, LLP and Haley Wiener of L/B/W Insurance & Financial Services, Inc. join the panel for the Ins and Outs of the Affordable Health Care Act - What It Means to You event presented by SCV Chamber of Commerce.

Affordable healthcare may not be so affordable, according to a panel of healthcare reform experts.

Addressing the concerns of local businesses, the SCV Chamber of Commerce provided members with an idea of what they can, and cannot, expect on Jan. 1, 2014 when the Affordable Healthcare Act takes effect.

The luncheon panel consisted of Brian Koegle from Poole & Shaffery, Haley Wiener of L/B/W Insurance & Financial Services and Joan Buck-Plassmeyer from Los Robles Homecare Services, and was hosted by Leon Worden from SCVTV.

The purpose of the act is to provide affordable healthcare, and to ensure access to healthcare for all Americans, Koegle said.

All panelists agreed there is a cost associated for businesses and individuals with such a large undertaking, as there are so many variables and not all the details are fully flushed out yet.

“Premiums will continuously rise,” Wiener said. “‘Affordable’ is not affordable.”

The theory behind states setting up health coverage exchanges is to provide small businesses and individuals with the same ‘buying power’ to purchase insurance as large companies have today.

California was the first state to commit to launching an exchange service in March 2010, Koegle said.
What the panelist do agree on are the basics.

For companies with 25 or fewer employees, they are eligible for tax credits for providing benefits.

If a company has 50 or more employees, it must provide benefits by Jan. 1, 2014. An employee working at least 30 hours equals a full-time employee under the law.

One way to determine the number of full time employees a company has is through the number of actual full time positions that are filled.

But, it can also be determined that a company has 50 employees if the total number of hours worked by all employees, divided by the total number of people employed, averages 30 hours per employee, per week.

If the result of that formula is the equivalent of 50 employees, a company must provide coverage.

The coverage provided by a company must cover at least 60 percent of the cost of services covered for the employees or it may face extra fees.

Offering affordable care is also defined by how much employees earn, the panelists said.

If the premiums exceed 9.5 percent of the employee’s gross family income, Koegle said, then the coverage is not deemed ‘affordable,’ he said.

Under the income condition, an employee is then free to purchase coverage under the state’s exchange program but the company would be penalized, he said.

One of the hurdles facing everyone is access to healthcare. It remains unclear if all healthcare providers will accept patients through the state exchanges or Medical patients, although a spokesperson at the luncheon for Kaiser Permanente said the healthcare provider is participating.

Kaiser is one of the models the California state exchange is looking at for modeling its own program.

And large groups of doctors are forming partnerships – Accountable Care Organizations - to move Medicare patients into group care models, because the healthcare system today is very inefficient, Buck-Plassmeyer said.

“There are 48 million Medicare patients today,” she said. “In less than 17 years there will be 80 million. We simply do not have the healthcare system in place to handle 80 million people.”

Some small business owners at the luncheon, however, said they are trying to figure out if the cost of providing coverage is higher than just paying the penalties for failing to provide coverage.

Employers should work with their insurance brokers, tax attorneys and a team of people helping to ensure they’re compliant with the law, Koegle said.

The last thing a business wants is the U.S. Dept. of Labor, state labor board, the IRS or any kind of government agency looking at their company for compliance, he said.


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