Thirty executives gathered June 28 at Landmark Square in Stamford to hear Phil Boyle expound on details of the Patient Protection and Affordable Care Act, including word that it”™s not an exchange; it”™s a marketplace. The proverbial elephant in the room was the absence of details on that marketplace ”” promised later this month.
“It”™s difficult to buy a car when you can”™t kick the tires,” said Boyle, the business outreach manager for Access Health CT, which will manage the marketplace.
As for the health exchange: “We dropped exchange for several reasons, one being it does not translate well into Spanish,” he said.
If Boyle lacked specific rates at The Business Council of Fairfield County”™s Center for Growth event, he offered rafts of known facts: Everyone must have medical insurance by Jan. 1 or face a penalty. Plans can be marketed through the Connecticut marketplace starting Oct. 1.
Connecticut has already invested $140 million in federal funds to create its marketplace. Under current guidelines, pre-existing conditions ”” sometimes even allergies and pregnancies ”” may disqualify an individual from coverage. Under the Affordable Care Act that will end. And spouses are no longer considered dependents.
A Boyle attention-getter was that businesses with more than 50 employees are not required to insure them. But if an employee of one of those businesses seeks coverage through Access Health CT, the $2,000 federal tax credit the marketplace offers him or her will be foisted upon their un-insuring employer ”” and it is not tax deductible for the company.
Some companies, Boyle speculated, might opt not to insure and see how they fare.
“But,” Boyle said, calling upon two decades in the health industry, “my experience is the vast majority of companies in this category already offer solid coverage.”
One difference coming: Companies typically offer insurance beginning the first of the month beyond 90 days of employ; the new rule is a strict 90-day wait.
Another coming difference: prevention.
“A big part of this ”” underreported ”” is wellness,” Boyle said. “You”™re already seeing more wellness programs. Now, when I go to the doctor, I”™m told to drink more water, to walk more. It”™s like somebody put out a memo.”
Aetna, Anthem Blue Cross & Blue Shield, ConnectiCare and the nascent nonprofit Healthy CT will offer their competing products in the state marketplace. The private sector is expected to counter with its own health plans, which will not offer federal tax rebates.
The state will employ in-person assistors from October to March 2014 and so-called “navigators” full-time beyond that to help businesses and individuals with enrollment. The Access Health CT website will offer a calculator to tabulate various offerings across carriers and levels of coverage.
For small businesses with two to 50 employees, a separate Small Business Health Options Program ”” or SHOP ”” marketplace is coming. Its competing vendors will be Anthem Blue Cross & Blue Shield, ConnectiCare, Healthy CT and UnitedHealthcare. Boyle said sole proprietors would probably get coverage in the individual marketplace.
“We want to see a return on investment,” Boyle said. “Right now, we are all paying. Take all this away, we are all still paying. Are we lowering costs? Are we improving quality of life? Is this going to work? That”™s the $64,000 question.”
The Affordable Care Act was referred to by one invitee as “Obamacare,” but the presentation and its studious reception spoke of nonpartisanship, or perhaps of the practiced diplomacy of executives from the likes of Webster Bank, Cushman & Wakefield, Sikorsky and half-a-dozen each law and accounting firms. Rather, Michael Kedersha, senior account executive at Pierson & Smith in Norwalk, amicably jousted with Boyle, alternately underscoring and refuting what was reported.
Where Boyle saw a hoped-for future of healthier citizens ”” “It will take some time to show itself” ”” and competition-fueled savings, Kedersha expressed interest less abstractly.
“How is the program going to run?” he asked. “It”™s important to remember it”™s not your company alone. You may say, ”˜I know my company and we”™re doing fine.”™ But it”™s based on blocks. How is the entire block running?” Referencing the lack of quantifiable data, he said, “You can only be so pro-active when all the information is not out.”
“The rates are filed, but you”™d need a Ouija board to figure them out,” Boyle said. “Actuaries are reviewing them now for compliance ”” the providers”™ actuaries and the state”™s actuaries.”
Kedersha drew a knowing laugh relating a discussion he had with an official on coverage changes and their tax implications: “I said this didn”™t make any sense. And he told me if it does not make any sense it”™s probably correct.”
Boyle spoke of deadlines, with Oct. 1 ”” the day the marketplaces open ”” the big one for him. “After sequestration, an election, the Supreme Court ”¦ we”™re here,” he said.
Kedersha”™s take was less certain: “Everyone is being told we”™re on target for January 1,” he said. “They probably won”™t know until late September they won”™t meet the deadline.” He possesses “zero faith” in the IRS to ride herd on the health law questions. Even overturning the Defense of Marriage Act will factor, he said, noting the repeal”™s tax implications begin immediately: “The IRS has to tackle gay marriage ”” New York and Connecticut allow it; it”™s a mess to figure out. And the IRS has their own problems right now.”
After saying there were no tires to kick, Boyle said. “It”™s difficult to make decisions now because there are no products to look at.” No specific products, perhaps, but he outlined the larger bronze, silver, gold and platinum levels offered by four carriers on the state marketplace and their personal payment obligations.
Bruce Blasnik, a partner at accounting firm O”™Connor Davies Munns Dobbins, hosted the meeting for the business council. He said he was hearing of “20, 25, 30 percent increases in premiums ”” and we”™ve had a bit of a reprieve of 7 percent (increases) the last couple of years.”
Kedersha said that was steep: “A lot of the features that are being added that account for those big increases are already present in the Northeast; 3 to 5 to 8 percent is what we expect.”
The invitees”™ questions proved the complexity of the issue: “I have COBRA, but …”; “A young man falls off his motorcycle, and …”; “I have a New York company that does a lot of business in Connecticut, so …”
The questions taxed the 90-minute meeting time frame.
Said Maura Carley, president and CEO of Shelton-based patient advocacy company Healthcare Navigation L.L.C., “It”™s a reminder of how harsh our current system has been and is. So many are foisted off their coverage. The system we live with is so unjust. I hope this, with all of its flaws, will at least be more just.”
