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I have no problem understanding why people are confused about the Patient Protection and Affordable Care Act. In Shakespeare's words, “The time is out of joint.”
On April 5, I received an email with this subject and first line: "Reversal sought for delay to small-business exchanges. Small business groups and some lawmakers want the White House to reverse course on plans to wait one year to give workers at small firms a choice among health plans obtained through new exchanges."
On April 8, I received an email with this third line: "Beginning in 2014, Pennsylvania small business owners will have access to a new Health Insurance Marketplace — which opens for enrollment on October 1st — that will allow them to make side-by-side comparisons to find a plan that fits their budget and that's right for their businesses and employees."
On April 1, the Department of Health and Human Services announced that full implementation of the Small Business Health Options Program for the marketplaces would be delayed a year, to 2015. It was no joke. Small businesses are still supposed to have access to a health plan for their employees through the marketplace in 2014, but the whole "select among options" aspect will be absent.
The senders of the April 8 email — organizations that should have known that — obviously hadn't gotten the message.
But then, the proposed rule delaying SHOP was released on March 1, and I wasn't aware of it until April. And I get millions of health care email updates a day. (OK, OK: Dozens.)
On March 29, HHS issued a news release with the subject line, "HHS finalizes rule guaranteeing 100 percent funding for new Medicaid beneficiaries."
Feel free to blink here; I did. There are lots of ways to be confused about the possibility of expanding Medicaid, but one message has come through radiantly clear for years: The feds will pay for 100 percent of the expansion from 2014-16, 95 percent in 2017, 94 percent in 2018, 93 percent in 2019 and 90 percent in 2020.
So, what's the news here? Just that it's now the rule, which in the case of PPACA is kind of more significant than being the law.
Moral of the Stories
PPACA has many facets, and we have been seeing early predictions, later predictions, proposed regulations, final regulations, reactions, reports, studies in rapid and random succession. Often there have been changes somewhere along the way. Confusion is a natural response — and while it behooves you to stay as current on it as you can, for business owners there's really no getting around the need for professional advice on this issue.
Speaking of professional advice, chances are your insurance broker or benefits provider is offering some sort of seminar. In Lancaster, Everence Financial is planning one for May 14.
I was recently in a room full of people who handle health insurance for their companies — and when asked if they were familiar with defined-contribution plans, few of them raised their hands. If you also don't know what defined-contribution plans are and why they might matter for your business, you should read this story I wrote last year: Plans offer defined-contribution options to smaller firms.
Similarly, if your area of ignorance is on self-funded (aka self-insured) plans, you should read these articles by Matthew Kirk and yours truly, respectively — How will PPACA affect self-funded plans? and Group takes health insurance costs captive.
Oh, and there's a related study: Health Insurers Anticipate an Increase in Self-Funding by U.S. Employers.
This Won't Make You Feel Better
Neither Will This
But This Might
Surely you remember "Bitter Pill," the Time cover story starring The Chargemaster. But I suspect that you, like me, did not know that, as a result of the PPACA, the IRS has published draft regulations pertaining to such practices. In the words of this article, "Hospitals cannot charge uninsured individuals who qualify for financial assistance more than what is charged for insured patients."