Treasure Valley business owners had more than a few questions Tuesday afternoon as they huddled to consider the realities of the Affordable Care Act, recently upheld by the U.S. Supreme Court. In fact, the title of the invitation-only event was: "What The Bleep Now?"
“You may be more confused at the end than you are now,” said Kelly Madison, beginning her afternoon-long presentation.
Madison, who consults businesses big and small on the health insurance industry, focused on the elements of the ACA, some of which have already been rolled out and some of which won't begin until 2014.
“No matter what you call it, it does bring the most sweeping changes to health care since I-don’t-know-when,” she said.
Madison walked the audience through the various provisions of the ACA, including Idaho’s position in establishing a mandatory health insurance exchange, or face a federally created iteration. So far, Gov. C.L. “Butch” Otter has yet to make a decision on Idaho’s next steps.
Madison compared proposed insurance exchanges to what she called “e-trade for insurance.” The individual mandate requires citizens to carry insurance, or suffer a penalty issued in the form of a tax.
Madison said the penalty might often be cheaper over the course of a year than Idaho’s current average insurance premium. She said some individuals and small businesses may choose to go without insurance based on cost and suffer the penalty.
Some attendees guessed they would opt out because of cost concerns related to expanded coverage provisions, such as preventative women’s health care. Those required covered services apply to all insurance plans sold, not just those sold through exchanges, said Madison. The extended benefits could cost the government and business more, she said.
“Even if you don’t want to buy insurance through the exchange,” said Madison, “they’ve still defined what the insurance companies can sell outside the exchange.”
Businesses with more than 50 full-time equivalent employees are required to provide insurance, and to report a comprehensive list of benefits to those employees. Or businesses may opt out, and pay a penalty that could amount to $2,000 per full-time employee, excluding the first 30.
Audience members asked if the cost of the penalty could be cheaper than their current or prospective group insurance plans. But they also worried that failing to carry insurance would cause problems with employee retention.
Madison concluded by saying much more needed to be done to stop the spiraling cost of health care.
“Lots of what’s been put in place is insurance reform and insurance regulation,” she said. “What’re we doing to reduce the cost of health care? The cost of all that is the driver of the health care crisis. If you look at the cost of premiums, that’s a driver of the cost.”