by Jeff Hankins
Posted 9/24/2012 12:00 am
Updated 2 years ago
One gets the sense that an awful lot of people who were and are opposed to the Patient Protection & Affordable Care Act are holding out hope that Congress will "repeal and replace" it after the November elections.
In the aftermath of the U.S. Supreme Court ruling upholding health care reform laws, the opposition needs Mitt Romney to be elected president and the Republicans to capture a filibuster-proof 60 seats in the U.S. Senate. Washington Post columnist Ezra Klein seems to think 51 votes in the Senate might work with Romney in the White House because he could use the budget reconciliation process.
If those options don't pan out, then the standoff continues its shift from D.C. to the statehouses, particularly those controlled by Republican governors and legislatures. Solidarity by these conservative states could indeed wreak havoc on the national reform system.
Republican legislators in Arkansas, with their newfound power resulting from the 2010 elections, are feeling confident that they can enable the state to join the movement to derail Obamacare. Refusing to fund an expansion of the Medicaid program - which would actually be paid for by the federal government for the first three years - would be the first step, and it's plausible because of the 75 votes in the Arkansas House needed to pass a budget.
So what are medium-sized and large businesses in Arkansas to do in the meantime with major elements of the law becoming effective in 2014? Assume that it will be the law. That was the message from our panels of experts at the recent Arkansas Business Health Care Reform Symposium.
First, it's important to note that the law, in terms of reporting and insurance requirements, won't directly impact most businesses in Arkansas. That's because it doesn't apply to businesses with fewer than 50 full-time employees, and 95 percent of Arkansas businesses fall into that category.
For everyone else, it's time to start evaluating where your company stands. The formulas have been established to determine required standards for insurance premiums as a percentage of incomes and to outline potential penalties.
When you consider that we're approaching private insurance renewal and enrollment season for 2013 now, then that means we're just a year away from the 2014 season. Decisions about whether to continue a private insurance plan or push employees to the state exchange will have to be made in mid-2013. There are logistical, budget and tax consequences to consider, not to mention the variety of insurance options to begin with.
Jay Bradford, commissioner of the Arkansas Insurance Department, said he's working to encourage more competition from health insurance carriers. Of course, national carriers are likely to flock to more populous metropolitan areas of the state, but there's a major concern about what options will emerge for rural parts of the state.
Details about how the state exchange will work aren't expected to emerge until early next year. Greg Hatcher of The Hatcher Agency, which as a health insurance broker has guided many businesses through the benefits process, says he doesn't expect employees who are on an existing plan to switch to a plan on the exchange.
One of the major questions no one seems to be able to answer is how will all this impact insurance premiums for private, company-sponsored plans? The insurance participant pools will grow, but so will the benefits that are required.
Finally, let's assume that some major political developments actually lead to substantial changes in the health care reform law. I don't think we have a clue what they would be or how the industry would react. The GOP election theme has been "repeal and replace." There are multiple ways to change the way we're going to reform the system, but I honestly don't know that I'll like the Republican plan any better than what the Democrats developed.
Ultimately we're going to face a bunch of frustrated consumers who simply want affordable, quality health care but find themselves caught in a quagmire created by one of the biggest political standoffs in U.S. history.