Like it or not the Affordable Care Act (ACA) is law and the regulations pertaining to that law will continue to grow until Jan. 1, 2014, when it will be fully in effect. That was the message from the Utah Health Exchange during a meeting on Thursday night in Price
"Our health care system will look very different at that point than it does today," said Patty Conner, the director of the exchange.
Regardless of what happens in the presidential election this fall, at least some of the law will affect people. Parts of the law have already come into effect.
Conner pointed out a number of the things that are already on the books.
â¢ Now preventive care is covered at 100 percent.
â¢ All dependents are covered under their parents' health care until age 26.
â¢ Women's wellness checks are covered at 100 percent.
â¢ Industry is required to use standard coding for costs incurred by insureds (to avoid claim errors).
â¢ There are summaries of benefits and coverage available for use along with a uniform glossary (so that lay people can understand their coverage without wading through 40 pages of legalese).
One of the things that will be mandatory for states to do when the law fully comes into affect will be to set up a health exchange. That idea of health insurance exchanges is one of the keys to the ACA. Utah already has its own in gear.
Conner and her staff were in Price to explain how the Utah Health Care Exchange is working and will work as time moves along. In the meetings in Price on Wednesday, they were particularly concentrating on how they can help small businesses when it comes to offering insurance to their employees and to deal with the new regulations.
"We are a small business state," she said. "Utah has 67,000 small businesses that have between two and 20 employees. Only one third of those businesses offer health insurance to their employees."
The main reason most don't offer it is because of cost, but limited choices that have been available and the administration of a health plan for a small management staff can be a substantial burden. However many would like to be able to give their employees insurance for a number of reasons, including retention of personnel so they can stay competitive and productive. Now they also have another reason: The ACA will require it.
The Utah Health Exchange (UHE) is a market-based information portal that connects consumers to vital information so they can make informed choices about healthcare. The exchange currently has nearly 300 small employer groups participating, covering more than 6,500 lives. Small businesses with two to 50 employees are eligible under the following circumstances:
â¢ There must be a 75 percent participation rate among eligible employees.
â¢ Seasonal and part-time employees are not eligible.
â¢ Contract workers (those that are not employees but are paid and get 1099 forms) are not eligible.
â¢ Fifty percent or more of the employees must be Utah residents.
Over the years many small businesses have dropped their health insurance for employees, with the main factor in that being cost. The UHE can help because the program works on a defined contribution. The employer decides how much he or she can afford to put into the exchange per employee and then the employees can select from a number of choices for insurance (based on what it will cost beyond the defined employer contribution) and on their exact needs. A number of insurance companies are working within the plan, so the choices are wide ranging.
The old way of doing insurance, where one size fits all, can be replaced with this, making almost everyone from employer to employee feel better about their coverage.
According to Conner the Utah program is only one of two that are actually functioning in the country. The other is Massachusetts, where the program was set up to help big employers, because that is what they have in that state.
"All the states will have to have an exchange under the ACA," said Conner. "Most are struggling with setting up a plan. We are the pioneers in this and many states and a couple of territories have come to us to learn what we do, and how we do it."
It's important for tax payers to know that Utah's plan has been set up and is running for right around $1 million. The federal government has been offering money to the states to help them start up plans, but Utah didn't take any. States like California are taking up to $200 million to develop their own.
"We have been frugal in setting our plan up," said Conner who came from a private enterprise background with a large company to run the plan for Utah about a year and a half ago.
The fact is that in about a year and a half everyone will be mandated to have health insurance. This plan will help many businesses and individuals get through the new provisions.
When 2014 rolls around, the ACA will also bring into effect many more provisions beyond that too, including:
â¢ Insurance will be guaranteed issue. Everyone will qualify regardless of their health or pre-existing conditions.
â¢ There will be a maximum cap for out-of-pocket costs.
â¢ There will be quality and transparency enhancements.
â¢ There will be essential health benefit packages.
â¢ Medicaid eligibility rules will change.
â¢ There will be insurance premium tax credits and cost sharing reductions.
â¢ There will a creation of health insurance exchanges in every state in the union.
The UHE team that was in Price on Wednesday spent much of the day training brokers for the plan in the area as well. This means many of the insurance people in the area now are credentialed to help businesses set up their company with the UHE. These agents can explain the process and then the company can decide if they want to join the exchange.
For more information on the UHE and how it works go to www.exchange.utah.gov.