Article By Michael Daigle | Inside Business (November 2015)
The 2010 passage of the Patient Protection and Affordable Care Act (Obamacare) kicked off a plethora of changes in the health care arena – changes that are constant and, at times, confusing.
For benefits consultants this means continual learning – being prepared to discuss with clients the costs of health benefits as they relate to emerging mandates and a willingness to become educators as well as advisors, according to Michael Venditto, a group benefits specialist with Hafetz & Associates, a benefits management firm in Linwood and Woodbridge.
The goal, according to Steven Rosenthal, chief executive officer and president of Triton HR of Woodbridge, is to ensure clients are compliant and offer a benefits plan that meets each individual company’s financial and human resource goals.
“Education is important,” Rosenthal said. “We do employer models, offer examples of plan designs and then show them the costs.”
Compliance, especially with the new reporting forms required by the IRS, is vital, Rosenthal added. Ensuring those forms are accurate is an important service for clients, since a mistake could haunt the company for some time.
Such inside discussions take place under an umbrella of potentially larger political and legal changes that could again alter the landscape.
The national Society for Human Resources Management advised its members in its 2015 outlook on health care reform: “Entering 2015, the ACA faces challenges both in a new Republican-controlled Congress and in the Supreme Court. Yet the political and
legal uncertainty surrounding the ACA should not deter employers from ensuring they are prepared for the ‘play-or-pay’ mandate and other upcoming requirements.”
One of those requirements, which would have mandated that all employers with 50 or more full-time employees offer a health insurance plan or pay a tax, was delayed. The date for requiring employees with 50 to 99 qualified employers to meet this mandate will take effect on Jan. 1, 2017.
That change is typical of the way the health law has rolled out, according to Ed Gunther, president of Centric Benefits Consulting in New Providence.
“There are changes every day,” Gunther said.
His job is like juggling 48 balls and every day adding two more, he said.
Generally, employers are engaged in keeping in place their employer-based health care system rather than having their employees enter into the ACA-offered exchanges, Gunther said. Solid benefits packages, including health insurance, are a competitive factor, he added.
According to experts, among the new changes evident in New Jersey:
• Hospital are joining with doctors’ offices to form networks and those networks are combining to form hospital networks, or accountable care organizations;
• Hospitals are focused on ensuring that patients do not return for treatments of the same condition, for which they are fined;
• There is an increased attention to wellness and disease prevention.
In response to the new attention to wellness, Triton has opened two health centers, Rosenthal said.
He added that the ACA requires companies to adhere to strict rules on how they offer health benefits, how they structure those benefits and how they report that compliance to federal agencies, especially the Internal Revenue Service.
Gunther said the increase in health care information has generated a change in how an individual perceives the cost of health care and how they and their employers sculpt their coverage.
“We used to gauge the costs of health care by the co-pay and deductibles we paid,” Gunther said.
Today, with more detailed cost information available, individuals and companies are able to see a direct impact of the lifestyle and health choices they make on their insurance costs, he said.
Rosenthal and Venditto both said they work closely with companies to examine the make-up of the benefits-eligible population in the workforce (younger versus older workers) and to balance the law’s requirements with company goals, including costs. For example, for employees who are still working but eligible for Medicare, it benefits the company to move them out of a traditional plan and into Medicare with a Medicare supplement, Venditto explained.
Now even more change is coming.
Horizon Blue Cross Blue Shield has proposed its OMNIA Health Alliance that would establish Tier 1 and Tier 2 hospital networks promising lower costs for use of Tier 1 facilities and accenting prevention, wellness and fewer repeat hospital visits.
Venditto said he was encouraged by the potential for lower premiums and Rosenthal said the effort to reduce return hospital visits was a key goal but he wondered how this plan would be different than earlier attempts at managed care with its system of networks.