About this series
The Affordable Care Act requires all Americans to have health care coverage. Beginning Oct. 1, they can shop on health care exchanges for insurance plans. The Times takes a look at what that change means for the average Northeast Georgia resident.
Previous stories from this series:
Some major parts of the Affordable Care Act for employers are delayed until 2015, but that doesn’t mean companies aren’t looking at the new law and making decisions now on how they will offer health benefits in the future.
The health care reform was passed in 2010, but major provisions of the law are scheduled to take effect this year and next, with open enrollment for the health insurance exchanges scheduled to begin in about a week.
People looking for coverage can use online health insurance marketplaces starting Oct. 1 to get insurance that will take effect Jan. 1.
Some Gainesville companies are restructuring the way they offer benefits to make providing it more cost-effective because of the law, while some are placing less emphasis on changing business growth because of changes in the law.
The employer mandate, which requires businesses with 50 or more employees to cover full-time workers, has been postponed until 2015. The mandate penalizes employers that fail to offer plans with minimum government requirements or have had at least one full-time employee who enrolls in an exchange plan.
The law also makes employees working 30 hours or more eligible for health insurance.
Some companies are exploring new ways to cut costs and provide service, including biometric screenings, questionnaires, consumer-driven health plans, dropping spousal coverage and vouchers.
Some large commercial companies are dropping out of the state exchanges, and private marketplaces are popping up.
UPS has announced it will start dropping spousal insurance in 2014.
Barbara Rambo, chief financial officer for Gainesville-based ProCare Rx, said the company started restructuring the way it handled health insurance last year, expecting the employer mandate to take effect this year. Rambo said the pharmacy benefit management company employs about 131 full-time workers and 26 part-time employees who mostly work in its call center.
“We limited part-time employees to only being able to work less than 30 hours a week,” Rambo said. “So the good part of that is that we obviously had to hire additional part-time employees.”
One of the other areas Rambo focused on last year was the premium cost share that was passed along to employees.
The amount was previously a flat rate, but was changed to a percentage of gross income to make the insurance premium price more fair to lower-paid workers, she said.
ProCare Rx is seeing an upside to the law on its sales side with clients, including self-funded plans, third-party insurance administrators and brokers trying to bundle medical and pharmacy coverage, Rambo said.
The ACA set up some state cooperatives, and ProCare expects to manage the pharmacy benefit for co-ops in Kentucky, Louisiana and eventually Ohio. The co-ops are nonprofit, member-controlled health insurance companies.
Private exchanges may have provider and hospital networks, but may not have a pharmacy network.
“As those private exchanges crop up more and more, that’s going to provide even more of an opportunity for ProCare on the sales side,” she said. “The notion of the Affordable Care Act is affordability, and that’s one of the things we do and we do very, very, well.”
Some small businesses are keeping the number of full-time employees to under 50 people.
RK Whitehead, owner of Whitehead Die Casting, recently went from 49 full-time employees to 52, not counting temp-to-hire workers through a staffing agency. But the ACA didn’t affect his hiring or business growth, Whitehead said.
“When we were at 49 and I had a supervisor come to me and say, ‘Well, I’ve got three folks that I would like to put on our payroll,’ I made the conscious decision to go and move forward with that because it was the right thing to (do for) them and the right thing to do for us,” he said. “And it didn’t really change (whether) we had to offer health insurance or not through the Obamacare.”
He said his plans already meet government requirements.
Whitehead Die employee health insurance rates will stay the same until November 2014. That’s when he will see what the plan rates will be for 2015, right before the employer mandate takes effect, and what his employee renewal rates will be.