A University of Georgia health policy expert said Tuesday she doesn’t see the Affordable Care Act taking effect Jan. 1, 2014, because of time-consuming work involved in setting up health care exchanges, or marketplaces for private insurance.
“In order for that to happen, open enrollment has to occur in October 2013,” said Phaedra S. Corso, a Gainesville resident who teaches in UGA’s Department of Health Policy and Management. “I don’t see any possible way that our state — or many states — is going to be prepared for that.
“My guess is that one of the things (Congress) is going to have to do is to extend that deadline on when those exchanges need to be operational, either June 2014 ... or maybe 2015.”
Corso added, “So here’s the domino (effect): If the exchanges aren’t in place, the individual mandate won’t be in place.”
The health care law’s most controversial point is that it requires all Americans to have health insurance. In June, the U.S. Supreme Court found that President Barack Obama’s health care overhaul was constitutional, including the individual insurance requirement.
Corso spoke Tuesday morning on the subject at a Greater Hall Chamber of Commerce seminar for small businesses on the post-election implications of health care reform. Nearly 50 people squeezed into a meeting room for the hourlong session.
States were expected to make the initial decision on establishing exchanges by Friday, but Obama announced last week that the deadline would be extended to Dec. 14. In states that don’t set up an exchange, residents can choose from insurance plans in a federal exchange.
Last week, Georgia Gov. Nathan Deal suggested he would not implement a Georgia health insurance exchange as part of the law, but that he wouldn’t disclose his decision until notifying federal authorities.
Deal noted, however, that the state stopped planning an exchange once federal agencies wrote regulations that he says restrict Georgia’s ability to design its own program.
“There are heavy, heavy regulations, even if it’s a state-based exchange,” Corso said.
She doubted the ease with which even federal exchanges can be set up based on the diverse makeup of states.
“We have such a rural community here in Georgia, they might just have to operate it in a very different way here than in California,” Corso said.
The key point she tried to make with business owners is that those with fewer than 50 employees will see little impact.
Employers with 50 or more workers could face penalties — $2,000 for every employee minus 30 — if they don’t offer insurance to full-time workers.
That provision has drawn a couple of sharp criticisms, including that employers might decide it’s cheaper to take the penalty than offer the insurance.
And then, “what if you’re right on the cusp of (having 50 employees)? What if you’re thinking about expanding?” Corso asked the audience.
“Here’s where I think you’re going to have some serious implications for small business, as in not wanting to expand,” she said.
Several members of the audience agreed, saying, “And killing growth.”
Kit Dunlap, the chamber’s president and CEO, also voiced concerns about that part of the law, saying that small employers make up a huge chunk of the county’s work force.
She said she expects the chamber will continue to hold future forums on health care reform.
“We don’t know when the next one will be,” she said. “Maybe next time, we’ll do a panel. We could do some really good interaction.”