By Wally Kennedy
JOPLIN, Mo. —
Implementation of the Patient Protection and Affordable Care Act presents a tremendous challenge for businesses, and many key elements of the federal health care law are still unknown.
That’s the message human resources managers heard during a health care reform workshop Tuesday at the Holiday Inn in Joplin. The workshop, organized by Adviant, a human resources and benefits consulting firm, and Sisters of Mercy Health System, focused on the major elements of the act that are known.
Jonathan Scales, an Adviant official, said the theory behind the law is that a large risk pool with people of good, average and poor health will result in lower medical care costs than a pool that contains only sick people, which is the case now.
The act, which is 3 years old, is being implemented in stages and through both federal and state exchanges. Scales said it is not clear at this time what those exchanges, also known as marketplaces, will look like and how they will operate. Missouri will be one of 33 states where the federal government will be running the insurance exchanges.
Scales said implementation of a key piece of the legislation, which would provide affordable health insurance to small businesses and their employees, has been delayed until 2015. That option, already available for many larger businesses, originally was supposed to be available to small employers this past January. Employers with fewer than 50 employees are not required to provide coverage.
Scales said individuals will have three options under the act: They can receive insurance through their employer; they can get coverage through an exchange that will offer an insurance plan through a private company; or they can be uninsured and pay a monetary penalty that the Internal Revenue Service could withdraw as part of their federal taxes.
Scales said it is possible that an employer and employee could both face penalties.
Open enrollment for individuals will take place from Oct. 1, 2013, through March 31, 2014, he said.
An individual will fill out a health care application. After that is done, the person will be certified to purchase insurance through an exchange if no coverage is provided by the employer.
Rates for purchased insurance through the exchanges will be based on a number of factors, including, for example, age and tobacco use in Missouri. The rates will not be based on gender or the health of the patient, among other things.