Changes to major Obamacare provisions progress

Changes to major Obamacare provisions progress

Feb 07, 2014

Some of Obamacare’s toughest requirements for small businesses looking to meet new healthcare mandates center on the change of “full time” status from 40 hours a week to 30 hours. And, if businesses cannot afford to insure all workers meeting that minimum, challenges may arise for those employees in finding affordable, in-network care on their own.

Of course, the troubles of small businesses and individuals are foremost on the minds of the insurance producers seeking solutions for their clients. Help may be on the horizon on both fronts, however.

David Shore, president of the Massachusetts Association of Health Underwriters, has found that many insurers provide just “limited network plans,” which makes it difficult for low-income and chronically ill employees to find and afford appropriate providers.

Indeed, a December study from consultant McKinsey & Co. found more than two-thirds of health plans offered on the exchange have assembled provider networks considered “narrow” or “ultra-narrow.” In these networks, as many as 70% of hospitals and other local health providers aren’t included.

Even when insurers boast a wide network, the sale is difficult, said Steven Hurd of Pacific Insurance Brokers in California.

“A lot of times, people go for name recognition and they don’t know that smaller regionals are actually able to offer excellent value,” Hurd said. “Down here in San Diego, Sharp offers a lot of value, but people aren’t used to them and don’t want to figure out where those directories are and the nuances of putting people in there.”

That’s why the Health and Human Services Department felt prompted to issue a letter to insurers, urging them to cover 30% of “essential community providers” come 2015. That’s an increase from the 20% required this year.

The HHS also said it would review insurers’ provider networks to ensure they provide “reasonable access” to healthcare, including federally funded health clinics, safety-net hospitals and other medical providers commonly used by low-income individuals. Robert Zirkelbach, a spokesman for America’s Health Insurance Plans (AHIP), told Bloomberg the nation’s insurers were willing to comply with the request.

“It is important to ensure patients can continue to bebefit from the high-value provider networks health plans have established, which are helping to improve quality and mitigate cost increases for consumers as the new healthcare reforms are taking effect,” Zirkelbach said.

As for the 30-hour work week, would-be ACA reformers on the House Ways and Means committee advanced a bill that would change the law’s definition of a full-time worker to those who work 40 hours per week.

The legislation, which was passed on a vote of 23-14, will be referred to the House for consideration.

Mark Brown of Illinois-based M. Brown and Associates said the current definition of full time work has several of his clients in a bind.

“The business needs to survive, so what do you do? I have a client who bought up a company a year ago who needs to insure 50 to 70 people and there is no money to do it,” Brown said. “I feel really bad—what do you do for a guy like this? Make all 70 employees under 30 hours? Then nothing would get done.”

The HHS proposal is still in draft form, while the House bill must now be scheduled for debate.