Thought Leadership Blog

The HRS Thought Leadership Blog delivers validated findings, visionary perspectives and op/ed commentaries related to HR, Leadership, Organizational Development and Employment Law. To enjoy the full volume of available articles, please enter topic keywords in the search box to explore our body of work. Articles are regularly presented by the HRS team and guest experts.


HRS Addresses the ACA: New Cures for the Lingering Headache

Update: Shortly after this article's publication, the US Federal Government announced a one-year delay of certain ACA mandates including the "pay or play" component.  Visit our January 2014 update. As of February 2014, the component has been pushed back again.  Stay tuned for more info. 

 

As employers sift through immediate and forward moving impact of the Patient Protection and Affordable Care Act (ACA, PPACA or “ObamaCare”), we consulted with nationwide ACA experts to provide a quick blueprint of action items, FAQs and debunked myths. In respect to our expert unbiased objectivity, HRS employer clients have been asking us for credible and clear answers on this topic.

Preparation & Timeline

While some employers still believe they have until 2014 to make decisions, a more practical deadline is October 1, 2013, when health exchange notices need distribution to employees. Once these notices hit, employee questions will abound, and the risk of providing inaccurate or unsavory answers will impact employee retention, engagement, productivity and legal compliance. With employee access to health exchange, employer programs will find heightened scrutiny and explanations must be ready. In addition to impact upon talent resources, employer failure to meet ACA guidelines will result in substantial fine. While employers initially pledged to “pay” are shifting to “play,” due diligence is essential to “play.”

With minimum coverage covenants higher than ever before, minimum premiums are expected to increase as well. Employers are encouraged to anticipate this perception gap and to strategically educate employees as to the comparison between employer-sponsored and health exchange coverage. Summaries of benefits and coverage (SBCs) will not be enough to address this topic.

Matthew Weimer, Director of Employee Benefits Operations for Diversified Insurance Solutions, advises employers to prepare for employee surprise once the exchange opens. Weimer advises that many individuals are expecting exchange premiums to be lower than they actually will be, and an opportunity for an employer “win” is present. 

Karen McLeese, JD, Vice President of Employee Benefit Regulatory Affairs for CBIZ Employee Services, Inc., advises employers of all sizes to “work with insurers, TPAs, benefit consultants, brokers and other advisors to ensure compliance with all ACA market reforms.” McLeese further advises to be prepared to deliver notices to all employees, not just those covered by the health plan, by October 1, 2013; to be familiar with single source market place applications; to ensure summaries of benefits and coverage (SBCs) are properly distributed; and to properly classify and count workers. HRS, Diversified and CBIZ are addressing these mandates by providing guidance as to crafting exchange notices, counting employees, educating team members and selecting plans to meet affordability standards.

Criticism, Fact Versus Fiction & Recent Developments

The relentless politicizing and profit taking on this topic have created mistrust and frustration among employers, so HRS has stepped in. We have no vested interest in insurance program sales. Our interest and reputation are tied only to accurate top shelf information and legal compliance standards. We have additionally invited adjacent field experts who have responded with transparency and integrity to our news campaign.
 
While arguments abound, opponents of the Act assert that the “Patient Protection” provisions can be mutually exclusive to the “Affordable” provisions, and employers need to address this concern.  Some employees will undoubtedly be forced to buy more coverage than perceived necessary. Whereas the counter-argument is that these forced coverage levels will ultimately decrease overall health care costs, we cannot ignore and must address the initial sticker shock. Along that same line of thinking, Weimer addresses that many of his insured clients are already electively providing coverage levels that exceed ACA standards, and therefore, when employee premiums exceed health exchange premiums, the gap must be addressed to safeguard employee trust and engagement. Under affordability standards the employer must absorb the majority of premium costs, and therefore, while employees may pay higher premiums through the employer, it is imperative that they fully understand the value received and that the employer is absorbing the majority of excess benefits costs.
   
Employers were justifiably concerned by the initial ACA language which required employer review of “household income” in determining affordability. Not only did this pose an infeasible burden of costly administration but also a grave concern over privacy rights and employee discomfort. Affordability measurements have been thankfully addressed by updated calculation methods to include the W-2, rate of pay and federal poverty line (FPL) methods. These investigations are simpler, less invasive and consider only employee income rather than household income. As the federal ACA regulations shift substantial administrative burden to individual states, HRS urges employers to research state regulations and not just the federal. As the federal regulations do not protect spousal coverage, look to states for spouse and domestic partner rights. 
 

Strategies & Caveats

Employers will choose plans based upon overall compensation scheme, labor intensity and workforce demographics. Benefits should be tailored to unique team attributes and perceived needs. Several HRS clients are employing primarily young, entry level, and therefore typically healthier teams who prioritize basic health but would rather receive other forms of compensation over benefits plan upgrades. For these employers we suggest consideration of a Minimum Value (MV) plan offering optional buy-ups. By deploying this strategy, the employees see premiums competitive to the exchange but also see their employers willing to absorb costs toward employee-elected upgrades. Employers who determine to trade plans down without proper employee education will likely find disaster rather than reward by this practice. “Design your health plan in such a way as to facilitate attracting and retaining your employees.  Design the program to maximize personal engagement.” advises McLeese.

Some of the most common pitfalls will likely be linked to employer size, affordability and minimum value coverage. Small businesses (less than 25 FTEs) are offered conditional tax credits but not for business owners. Large businesses (50+ FTEs) will be fined for offering inadequate coverage. Minimum Value (MV) and Actuarial Value (AV) are impractical to calculate for most employers, and therefore working with insurance brokers and carriers you trust becomes more important than ever before. Safe harbor rules allow employers a small margin of error. Weimer advises employers to look to carriers for proper disclosure of MV and AV data. He tells us Diversified is overseeing these calculations for insured clients. McLeese adds that employers should properly classify employees as a new hire routine and to “work closely with a payroll provider who can assist in these recordkeeping requirements.”
 
Matt Weimer, Karen McLeese and HRS are all addressing proper FTE calculation methods. Weimer and Diversified have released a webinar rich with affordability calculators and employee counting rules. McLeese adds to these metrics a few cautions, including proper classification of employees versus independent contractors. HRS advises that improper 1099 classification is suffering more scrutiny and penalty than ever before, and not just with regard to ACA guidelines but also overall taxation and FLSA compliance impact. McLeese summarizes “Determine which employees are full-time, part-time, variable or seasonal. Decide whether to take advantage of a look-back (measurement) and stability period, and if you're not using a measurement/stability period, analyze status each month.” “Know your shared responsibility risk.  How many full-time employees are offered minimum essential coverage? Is it affordable? To avoid a penalty risk, offer adequate coverage at an affordable rate. It is the offer, not the take-up rate, that matters,” continues McLeese.

McLeese recommends to “Establish a wellness program that promotes health and well-being; and ensure it is compliant with new ACA rules.  If a wellness program currently exists, review it to ensure compliance with new ACA rules.” The ACA addresses wellness programs, and Weimer adds that wellness, HRA and HSA programs are under current review for their rightful position in coverage ratio calculations.

ACA guidelines will continue to address access and will require annual open enrollment for employer-sponsored plans. Employees will need to be offered health exchange notice within 14 days of new hire following group notification by October 1, 2013. Many employees will not be eligible to purchase insurance on the exchange but must be advised by employers as to availability for application.

HRS is addressing the Affordable Care Act with three new dedicated initiatives: 1) PPACA News Campaign, 2) Individualized Employer Workshops, and 3) Employee Education Tools. We remind that much of law is based upon case precedents rather than statutory language. Look for PPACA to be taking shape for years to come. Please consider us a resource, and stay tuned for more information.

 

Article by Jessica Ollenburg, HRS Senior Executive Consultant & CEO. Summary bio

Matthew Weimer is Director of Employee Benefits Operations for Diversified Insurance Solutions. Matt’s extensive insurance industry knowledge and leadership helps to keep the entire benefits department abreast of legislation. He is Diversified’s Health Care Reform onsite expert and sits on the Board of Directors for the Independent Insurance Agents of Wisconsin (IIAW) along with several other industry and legislative committees. Matt has served on a number of advisory councils for the Wisconsin Office of the Commissioner of Insurance and still meets regularly to discuss state and federal insurance regulations. Matt holds a Bachelor of Arts degree in Business Administration and Marketing from Carthage College. 

Karen R. McLeese, J.D., is Vice President of Employee Benefit Regulatory Affairs for CBIZ Employee Services, Inc., a division of CBIZ, Inc. McLeese serves as in-house counsel with particular emphasis on monitoring and interpreting state and federal employee benefits law. She follows and analyzes trends and provides information and technical support in response to technical questions regarding employee benefits.  McLeese is a member of the Employee Benefits Committee for both the Kansas City Metropolitan Bar Association and the Missouri Bar Association. She is also a member of the Health Law Forum and the Labor and Employment Law Section of the American Bar Association. She has spoken professionally on wide variety of topics related to employee benefits, including HIPAA, COBRA, Welfare, Medicare, FMLA benefits. McLeese serves as an editorial board member for the publication Benefits Law Journal and is a graduate of Notre Dame and Duke Universities.


Jessica Ollenburg - Wednesday, June 26, 2013