Paul Hardin of Moulton and Hardin addresses a group of area business leaders at a lunch session on the Affordable Care Act on Wednesday at the Albany Welcome Center. The focus on the session was the impact the health care reform will have on businesses. (Staff Photo: Jennifer Parks)
ALBANY — The onset of the Affordable Care Act, specifically the marketplace exchange, has many people confused — including business leaders.
As a way to help ease that anxiety, there was a lunch-and-learn session held at the Albany Welcome Center on Wednesday for area business leaders to learn more about how the health care reform will impact them.
Leading the session was Paul Hardin of Moulton and Hardin, an employee benefits, payroll services and human resources solution firm with offices in both Athens and Albany.
The health reform law, he said, is designed to make significant changes to the health care system. Most employers that offer health plans will be impacted in some way, and it will potentially be a huge drain on insurance companies.
“It is tremendously impacting business and individuals,” Hardin said.
He began with an overview of the marketplace exchange that went live last week, which in Georgia’s case, is the one being provided by the federal government.
“It is an online marketplace,” Hardin said at the luncheon. “Think of it as an online shopping mall for health insurance.”
Attention was also paid to the Small Business Health Options Program — or the SHOP — exchange, which applies to businesses with 50 or fewer employees. Next year, states will be able to limit it to a size of up to 50 employees. Effective 2016, states must increase the size to 100 employees, and the following year, states can let an employer of any size participate.
Small employers, Hardin said, can offer employees enrollment in a qualified health plan, or QHP, through a SHOP, and can offer benefits through a cafeteria plan.
With all the changes going on, there is at least one thing that will remain the same, he said.
“The agent and broker role won’t go away,” Hardin said. “(He or she) can advise whether to go on or off the exchange.”
For the individual and SHOP plans on the marketplace exchange, the insurance carriers for Georgia will be Blue Cross Blue Shield, Humana, Kaiser and Alliant.
“There are 16 regions in Georgia,” Hardin said. “In the Albany area, it is just Blue Cross.
” … (For the decision to go on or off the exchange), we are not solely looking at plan versus price versus tax. There are a lot of things involved.”
Hardin said officials are expecting most of the business on the marketplace to come from people who have been rejected for coverage before due to a pre-existing health condition. The result, he said, will be a squeeze in reimbursements and the network, but that the difference will be made up in volume. With the way the system is currently set up, he added, individuals will be unable to leave the Georgia service area for care unless it is an emergency.
The requirements for QHPs, Hardin said, are that they are offered by an approved insurer, are certified to meet exchange requirements, offer essential health benefits, meets cost-saving limitations, priced like plans outside the exchange and that they are offered on bronze, silver, gold and platinum levels along with a catastrophic plan for younger adults.
“There is only bronze, silver and gold in Albany,” he said. “There are no platinum or catastrophic plans.”
For those who don’t purchase the essential benefits, there is an individual mandate that, next year, will be the higher of $95 per person or 1 percent of household income — an amount which will go up over time.
“To avoid the fee, you must have coverage,” Hardin said.
Small employers are not required to offer coverage, while large employers must offer coverage to full-time employees and dependents to avoid penalties — which will be triggered in 2015 if a full-time employee receives subsidized coverage in an exchange. The coverage must be affordable and provide minimum value.
Hardin said “affordable” is defined as self-only coverage not exceeding 9.5 percent and “minimum value” as a plan that covers an average of at least 60 percent of claims costs.
For the individuals enrolling between now and Dec. 15, coverage will start on Jan. 1. Annual open enrollment will begin Tuesday and run through Dec. 7. The marketplace is set to remain open through March 31 of next year.