Advice as healthcare heats up: ‘Hold tight’

By Jim Kendall

This column originally appeared in the November 24, 2014 Daily Herald


The noise and confusion surrounding employee healthcare coverage is about to become even louder and, probably, more confusing:

* With added energy from the new Republican Senate majority, the debate over the Affordable Care Act, the formal name for Obamacare, will be more intense than ever.

* Adding to the din will be Supreme Court hearings that some say could lead to a decision that effectively ends the federal health insurance plan. Current thinking is that hearings will begin in March.

For employers, the best what-to-do advice may come from Larry Grudzien, who says, “Right now, hold tight.” An Oak Park attorney with an extensive employee benefits practice, Grudzien seems to have an unusually clear-eyed view of the ACA.

Here are the currently main issues:

* The ACA could be “blown apart,” Grudzien says, by the Supreme Court’s determination on whether federally created state insurance exchanges can provide subsidies to insurance purchasers.

* The plan could be tweaked by changes to the number of hours an employee must work to be considered full-time and qualify for health insurance benefits.

* Congress could vote to repeal Obamacare, although most observers believe the Republicans couldn’t corral enough votes to override the expected Presidential veto.

The present consensus seems to be that a change in the definition of a full-time employee, for ACA purposes from one who works 30 hours a week to one who works 40 hours, has a decent chance of becoming reality. So, apparently, does repeal of a scheduled tax on medical devices – pacemakers and hips, for example.

Somewhat less certain is a change in the size of businesses required to provide health coverage – from those with 50 full-time employees or equivalents to those with 100.

Further complicating the issue, according to Grudzien, is that businesses will be required to gather data next year for federal reports that must be filed in 2016 on the types of coverage offered to employees.

It’s action to be taken by the U.S. Supreme Court, which has agreed to review whether the ACA allows subsidies to insurance buyers in states that haven’t established their own health care insurance exchanges, that many believe could destroy Obamacare – or strengthen it as perhaps the last serious challenge.

The ACA required states to establish marketplace mechanisms – i.e., insurance exchanges – that would make it both easy and affordable for uninsured Americans to buy healthcare coverage. The idea was that each state would establish an exchange; in those states that didn’t, the federal government would do so.

The issue matters because 36 states haven’t done so, acceding to federally sponsored exchanges. The decision, which may not come until close to mid-year 2015, “is going to be a huge deal,” Grudzien says. “Instead of changing (Obamacare) around the edges, this could blow a hole in it.”

Holding tight – and staying in touch with your health insurance agent – may be a good idea.


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