Confusion, delays mark approach of key "Obamacare" provisions

It's confusing, it's complicated and it might be costly. But it may help improve the health of the nation. Although it elicits strong reactions on either side, not many people admit to really understanding the Affordable Care Act.

Last week Ward Haessler, Sales Manager for individual and small group products at Blue Cross Blue Shield, traveled across Nebraska to hold talks with small business owners from Scottsbluff to Lincoln to educate them about the ACA.

"What I found when I did these meetings is, there's a lot of confusion," Haessler said.

Businesses with fewer than 50 employees do not have to supply insurance to their employees and aren't subject to the same penalties as larger employers.

"Small employers are under the impression that if they don't offer coverage, they have to pay a penalty," Haessler said. "It's the number one misconception."

Yesterday, President Barack Obama delayed the time at which penalties would take affect for those businesses with more than 50 employees that don't offer health insurance. These penalties were set to take affect in 2014.

The decision pushes the start date for inforcement into 2015.

One of most controversial portion of the ACA or "Obamacare," the individual mandate, goes into effect January 1, 2014. Many Americans, including some who sell health insurance for a living, don't agree with the portion of the law that requires everyone to either buy health insurance or face a fine.

"Although I believe people should have health insurance," said Brooke DeNovellis, owner and sales agent at Farmer's Insurance in Sidney. "I don't believe it should be forced upon them."

Many agree that some portions of the healthcare law are beneficial but few are proponents of the entire bill. Some insurance providers know that changes needed to be made to how America did healthcare, but aren't sure if the ACA is the right way to do it.

"There definitely needed to be changes," said Jackie Gartner account executive at OCI insurance and financial services in Sidney.

The wellness benefits are a plus, and offering coverage to those who previously couldn't get it were both positive changes, she elaborated. Gartner does not agree, however, that people should be forced to buy insurance if they don't want it.

Individuals who don't wish to buy health coverage do have the option to pay a fine instead. The penalty for not purchasing coverage in 2014 will be $95 for the year, said Haessler. This fine will likely be much less than the cost of actually buying insurance.

The open enrollment period for plans under the new law is October 1, 2013 through March 31, 2014 for guaranteed individual coverage. After that, unless a person has a qualifying event like the birth of a family member, a marriage or the loss of a job, the person can no longer enroll. It is up to the individual to decide if they want to go through the marketplace, the exchange or to buy directly from a company, Haessler said.

Although many small businesses aren't required by law to provide insurance, Haessler thinks many will continue such programs.

"Most employers will continue to offer benefits to remain competitive," he said.

Small businesses have the option of buying insurance through a broker like they did previously or buying through the small business health options program, which is the federal government's insurance marketplace. Those shopping in the marketplace might qualify for tax credits, but they must list fewer than 25 employees, pay an average wage of below $25,000 and contribute more than 50 percent of employee premiums.

Most people that Haessler spoke with on his informational tour across the state were not pleased with the law.

"I would say they're less than happy," Haessler said.

There is some consensus, however, that elements of the new healthcare law are useful.

"The law dictates specific benefits that'll have to be covered that weren't in the past," Haessler said.

There are some positives, in Gartner's opinion. The law might make healthcare affordable for people who don't currently have insurance. Those with pre-existing conditions will finally be able to receive coverage, she said.

Insurers are also now required to cover preventative care, such as cancer, blood pressure and diabetes screenings. Adults under 26 who can't get coverage at their jobs can stay on their parents' plans.

All insurance plans for individuals, families and employers with more than one and fewer than 50 employees must offer some specific benefits as mandated by the federal government. These include outpatient services, emergency services, hospitalization and maternity care. Mental health care must also be included, as well as prescription drug coverage, rehabilitative care and laboratory tests.

Vision and dental coverage for children must also be covered.

Although there are some benefits to the new law, it undoubtedly makes the process of buying and selling insurance much more confusing for all those involved.

"What's more complicated than in the past is how you purchase insurance," Haessler said.

There will be many more people involved in the insurance process. It will include consultants, brokers and navigators.

Navigators will be government employees who explain the health insurance to consumers but don't sell any insurance. Consultants will be paid a fee to explain the law and brokers will sell the insurance, Gartner explained.

Consumers will be able to buy their insurance in a number of different ways. The exchange is an online marketplace for people who don't have coverage or can't purchase it through their state. The private exchange are private companies creating plans within the government regulations and the subsidy plans are the government plans, Gartner said.

The new law is so complicated, some agents are considering backing out of insurance altogether, rather than dealing with the ACA.

"I'll have to see what impact this has on my office's function to see if it's gonna benefit me to do it anymore," DeNovellis said.

She currently sells health, life, auto, home, business and farm coverage, but is considering getting out of the health insurance game. With all of the new regulations, taking the time to do health insurance might not be worth the money, she said. She thinks that most people, even some insurance sales people, probably haven't taken the time to read or understand the bill.

"It takes more time than its worth," DeNovellis said.

There will also be more taxes and fees involved, so premiums will probably go up, Haessler said.

Staying informed is the best way to be sure that you'll go into next year feeling a little better about your healthcare options, Gartner pointed out.

"Read your policy," she advised. "Know what your options are. If the subsidy is better, take advantage of it. If it's a health plan, take advantage of it. Because now there's gonna be a lot more options out there for people."

Gartner urges everyone who doesn't have insurance to see knowledgeable broker who can explain all the facets of the new law.

"People shouldn't be afraid of it, they should welcome it," she said.