You Oughta Know

David Pate: What's next for health care reform?

President and CEO, St. Luke's Health SystemMay 21, 2014 

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David Pate

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Though implementation of the Affordable Care Act began soon after its enactment in 2010, the most sweeping provisions began this year. The individual mandate went into effect, and those who do not maintain health insurance coverage for the rest of the year may be subject to a penalty when they file their 2014 federal tax return.

Also this year, every state was required to operate its own insurance exchange or default to the federal exchange. While many states struggled to establish exchanges, Idaho was extremely successful, enrolling almost twice the goal set by the Congressional Budget Office. Idaho was the third most successful state on a per capita basis for insurance enrollments. After a botched rollout, even the federal exchange exceeded goals and expectations, with more than 8 million enrollments.

In partnership with St. Luke's Health System, SelectHealth introduced new insurance products on the exchange that offered Idahoans additional options. The competition greatly benefited state residents, evidenced by the thousands of people who signed up with SelectHealth. The Montana Health Co-op may enter the Idaho exchange for next year, bringing additional choices and competition.

Here are four areas Idaho's employers will want to keep an eye on going forward.

1. The employer mandate

This requirement - that all businesses with more than 50 full-time equivalent employees provide health insurance for their full-time employees or pay new fees - goes into effect in 2015 for businesses with 100 or more full-time employees and in 2016 for those with 50 to 99 full-time employees.

2. Next year's premiums

The next open enrollment period for the health insurance exchanges will be in mid-November. Insurance companies will submit their new rates this summer.

There has been concern that a low rate of registration among "young invincibles" ages 18 to 34 might result in higher costs than predicted, meaning that insurance companies might have to significantly increase premiums for next year.

3. Insurance plan trends

So far, there has not been any significant movement on the part of employers to stop offering insurance plans for employees and to push employees to the exchanges. This could change if premiums skyrocket, as some suggest they will. Regardless, it is likely that employers will continue to shift cost-sharing responsibilities to employees.

Some employers are looking at private health insurance exchanges for the future, but surveys indicate that most employers are hesitant to move in this direction and still believe that employer-sponsored benefits are a competitive advantage. These private exchanges would feature a defined contribution from the employer, and participants would not be eligible for the tax credits or subsidies now available to those earning less than 400 percent and 250 percent of the federal poverty level, respectively.

4. Medicaid expansion

Idaho opted not to expand Medicaid but is pursuing options to reform its Medicaid program. It is conceivable that Medicaid expansion might be approved next year.

drpate@slhs.org

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