How PPACA changes 2014 – whats next?

OK, so its been a mess.  Rising premiums, falling benefits, confusion, failed websites – but you knew that already.  Soon, that will be water under the bridge and we need to look forward  So here goes:

INDIVIDUAL MANDATE – this technically starts on January 1, but all Americans really have to have insurance by 4/1/14.  If not they will be fined 1% of their income per person, with a minimum amount of $95.  This will be collected on their tax return.  The logistics on this are still in flux, however – what if I do not file a return, does it carry over year after year?  What about the people that should have been on Medicaid, but are in states that did not adopt the expanded Medicaid Program?   They are in a great spot- they earn too much for medicaid, not enough for a subsidy, cannot afford health insurance, and they are going to get fined…

TAX CREDITS- the “subsidy” is actual a Tax Credit.  Many people don’t realize that – should their income change significantly – they could owe back part, or all, of the subsidy to the government.

NEW TAXES-  There is a new tax on insurance companies, and a tax on self insured plans, which will undoubtedly be built into our premiums going forward.

NEW COMPANIES- THere are a wheelbarrow-full of insurance companies you have never heard of.  CO-OPS like Consumers Choice (SC), Louisiana Co-Op and Health Republic (NY).  New private plans have rushed to market.  Will employees and individuals join a health plan they never heard of?  Will these plans have the enrollment and capitilization and knowledge to survive?

WAITING PERIOD CHANGES – You cannot have a waiting period longer than 90 days for your employees.  That means that your choices are 30 days, first of the month after 30 days, 60 days or 90 days.  You cannot use first of the month after 60 days because 7 months have 31 days (60+31=91).

WELLNESS REWARDS- For participating in wellness programs, employers can discount premiums up to 30%.  50% for smokers.  Will employers take this more complicated approach, and will it be enough to stimulate employees to make lifestyle changes?  Alot may come down to how the leadership handles change at that company- in a company devoid of supportive leadership, the employees typically handle change as an attack, and fail to embrace it.