Changes in Affordable Care Act frustrating employers, insurers

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So now some insurers CAN renew health policies into 2017, even though they don't meet minimum coverage requirements under the federal Affordable Care Act.

That White House announcement last week would seem to be welcome news since it eases the transition to the new health care world and could slow the growing number of employers canceling employee health plans.

At a grass-roots level, however, the decision adds another layer to the ongoing confusion and uncertainty about the landmark health overhaul's shifting deadlines and moving-target regulations.

"I've never seen the chaos I've seen the last three years, and it gets increasingly worse as we get to the deadlines, which then get delayed," said Daniel Severino, president of the Meadville, Pa.-based insurance broker DJB Group, which itself provides health insurance for 10 employees. "How do I plan when it keeps changing every couple of months?"

"There is mass confusion out there," agreed Deb Wilkinson, vice president for health plan options at the wholesale brokerage firm URL Insurance Group in Harrisburg.

URL operates as a middleman for more than 300 independent health agents and agencies in Pennsylvania, responding to their questions and helping them navigate the regulations to make sure they are in compliance. Clients turn to the brokerage firm for expertise but, she said, URL can't always get answers either.

"What we're trying to do is to keep our agent clients informed," said Ms. Wilkinson. All too often, "We have to say, 'There's been no guidance on that yet.' And, I mean, that's daily."

The sweeping law enacted in 2010 has already undergone an array of changes and delays, most notably pushing back the employer mandates to provide at least basic coverage or face a fine, and exempting those with canceled plans from being penalized under the individual mandate to purchase insurance.

The latest change, announced Wednesday, gives states discretion on whether to allow insurers who offer plans that don't comply with ACA's minimum coverage to renew those plans. Because of that, Highmark and UPMC Health Plan say they're awaiting guidance from state officials before deciding what to do.

Even if insurers get the go-ahead from the state, that doesn't mean they will renew those plans -- or if it's even a good idea for employers to buy them, said Carl Knoblock, district director for the Western Pennsylvania office of the U.S. Small Business Administration.

The latest rule change, Mr. Knoblock says, means, "I get to keep my insurance plan if they still have it. But, even if they have it, is it going to cost more or the same? Or would it just be better to find a new plan and be done with it?"

Mr. Knoblock said one employer, a manufacturer in north Central Pennsylvania with 47 employees, decided -- as did many others -- to renew his current health plan late last year so he would have at least another year to decide the best course going forward.

But, in order to comply with ACA requirements, his insurer had to develop a different plan for him this year. And the new plan is going to cost the employer an additional $14,000 per month.

For some, it's all just too much.

Ms. Wilkinson said her firm expected that many small business owners will decide to get out of the health coverage business and direct their employees to the health exchanges where individuals choose their own plans and pay for them.

"What we didn't expect was a lot of the larger groups are saying they're done with the employer-sponsored group model. They're done with group coverage and they're sending everybody to the exchange."

While the string of delays has relieved some time pressure to make decisions, the uncertainty it has created adds a whole new layer of complication for those trying to run a business, Mr. Knoblock said. "It almost doesn't matter if it's good news or bad news. You'd like it to be good news, but as long as I know what it is -- good or bad -- then I know what I have to do in my operation to comply and at the same time keep profitability."


Steve Twedt: stwedt@post-gazette.com or 412-263-1963.

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