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Introduction by Brien Smith, dean of the Scott College of Business at Indiana State University and Network's Acting Executive Director, and Jack Tatom, Networks' research consultant.
David Kendall, Senior Fellow for Health and Fiscal Policy at Third Way began his remarks by noting that public misunderstanding coupled with mystery about what the ACA entails have kept people from focusing on what is ultimately desired - a stable health care system. He continued by comparing the ACA with Medicare Part D.
Dr. Scott Gottlieb, practicing physician and Resident Fellow at the American Enterprise Institute emphasized that the ACA is shifting medical risk from insurers to providers, primarily through various forms of capitation. In the future, large employers, government and insurance providers will assume risk under the ACA, but a shift in risk will transfer it to providers.
John Liu, Indiana State University Associate Professor in Insurance and Risk Management moderated a panel of industry experts.
John Boss, Executive Vice President, Employee Benefits Consulting Group, AON Risk Solutions noted that over the past 25 years, employers have been inundated with new benefit laws including COBRA, HIPPA and Medicare Part D, among many others. As such, the ACA and its corresponding requirements did not come out of a legal or regulatory vacuum. Several changes to health insurance coverage have been leading up to the opening of the exchanges and the 2014 ACA enactment date.
Dan Grelecki, Director, Patient Protection and Affordable Care Act, Old National Insurance discussed the cost of the ACA to individuals ands small companies. The mandate that all individuals share in the cost of coverage will naturally present "rate shock" to the young and healthy that may elect to pay the fee rather than face the premium. The mandate requiring employers to provide coverage – particularly the details in the mandate regarding size of workforce, full-versus-part-time and seasonality considerations – are an administrative nightmare for employers.
Wes Mantooth, Principal and Employee Benefits Practice Leader, Gibson Insurance noted that a key goal of the ACA is to increase access and affordability for small employers; those with fewer than 50 employees. Yet providing this access does not come without challenges. A key concern is the narrow networks that are available as mass consolidation continues. In order to maintain their margins, hospital systems have cut back on their employment numbers. Moving forward, we will see these forces creating an environment where the narrowing of networks results in health care costs that exceed discounts.
Jonathan Gruber, Professor of Economics, Massachusetts Institute of Technology is recognized as the architect behind Massachusetts’ landmark reforms, and a key adviser to the Obama administration during creation of the Affordable Care Act. Dr. Gruber noted, "The law is misunderstood," and advised that it is legislation that has been in progress for nearly a century. "How we got here has been a nearly hundred-year process with roots in the Teddy Roosevelt administration."
Jim Mills, vice president of human resources, Fairfield Manufacturing said that the ACA is steeped in uncertainty. The floating regulation has created a constant flow of changes. It is not certain what the delayed employer mandate means. Nor do employers understand related tax changes that may be required. The Act is particularly hard for a union-based organization that typically negotiates benefits over several years. The bottom line is the ACA is a huge failure and we’re really disappointed in Washington.
Theresa Jasper, vice president of human resources, Hulman & Company and the Indianapolis Motor Speedway said that as an organization that maintains several employee classifications including permanent, full-time; permanent, part-time; seasonal, part-time; and seasonal full-time; Hulman & Company had to be particular cognizant of ensuring compliance with ACA language regarding an employee’s status.
Seema Verma, president, SCV Consulting asked that looking at the post-ACA environment, what is next for states? As the exchanges opened, the majority of states elected to implement the federal exchange option. The early troubles plaguing implementation have not come as a surprise to employers, especially considering that the political environment (2012 elections) created uncertainty and delayed distribution of information until following the election.