POSTED ON OCTOBER 9, 2013:
The Employee Conundrum
For workers, what's the best insurance choice?
Change likely won't be coming right away if the goal is for more small businesses to offer health insurance to workers, according to one Tulsa attorney.
"Employers who have wanted to offer insurance are probably already offering it," said Debbie Blackwell.
But she wonders if it might be workers choosing new insurance options, perhaps leaving behind the firmly-established model of working-for-benefits.
"I think there could be some situations where, even just without a subsidy, the exchange might be cheaper for the whole family then buying at the employer," said Blackwell.
It's hard to predict what trends will emerge from health care reform, Blackwell said. Part of her job involves advising businesses on how to handle health care coverage options.
While reforms may target the uninsured, it's through jobs that most people still get insurance. A national Gallup survey this year showed that about 44.5 percent of adults receive employer-based health care coverage.
Businesses often buy group plans, but those plans typically require 75 percent of employees to enroll, Blackwell said.
Now, small business owners have another option available to them now through the health insurance marketplace. Available through the HealthCare.Gov portal that opened for business Oct. 1, a program called SHOP -- the Small Business Health Options Program -- offers coverage aimed at businesses with 50 or fewer full-time workers.
Blackwell said the SHOP plan may offer a bit more flexibility on when employers have to meet a minimum enrollment threshold. But she said she doubts it will be much of enticement to small businesses not currently offering insurance.
Some of those employers have found that it's been workers choosing not to sign up, Blackwell said. "In some lower-income industries, the employees just don't sign up because they can't afford it," she explained.
Now, lower-income individuals have access through the new exchange to government subsidies. Also, penalties begin next year for those shunning "affordable" -- as defined relative to income -- insurance.
Bob Fleischman, co-owner of Chrysalis salon and spa, said he offers health insurance to three full-time employees "because it's the right thing to do."
"We will be definitely looking into the ACA to see what that does for us with respect to the cost of premiums. It's just a crazy amount of money," Fleischman said.
Options through the SHOP program are limited this year, however, one of several aspects of health care reform with temporarily scaled back ambitions.
Earlier this year, the Obama administration unexpectedly pushed back to 2015 penalties for businesses with 50 or more full-time employees not offering affordable insurance to workers.
The way the Tulsa Regional Chamber described the penalty postponement, businesses then "breathed a sigh of relief," according to language on the chamber's website.
It's a politicized issue, to be sure, but Kian Kamas, the chamber's director of governmental affairs relating to health care, said the chamber wants to help businesses understand health care reform. A new website, tulsachamber.com/acainfo/ provides members with resources and information.
"Our position is that we want to ensure that businesses have affordable health care options," Kamas said.
The website includes details about future events, including an Oct. 17 presentation where Blackwell and another speaker will discuss some of the nuts and bolts of health care reform.
A big change taking effect Jan. 1 involves requirements that pre-existing conditions not keep someone shut out from coverage.
But "there's a cost there," Blackwell said. The reform may be "a good goal as a society," but "for that particular plan or that insurance company, it's more expense," she said.
Some employers have responded by "locking in early" rates before the reform takes effect Jan. 1.
She envisions the possibility that employees will prefer the exchange.
"It's very expensive to buy family coverage or child coverage from an employer plan if the employer doesn't subsidize it," Blackwell said.
Subsidies are designed to make the exchange appealing for the uninsured with income between 100 and 400 percent of poverty level. But they don't exist for people whose employer offers affordable health insurance options.
In the case of a young family, for example, a spouse that's working and offered insurance may mean "the whole family is barred from getting a subsidy at the exchange," Blackwell said.
And for the state's working poor whose earnings fall below 100 percent of the federal poverty level -- about $23,500 for a family of four -- the system doesn't provide a subsidy on the new marketplace.
Blackwell said she hopes that Insure Oklahoma, a state-based program, could provide assistance to that population.
Ultimately, the system is designed to work if people sign up without knowing that they'll need coverage, Blackwell suggested.
"The whole idea of ObamaCare is, 'We're going to get everybody in the system, so, on average, it's affordable.' That's the theory, is that we get healthy and unhealthy people into coverage," Blackwell said.
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