Leaders briefed on health law

Published 8:00 pm Thursday, September 20, 2012

With full implementation of federal health care reform inching closer, local business owners and medical professionals are working to stay informed of what changes could be coming.

     To assist this education, the local chamber of commerce devoted its quarterly breakfast held Thursday morning to presentations on the Affordable Care Act, popularly called “Obamacare.”

     Dennis Valentine of Insurance and Risk Managers briefed the crowd on the basic provisions of the law and the timeline of their implementation.

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     The most significant requirement for local businesses is a provision that goes live in 2014 requiring businesses with more than 50 employees to offer coverage to employees or pay penalties. However, Valentine said there are fears large and small businesses alike may choose to weather the penalties.

     “The fines for individuals and businesses are fairly small compared to the cost of insurance,” he said. “That’s my fear, that we will see companies get away from the employer-provided insurance we are used to.”

     There’s a waiting game in progress right now, Valentine said, as no company wants to be the first to announce plans to pay the fine rather than offer insurance.

      Steve Dickson, a lobbyist with the Mississippi Hospital Association, discussed the changes the hospital industry will have to absorb as the remaining federal reform provisions kick in.

     In summary, Dickson believes the ACA will force hospitals to overhaul their business model. They have about three years to do it.

     “Changes are coming,” Dickson said.

     Both Valentine and Dickson highlighted the significance of the year 2014.

     “That’s when we get full-blown Obamacare,” Valentine said.

     That year brings with it the individual mandate that individuals hold health insurance or pay a penalty, no longer called a fine but now a “tax” following a June ruling by the U.S. Supreme Court.

     The individual mandate also activates state insurance exchanges where individuals may purchase insurance.

     Valentine praised the efforts of Mississippi Insurance Commissioner Mike Chaney to prepare a Mississippi insurance exchange, despite criticism from some quarters, particularly tea party groups.

     “I think he was wise to do that,” Valentine said, adding that some states have not done so in hopes the ACA will eventually be modified or repealed.

     Once the individual mandate activates, lifetime benefit caps for insurance plans will be barred and no one may be denied coverage based on a pre-existing condition.

     The remaining provisions of the reform bill also include some tax credits for small businesses, something Valentine wishes there were more of.

     “I think that should have been the focus of the law, incentivizing businesses to offer health insurance,” he said.

     On the provider side, Dickson said hospitals will see many changes to how they are compensated. For federal compensation to health care providers, the ACA moves away from payment for services rendered to a payment for performance model, Dickson said.

     Hospital performance will be determined partially by the readmission rate for patients treated for certain conditions, as well as whether a hospital complies with electronic health records provisions and other requirements.

     The ACA aims to reduce federal compensation for health care and shift more of the cost to private insurance by reducing uncompensated care, but there’s much uncertainty about this, Dickson said.

     This reduction in federal dollars will also come at time when many Mississippi hospitals are operating in the red or at less than a 1 percent profit margin. These hospitals, though, are often essential elements of their local communities; Dickson emphasized the importance of the hospital industry in the state.

     “We are a major economic engine in the communities we are located,” he said.