Charles Warner Editor
August 30, 2013
UNION — While there’s still a great deal of uncertainty about the federal Patient Protection and Affordable Care Act and its ramifications the one thing that is certain is that it will affect all employers regardless of how many people they employ.
In an address to Wednesday’s meeting of the Union County Human Resources Association, Chester attorney Joanie Winters discussed the PPACA which is more commonly known as the Affordable Care Act or “Obamacare.” Winters outlined the legislative history of the PPACA which she said began in Sept. 2009 with legislation introduced in the U.S. House of Representatives and passed by the House in November of that year. The U.S. Senate passed its own version of health care reform in Dec. 2009 which had to be reconciled with the House bill. The House agreed to this in March of 2010 and the legislation was signed into law by President Obama later that month.
Even though the PPACA was now the law of the land, Winters said much about it remains unclear more than three years later. Implementation of the law was turned over to the U.S. Department of Labor, the U.S. Department of Health and Human Services, and the Internal Revenue Service, but Winters said these agencies are continuing to struggle to clarify the meaning of the legislation. Holding up a copy of the PPACA, Winters told the association members that it states 1,045 times that “the secretary shall decide,” the meaning of the law and its requirements, a process that she said is continuing and will likely continue into the future.
Winters said that what is already clear, however, is that all employers will be affected by the law regardless of how many or how few employees they have. Under the law, employers are required to provide their employees with health care coverage and can be fined for failing to do so. This applies only to employers with 50 or more full-time employees, with full-time defined as 30hours or more a week.
Even if their employees are part-time, Winters said employers may sill be required to provide health care coverage under the “full time equivalent” formula. Winters said the formula calculates how many part-time employees a business has multiplied by the number of hours and multiplied by the number of weeks divided by 120. She said this could mean an employer with 47 employees could find themselves having 50 employees in the eyes of the law.
Winters said businesses wiill be even further affected by the notification requirement in the law. All employers are required to notify thei employees of the health insurance exchanges that will bet set up in the states. The notification must go out by Oct. 1.
The process of clarifying the meaning of the law and its implication has lead to the delay of the implemenation of some of the provisions of the PPACA. This includes the penalties employers would have to pay for not providing their employees with health care coverage which was delayed until 2015. However, Winters said that while the penalties have been delayed the mandate that employers provide their employees with health care coverage has not, something she said employers must keep in mind.
Though some, such as the fines for employers who do not provide their employees with health care, have been delayed, the provisions of the PPACA began being implemented when the legislation was signed into law. Even with many questions about the meaning, requirements and ramifications of the law remaining, its provisions continue to be implemented and are scheduled to continue to be implemented through most of the remainder of this decade.
Other aspects of the PPACA that have already gone into effect or will in the coming years include:
• Insurers prohibited from imposing lifetime dollar limits on essential benefits such as hospital stays.
• Dependants allowed to remain covered by their parents’ insurance until they are 26.
• Insurers prohibited from denying coverage or charging higher rates based on prexisting conditions.
• All new insurance plans must cover preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance.
• The establishment of health insurance exhanges through which individuals may purchase health insurance.
Winters pointed out that while states are allowed to set up their own health insurance exchanges, South Carolina is one of a number of states that has declined to do so. She said that doesn’t mean that there won’t be a health insurance exchange in South Carolina, only that it will be run by the federal government instead of the state.
Like the legislation itself, each provision of the PPACA is generating questions and the need of employers and the general public for answers grows with it. During her presentation Winters discussed sources of information that could help answer those questions and recommended the website HealthCare.gov as the best online of source of facts about the PPACA that can help employers and employees alike make informed, pragmatic decisions about the law and its impact on their businesses and lives.
Editor Charles Warner can be reached at 864-427-1234, ext. 14, or by email at firstname.lastname@example.org.