With little more than eight months before key mandates of health care reform take effect, new research shows almost half of Americans don't know much if anything at all about the new federal laws.
Come Jan. 1, reforms require most individuals to have insurance or pay taxes, larger businesses to offer affordable health insurance or pay annual penalties, and insurers to follow new plan regulations.
Only 10 percent of Americans surveyed said they are very knowledgeable about the Affordable Care Act, or Obamacare, according to a survey conducted by Princeton Survey Research Association International and released by InsureQuotes.com, based in San Francisco, this month. Twenty-eight percent said they aren't too knowledgeable, and 31 percent said they're somewhat knowledgeable.
Meanwhile, 90 percent of Americans don't know new health insurance exchanges will be available for online and telephone enrollments Oct. 1. Oklahoma's federally-run exchange will let residents and employers with up to 100 workers compare and buy health insurance policies, much like they shop online for travel packages.
Considering this lack of awareness, it's no surprise Crowe & Dunlevy chose a puzzle theme for its annual employer health care conference last week at the Skirvin Hilton Hotel. Jigsaw pieces and Rubik's Cubes adorned tables, and some 150 attendees were invited to complete Affordable Care Act crosswords. The opening update was titled “The Puzzle Is Taking Shape.”
Karen Rieger, who directs Crowe's health care practice, said the fact that Oklahoma has chosen not to expand Medicaid, which would have provided health care to the state's working poor — combined with what many perceive as ineffective, low penalty taxes for individuals without coverage — have made for weak price controls.
Industry observers predict employer-sponsored health plans will cost 2 to 3 percent more next year, she said. Other small employers attending, including the office manager of a 17-employee dermatology practice, expect increases as high as 35 percent.
Many healthy, young professionals will pay the penalty without buying the insurance, Rieger said. And the uninsured — including some 180,000 who theoretically were to be covered by Medicaid — will continue to use emergency rooms for care, prompting higher medical costs for those who have coverage.
Based on family incomes, some 20 to 30 percent of Oklahomans are estimated to qualify for tax credits to buy insurance on a federally-run exchange in Oklahoma, Rieger said. Crowe's president, Kevin Gordon, expects hardship allowances will come for the state's working poor so they, too, may shop the exchange.
Gordon doesn't expect state Attorney General Scott Pruitt's challenge to the Affordable Care Act to prevail. Based on standing, “only citizens, not states, have the right to sue the federal government,” said Gordon, who expects taxpayers will bring challenges — but only after individual taxes are assessed and paid.
Crowe attorney Cori Loomis said 2013 is the critical year for employers to make adjustments to their workforce. Some, Loomis said, are limiting employees' hours to avoid mandates required of businesses with 50 or more full-time equivalent employees. Others, she said, are contracting staffing firms versus hiring employees.
Conference attendee Thomas Belding, who sells stop-loss insurance to companies that self-fund health plans versus contract fully-insured plans, said more Oklahoma companies are following a nationwide trend toward self-funding. Though employers assume more risk, they avoid many government mandates and hold down costs, Belding said.
Analysis published Thursday by the Robert Wood Johnson Foundation showed that, of Oklahoma employers who offer health plans, 38.9 percent were self-funded in 2011, up from 33.5 percent in 2001. Of those with fewer than 50 workers, 14.1 percent self-funded in 2011, up from 10.4 percent in 2001.
Patti Davis, Oklahoma Hospital Association executive vice president, said she hoped state leaders would expand Medicaid. The hospital and nursing home industries agreed to cuts in government reimbursements under the ACA in exchange for a greater number of insured patients, she said. “Without expanding Medicaid, Oklahoma not only will lack those patients, but also the federal funds,” she said. “It'll be a double whammy.”
Davis said expanding Medicaid by 2020 would bring 23,500 new high-salaried jobs to Oklahoma, with associated revenues. Most importantly, research shows increased access to health care translates into better health outcomes she said.
Robert Roswell, physician and associate dean of the University of Oklahoma College of Medicine, focused on the need to coordinate services, thereby improving care and cutting costs. “The ACA's coverage reform will be what drives payment reform, and payment reform ultimately will drive delivery reform,” he said.
New mandates coming