National Health

Reform Discussion
Allison Rogers
King University
 Scenario

You are a physician who has a small private practice. You

currently have 8 employees, and the office is responsible for
carrying health insurance to all employees and their families.
 Legislations Impact on this Scenario

Small businesses or non-profit organizations having 50 or

fewer full-time equivalent employees (FTEs) are not required
to offer health insurance to their employees, and will not face
penalty for not offering coverage.
(Healthcare.gov,
n.d.a)
 How Affordable Care Act will Impact:
Access to Healthcare

The Affordable Care Act allows small businesses to keep their existing
insurance plan if they wish, as long as there are no significant changes made
to the plan (for example increase cost-sharing or cutting employee benefits).
(The Henry J. Kaiser Family Foundation, 2012)
In 2014, the Small Business Health Options Program (SHOP), in the healthcare
marketplace, was implemented and available to assist small business owners
with options for those who desire to offer their employees health insurance
coverage.
(Healthcare.gov, n.d.a; The Henry J. Kaiser Family Foundation, 2017)
 How Affordable Care Act will Impact:
Access to Healthcare (continued)
No healthcare plans (regardless of new or existing
grandfathered plans) will be allowed to exclude persons with
pre-existing conditions
Effective 2010 for children under 19
Effective 2014 for adults
(The Henry J. Kaiser Family Foundation, 2012)
Beginning in 2014, all health insurance plans must guarantee
the availability and renewal of coverage regardless of health
status (The Henry J. Kaiser Family Foundation, 2012, para 5).
 How Affordable Care Act will Impact:
Quality Healthcare

New mandates on insurance coverage/ Essential Health Benefits:

Ambulatory patient services
Emergency services
Hospitalization
Pregnancy, maternity, and newborn care
Mental health and substance use disorder services
Prescription drugs
(Healthcare.gov, n.d.c)
 How Affordable Care Act will Impact:
Quality Healthcare (continued)
Rehabilitative and habilitative services and devices
Laboratory services
Preventative and wellness services
Pediatric services, including vision and dental coverage
(Healthcare.gov, n.d.c)
Employers with an existing grandfathered plan do not have
to follow these mandates.
(The Henry J. Kaiser Family Foundation, 2012)
 How Affordable Care Act will Impact:
Healthcare Cost
SHOP Marketplace offers high-quality plans from private insurance
companies
Offers the employer choice and flexibility:
Decide how long employees initial enrollment period is and when new employees
can join the plan
Health coverage only, dental coverage only, or health and dental coverage
Different tiers available depending on cost and coverage desired: Bronze, Silver,
Gold, and Platinum
Choose how much you pay toward employees premiums
Choose whether to offer dependents coverage
(Healthcare.gov, n.d.a; The Henry J. Kaiser Family Foundation, 2012)
 How Affordable Care Act will Impact:
Healthcare Cost (continued)
In 2014, the premiums for all new plans were only allowed to vary
by age, tobacco use, geographic location, and type of coverage
(individual or family).
Participation in a qualified wellness program gives health plans the
option to reward participation by giving up to 30% discount on the
cost of coverage. The only stipulation is reasonable alternatives,
or waivers, have to be made available for employees with medical
conditions that would prevent them from participating.
(The Henry J. Kaiser Family Foundation, 2012)
 How Affordable Care Act will Impact:
Healthcare Cost (continued)
Small Business Healthcare Tax Credit
is available for:
Small businesses with fewer than 25
FTEs
Average employee salary is less than
$50,000 per year
Business owner pays at least 50% FTE
employees premium costs
Offer coverage to FTEs through the
SHOP Marketplace
(Healthcare.gov, n.d.b)
Generally the smaller the business,
the bigger the credit.
Example scenario provided by
Healthcare.gov:
10 FTEs employees
Total wages per year $250,000
($25,000 per employee)
Employer contribution to employees
premiums is $70,000
Tax credit amount is $35,000 (which is
50% of employers contribution)
(Healthcare.gov,
n.d.b)
 Key Points
Affordable Care Act allows small business owners to keep existing insurance
plans if desired, as long as no major changes are made, these plans will be
grandfathered
In 2014, SHOP Marketplace became available for small business owners to
purchase health insurance for their employees
All healthcare plans will be prohibited from excluding individuals for pre-
existing conditions and must guarantee ability to renew coverage regardless
of health status
The Affordable Care Act placed new mandates on insurance coverage called
Essential Health Benefits, however existing grandfathered plans do not
have to abide by these mandates
 Key Points (continued)

The SHOP Marketplace allows employers the ability to compare and

contrast plans from private insurers which permits choice and
flexibility
Premiums can only vary due to age, tobacco use, geographical
location, and type of coverage (individual or family)
Health plans have the option to offer up to a 30% discount for
participation in a qualified wellness program
Small Business Healthcare Tax Credit is available
 References

Healthcare.gov [Internet]. Baltimore (MD): U.S. Centers for Medicare & Medicaid
Services (n.d.a). Overview of the SHOP marketplace. Retrieved from:
https://www.healthcare.gov/small-businesses/provide-shop-coverage/shop-marketp
lace-overview
/
Healthcare.gov [Internet]. Baltimore (MD): U.S. Centers for Medicare & Medicaid
Services (n.d.b). The small business healthcare tax credit. Retrieved from:
https://www.healthcare.gov/small-businesses/provide-shop-coverage/small-business
-tax-credits
/
Healthcare.gov [Internet]. Baltimore (MD): U.S. Centers for Medicare & Medicaid
Services (n.d.c). What marketplace health insurance plans cover. Retrieved from:
https://www.healthcare.gov/coverage/what-marketplace-plans-cover /
 The Henry J. Kaiser Family Foundation [Internet] (2012). Explaining
health reform: How will the affordable care act affect small
businesses and their employees? Retrieved from:
http://kff.org/health-reform/fact-sheet/explaining-health-reform-how
-will-the-affordable-care-act-affect-small-businesses-and-their-empl
oyees/
The Henry J. Kaiser Family Foundation (2017). Health reform
implementation timeline. In C. L. Estes, S. A. Chapman, C. Dodd, B.
Hollister, & C. Harrington (Eds.), Health Policy: Crisis and Reform
(6th ed.), (pp. 149-160). Burlington, MA: Jones & Bartlett Learning.