Tag Archives: affordable care act

Affordable Care Act from De Pere at Dawn!

Good Friday afternoon everyone!   Hope this week has treated you well.

Today I bring you my promised post from last week’s De Pere at Dawn.  Getting the video parsed down and uploaded was a process.  *long process*.  Unfortunately, we don’t have the full segment from Daren Allen, the final presenter because there was a video failure.  We had part of it, but decided not to post only that segment since it was jarring.

I will post this with each presenter’s identifying information and a link to their PowerPoint presentation as well as the video link at YouTube (except for Daren).  In a future post, I will link to an upcoming edition of Wisconsin Eye featuring a town hall with J.P. Wieski that will have the most current information.

Summary statement?  Wow was it a great great panel.  “Best ever” in the words of one of our guests.  With no further ado:

Introduction section  (Cheryl Detrick, President/CEO De Pere Area Chamber)

Overview from the State perspective (J.P. Wieski,  Legislative Liaison/Public Information Officer from the Office of the Commissioner of Insurance, State of Wisconsin)

Overview from business organization perspective (Lori Compas, Executive Director of the Wisconsin Business Alliance)

More details, yet still overview from insurer in Health Insurance Marketplace (David Grunke, Manager Strategic Accounts, WPS Health Insurance/Arise Health Plan)

And, MORE details, overview from insurer, Common Ground Healthcare Cooperative (Daren Allen, Vice President of Sales & Business Development for the Common Ground Healthcare Cooperative)

Long story short … on October 1st, go look. It will cost you nothing but a bit of time, may save you money and will satisfy your curiousity!

 

October 1st is Just 3 weeks away!

October 1st in 3 weeks away.

If you are furrowing your brow and wondering why you should care … well, if you provide, have or need health insurance, it is an important date.

First of all, the “exchanges” will be open for enrollment and we will have the rate information. For individuals, families, business owners and employers of all sizes shopping “apples to apples” (should) be available.  If you want more information, *lots* more information, we still have some room at tomorrow’s De Pere At Dawn event.  This panel is going to be epic. Our panels always are, but wow. The brain power & knowledge of J.P. Wieski (OCI, Wisconsin), Lori Compas (Wisconsin Business Alliance, David Grunke (WPS Health Insurance/Arise Health Plan) and Daren Allen (Common Ground Healthcare Cooperative) will be more than worth the 90 minutes.  LINK HERE

Second, since the Health Insurance Marketplace (a.k.a. “the exchanges”) will begin offering health insurance on January 1st, on October 1st employers must give notice to their employees about coverage options available through the marketplace with a separate notice sent to dependents and others on their health insurance.

  • The notice must information employees of the existence of the Marketplace in each state, what the services are to be provided by the Marketplace and how to contact the Marketplace
  • The employer must also provided information on their sponsored/provided health insurance, if any, and state the intent of the employer to meet the Employer Mandates requirements (if more than 50 FTE employees).
  • Also, the notice must explain that employees may lose the employer contributed amount toward health insurance (if that is what the employer chooses to do and if the employer does contribute toward health insurance).
  • Finally, the notice must inform the employee of the employee’s potential eligibility for a premium tax credit if the employee purchases insurance through the Marketplace.

There is some dispute as to whether this requirement is limited to only those employers with 500k or more in annual revenue.  To be safe?  I’d say send it out.  To be certain for *your* business?  Contact your broker, your tax guy and/or your lawyer.

A quick pit stop

Not quite as quick as a NASCAR pit stop but hopefully a quick one!  I went to the meeting yesterday regarding the Common Ground Healthcare Cooperative and I will post about that but first, my pit stop.

One of the programs that we conduct here at the De Pere Chamber is called Live Healthy Brown County, a community and worksite-based wellness program.  Most of our members have less than 70 employees so having these types of resources available to them is important, since they probably don’t have a dedicated staff person for this type of initiative themselves.  This is the third year and we just motor along letting people know what we’re doing, inviting them to join in as well as providing information.  Occasionally though, we get reminded that not all of us are on the same page as far as what and why we are doing things as a Chamber.  This morning was one of those times.

Each Tuesday, we publish an e-newsletter for the Live Healthy Brown County program.  The newsletter features a healthy tip from our sponsor Aurora BayCare Medical Center, a healthy recipe, information on activities going on in the community for fun and activity, and links to articles we found interesting.  Today, in reply to this weeks edition, a long time valued member and friend replied with, “Interesting reading.  But I still don’t see what this has to do with Chamber of Commerce Business.”

My initial response was a bit of furrowed brow and then I realized that while I would of course respond to him;  this is an opportunity for me to make sure that we are engaging with our other members and community members as well.

This is how I replied:

This is the third year that the Chamber has been managed the Live Healthy Brown County program. As the workforce gets older and smaller, the Chamber recognized that we need to encourage members of our workforce and our community to live healthier lives so that they can be more productive workers. Many studies regarding “quality-of-life” have also shown that communities place an emphasis on community health and worksite wellness have a better return on their workforce expansion/retention efforts.

 Additionally, beginning January 1st with the full implementation of the Affordable Care Act, the shift to “community rating” will link the wellness/illness of our community members to our health insurance costs giving all of us a stake in promoting wellness.  Finally, also beginning January 1st, companies that offer wellness programs can hit workers who don’t meet certain health targets — such as lowering cholesterol, blood pressure, or body-mass index — with premiums that are as much as 30 percent higher than other employees’. Smokers who don’t quit face even bigger expenses: companies can charge them up to 50 percent more than other workers. Since business pushed very hard for those components to be included, we feel it is very much the business of the chamber of commerce, as a business organization charged with community and economic development, to be a leader in information, education and resources in this area.

 I hope that helps!

He answered back, “Well done…. Thank you.”

I truly do welcome these opportunities.  Not only does it allow me to clarify questions and respond to member concerns, but also allows me to talk about what we’re doing and why.  Everyone who knows me for longer than three minutes knows that I’m very enthusiastic and passionate about what we’re doing here and why we’re doing it.

During yesterday’s Path to Leadership session, Wendy Franklin asked the question, “why is mission important?”  And I answered with something along the lines of, “If it’s not mission-critical we stop doing it.  Mission is not only what drives the organization, it’s what drives me personally.”

Emails like the one I got this morning remind me about our mission and remind me why we need to tell our story of what we’re doing.  We can’t tell it just once or twice and think that’s enough we have to continue to do it.  We have to continue to show our relevance and we have to continue to sell the value.

There, pit stop done! Thanks for the reminder, thanks for the mission, thanks for the time!

 

On tap this week – health care

Yes, I hear the groaning.  While the last several years have been punctuated by the “health care debate,” the rubber begins to hit the road over the next 7 months.  Many of the components of the Affordable Care Act are already in place (timeline here) but in 2014 is the 800 pound gorilla – the arrival of the health care (insurance) exchanges for individuals.  They will technically begin operation on October 1st of this year, according to www.healthaffairs.orgStarting in October 2013, people without access to coverage through an employer, Medicaid, or the Children’s Health Insurance Program will be able to purchase health plans through health insurance exchanges for coverage taking effect in 2014. These new marketplaces are one of the Affordable Care Act’s key mechanisms for expanding affordable coverage.  

This Thursday, June 6th, I will be attending an educational session sponsored by Wisconsin Manufacturers and Commerce, “Preparing for the New Normal Part 2:  Implementing the Affordable Care Act in Madison.  If anyone would like to attend and carpool, please let me know.  There is a $50 fee per attendee (link is the title), the ride will cost you nothing except 5 hours in the car with me!

However, according to an article in USA Today on May 30th, “Seventeen states and the District of Columbia have received HHS approval to create their own exchanges, and 15 states will work with HHS to run a marketplace, while the 19 remaining states will operate exchanges created for them by the federal government. Many states, particularly those with Republican legislatures and governors opposed to President Obama’s health care law, did not create exchanges.”  (Wisconsin was one of the states to not create an exchange.)  “Beginning in October, individuals will be able to do a side-by-side comparison of plans either through online state or federal exchanges. Insurers will not be able to charge more for or exclude those who have pre-existing conditions.

Insurers have submitted proposed pricing and plans, and, in the states that have released that data, there is a large variety of pricing. California’s premiums came in 50% lower than what had been projected, and in Washington and Oregon, people will pay less for premiums on the individual market than they did before the law, also called the Affordable Care Act.”

While we don’t know what the exchange will look like in Wisconsin, there was an additional option in the legislation: healthcare cooperatives.  The new cooperatives are an option that came out of the debate for “a public option” during the national discussion on this topic.

More from Healthaffairs.org: “The provision created what was originally a $6 billion federal fund–reduced by law in 2011 to $3.4 billion, and reduced again in January 2013 as described below–that would enable sponsoring organizations to apply for loans to create new health insurance cooperatives.

These nonprofit, consumer-driven organizations would offer health coverage–and possibly also care networks–through the exchanges under the same regulatory requirements imposed on private insurance companies at the state and federal level. The provision was incorporated into health reform legislation in the Senate, and became law when the Affordable Care Act was signed by President Barack Obama in March 2010. Under Section 1322 of the Affordable Care Act, CO-OPs will offer coverage through the exchanges primarily in the small-group market, which generally serves companies or organizations with fewer than 100 full-time employees, and in the individual market. Like other plans offered through the exchanges, CO-OPs must be ready for open enrollment beginning October 1, 2013. The law required the Department of Health and Human Services (HHS) to distribute funds to at least one CO-OP in each state. But because of the most recent funding cuts, no more new CO-OPs will be established beyond the 24 that have already been created, at least for now (Exhibit 1).”

"Health Policy Brief: The CO-OP Health Insurance Program," Health Affairs, February 28, 2013.2013.http://www.healthaffairs.org/healthpolicybriefs/

“Health Policy Brief: The CO-OP Health Insurance Program,” Health Affairs, February 28, 2013.2013.http://www.healthaffairs.org/healthpolicybriefs/

 

Wisconsin got one of the loans.  The Common Ground Healthcare Cooperativebased in Milwaukee, will serve individuals and small employers in Brown, Calumet, Door, Fond du Lac, Kenosha, Kewaunee, Manitowoc, Marinette, Milwaukee, Oconto, Outagamie, Ozaukee, Racine, Shawano, Sheboygan, Walworth, Washington, Waukesha, and Winnebago counties and any individual, non-profit or small business will become a member when they purchase health insurance through Common Ground Healthcare Cooperative..  There are, in fact, health care cooperatives already in Wisconsin, but this is not a purchasing cooperative, but rather an actual insurance company.   In answer to the question, “why will this work when similar concepts have failed?” According to their website, “Unlike other initiatives for small employers and individuals, Common Ground Healthcare Cooperative will not be contracting with an existing for-profit health insurance company to buy insurance and create a purchasing pool. Common Ground Healthcare Cooperative will be the insurance carrier and with its non-profit, member governed structure, Common Ground Healthcare Cooperative will provide quality plans that are affordable, coordinated, and responsive. Common Ground Healthcare Cooperative leaders have a strong vision for improving the health of members and for controlling the health care costs of its members which are the key factors to control premiums.”   Open enrollment will begin October 1, 2013 and coverage will become effective January 1, 2014. Enrollment will be continuous throughout the year so prospective members can enroll on January 1, 2014 or after.    The cooperative has been and will be holding education seminars.  The seminars are designed for individuals (under 65) without insurance, self-employed individuals, small business owners and nonprofit leaders. Topics for discussion include the new insurance  marketplace (exchange), subsidies for purchasing insurance, the individual mandate and other important issues. Each seminar is identical.  

I will be attending the June 12th session in Milwaukee and extend the same carpool offer as above.   I can’t find a fee for the session and the ride with me would be no cost (other than 4 hours in the car with me!).

I will report back here on what I learn and my thoughts if you can’t attend yourself (or just can’t bear to!).  Whether you plan to attend one of these sessions, or the one we will hold in the fall, I hope you will get yourself educated.  This is vital to you individually, your family and your employees.  Stay tuned…