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Health Care Reform: Prep Now for Health Benefits Negotiations

Steven Balentine 1/15/2013
Steven Balentine

Key components of the Affordable Care Act (ACA) kick in on January 1, 2014. Employers and unions have a lot to do before then. Here are some of the questions to ask and steps you can take now to prepare.

How does health care reform impact the employer vs. the employee? The parties need to understand both sides of this coin. Joint training, either with the negotiating teams, the health insurance committee members, or both, is a must.

ACA rules and regulations, and frequent changes to regulations make for a bumpy learning curve. Roll out your training in a series of sessions, rather than a single session, so all parties can navigate changes as they occur.

Health Care Reform Training Goals

Orient training sessions to address all of the following:

  • Identify relevant issues
  • Review the CBA and current plan designs
  • Review the timelines for renewals and open enrollment dates
  • Create scenarios for discussion

Health Care Reform Training Topics

Successful health care reform training will tackle the subject from several angles. Key issues can then be broken down into a series of sessions, such as the following:

       To Exchange or Not To Exchange Session:

  • Identify incentives or disincentives in current plan design that would cause an employee or employee groups to choose the Exchange or stay with the current plan, and whether that is positive or not.
  • Evaluate cash-in-lieu with respect to employees potentially eligible for the Federal subsidy.
  • Evaluate and compare coverage with what will be on the Exchange (Platinum, Gold, Silver, or Bronze).
  • Identify the employees and groups of employees most likely to be eligible for tax credits and subsidized cost sharing.
  • Evaluate potential tax penalties for the District. Good or Bad?

       Collaborative Cost Control Session:

  • What employee behaviors should be encouraged and how should that be done?
  • What are the current defaults if an employee doesn’t enroll in a health insurance program? Single coverage? Family coverage? Least expensive plan? HMO?
  • Identify who must be enrolled automatically into the District’s plan.

       Contractual Consensus Session:

  • Review the Contract and identify subjects for discussion as well as vague or unclear language.
  • Review opt-out provisions, employee waivers, and cash-in-lieu. What is the impact?
  • Look at the rationale for having opt outs or cash-in-lieu. Does the rationale need to be reconsidered?
  • Develop an approach to estimating employee Household Income (HI) for planning purposes.
  • Establish the cost for employee only coverage as a percent of HI for those employees and employee groups.
  • Develop assumptions for percent of HI for single and multiples of the single percentage for married.

4 Tips Regarding Health Care Reform Preparation:

  1. Don’t try to do everything now. Too many regulations still need to be written.
  2. Take one year at a time. Look at 2013, then 2014, and so on.
  3. Be flexible.
  4. Strive to offer as much employee/member education as possible.

We should all seek to understand as much about the Affordable Care Act and its provisions as possible before acting. There is a lot at stake for everyone.