Navigating the Exchange for Small Business Owners and Employees

Many small employers do not offer health insurance and are wondering what to do for themselves and their employees before January 1^st, 2014 rolls around.  Small businesses (fewer than 50 employees) are not subject to the employer mandate and thus do not receive a penalty for not offering health insurance.  However small businesses owners and employees are considered individuals and thus are subject to the individual mandate (see my article on this topic in the first link below).  If either of the aforementioned individuals do not obtain health insurance the following penalties apply.

2014 - $95.00 or 1.0% of income whichever is greater

2015 - $325.00 or 2.0% of income whichever is greater

2016 - $695.00 or 2.5% of income whichever is greater

2017 on – Increases with inflation

To avoid this penalty an individual must purchase insurance that meets the minimum standard value.  These plans are available through a state or the federal health insurance exchange.  To see if you should go to a state or federal exchange use this link: https://www.healthcare.gov/  For an individual purchasing health insurance who does not currently have coverage and is not offered a plan through their employer, the website will walk you through several questions to determine if you qualify for a subsidy for all or some family members.  You can apply online and obtain a quote for a variety of plans.  There are three basic levels of coverage (see article on the options and pricing available in Oregon below).  Then simply enroll online.    Well, maybe it is not that simple for everyone. Because of the complexity of the new law you may choose to access the health insurance exchange with the help of a navigator (or community partner). The idea behind a navigator is that sometimes it is better to have a human walking you through your options.  You can connect with a navigator in your area by going to this website. https://localhelp.healthcare.gov/  Another option is an insurance agent. Many insurance agents have been through training and can help guide an individual with the enrollment process.   There are other ways to obtain assistance like calling the health insurance exchange’s toll free number and asking questions while shopping online.

Health insurance plans went on sale as of October 1^st, 2013. The first day of coverage can begin is January 1^st, 2014.  If you are going to buy coverage you need to buy a plan before March 31^st, 2014 when open enrollment ends.  After that date I should note that in most cases, without a qualifying event, you cannot buy health insurance until open enrollment begins again on October 15, 2014. 

Individual Mandate

http://cardinalservices.blogspot.com/2013/05/employer-mandate-vs-individual-mandate.html

Oregon Health Insurance Plans

http://cardinalservices.blogspot.com/2013/07/health-insurance-rates-have-been.html

Arin J. Carmack

Replace Oregon Workers’ Compensation with a single payer health insurance system?

I remember when the Affordable Care Act (ACA) became law and one of the questions that came up was, ‘Would the ACA replace workers’ compensation?’  The logic behind the question was if everyone has health insurance, then they really do not need medical benefits from workers’ compensation.  Similar logic was raised in a version of a recent bill in Oregon’s last legislative session, HB 2922.  The bill states, “SECTION 26.  { + (1) The Affordable Health Care for All Oregon Plan shall be the primary payer of reimbursement for health services provided through the plan, including but not limited to compensable medical expenses covered by workers' compensation insurance.”  This bill did not pass but a study was funded by HB 3260 to see if a single payer system is advisable for Oregon. (see links to these bills below)

When considering any changes to our workers’ compensation system one should step back and take a look at the larger picture. It seems that employers in Oregon have been subjected to frequent double digit rises in health insurance premiums almost as long as Oregon’s workers’ compensation rates have been stable.  Oregon’s workers’ compensation system is the envy of many states with its stable rates and the balance it strikes between employers and employees.  When business and labor interests hammered out a framework in the late 1980’s, our workers compensation system became a model that other states and nations emulate.  This balanced system is not perfect but is far better than most other states. 

When you contrast the two systems you cannot help but see the disparity between the unpredictable rise in health insurance costs and predicable workers’ compensation rates.  There are signs that the rise in health insurance rates is abating but it is ill advised to substitute something that has been so unstable for so long in place of our workers’ compensation system.  A far better solution is to table this part of the discussion until much later. 

HB 2922

http://www.leg.state.or.us/13reg/measures/hb2900.dir/hb2922.intro.html

HB 3260

http://landru.leg.state.or.us/13reg/measures/hb3200.dir/hb3260.en.html

Arin J. Carmack