Issue link: http://www.insightdigital.biz/i/180153
insight on Health Insurance By Margaret L eBr un Ready or not … A fter years of debate, the Affordable Care Act – better known as Obamacare – is gearing up to begin in 2014. The Health Insurance Marketplace, offering options on the "exchange," launched Oct. 1. Insight invited a panel of health insurance professionals to discuss what we might expect. Panelists are: Dr. Ashok Rai, president and chief executive officer, Prevea Health; Dustin McClone, executive vice president, employee benefits, McClone Insurance Group; and Joel Lingenhag, director of Individual, Small Group, and Exchange Sales and Service at Network Health Plan. Here are excerpts from their discussion. INSIGHT: What do we know for sure about the Affordable Care Act? Rai: The only thing we know for sure is that it's not going away. Oct. 1 is the day we think we'll know what is going on, but given the changes the administration has made at the last minute, such as with large group employers, there's no guarantee. McClone: The key certainty is that costs are going to go up. Probably the only other certainty is that it's going to be constantly changing. It's not going to be like Y2K where (people fear) all of a sudden the lights are going to go off. This is going to be a change that will happen over time. INSIGHT: The mandate that companies with 50 or more employees buy insurance for their w w w. i n s i g h t o n b u s i n e s s . c o m employees was postponed until 2015. What is the impact of that? Lingenhag: From the employer's perspective, it buys them a little time. A lot of the larger employers already offer insurance so I'm not sure it's as big of an impact as it sounds. Rai: The larger employers, especially manufacturers, have covered their employees. But there has been a lot of noise from the retail and hospitality industries, where health insurance traditionally hasn't been offered. They are talking about the "29 rule;" nobody can work more than 29 hours a week because then they would be considered a full-time equivalent and need benefits. McClone: There are so many different calculations of everything. No employer is going to have the time or ability to be a health care reform export. Lingenhag: It's an interesting paradox that you set up a very complicated system and then you have "navigators" who are not trained as thoroughly as agents to try to guide people through it. I think you'll see more products that will be even more complicated to try to counteract some of the provisions of the ACA. Small group self-funding is a big one – I think you're going to see products developed for that. INSIGHT: What will be the impact on individual insurance? Rai: Those who are young and healthy who are on the individual market are going to see some pretty significant sticker shock as they go PHOTOGRAPHS BY JOHN BEHRENS, ARK MEDIA GROUP The Affordable Care Act rolls out with health insurance exchanges this month. Our panel of experts shares insights on what to expect "Those who are young and healthy who are on the individual market are going to see some significant sticker shock." – Dr. Ashok Rai, president and CEO, Prevea Health to buy individual insurance. We lost the creativity to design a plan around that individual. For example, if you're relatively young and you don't need pharmacy coverage, we can adjust that. Now because there are a significant amount of mandates in the ACA of what needs to be in a plan and how it is delivered, all that flexibility goes away. Everybody's got to pay for basically a Cadillac when they might have just needed a Yugo. Lingenhag: One of the things that is needed to make this successful is an infusion of the young, uninsured – the so-called "invincibles" who don't carry insurance because they're healthy. They either take a catastrophic plan with a $10,000 deductible, or they choose not to take it. That's who [continued] » O c t o b e r 2 013 • Insight | 29