Keeping up with Obamacare, Private Insurance & Compliance: "It Takes a Team"

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By Kenneth Rashbaum
| Employment Our Attorney Network

This post is part of Priori’s new blog series “From Our Network,” where we feature lawyers in our network discussing important issues small businesses face. In today’s post, healthcare lawyer Kenneth Rashbaum demystifies Obamacare compliance for small businesses. Over the past weeks, we've heard that healthcare.gov won't be accessible to businesses for a year, but what does that really mean for your business? Rashbaum explains how you can take advantage of its benefits now.

teamwork

One cannot open one’s browser, turn on the television or tune in a station on one’s car radio without hearing something about Obamacare (the "Affordable Care Act") that sets one’s teeth on edge. Small business owners have felt buffeted about like pinballs, unsure of their compliance requirements and, more particularly, how to make sure their employees obtain coverage without breaking the business’s budget. To mix metaphors, how does a small business owner navigate this tempestuous sea that appears to have no stars above it or landfall within sight?

There are, in fact, a number of guideposts to the Affordable Care Act, though the complexity requires often hours to parse the various offerings on the websites of states that have enabled their exchanges. Federal website online enrollment for small businesses through the Affordable Care Act’s SHOP program ("Small Business Health Insurance Options") has been delayed for one year, but the program can be accessed through state insurance exchanges or insurance brokers or agents. SHOP is very much alive and can offer myriad benefits for small businesses.

SHOP offers qualified small businesses of up to fifty employees a tax credit of up to fifty percent of the cost of employee health coverage provided through participating private insurers. There are requirements for the number of employees who must sign up in order for the business to obtain the tax credits. The number of insurers and plan designs will vary by state, and State and local laws may mandate particular levels of coverage. Side-by-side comparisons are advisable, and they can be provided through brokers or the exchanges of certain states. Businesses with unionized workforces should refer to their collective bargaining agreement in this regard, with consideration of a union health plan as perhaps a form of co-insurance. Coverage for spouses, partners and children, levels of coverage, physicians and hospitals in the coverage networks of the new plans, premium levels and effective dates of coverage all figure into the decision matrix for a small business.

And, as sure as jelly follows peanut butter, governmental compliance mechanisms will follow these plans and the new record-keeping and reporting requirements will be daunting, perhaps too much for businesses to follow and meet without guidance and assistance. Healthcare providers have already experienced this phenomenon with regard to the incentive payments for transition to electronic health records systems under the American Recovery and Reinvestment Act of 2009 section know as HITECH (Health Information Technology for Economic and Clinical Health). The Office of the Inspector General of the U.S. Department of Health and Human Services has begun to audit healthcare providers who applied for HITECH incentive payments with regard to their assertions of compliance with the rules governing such payments.

The landscape of health benefit regulation for small business is still evolving, and it may be challenging to keep up with it all. Doing so, with apologies to Hillary Clinton, takes a team. Brokers can advise on the availability of plans, and counsel can guide the business through the thicket of legal requirements for employee coverage and the record keeping and reporting mandates, and accounts can advise on the tax credits and treatment of health coverage expenses. The time to begin assembling the team is now.

Have questions about ACA-compliance for your small businesses? Wondering how to navigate the thicket of new laws? If so, submit your questions in the comments section below, twitter, facebook or to hello@priorilegal.com before Wednesday 12/11 at 11:59pm and Kenneth Rashbaum will pick 1-2 to answer. We will post his answers to the blog later this week.

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