What's So Affordable about the Affordable Care Act?

The real irony here is the word "Affordable" as it certainly does not take into account the facts surrounding the impact on small businesses over 50 employees and certain industries such as public education, which in many states like New Jersey is funded by the taxpayer. 

FAQ on Notice of Coverage Options

Q: Can an employer be fined for failing to provide employees with notice about the Affordable Care Act's new Health Insurance Marketplace?

A: No. If your company is covered by the Fair Labor Standards Act, it should provide a written notice to its employees about the Health Insurance Marketplace by October 1, 2013, but there is no fine or penalty under the law for failing to provide the notice.

The notice should inform employees:  About the Health Insurance Marketplace; that, depending on their income and what coverage may be offered by the employer, they may be able to get lower cost private insurance in the Marketplace; and that if they buy insurance through the Marketplace, they may lose the employer contribution (if any) to their health benefits
The U.S. Department of Labor has two model notices to help employers comply. There is one model for employers who do not offer a health plan and another model for employers who offer a health plan or some or all employees:

THIS GUIDANCE IS TAKEN FROM THE U.S. DEPARTMENT OF LABOR'S WEBSITE:
http://www.dol.gov/ebsa/faqs/faq-noticeofcoverageoptions.html

• Model Notice for employers who offer a health plan to some or all employees
• Model Notice for employers who do not offer a health plan

In many instances, the cause and effect in education will result in reduced hours for substitutes and aides along with added administrative and clerical time on implementation, monitoring and compliance.

Eligibility is triggered at 30 Hours or more per week

or an avg. 130 Hours a month;

 for a minimum of 120 days in a year

 

Add to this very little clear information with a myriad of links, time lines, scenarios and unanswered questions that are left to interpretation with a healthy dose of threats and fines...

Below is an article that appeared in the Suffolk News Hearld:

Schools weigh Affordable Care Act cost

suffolknewsherald.com/2013/07/02/schools-weigh-affordable-care-act-cost/

Annual fees approaching $180,000 and the possibility of penalties is the cost of the new health care law on Suffolk Public Schools, its finance director says.

Unlike many of us, Wendy Forsman doesn’t have the luxury of quietly ignoring the fine print of the Affordable Care Act — “a massive document,” she told School Board members this week.
The school district is subject to the act’s “pay or play” mandate because it has more than 50 employees, Forsman reported.
But it could get a yearlong reprieve. Late Tuesday, national media outlets were reporting President Barack Obama is expected to delay the implementation of the employer mandate until 2015.
When the mandate does go into effect, the district can either not offer coverage and pay $2,000 per employee annually, or provide coverage but pay a penalty for any qualified employee who uses the exchange the act requires states to establish, where individuals and businesses can select affordable plans.
Suffolk Public Schools appears to be going with the “play” option, requiring it to offer insurance covering at least 60 percent of average medical costs to employees working at least 30 hours per week for at least 90 days, Forsman said.
Also, the cost of coverage for employees making less than four times the federal poverty line cannot exceed 9.5 percent of their household income, and that poses the greatest risk for the district penalty-wise, Forsman said.
“We have no way of determining household income, so we have to look at individual income and assume that’s all they have,” she said.
If the assumption is wrong, the penalty kicks in.
“If we offer insurance and the employee goes to the exchange and are eligible for the exchange, we have to pay $3,000 as a penalty,” Forsman said.
The requirement to extend coverage to all employees working 30 or more hours a week, known as “fair access,” also could be problematic when it comes to substitute teachers, whose hours can creep above the threshold.
The district has taken steps to ensure employees working 30 or more hours a week and exceeding the income threshold are getting coverage, Forsman said.
Software handling substitute placements can also be set to ensure employees don’t exceed 29 hours, she said.
“We feel like we are in a good position to not pay that penalty,” she said.
Despite its efforts to avoid penalties, the district will still have to pay Transitional Reinsurance and Insurance fees to the Department of Health and Human Services, and Patient Centered Outcomes Research fees to the IRS, with an estimated annual cost of  $172,500 and $5,476, respectively.
It will also have to devote extra staff time generating several employee notices about the new options, Forsman added.