<p>But aren’t the large employers already impacted by ACA since they currently insure their employees? My company probably has over 100k employees in US and I have not seen any changes in costs/deductibles for 2014. I don’t see anyone complaining about their plan changes here either (at least so far).</p>
<p>I am still confused about employer mandate delay. Other than the rule asking companies to offer insurance or pay a fine if they are larger than 50 people, what else has been pushed out?</p>
<p>I think the biggest change for large employers will be the mandate that has been pushed forward to 2015. Companies will have very burdensome reporting requirements, which in the 3 years since passage of the law, they were not able to comply with. Also, some companies will have to pay a greater share of the premiums than they do now. It’s conceivable depending on how onerous the regulatory requirements are, that some companies will pay the penalty.</p>
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<p>When we talk about changes in response to the ACA, we need to be sure that the changes weren’t happening anyway. Large employers have been incentivized to cut health care costs for a long time: look at what emilybee’s employer is paying for their insurance. Look at what Mr. Fang’s insurance costs are. Employers have been on this for a while. Larger deductibles and copays were happening anyway. </p>
<p>Narrower networks, not so much, but consider this idea of narrower networks. If private insurance doesn’t pay for patients to go to UCLA hospital, and employer-supplied insurance doesn’t pay for patients to go to UCLA hospital, where are the patients going to come from? Medicare? Medicare reimbursements aren’t princely right now.</p>
<p>My company is a small business, but because we have some high paid sales staff - we don’t qualify for any subsidies/tax credits - despite having a number of employees who make under 35K. We’re keeping our grandfathered plan - no deductibles, and no contributions from the employees. The rate went up only 4% for renewing early this December. However, I don’t know what will happen 1 year from now - we have many employees in their 20’s and 30’s so the word is our plan will be probably more expensive than before - because the rates for our younger employees will increase while those for our older employees may decrease. What will the company do if it does go up a lot? Not sure, perhaps go to a less expensive plan from the same insurer (Kaiser) or, perhaps, ask the employees to contribute something to keep the richer plan.</p>
<p>CF, if hospitals like UCLA have to accept very low medicaid-like reimbursements, what do you think is going to happen to the quality of medical care in these technology-intensive, research-oriented hospitals?</p>
<p>An article about the reporting requirements for the employer mandate:</p>
<p><a href=“http://boss.blogs.nytimes.com/2013/08/22/employer-mandate-delayed-by-paperwork-and-efforts-to-reduce-it/[/url]”>http://boss.blogs.nytimes.com/2013/08/22/employer-mandate-delayed-by-paperwork-and-efforts-to-reduce-it/</a></p>
<p>Sounds like the specific requirements for the reports were not available in a timely manner. The report itself doesn’t sound horrendously complicated, but one can’t expect a business to supply a report without specifying exactly what has to be in it.</p>
<p>Is overcharging for gall bladder operations the right way to fund research? I think not.</p>
<p>All drugs have huge profit margins to account for 20 other that failed during R&D. What we think how things should get funded is irrelevant, only whether it is legal.</p>
<p>CF, I read your article and it didn’t sound easy to me.</p>
<p>OK then. I say that if UCLA Hospital gets squeezed by insurers, it will be perfectly legal, and they’ll have to figure out to lower costs.</p>
<p>I thought this article was interesting about some of the ACA impacts on different sized employers:</p>
<p>[Employers</a> weigh health care costs, penalties](<a href=“http://www.usatoday.com/story/news/nation/2013/09/01/employers-weigh-health-care-costs-penalties/2751801/]Employers”>Employers weigh health care costs, penalties)</p>
<p>"I say that if UCLA Hospital gets squeezed by insurers, it will be perfectly legal, and they’ll have to figure out to lower costs. "</p>
<p>Some how I think of hospitals and doctors as airlines. The rates they charge each person seems totally dependent on what plan they are on. The story dstark posted a few days ago about different prices based on the insurer of the patient seem so arbitrary. The main difference seems to be whether some of them stopped accepting some type or the other.</p>
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Isn’t that the truth. It’s also something I kept in mind when I bought my now cancelled policy. When I’m looking at a 20% coinsurance and one company has very reasonable negotiated rates and the other doesn’t, which one do you think I picked? The prices, from my perspective are completely dependent upon which insurer you have.</p>
<p>Goldenpooch, SMP. Small matter of programming. That’s a programmer’s joke, because sometimes a small matter of programming isn’t so small, but in this case, the companies have all the information in their databases and just have to fish it out, so it is routine. Since all companies will have to report it, the reports will soon be built into payroll systems. It doesn’t sound particularly difficult.</p>
<p>In my community, the hospital which enjoys inpatient monopoly status is trying to buy the largest outpatient provider. The independent practitioners are scared to death that they will be swallowed up by the hospital. The merger is being reviewed by the FTC for ant-trust violations. The hospital claims they have to go forward with the merger because of the implications of the ACA law. The one thing I know from these developments is that the consumer is not going to end up in a better position.</p>
<p>Thanks for the link Samurai. I just realized a non-profit I work with might be able to get tax credits but they currently use a regular market place.</p>
<p>Does anyone know anything about SHOP?</p>
<p>Glad it could help, texagpg. :)</p>
<p>I think the bigger companies who can buy in larger pools of employees, have infrastructure and good IT and payroll support will have less accounting issues with ACA compliance. For the smaller companies, non profits and ones with quirky work schedules and maybe not the 40 hour work week, compliance will be tougher.</p>
<p>It is all very confusing.</p>
<p><a href=“http://www.booz.com/media/file/BoozCo-Emergence-Private-Health-Insurance-Exchanges.pdf[/url]”>http://www.booz.com/media/file/BoozCo-Emergence-Private-Health-Insurance-Exchanges.pdf</a></p>
<p>Looks like some employers are going to go from a defined benefit way of psying for insurance to a defined contribution way.</p>
<p>This is similar to eliminating pensions and moving to 401ks.</p>
<p>The link can be skimmed to get the general idea. </p>
<p>Employers based exchanges already exist.</p>
<p>To get to shop you have to go through dotgov. Go to the small business link. Same problems as dotgov. In our state only one provider. Offering same as individual. </p>
<p>To get shop subsidies employer has to pay 50%. No employee can earn more than 50K a year. I don’t know if that includes the owner, but it might.</p>
<p>I linked the info up thread in the article from the Charlotte observer</p>
<p>All I know is that Treasury had almost 4 years to promulgate rules and companies an equal amount of time to adhere to the law, and neither were able to comply.</p>