Employer Based Health Insurance : The Affordable Care Act ( Aca ) Changes The Healthcare Industry

What’s next? Some experts say that if the consumer-directed approach doesn’t succeed, em wash their hands of health care altogether. A recent study by the Employee Benefit Researc showed that the proportion of U.S. residents covered by employment-based health benefits d percent in 2000 to 60 percent in 2004. Decades from now, observers may conclude that a counter- revolution in employer coverage began in these early years of the 21st century. —Terence F. Shea

This paper discusses how the ACA has impacted the employer stakeholder group. Peer-reviewed journal articles will be examined to show how employers have been affected now and into the future, along with how employees are affected as well. Many mandates and changes have influenced and impacted employers in how they handle and deliver health care coverage, as well as impacting their business as well. Many changes affect large employers the most, but small to mid-size employers are also affected as well. This paper will also discuss commonly used strategies and their risks for employers to use in order to help lessen the impact of the ACA.

The National Federation of Independent Business (NFIB) agrees that the cost of health insurance is a high ranking concern for business owners. Every year, they conduct a study to see what the top general concerns facing small business owners. From the beginning of the fiscal year of 1986 to the present, every year has concluded that the cost of health insurance is the top burden facing small business owners in America. (Wade, Holly Pg 24, table 5). Another important factor to consider are lost capacity due to employee illnesses or unemployment. Brad Plumer of the Washington post recently did an interesting study to determine the amount of money lost due to inactivity at the workplace. Including businesses in both the public and private sectors, Plumer estimates that over $1.8 trillion dollars per year in lost productivity at the workplace. While the Post acknowledged the idea of lost productivity is not a clear science and can be overvalued this is nonetheless a huge amount of money wasted each year.

Most of the uninsured go without health coverage because they can’t afford it, and they would purchase it if they could” (APHA, 2012). Because of the lack of medical doctors, the fees for medical treatments and preventions are extremely high, there are many people could not afford it. According to Jonathan Gruber, in the book Health Care Reform: What it is, Why it’s Necessary, How it Works, he mentioned that people who work in large companies will have their insurance covered, but for individuals who are working for small companies but earns more than those who can get Medicaid, will have to buy their own insurance. Usually these insurances are not cheap, and once they use the insurance once, the insurance companies will raise their insurance price or find ways to kick them out of the insurance coverage. In this case, ACA will “reduce premium costs for millions of working families and small businesses by providing hundreds of billions of dollars in tax relief …also reduces what families will have to pay for health care by capping out-of-pocket expenses and requiring preventive care to be fully covered without any out-of-pocket expense…Americans without insurance coverage will be able to choose the insurance coverage that works best for them in a new open, competitive insurance market… keeps insurance companies honest by setting clear rules that rein in the worst insurance

were already providing health insurance because we’re in a competitive market and that helps us to retain and recruit good employees,” the Sacramento-based small business owner said, . One benefit for small businesses are tax credits“For us it was just good business. But pretty quickly we saw that our firm could benefit from the law. What appealed to us about the ACA were the tax credits and other financial incentives” (Taylor, 3), “A tax credit is an amount of money a taxpayer is able to subtract from taxes owed to the government” (investopedia.com , 1). this is good because businesses that barely make any money don't have to pay much taxes and they can maybe get more popularity due to the money they are saving. This is one example of how the ACA helps Small Businesses since …“ObamaCare creates the Small Business Health Options Program or SHOP, a part of each State’s Health Insurance Marketplace, where small businesses with 50 full-time equivalent employees or fewer can shop for group health plans. Starting on November 15th, 2015 those with 100 full-timers or less can use the SHOP” (www.obamacarefacts.com ,2 ). Small businesses are not required to provide health insurance to their employees if they wish because “... the answer is no. Under the Affordable Care Act, businesses with fewer than 50 full-time equivalent employees are not required to provide health insurance to their employees, and those employers will not face tax penalties if they decide not to offer their employees health insurance” (resources.ehealthinsurance.com, 1).This is good that very small businesses have the freedom not to get insurance because some businesses need to save money because of the expensive previous health care. Despite it being affordable, ObamaCare has given the freedom for small businesses to not give healthcare to employees. “Since health insurance for small business isn’t mandatory under the ACA, small

Nurse leaders play a vital role in establishing standards and leading organizational change. The effects of the Affordable care Act (ACA) on the healthcare industry is characterized by change (Delmatoff & Lazarus, 2014). Given this ACA paradigm transformation, I believe today’s nursing leaders must adapt quickly and assist new leaders to develop the skills necessary to envision and evaluate new healthcare delivery systems. According to Chism (2009), the roles of the doctor of nursing practice (DNP) prepared nurse graduates may be incorporated to meet the transformation of today’s contemporary healthcare. After reading the assigned material, I gained confidence that the DNP program will prepare me for eligible leadership roles within the healthcare industry.

It was stated earlier in this paper that big businesses would benefit from this law; however, the exact opposite is true for small businesses. Businesses will be forced to provide healthcare for their employees or pay a fine, something they may not be able to afford. This may result in employees’ hours being cut or even the termination of the employee (“ObamaCare”).

Rising health insurance premiums have made healthcare unaffordable in the United States. Health insurance premiums in this country have undergone a steady rise over the past few years while incomes have remained the same. More than 50% of individuals with low incomes holding private insurance in the United States are unable to afford their healthcare costs (Collins, Gunja, Doty & Buetel, 2015). In addition, costs related to healthcare are equally unaffordable to 25% of working-age individuals who hold private health insurance policies (Collins et al., 2015). According to the Kaiser Family Foundation/Health Research and Educational Trust (Kaiser/HRET) survey on employer health benefits, employer-sponsored health insurance plans have also had moderate rises in premiums in 2013 for both individuals and family coverage (Claxton et al., 2013). While

Health insurance is provided by Medicaid and Medicare to elderly and disabled people and poor children. People working for large companies receive health insurance through their employer. Unfortunately, people working for small businesses, those self-employed, and the working poor are left without options to purchase health insurance at an affordable cost. This creates a divide between the haves and have-nots in terms of health care. Those who have health insurance will access the care they need, but those who do not have insurance will go without. This may include primary care interventions such as immunizations and regular health screenings. Rising health care costs have a direct effect on the number of uninsured individuals and, therefore, a direct effect the number of individuals that can access care.

of the patient with controlling the costs of care, the issue of the uninsured began to grow. The concept of some sort of governmentally funded universal health care for all began over a century ago, however, never successfully implemented. From a historical viewpoint, individuals obtained health insurance by purchasing their own policy, as a benefit of employment, or through governmentally funded programs that required certain eligibility criteria be met in order to be eligible. If a person did not qualify for one of these types of health insurance, they generally were left without health insurance coverage.

Humana, Inc. is a health insurance company from Louisville, Kentucky that started in 1961 by Lawyers Wendell Cherry and David A. Jones, Sr. Humana started as a nursing home where it later become the largest nursing home company in the nation. After the nursing homes they soon began to purchase hospitals entirely for expansion. The name of the company changed to Humana, Inc. two years later. Cherry and Jones continued to expand by purchasing other companies. In 1984, the company began focusing on Health Insurance where it remains to focus on even today. Since 2014, Humana has had over 13 million customers and over 52,000, and a revenue of $41.3 billion that was reported in 2013.

A series of events has recently occurred to cause the passage of PPACA. Economics are explicitly linked to health care. In the United States, health care coverage is provided primarily through an employer-based system. This system began in the depression era when pay was federally frozen. Companies, in an attempt to lure scarce workers, used benefits packages including health care as bait. Described as a “uniquely American” “private social security” health care system, the employer-sponsored system is the “cornerstone” of United States health care system (Blumenthal, 2006). This system has left many un- or under-insured. Blumenthal states (2006), “The United States’ dependence on employer-sponsored insurance means that the protection of its citizens against the costs of illness depends directly on the ability of private businesses to manage and absorb health care expenses that have defied all efforts to contain them.” Recently, economic downturn and the need to reduce expenses to better compete on the global market has caused many companies to both reduce their insurance benefits package and their work force causing many to lose their health care coverage. The employer-based system merged with the economic downturn, unaffordable health care costs for businesses, and

The National Federation of Independent Business (NFIB) has repeatedly stated that the cost of health insurance is a high ranking concern for small business owners. Every year they conduct a study to see what the top general concerns facing small business owners. In each fiscal year since 1986 the cost of health insurance has been shown to be the top burden facing small business owners in America. (Wade, Holly Pg 24, table 5). Another important factor to consider are business which suffer from lost capacity due to employee illnesses or unemployment cost. Brad Plumer of the Washington Post recently conducted a study to determine the amount of money lost due to inactivity at the workplace. Including businesses in both the public and private sectors, Plumer estimates that over $1.8 trillion dollars per year in wasted each year as a result of lost productivity at the workplace (Plumer, Brad). While Mr. Plumer acknowledged the idea of lost productivity is not a clear science and can be overvalued this is nonetheless a huge amount of money wasted each year.

In 1954, Congress passed legislation allowing employers to provide health insurance benefits to employees on a tax-free basis (Sih and Singh 99). This legal provision marked the beginning of the rapidly expanding health care costs still apparent today due to the major incentives provided by the government to obtain employer-based health coverage. The overwhelming popularity of employer-based health insurance has led to a serious market inefficiency resulting from the system of third-party payment. As individuals rely on their insurance companies to pay for their medical expenses, this provides

The higher cost of affordable Health care is also eroding the ease with which to afford other insurance that covers about 30 percent of Medicare enrollees ‘expenses. In 2005, about 89 percent of beneficiaries obtained such additional coverage, including through former employers (33 percent), medical policies (25 percent), Medicare advantage plans (13 percent), Medicaid (16 percent), or other programs (1 percent) (MedPAC). These supplemental insurance programs were all very helpful at the onset, but with the passage of time and as health care costs continued to rise, employers are finding it difficult to support these programs and as a consequence, a greater number of these employers are either reducing the benefit or eliminating these benefits especially those that affects their retirees thereby increasing the cost of these supplemental insurances.