As local governments plan their upcoming budgets, the impact of federal health care reform and the full implementation of the Affordable Care Act, ACA, in 2014 is becoming apparent.
There are three ways in which all large employers (those with more than 50 full-time employees) are affected by the roll-out of the ACA's final provisions: a substantial annual reinsurance fee through 2016 for each covered individual; an initial $1 per person levy for research; and a mandate to offer health insurance to employees who work 30 hours a week or more.
In Newport News, Lisa Cipriano, director of budget and evaluation for the city, estimates the associated costs could be as much as $350,000. She anticipates that the city — and not the individual employees — will absorb the costs.
The reinsurance fee starts around $63 the first year per full-time employee, and then declines over three years, according to Cipriano. Nationwide, the levy is intended to raise $25 billion for a fund administered by the U.S. Department of Health and Human Services "to help cushion" insurance companies covering individuals in the high risk pool in the state exchanges, she said. "We have to get ready for that expense. How the money is redistributed, I don't know," she added. According to summaries of the Affordable Care Act, the "contributions" are intended to help stabilize premiums for coverage in the individual market from 2014 through 2016.
In Hampton, Benefits Manager Shari Declet, put the anticipated expense of the reinsurance fee at $22,000 per month, or a little over quarter of a million dollars a year. "The big trend I'm seeing is plans that impose a spousal surcharge — if they have access to insurance through another employer — to incent them to get off the plan," she said. Hampton hasn't done that yet, but the new reinsurance fee might change that, she speculated.
Providing health coverage to part-time employees who work an average of 30 hours per week would be another large expense for Newport News, said Cipriano, estimating the potential cost at up to $200,000. Isle of Wight already covers 30-hour employees, but for York County, which employs a number of seasonal workers, the requirement will create a dent, said Sharon Day, chief of budget and financial reporting. The county has already floated the idea of raising the real estate tax to cover rising costs, including health premiums.
In all, York County is estimating a $500,000 increase in ACA-related health care costs for its employees, their dependents and retirees; currently, the county covers approximately 1,900 people. In addition to the "transitional reinsurance program" fee, which Day said could cost between $60 and $100 per person covered, she cited the additional $1 fee that's designated for research. The recipient, the Patient-Centered Outcomes Research Institute is charged with advancing clinical effectiveness through research. This fee is scheduled to increase to $2 per person after the first year, she said, with future increases through 2019 as yet unspecified.
In Isle of Wight, public information officer Don Robertson said the county was anticipating a 1 1/2 to 2 percent increase in annual premiums — between $30,000 and $40,000 — for its 200-plus employees as a result of the combined additional costs.
Localities are taking different measures to shield employees from rising health care costs. In January, Newport News abandoned its single plan, in which it split premium costs 75/25 percent with employees, and started offering a choice of several plans with their premium percentage to be determined annually.