Smaller Companies Want More Certainty, Less Affordable Care Act Regulation

For many small businesses no matter what size, corporate healthcare plans are tinged with uncertainties entering Donald J. Trump’s presidency.

However, Information Strategies, Inc. (ISI) focus groups and other surveys indicate for smaller companies, $10 to $30 million dollars in sales, there are several provisions that would appear to be most needful of change or repeal.

In the six years since passage of the contentious Accountable Care Act (ACA) executives and consumers alike have wrestled not only with its provisions but also the strong employer, individual opposition to many of its mandates.  This has led to a feeling the law would at the least be amended and perhaps even repealed.  As many company leaders pointed out in the run-up to the last Presidential election, this perception restricted implementing longer term business solutions. With a President and Congress controlled by Republicans, in 2017 changes if not outright repeal of ACA provisions are expected. Most of the most sought after changes are also primed to have more bipartisan support.  With this bipartisan support evident, they are expected to be perceived as more permanent than the law itself.

Already, there seems to a more positive attitude toward employer sponsored healthcare solutions.  For instance, despite significant increases in healthcare insurance premiums (9% in 2016 vs. 6% in 2015), a new study from Transamerica Center for Health Studies (TCHS) conducted by Harris Poll found that employers are optimistic about the ability to provide robust benefit packages to employees.

In fact, the number of smaller employers offering health benefits to part-time employees has nearly doubled since 2013 (26% in 2016 vs. 13% in 2013).

In ISI’s focus groups and other polling respondents indicated the following changes small businesses would like to see happen:

  • Eliminate all state-mandated requirements so companies can offer one policy to all employees regardless of work location.
  • Reduce the number of mandated requirements in healthcare policies to decrease overall costs.
  • Permit the purchase of gap healthcare insurance policies with Consumer Directed Healthcare (CDH) funds to better protect employees against catastrophic illnesses or accidents.
  • Simplify the regulations to ease need for outside counsel, consultants to interpret.
  • Through additional Congressional regulation, greater reliance, encourage CDH offerings, particularly high deductible plans coupled with Health Savings Accounts (HSAs).
  • Waive/get rid of penalties for any companies that do not comply with ACA requirements, making them voluntary.
  • Increase the HSA limit of families from the current level to a minimum of $10,000 and allow the increase of contributions the match the increase of annual premiums. Meaning if annual premiums are increasing by 10-15%, the contributions should be able to increase the same rate, keeping their HSA fully funded.
  • Reduce or eliminate luxury tax on healthcare benefit packages and replace ability to vary plans by categories or salaries.
  • Allow for different levels of healthcare insurance for part-time workers. Make identification of these workers more employer friendly.
  • Encourage more competition from healthcare insurance providers in the form of new competitors, differing healthcare options.
  • Create more flexible methods to provide stipends in lieu of healthcare programs for employees allowing them to purchase individual or supplement insurance.
  • Accept or deny elimination of prior health conditions as acceptance criteria.

What does come through from numerous soundings is the desire for many companies to have lower healthcare costs without reduction in the quality of care.  Under the ACA, CDH plans were not encouraged but for a growing group of companies in this sector HSAs are becoming more appealing.

“There is no doubt CDH efforts and most particularly HSAs have a positive effect for employers and employees,” said former White House advisor Roy Ramthun, President of HSA Consulting Services. “What we are seeing is a need for the employee to be more involved in the financial side of the healthcare services area. For companies in the $10 to $30 million range it can make a significant difference in their healthcare costs.”

Many small business leaders are looking for improving the benefits of providing employee healthcare; they are just unhappy with the many mandates, rules, and regulations of the ACA.  They hope for changes in 2017.

Key Words:  smaller companies, small business, health care, healthcare plans, Affordable Care Act, ACA requirements, Trump,  Transamerica Center for Health Studies, Harris Poll,  gap healthcare insurance policies,  regulations, Health Savings Accounts, HSAs, CHD plans, healthcare insurance providers,  Roy Ramthun, employee healthcare, 2017


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