Is there anything I need to do right now?
In a word, "No—not yet!" The first reason is that while the Senate Bill has been passed and signed into law, it still is subject to modification by the Reconciliation Bill. The Reconciliation Bill has not been passed by the Senate and signed into law by the President. Secondly, depending on how aggressively opponents of the Bill decide to pursue other remedies, there could be legal battles that tie up key pieces of the bill (such as constitutional or state-based challenges to specific provisions). Thirdly, except for very few exceptions, the earliest effective dates are not applicable for at least six months and several of the main features of the Bill will not come fully into existence until 2014.
Looking ahead
If you have coverage, insurance that was in effect before the Bill becomes law is grandfathered in. Still, some provisions in the "sidecar bill," like bans on lifetime benefit caps, would apply even to those plans.
Including the Reconciliation Package, the Bill is ultimately expected to add over 30 million people to the insured population, with the big influx starting in 2014. There likely will be shortages in primary care physicians (more insured folks now making office visits rather than going to the ER!) so if you don't have one, pick a "doc" now!
And, expect new taxes. For those making more than $200,000, or $250,000 for a couple, you'll likely see an increase in the Medicare payroll tax beginning in 2013 and a surtax on unearned income as well.
What are the main provisions of the bill that I need to be aware of looking to the future?
- Required Coverage: One of the main thrusts of the legislation is to provide coverage to the uninsured. Since your school already provides health insurance coverage to your employees, the requirement for organizations of 50+ employees to do so will not have any effect on you.
- Affordability: Another key goal of the legislation is to rein in insurance costs through a variety of incentives and process changes. The impact of these efforts remains to be seen. We will monitor the insurance marketplace on an on-going basis and continue to seek the most cost-appropriate coverage for your school each year.
- Pre-existing Conditions: If you offer plans that carry "pre-existing condition" restrictions, most of these restrictions will be eliminated by the legislation. More information on this point will be available from your insurance carrier in the future.
- Continued coverage for children—even adult children : This might be the area that has the most direct impact on your health care plan and benefits administration policies. The legislation requires employers to permit dependent children ( it's not yet fully clear what a dependent child means) to stay on coverage through age 26 if not covered elsewhere. This will be one of the items we will review with you the next time we sit down together to examine your policies.
- Exchanges: Beginning in 2014, the legislation permits establishment of insurance "exchanges" that will make available a variety of health care plans, possibly focusing on the "catastrophic" type plan for small businesses (a category which seemingly includes private-independent schools). While this holds the potential to create new marketplace options for a school's coverages, it is too early to tell exactly what form the exchanges will take and what impact they will have on costs or options. We will keep a close eye on developments in this area as time goes on. [Note: catastrophic pools will be available virtually immediately. Exchanges are to be available 2014.]
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