Health care concerns

Two Bend insurance programs could be threatened by Affordable Care Act

By Elon Glucklich / The Bulletin / @EGlucklich

Published Oct 27, 2013 at 05:00AM

Julie Childress just wants a little certainty when it comes to health insurance for her employees.

Since 2010, Childress, owner of Sunset Plumbing in Bend, has covered her workers though a local health insurance plan set up by the Bend Chamber of Commerce, which lets its business members buy insurance in a single pool that spreads costs out among the businesses.

She likes the plan and its premiums — about $320 a month for each of her nine employees.

But neither Childress, the Bend Chamber nor the Bend insurance brokerage that sells the plan knows what its status will be in two months, when coverage through the new federal health care program, the Affordable Care Act, debuts on Jan. 1.

It's one of two Bend-based health insurance plans covering more than 2,200 Central Oregon workers, who don't know if they'll be able to keep their plans when the Affordable Care Act kicks into gear in January.

The Bend Chamber Association Health Plan and SharedCare, a regional health care collaborative run by St. Charles Health System, were created as efforts to provide affordable health insurance in the years before health care reform took effect.

The state classifies the chamber's program as an “association plan” that lets it cover members employed by multiple businesses. That's different from typical small-business plans, which are regulated under separate rules of the Affordable Care Act and will take effect Jan. 1. Oregon had classified association plans as exempt from some of the small-business coverage requirements.

But that exemption disappears on Jan. 1.

Chamber officials have petitioned the U.S. Department of Labor to re-designate their plan and let it keep operating. They're still waiting to hear back.

Tom Spear, the owner of Johnson Benefit Group, which sells the chamber-sponsored plan, doesn't know if they'll get an answer by Jan. 1, or what it would mean for its 1,800 members if they don't find out.

“Have you ever worked with the federal government?” Spear said Thursday. “I couldn't say when we'll know. It might happen tomorrow, it might happen in July.”

Labor Department officials did not reply to several messages from The Bulletin.

SharedCare faces hurdles

Also launched in 2010, SharedCare is a collaborative effort between small businesses, which split the cost of health insurance among employers, employees and community grants.

And like the chamber plan, SharedCare faces uncertainty.

St. Charles Health System took over the plan in late 2011 after SharedCare lost much of its grant funding.

SharedCare is known as a multishare program, designed to give lower-income workers at businesses that don't offer insurance access to coverage.

The Affordable Care Act lets multishares keep operating, but changes to federal tax laws mean each program needs to meet new guidelines with the Internal Revenue Service before they can be considered a qualified health plan.

St. Charles officials met last week with Cover Oregon, the agency implementing the Affordable Care Act's marketplace in the state.

“They recognized SharedCare fits a niche in Central Oregon,” said Maryclair Jorgensen, director of health plan administration for St. Charles.

But Jorgensen said SharedCare probably won't be able to provide benefits next year.

Still, they're urging SharedCare's roughly 420 small-business owners and their employees to stay enrolled. Hospital administrators are planning to work with the state to make changes to the SharedCare program, so it will be able to provide benefits in 2015.

Jorgensen said she's confident that will happen. In the meantime, businesses won't be fined for not providing coverage until Jan. 1, 2015.

“We figure we've really got 2014 as the year to make the changes to the program we need to, so by 2015, we'll be ready to go,” Jorgensen said.

Incentive or burden?

Proponents of the Affordable Care Act say the new law will help provide insurance for those who do not have it and broaden coverage options for individuals and small businesses.

By setting up health care exchanges for customers to shop for insurance, the idea is that the Affordable Care Act will create a sort of insurance marketplace, where competition among insurance providers for customers will drive premiums down.

Cover Oregon spokesman Michael Cox said the law is full of incentives for small-business owners to jump into the exchanges.

“If you have fewer than 25 employees, you might be eligible for tax credits,” Cox said. “We think that, all told, there are some really great options.”

The law's success hinges on young, healthy people signing up for insurance alongside the sick and elderly. It includes a penalty for individuals that don't sign up for coverage — $95 or 1 percent of their annual income in the first year. Those penalties rise in future years, and expand to hit large businesses that don't cover employees starting in 2015.

The law's opponents worry that young workers will opt to pay the penalties rather than sign up for insurance. Without healthier workers joining the exchanges to balance out the cost of care, premiums and deductibles could rise.

Childress isn't sure what to believe. She's read some information about the Affordable Care Act exchanges for small businesses. But she hopes to stay enrolled in the chamber program.

“It's so confusing,” Childress said of the new law's requirements and guidelines. “We've been supplying our employees with insurance since 1997. We've never had to stop providing that. But we want it to be affordable.”

On the Web

For more information about the Affordable Care Act in Oregon, visit www.coveroregon.com.