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Healthcare law a likely survivor

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CLEVELAND—Even if the Republicans sweep the November elections, the chances for total repeal of the Affordable Care Act (ACA) are slim, according to a speaker at ITEC 2012.

“That horse has left the barn,” said Martin Hauser, president of Akron-based SummaCare Inc.

Most of what has happened since 2011 in implementing the law, or what is scheduled to be implemented in 2013, is here to stay, according to Mr. Hauser.

It shouldn't be forgotten, he added, that when he was governor of Massachusetts, Willard “Mitt” Romney signed into law a health care plan similar to President Barack Obama's, and that Mr. Romney has expressed support for certain portions of the ACA.

Although the law is already two years old, much of it is still a mystery, according to Mr. Hauser.

“More than 1,300 times in the bill, it says, “'The Secretary shall issue,'” he said. “That means the Secretary of Health and Human Services is expected to write the language for that section.

“To date, less than one-third of those sections have been written, so the law is still a work in progress.”

The ACA already survived a Supreme Court challenge last June, in a 5-4 decision, when Chief Justice John Roberts ruled that the “individual mandate” provision of the law was a tax imposed by Congress and therefore constitutional, Mr. Hauser said.

The court struck down only the provision involving Medicaid expansion, he said.

Mr. Roberts' ruling was sound according to both federal and state precedents, Mr. Hauser said, noting that “in Ohio, we have a mandate for every motorist to buy car insurance.”

Among the ACA provisions that are already law are the prohibition against insurance companies' denying coverage to children with pre-existing conditions and the mandate allowing coverage of dependent children until age 26.

In the case of Ohio, the coverage mandate for children was extended to age 28. It is the only state so far to do this, Mr. Hauser said.

The big year for the ACA will be 2014, according to Mr. Hauser. That is when the individual mandate for every American to either buy health insurance or pay a fee to the government begins.

The state exchanges—to help individuals find the coverage they want—also will be established that year.

The state exchanges will create a quandary for employers with more than 50 workers, Mr. Hauser said. Those employers will have to pay a $2,000 penalty for every employee above a base of 30 employees if they choose not to provide health insurance, he said.

“The $2,000 fine is about one-tenth of the cost per employee for offering health insurance,” he said.

Employers in 2014 will have four choices, according to Mr. Hauser:

c They can pay the fine and let their employees figure out health insurance on their own;

c Continue the status quo of offering a traditional health care policy;

c Give their employees extra money to shop for their own insurance on the exchanges; or

c Choose a “value-added” strategy in which they offer more innovative coverage, stressing wellness programs and giving incentives to employees to take more responsibility for their own health.

Recent studies show that anywhere from 8 to 30 percent of employers will simply choose to pay the fine, according to Mr. Hauser.

But others are showing interest in health care programs that, for instance, will lower employees' shares of health care premiums for quitting smoking, lowering their blood pressure or losing weight, he said.

In any case, the ACA is expected to lower healthcare costs in general, Mr. Hauser said.

“The hospital industry has finally gotten the message. It cannot continue to pass on price increases to insurance companies that pass them on to consumers.”



To reach this reporter: mmoore@ crain.com; 202-662-7211.
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