Beth Larchus, an agent with the Cambron Insurance Agency in Johnson City, Tennessee, deals specifically with businesses and their health care programs. We asked her how the ACA would affect employers and residents of the area.
Tell us what the Affordable Care Act's biggest implication is for someone who has 50 or more employees. What's the biggest thing affecting them?
Their benefits will change as far as all of their co-pays will need to go towards their out-of-pocket [expenses]. And 50 [employees] and above, depending on the cut-off, they would have to have no more than a 90-day waiting period for new hires. So they're not affected as much as the 50 and below. The 50 and below are really changing a lot, and that's really more based in our community. Because the small employers, people don't realize how many small employers we have. That's huge in the business. They're affected probably the most, definitely.
In a negative way, positive way?
That's hard to say, because every group is different. But in my experience, and I'm just talking about my booking business and the agents here in our agency, for the most part they aren't able to keep their current benefits. I've gotten more in, I haven't gotten all of mine in yet, but I have so far probably 90 percent of my employers will not keep what they've got. They're not able to because the plans are changing. The insurance companies had to develop plans that meet the criteria of a certain percent of coverage, and it has to be the way. It can't be any other way. The plans we had before, and the way it was before, if a group comes to me and had a huge increase, we could sit and create a plan for them. [We could] play with office co-pays and out-of-pocket expenses. We can't do that anymore. It's cookie-cutter plans, and you have to take them that way. Their deductible cannot be lower than $2,000. Their out of out-of-pocket can be no more than $6,350. Everything has to count towards that out-of-pocket. There has to be child pediatric care for dental and vision. There are 10 essential benefits that have to be in there. So, that increases the cost. The majority of mine are being affected in a negative way. Now, if you're under 25, you can if you go onto the shop, which is the federally-mandated insurance plan through the federal website healthcare.gov, if you go through the shop and you're 25 and under, you possibly could get a tax credit. But, we're not able to see that yet, because the website is not working. We don't know. Right now my job is to go look and find out what is the best route -- going into the marketplace, or coming off. From what preliminary rates that I'm looking at, it's going to be better to be off. I won't know that until I can get on there for sure, but it's what it looks like right now. There are more options off the shop too. There are only two plans; that's all there is.
Can you let me know when you can get on, when someone is successful? If someone is under 25, will the tax credit come in?
Yes, absolutely, because it is my job to find them the best deal possible on or off the shop because I can do either of those two. I will look on the shop for them, and I will look off the shop for them. Basically now, instead of looking at hundreds of plans and taking piece-meal plans together and finding the right way, I've got to look at 32 plans and try to match up as close as I can. I have had only one group really be able to keep what they've got so far, but I don't have all my renewals yet. I'm giving that that other 10 percent, maybe a few more, will be able to, but I would say more than 90 percent won't be able to because they cannot have any more than that $2,000 deductible or $6,350 out-of-pocket, and you can't have certain co-pays. It's just set up the way that our choices are gone. That's just the bottom line, but if you can get on the marketplace, and be under 25 and get the tax credit you might be better off. Also, it's going to be a positive for people that are an older group and have extremely high rates right now. They might actually get a rate reduction. So, that can be positive. But, the younger groups, and 40-45 and under, and I'm not dating anybody as far as age, but everything is just age-bended now. There are no rates that are just one person pays this amount, everybody that's individual pays this, everybody with an employed spouse pays this; that's gone away. It's all age-bended, and it's community-rated, which means we put them all together and the higher rates are supposed to come down a bit, and the lower people are supposed to subsidize all of that and pay for it. If they're older and had some health issues and are already starting out with extremely high rates, they may get a break. They may get help, but if you're a little bit younger, or a lot younger, you're going to pay higher rates. That's pretty much is the way it is.