I have always been one of those ACA (Obamacare) supporters who were in the "doesn't go far enough" camp. Single payer all the way. Yet if we are getting people insured, who am I to complain. Employers kick in and individuals kick in, okay. Let's give it a fair shot.
I also recall being livid when the employer mandate was delayed but not the individual mandate. Unfair! I found myself agreeing with Republicans. Well, really not. I just thought, well, what happened to shared responsibility.
Then I got a very boring job doing very boring things and realized the employer mandate needs at the very least some modifications. Follow me below the fold, if you dare.
The company I work for provides services for adults and children with Intellectual and Developmental disabilities via the Medicaid 1915 Innovations Waiver. Rates for services are determined by Managed Care Organizations and have not been raised since the mid-90s, and many times have been cut.
My job was simple for a person who does things that I like to do: make sure our policies and procedures are compliant with all all federal, state, and local regulations as well as regulations set forth by the Managed Care Organization and the national accrediting body that certifies the company to provide services.
Right now, we have around 120 overall employees and will probably hit just under the 100 FTE cap for the 2015 mandate exemption. Many of the employees are relatives and/or parents.
Our payroll is not determined by making more things or selling more products. The MCO determines the rate for each service provided. The available slots (or consumer base, to be even more crass), are determined by the money allotted by the MCO via Medicaid.
To make any amount of profit to stay in business under a capitated system makes offering insurance that meets the ACA guidelines unaffordable. Two consumers came to our office today seeking services because a competitor is cutting hours to avoid the mandate.
We are currently in the process of determining whether taking these cases will put us over the 100 FTE cap for the 2015 exemption. Because we are not a heartless bunch who just look at the bottom line, we are concerned that other providers cutting hours will reduce the services for the I/DD community.
If that happens, Medicaid could determine that if service hours are not being used they are not needed.
What I would like to see happen is the following, in no particular order:
1: Employees who are eligible for and receive Medicare or Medicaid do not count as an FTE under the ACA for companies with less than 100 FTE employees.
2: Delay the employer mandate for companies with less than 100 FTEs who provide Medicaid or Medicare services until 2020.
3: Expand the small-business exemption from 100 FTEs to 300 FTEs.
These are just some thoughts from a real-world perspective of a guy who supports full care and am trying to make it work. Any ideas would be welcomed and appreciated.