Stakeholders prepare for changes to federal health care law

More than a year after the federal government introduced its online health insurance marketplace, individuals, employers and hospital staff are gearing up for the Affordable Care Act's next open enrollment period, which began on Nov. 15 and runs through Feb. 15. Last year, almost 6 million Texans did not have health insurance, according to the U.S. Census Bureau.New provisions will take effect for hospitals and employers beginning Jan. 1.

Open enrollment

The marketplace's open enrollment period allows people to enroll in health care plans. The first enrollment period lasted from Oct. 1, 2013, to March 31, 2014. With the start of the current period, those who enrolled in coverage for 2014 need to re-enroll or choose a new plan for 2015. Many Texans waited until the first open enrollment period closed to look for marketplace health insurance, said Mimi Garcia, Texas state director for Get Covered America. While more people are aware of the next enrollment period and will search for insurance, this period is three months shorter than the last one, Garcia said.

"With the holidays right in the middle of that, it feels even shorter," she said. "We're going to be

working really hard to make sure that we're getting as many people enrolled in that shorter period of time."

The demographics likely to still be uninsured include young adults, men, Latinos and low-income families, Garcia said. She said financial assistance is available through the marketplace, which 84 percent of enrollees received during the last enrollment period. After open enrollment closes, people may only buy insurance in the marketplace if they have a qualifying life event, such as marriage, birth or loss of coverage, according to www.healthcare.gov.

"You have to have completed enrollment by Feb. 15, which means you should start early in case you have questions or want to go back and do it again," Garcia said.

Those without health insurance for all or part of 2014 will likely pay penalties when they file their income taxes next year.

"Why pay something when you're getting nothing?" Garcia said. "If you have to pay the fine, you might as well use that money to get health insurance coverage."

Employer shared responsibility provisions

The ACA's employer shared responsibility provision requires employers with at least 50 full-time employees to offer coverage to at least 70 percent of employees by Jan. 1. A full-time employee is considered someone who works at least 30 hours per week under the ACA. Many employers used to consider employees working 40 hours a week as full-time, according to the Texas Workforce Commission. With the new provisions, some part-time employees are now considered full-time.

The city of Plano decided to adjust the hours of some of its 400 to 500 part-time employees to keep them at an average of 25 hours per week, Plano Administrative Services Manager Andrea Cockrell said. Cockrell said the process of determining who is a full-time employee has been complicated, and the city is taking the process seriously to avoid any penalties for not complying with the ACA.

"You really have to look at what does the IRS consider a full-time employee," Cockrell said. "We are now in the process of looking at our independent contractors and our temporary workers in order to determine if the IRS considers [them] full-time employees."

Value-Based Purchasing program

The Value-Based Purchasing program for hospitals will also begin Jan. 1. The Centers for Medicare and Medicaid Services will pay hospitals for the quality of care provided based on assessment results and the number of patient readmissions. The program was implemented as a way to improve hospital clinical outcomes and the overall care of patients, according to the CMMS.