Stake holders 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 and new provisions.

New provisions will take effect for hospitals and employers beginning Jan. 1.

For individuals, the ACA's second enrollment period begins Nov. 15 and lasts until Feb. 15. As of last year, almost 6 million Texans did not have health insurance, according to the U.S. Census Bureau.

Open enrollment

The Marketplace's open enrollment allows people to enroll in health care plans. The first enrollment period lasted from Oct. 1, 2013, to March 31 of this year. With the next period beginning Nov. 15, those who enrolled in coverage for 2014 will 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 on 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. Some part-time employees are seasonal and generally work in the Parks and Recreation Department or libraries, she 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."

To avoid any reporting mistakes under the new provisions, Frisco ISD decided to offer coverage to all of its employees regardless of employment status, FISD Benefits Supervisor Brenna Rose said. The school district began offering coverage to all of its employees this year, she said.

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.

"[The program] requires us to think about our patients after they leave the hospital to make sure they don't get readmitted," said Steve Newton, Baylor Regional Medical Center at Grapevine president.

Newton said Baylor Regional Medical Center at Grapevine has been committed to outcome-based provisions before federal law required it. He said he is happy to see the outcome-based provisions and a push for preventive care under the ACA.

"It's impossible to overstate the importance of preventive care," he said. "So many things that we're seeing in the hospital are the result of failure to get preventive care and early intervention."

One way to push for more quality care in hospitals is to bring in more primary care providers, Newton said.

"I think it has been well-documented that there has been a national shortage of primary care providers," he said. "Today, we haven't seen a big change in the distribution of specialists and primary care doctors. Our hope is over the long term, more doctors will choose to go into primary care so they can work on the front end of disease management."