Health Insurance: Obamacare to Trumpcare

With the recent change in presidential administration, the topic of health insurance is on the minds of many. It’s a complex issue to begin with, and with the new administration’s plans to roll back the Affordable Care Act (ACA), understanding health insurance is likely to become even more complicated.

To give Strictly Business readers a little background and an idea of what to watch for in the coming months, I turned to Tish Biesemeyer, partner at Burnham Benefit Advisors in Lake Placid, NY.

Biesemeyer began her career with Burnham Benefit Advisors in 1984. In 2002, she became a partner with the firm, which today services over 400 employer groups. They focus on benefit strategies that contain cost, increase administrative efficiencies, and bring a high level of employee appreciation.

Here are excerpts from my interview with Tish Biesemeyer.

First of all, can you give SB readers a primer on the Affordable

Since the ACA was primarily designed to offer affordable insurance to the ranks of the uninsured (numbering over 30 million), North Country employers saw little or no change, and no opportunity to address their most pressing concern: out of control costs.

Small employers with fewer than 50 employees had virtually no new insurance mandates and in many cases obtained greater flexibility with respect to plan options and pricing. For employers with more than 50 employees ACA mandates created a “pay or play” scenario that changed the health insurance arena. If large employers did not offer “affordable” health insurance to their full-time employees, there were potential penalty exposures.

The vast majority of large employers continued to provide employer based insurance as a tool to attract and retain key employees. Offering an insurance package has still proven to be a positive recruiting tool even with the additional reporting requirements and compliance regulations.

Healthcare reform has impacted and will continue to impact businesses large and small. To what extent depends on a number of factors: legislative mandates, business size, benefit offerings, makeup of the work force (part time, seasonal), just to name a few.

In your opinion, what are some of the pluses of the Affordable Care Act?

First of all, we in New York State have been fortunate as it relates to health insurance as far back as 1993. We’ve enjoyed access to insurance without regard to pre-existing conditions, or lifetime limits. We have insurance portability, no individual underwriting, and the ability to cover our dependent children until the age of 23.

Following passage of the Affordable Care Act in 2010, there was an increase of the age which dependent children can be covered under their parent’s plan—to age 26, and new access points for purchasing health insurance. There is the New York State Exchange offering programs for individuals and Medicaid options, to name a few. This increase in access more fully enables those unemployed or employed part time to be covered by insurance.

And the negatives?

First and foremost, the taxes associated with health- care premiums increased. While these taxes were designed to help offset the cost of ACA programs, they are still an increased cost to businesses and benefit mandates equal more cost.
More relevant, however, is the “administrative tsunami” that the ACA has placed upon employers, especially those in the 50 to 500 employee range.

Tracking full-time employee eligibility and completing annual government required reporting has been burdensome and costly to business and HR departments.

With President Trump promising to repeal and replace, what advice do you have for small business owners in the North Country?

Just like when Obamacare was in its early pending stages, there were more questions than answers. It’s way too early to offer advice. Stay tuned.

Is there a simple solution? Is a single payer system the answer?

I don’t know if there is a simple solution to the complexity of health care in our country. As for single payer systems, we already have several with Medicare, Medicaid, and the Veteran’s Administration for example.

Health care is one of the only industries where we pay for services without any understanding at the outset of the actual cost of the service, not to mention the myriad ways in which billing is processed and claims actually paid. Ultimately, I feel the healthcare delivery system needs more transparency, along with greater market competition among insurers and providers.

For my last question, we’ve focused this discussion on small businesses but what of individuals in the North Country. How can the

For individuals who have questions about how to gain access to insurance, we recommend contacting the North Country Chamber of Commerce—they are perfectly structured to assist and do a wonderful job in this regard.