Lexington, KY - Over the next few years, Americans can expect to see a systematic elimination of small group practices and small hospitals in favor of larger, regional facilities. Universities will have to produce more physicians and nurses to fill those facilities. And there will be plenty of job opportunities for lawyers, IT specialists and actuaries.
Those were the common themes and messages heard at a recent seminar on health care reform sponsored by the Kentucky Chamber of Commerce.
The impending changes to the medical landscape will be due to the anticipated increase in enrollment in health care plans over the next few years, the need for more integrated health delivery systems, and the requirement for greater accountability using more technologically sophisticated reporting tools.
The Patient Protection and Affordable Care Act, which was passed in March 2010, will take about eight years to fully unfold its many components. The new law will provide coverage for an estimated 32 million people who currently do not have health care, will eliminate pre-existing conditions, will extend coverage for behavioral and mental health conditions and will level the playing field by eliminating so-called "Cadillac" plans for executives. Many of the law's components, however, are complicated, and details have yet to be determined.
Dr. Daniel Varga, chief medical officer for the Saint Joseph Health System, likened health care reform to a plane flying overhead, dropping all of the materials for a house - and hoping they will land in the form of a house when they hit the ground.
A small part of the house's foundation is in place. Right now small businesses (with 25 employees or less) can take advantage of tax credits to set up health care plans for their employees.
But looming in the near future is the key date of 2014, at which time health care coverage must be provided by those employers who have 50 or more on the payroll.
The 2014 date is also when state-sponsored "exchanges" (officially known as the Small Business Health Options Program, or SHOP) will be offering health care coverage as an alternative to plans offered by businesses. The exchanges must be set up by governments or non-profits - not insurers - and can be configured as each state chooses. Kentucky, for instance, could set up exchanges regionally or create one for each county.
Nevertheless, the business community must wait until regulations are in place before learning more details, such as what constitutes the minimum essential services health care plans must offer.
Lawrence Ford, vice president of government relations for Anthem Blue Cross and Blue Shield of Kentucky, stated that the health care reform bill is the most sweeping legislation this country has experienced since Medicare was passed in the 1960s. He jokingly predicted the next year will see a regulatory process that will be "as clear as the Gulf Coast" and require tens of thousands of pages to explain.
The regulations, now being drafted by the federal Health and Human Services Cabinet, must go through public hearings originally anticipated for mid-2011. Word is that the process is already well behind schedule, so it is not clear when the regulations will be passed.
Pat Mulloy of Senior Care said his organization, like many other businesses, is "trying to figure out how to make the economics work" and whether to "pay or play." He says many businesses may elect to pay a penalty rather than set up a health care program.
A similar issue will confront individuals who will be required to obtain health care insurance. Younger and healthier Americans may find it more economical to pay yearly penalties rather than paying for a health care plan they feel they don't need or won't use.
One fast-approaching deadline that will affect every business is January 2011. This is when an automatic payroll deduction for long-term care (community living assistance services and supports or CLASS) benefits must be effected. This "voluntary" deduction is something to watch for, because it relies upon the worker to "opt out."
In other words, you will have money automatically taken out of your paycheck unless you notify your payroll administrator that you do not want this to happen.
Judging from the off-the-record comments from human resource managers attending the chamber conference in Lexington, this provision is causing some consternation.
"It's going to be a mess," voiced one manager.
Another manager seemed to have a brighter outlook on the matter.
"I'll be retired before all this hits," she said with a slight grin.
"Thank God."
The Kentucky Chamber of Commerce encourages business to check their website, www.kychamber.com, for updates, alerts and notices of future conferences on health care reform.