4 more possible changes to health care reform law
November 18, 2013 4:14 PM
Here we examine four other changes to ACA that experts consider likely-to-possible. The status of pre-existing conditions? Probably not changing. Coverage to age 26? Not going anywhere. But here are some adjustments to ACA that it might just be worth preparing for, starting with a popular one among business groups: a push to change the threshold for full-time employees from 30 hours to 40.
1. Full-time workers
Before ACA, hardly any employers thought of a worker clocking 30 hours a week as a full-time employee, and many have struggled with calculators and algorithms trying to add up flex time and variable hours. In addition to lowering the number of eligible employees, experts tell EBN, upping the level to 40 hours a week would simply save on office time and cost. "It's a more comforting or easier-to-administer threshold for a lot of employers, says Paul Hamburger, co-chair of Proskauer's employee benefits, executive compensation & ERISA litigation practice center.
2. Out-of-pocket maximums
Also delayed for a year were limits on out-of-pocket spending ($6,350 for an individual; $12,700 for families) that includes deductible and co-payments but not premiums. Those limits now go into effect in 2015, but even when they do, theres no cap in place for out-of-network doctors. A patient who goes to a hospital for a procedure could find themselves seeing a non-covered specialist and getting no protection from their plan. Will regulators try to close this gap?
3. Hospital stays
Speaking of limits, it remains unclear whether day limits on hospital stays will remain in place after dollar limits have been lifted. Some plans limit participants to 120 hospital nights in a year for example; will they retain the authority to do so? Regardless of what happens with private insurance, many states are moving to cap hospital stays for Medicaid participants in an effort to keep costs down. Arizona is putting the max at 25 days; Hawaii could go as low as 10.
4. Rising fines
One number associated with ACA thats sure to go up: fines for lack of coverage. In 2014, the penalty (called a tax by the Supreme Court) is only $95 for an adult, but by 2016 its $695. Still, its unclear if the young and the healthy are signing up for the system and stiffer punishment might be the most effective motivator. Will fines go up ahead of schedule? Possibly, but probably not this year. With lawmakers on both sides of the aisle lambasting Obamacare's rollout, few in Congress are likely to have the stomach to give it stronger sticks when so few are getting the carrots.
