ACA Reset…Let’s All Take a Deep Breath!

This week’s post is meant to be sort of a “deep breath” or reset on where we’re at with respect to the Affordable Care Act (ACA). Clearly much is being said and written about the law, and in particular, its implementation. Those of us who are charged with explaining and implementing the various requirements of the law don’t have the luxury of questioning its content, complaining about its impact, or bemoaning its “unintended consequences”. It’s full speed ahead with implementation and compliance, unless or until Congress, HHS, DOL, CMS, IRS, or someone in a position of authority tells us to STOP…and that is highly unlikely.

So here are some important points to keep in mind as we take stock of where we are at, now some 3 ½ years since the law was signed. More importantly, for the Human Resource managers, Benefits Consultants, CFO’s, CEO’s, Executive Directors, and other stake holders charged with ACA compliance, the following points are meant to help keep “moving the implementation ball forward”.
1. THE SIZE AND SCOPE OF THE LAW– Stakeholders, elected officials, and certainly the media tend to get caught up in “the latest feature of the day”, with respect to the ACA. Since October 1st, the public marketplaces/exchanges have been “front and center” in terms of the overall conversation. But the marketplaces/exchanges are only one part of the law, albeit, a very important one. In time, the “glitches” will get fixed and individuals will be able to access the public marketplaces/exchanges via For now, the most important aspect of the inability of individuals to access information and enroll in coverage in the public marketplace/exchange is the absolute critical need to get the “young and healthy” enrolled and into the insurance pool. Much of the ACA hinges on evening out the insurance pool and getting as many people covered with insurance as possible. All of us need to bear this in mind, and focus on GETTING PEOPLE INSURED. The Kaiser Family Foundation has developed a free tool for individuals to calculate their approximate amount of subsidy eligibility. During this interim time when the government website is difficult to access, individuals can easily (and quickly) access this site, and get an idea of whether and if they should seek coverage with a subsidy through the public marketplace.Click here to access this tool…and spread the word about its availability –
2. THE INDIVIDUAL MANDATE –The Kaiser Family Foundation ( has repeatedly reported on the significantly high number of polled Americans that do not realize the ACA is THE LAW (as many as 40%!). That said, many do not realize that: a. they are required to have health insurance in 2014 or face a fine; and b. the public exchange/marketplace is NOT THE ONLY place from which to purchase coverage. There are a number of sources of ACA qualified health insurance, including:
  1. Employer based coverage (for dual income families, there may be a choice of two different plans, some with multiple options)
  2. Private exchanges/marketplaces (we’re hearing about large employers like Walgreens, Sears and Darden Restaurants utilizing these newly developed resources; subsidies are NOT available through these marketplaces/exchanges)
  3. Insurance Agents/Brokers (nothing has changed with respect to health insurance being offered/explained/sold by local insurance agents who are credentialed and licensed)
  4. Insurance Companies (some insurance companies offer their policies directly to consumers via websites like, or their own websites, for example
  5. Medicaid ( helps individuals evaluate their eligibility for Medicaid coverage)
  6. Tricare/VA (members of the military have coverage and care options unique to them)
  7. Public exchanges/marketplaces (the primary reason why an individual would seek coverage on the public marketplace is to receive a subsidy from the federal government. Remember, the PUBLIC marketplaces are the only place that coverage can be purchased with a subsidy. Again, the KFF’s subsidy calculator is a great tool –

    [IMPORTANT: Medicare beneficiaries do not need to change their coverage package in order to meet the individual mandate.  A previous post clarified that while the Medicare and ACA open enrollment periods coincide, there is NO reason for an enrolled Medicare beneficiary to consider alternative coverage to meet the individual mandate.]
3.  CHANGE IS INEVITABLE – There are bound to be “winners and losers” with a law the size and scale of the ACA. To focus on the “losers” does nothing to assist in implementing the entirety of the law, and work through the various imperfections. My prediction is that employer based/group health insurance coverage will end up being the best coverage available, at the least premium cost (factoring in the employer’s contribution to premium and spending accounts). The key to all of this is EDUCATION and COMMUNICATION. Employees/Individuals need to understand:
  1. They are required by federal law to have health insurance starting in 2014, or be subject to an increasing penalty/fine; and
  2. There are a variety of sources from which they can purchase health insurance; and
  3. Health insurance is not a plane ticket or a hotel reservation. Rather, it is a complicated, financial, risk management product that has many “moving parts” associated with it; and
  4. There are numerous resources available to assist in the process of evaluating options, and purchasing/electing coverage.
Again, for many, the coverage available at the workplace will be the superior alternative amongst the options listed above.