With the most impactful phase of the Affordable Care Act (ACA) scheduled to begin on January 1, 2014, dozens of states across the country are proactively lining up significant resources right now to handle the new law’s many provisions, and to make it as easy as possible for citizens to review and choose from the new health insurance options available to them.
Leading the charge in these efforts is California, which has already created the nation’s first state-run health insurance exchange, Covered California, which will be operational on October 1 of this year, and will guide consumers through their health insurance purchases under the act. Covered California’s primary objectives are to serve as a consumer-focused experience beneficial to small businesses and lower-income workers who previously could not afford health insurance, and create an innovative marketplace for health care coverage policies. The state expects to achieve these goals through the delivery of affordable options, earning the public’s trust via transparent communications and reliable resources, developing partnerships with health care providers, government agencies and employers, and measuring the results to ensure a process which benefits all California residents.
As the nation’s most populous state with nearly 40 million residents, and one of the largest in terms of square area, California has been proactive and forward thinking in its advance preparations for the ACA’s implementation, and serves as an excellent model and shining example for other states to follow.
The extensive work in advance was absolutely critical for reasons beyond the looming January 1 deadline. In California, over 2.5 million residents will be eligible for federal tax credits to help pay for their insurance policies, and another 2.7 million consumers will most likely sign up for coverage, even though they may not be eligible for subsidies because of annual income restrictions. Many individuals expected to qualify for ACA coverage are part of an ethnically-diverse, multilingual population that lives in a mix of rural and urban counties – making it challenging to reach, educate, and engage them about their options.
Besides the creation of the “Covered California” health insurance exchange, the state plans to hire, train, and deploy a massive, dedicated workforce of 21,000 professionals just to assist and sign up consumers when the exchange begins operation on October 1. These government-paid employees will be well-equipped with extensive knowledge of the system so they may help consumers navigate the complexities of the law, and choose the right coverage for them. Additionally, California is in the process of building and staffing three call centers which will be manned by 1,200 customer service representatives, who will also possess the necessary expertise to guide residents through their health insurance coverage selections and purchases. Even better? Many of these reps will be fluent in multiple languages, including Spanish, Korean, Cantonese, and Vietnamese, so they can properly communicate with and advise a diverse group of consumers from many different ethnic groups.
The state and its Covered California program are not just focused on individual citizens. California recognizes that small businesses, with one to 50 eligible employees, need the same level of support and assistance in dealing with the ACA’s new regulations, particularly when it comes to making sure these companies are in compliance in covering their respective employees.
To that end, beginning this summer, California will hire, train, and certify an army of workers the state is calling “in-person assisters.” These important professionals will work either as individuals, or in association with an organization such as a city government agency, chamber of commerce, trade organization, labor union or religious group, to offer appropriate, face-to-face ACA-related counsel to businesses. State officials anticipate that more than 3,000 organizations will participate.
Here’s how the assisters initiative will work. For starters, they will be scattered far and wide throughout the state to meet with different groups and assess the health care coverage needs of a specific area. For instance, if you’re a restaurant manager with a bilingual staff covering many age groups, you can meet with an assister to discuss new ACA enrollment options for your employees, as well as Medicaid, Medi-Cal, and children’s health insurance coverage. By October 1, when Covered California is open to all, assisters will already be trained and be out and about in communities meeting with individuals and business owners. This program is especially useful in advising residents and businesses in small towns located in remote, hard-to-reach areas throughout the state.
State officials and Covered California executives astutely recognize that choosing health care plans can be equally as overwhelming and confusing for employers and employees alike. Obviously, employers wish to choose adequate coverage for their workers that complies with ACA guidelines and minimizes costs, while employees desire plans that offer comprehensive coverage for themselves and their families at affordable rates.
That’s where Covered California comes in. Meeting with a Covered California representative to sort through and discuss all available options is just like meeting with many health care providers at once. Business owners get to compare premiums and benefits side by side — similar to shopping for car or homeowners’ insurance, but for an entire company instead of a whole family.
Covered California also emphasizes the importance of employee wellness programs, which deliver a distinct set of business incentives under the ACA. This is easy to understand as healthier employees typically incur lower medical costs because they don’t have to visit a physician as often as individuals in poor health. For instance, if a company has a program in place that helps employees quit smoking, which can reduce the frequency of doctor’s visits, the business owner can increase the benefits to them by making the program more of an incentive. In addition to talking about different plans with business owners, assisters can also review wellness program information and offer suggestions to help companies qualify for these incentives.
In the end, Covered California is all about facilitating effective health insurance enrollments for its many residents who qualify, helping small businesses be in compliance with ACA regulations, and being ready for the ACA’s many provisions that take effect in 2014. Through its extensive planning and preparations to date, the state is well ahead of many others, and it already has extensive resources in place to make this a relatively smooth and seamless transition for all concerned. While not perfect, Covered California is a huge step in the right direction for helping the state’s small business community and eligible workers evaluate and choose health insurance coverage that is right for them. The program’s website is an excellent resource and solid starting point for individuals and businesses looking to get up to speed on these important developments. To speak with a payroll specialist about how to simplify this part of your business, contact us today.
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