LIMA — The Lima Civic Center hosted a Healthcare Reform forum Wednesday sponsored by Lima Memorial Health System and St. Rita’s Medical Center.
The event, titled “What you need to do today...What you need to know for tomorrow,” focused on small-business compliance, tax credits, the healthcare reform timeline, summary of benefits and coverage, comparative effectiveness research fees, W-2 reporting requirements, exchanges, community rating and community wellness.
A panel of speakers, including Connie Miller, Bob Armstrong (Lima Memorial Health System) and John Renner (St. Rita’s Health Partners), addressed key requirements of the act that are currently enforced or will affect small businesses in the near future.
There is good news for small businesses. Under the healthcare reform law enacted in 2010, many small businesses and tax-exempt organizations proving health insurance coverage for their employees now qualify for a special tax credit.
“This credit specifically targets small businesses employing up to 25 employees, paying average wages of less than $50,000 per employee per year and maintains eligibility,” Miller explained. “Eligible employers can earn a tax credit of up to 35 percent.”
Benefit changes. Coverage requirements. Tax credits. Exchanges. When it comes to healthcare reform, there’s a lot to know – and a lot to do. Here are some key provisions that will affect citizens through 2018:
• Uniform summary of benefits and coverage/60-day notice for material modifications (delayed until final regulations are issued)
• First-year medical loss ratio rebates may be issued
• Value of employer-sponsored coverage on W-2s for 2013 tax year – meaning W-2s issued in January 2014 (originally required earlier but the IRS made reporting optional for 2011 and 2012 tax years for employers who issue fewer than 250 W-2s)
• Employee notification of exchanges and premium subsidies
• Medical flexible-spending account contributions limited to $2,500 per year
• Annual per-member fee for Patient-Centered Outcomes Research Institute (for fiscal year 2013, which technically begins October 1, 2012)
• Elimination of tax exclusion for Medicare Part D retiree drug-subsidy payments
• Penalties for employers who don’t provide minimum coverage to full-time employees (50+ employees)
• Employer requirement to auto-enroll employees into health benefits (200+ employees)
• 90-day limit on waiting periods for coverage
• Small group redefined as 1-100 (states may defer until 2016)
• No annual dollar limits on essential health benefits
• Annual cost-sharing for essential health benefits can’t exceed the maximum out-of-pocket limits for a high-deductible health plan (fully-insured small group)
• Individual mandate
• Guaranteed issue
• 30-percent incentive cap for wellness programs
• Coverage of routine patient costs for clinical trials of life-threatening diseases
• 40-percent excise tax on high-cost “Cadillac” plans
The conversation turned to patient compliance. Although there are many variables, the main problem seems to be the patient/payee disconnect, which has been addressed through payer initiatives promoting outcome-based payment rewards and wellness-based rewards, which hold care organizations accountable.
“Another huge step forward is bridging the gap between multi-state health information exchanges and ensuring the portability of electronic patient medical information,” Armstrong explained.
Renner focused on healthcare delivery. Nationally, the federal government spends up to 40 percent and employers chip in upwards of 30 percent on medical benefits. Rising costs are associated with higher levels of these diseases, which are cancer, stroke, heart disease and diabetes.
“The delivery model is not sustainable and patients must be accountable and live healthier lifestyles,” he emphasized.
For more information, visit irs.gov,, makinghealthcarereformwork.com/healthcarereform/ and dol.gov/ebsa/healthreform.