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Amy Umble is health reporter for The Free Lance-Star

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Four thoughts after attending a program on the Affordable Care Act

Lindsey Waters was the guest speaker at the Chamber program on the Affordable Care Act.

Last week the Fredericksburg Regional Chamber of Commerce sponsored a breakfast meeting that drew 180 people. The turnout was one of best ever for a Chamber daytime program.

The topic: health care reform and the Affordable Care Act.

Chamber leaders brought in Lindsey Waters, vice president of First National Brokerage Corporation in Richmond, an insurance consultant, as the featured speaker.

They concluded, based on the crowd, that local business owners are hungry for information about the federal law, and they said they’ll sponsor similar sessions in the future.

The law is historic, and its implications are only now starting to be understood. Brian Cook, vice president of operations for Palmer Gosnell Hospitality, which operates the Courtyard by Marriott hotel downtown, seemed to speak for many attendees when he said afterwards, “I think there’s still an awful lot that’s unknown.”

Here are four things that stuck me about Waters’ presentation. It goes without saying that these are simplifications. There are lots of definitions and exceptions that are important but not mentioned here.

1. This law is aimed at individuals, not businesses.

Much has been written about the Affordable Care Act and what it requires of employers. But the law also speaks to individuals, and the responsibilities it imposes on them are just as important as those of the employer, perhaps more so.

“This law is for the individual,” Waters said.

The law says that most people must have health insurance by Jan. 1, 2014, or pay a penalty. The penalty for the first year will be at least $95. Individuals can get insurance from their employers. They can purchase insurance on the private market. Or they can go to the government’s soon-to-be-available online marketplaces. The law doesn’t care where you get coverage as long as you have it.

2. Large employers are affected, not small ones.

The law distinguishes between big employers and small ones, and its weight falls almost entirely on the big ones. The dividing line is 50 full-time-equivalent workers. A large employer is one who has 50 or more of these full-time-equivalents. A small employer is one who has 49 or fewer. A full-time worker is one who works 30 hours or more per week.

3. Employers won’t be required to provide health insurance.

The law does not say that employers must provide health insurance to their workers. Those who don’t provide coverage can continue that. Those who provide coverage can drop it if they want. The law imposes penalties on employers, but those penalties don’t automatically kick-in just because an employer doesn’t offer health insurance.

4. Again, the law is aimed at the individual.

In fact, employer penalties are driven by the actions of the workers. If a worker goes to the federal exchange to buy an insurance policy and qualifies for a cost-sharing subsidy, the employer will be penalized. Penalties vary and fall hardest on employers who don’t supply insurance to their workers. Even so, they don’t kick-in unless a worker gets a subsidy.

Subsidies can go to low-income workers–those who earn between 100 and 400 percent of the federal poverty level. Subsidies also will be available to those who get insurance through their jobs if that insurance is determined by the government to be either too expensive or not comprehensive.

Stay tuned. There’s a lot more to come in the months ahead.

 

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