Restaurateur Kathie Chadbourne literally jumped for joy in November when President Barack Obama won re-election, but the landing was brutal.
She fell and broke her wrist.
The 60-year-old owner of Avenues Bistro on Third in Salt Lake City fretted because she didn’t have health insurance, a fact she’s lived with for more than 20 years.
“I set it up so I can pay [the emergency-room bill] $25 a month, and then I applied for financial assistance from Intermountain Healthcare. Now tell me this isn’t freakin’ nuts,” Chadbourne said. “The way I’m dealing with my health care issues is I’m just scooting around in circles.”
That lack of insurance is motivating her to figure out a way to find health coverage for herself and 18 employees. And she believes the Affordable Care Act (ACA) will pave the way.
“It’s kind of scary looking at the whole deal because it’s extremely complicated,” Chadbourne said. “All I know is that we have to do something.”
The vast majority of Utah small-business owners — 75 percent — don’t share Chadbourne’s optimism that the health reform law known as Obamacare will make insurance more accessible or affordable, according to a recent survey by the Salt Lake Chamber.
But with 90 percent in the same survey responding that employer-provided health insurance is a top priority for business, most companies are scrambling to learn about the new law and how they can comply.
Here are some basics about the ACA to get small-business owners started.
Who must comply?
Large businesses must provide coverage that meets ACA standards by 2015 or they will face a penalty.
Small businesses — with fewer than 50 full-time employees — don’t have to provide coverage to their employees. But their employees will need to get coverage or face a penalty. And it’s up to small businesses to let their employees know (in writing) their insurance options by Oct. 1. Sample exchange notice forms are on the Department of Labor website.
There is no fine or penalty for not issuing this notice, but employers who don’t could open themselves to being sued by an uninsured employee who misses the open-enrollment window and then comes down with a major illness such as cancer, said Utah legislative attorney Cathy Dupont.
“I am sure there is going to be some attorney out there who would be willing to take the case,” Dupont said. “It’s in all employers’ best interests to send out that notice to their employees.”
Small-business owners who want to voluntarily offer coverage to employees can consider using Avenue H.
What is Avenue H?
You may have heard about the state-run Avenue H exchange as well as the federal individual marketplace. To be clear, they are two different animals.
The federally run marketplace at healthcare.gov is where individuals and families can shop for plans on their own.
The state-run Avenue H is the Internet portal where small businesses and their employees can apply for coverage, comparison-shop and enroll in a health plan. If you’re a small-business owner, Avenue H is where you’ll want to start.
Which companies can participate?
Your small business qualifies for Avenue H if 1) it has two to 50 full-time employees; 2) half of them live in Utah; and 3) 75 percent of them want to participate in an Avenue H plan.
But count your employees carefully, advises Jeremy Sewell with FirstWest Benefit Solutions. Full time is defined as 30 hours a week or 130 hours a month, and the rules change for companies with more than 50 employees. “Some [small business] employers may not know that they fall into a large employer scenario,” Sewell said.
Do small-business owners choose a plan for their employees? Or do employees choose a plan for themselves?
Either way. Small-business owners who want to provide a plan for employees can apply on Avenue H or can still buy plans from private insurers outside the portal.
One main advantage to Avenue H is its “defined contribution” model, which means that the employer decides the amount of money they’re willing to spend on employees’ health care and then the workers do the shopping for a plan that meets their needs.
Proponents say the defined-contribution system simplifies health plan decision-making for employers and also allows them to budget for health insurance more accurately.
If a small business chooses not to select a health plan for its employees, the workers are then free to shop on the individual marketplace at healthcare.gov.
Small-business owners: What do you need to apply?
You’ll need to fill out an application at AvenueH.com.
You’ll also need to provide copies of a recent Quarterly Wage and Tax Form or your business license, payroll stubs and current health insurance plan information (if you have one). All of this needs to be submitted online.
How much is this going to cost?
Rates will no longer be based on the health status or claims experience of your employees. Under the new law, carriers are allowed to consider only age, the type of coverage (individual versus family policy), tobacco use and where your small business is located. Utah has been divided into six sectors and the community rating of risk may vary based on geography.
Still, no one knows yet the precise costs, said Greg Matis, general counsel of SelectHealth.
“The fact is it’s unknown,” said Matis. “We do know that for specific businesses there will be movement in both directions — some will see their premiums increase and others will see them decrease.”
What about a tax break to help payfor health care?
Starting in 2014, some small businesses can apply for a tax credit of up to 50 percent of what they pay for premiums for their employees. Only small businesses that offer a health plan on Avenue H will be eligible. The small-employer credit will be available for two consecutive taxable years and, according to healthcare.gov, the smaller the business, the bigger the tax break.
Because each company is different and the ACA rules are complicated (and keep changing), small businesses should find an expert to guide them. On Avenue H, there’s a list of insurance agents trained to give Avenue H quotes and advice. Working with an insurance agent or broker is not optional when it comes to the ACA, said Jeanine Wilson, president of the Utah Human Resources State Council.
“A lot of small businesses have an insurance broker anyway,” said Wilson. “Make sure you get somebody truly knowledgeable about the ACA instead of trying to figure it out yourself.”
For large businesses (50+ employees)
•You won’t be able to use Avenue H, at least not for now. It may be an option in the future.
•In 2015, you’ll face a penalty if 1) you don’t offer insurance; 2) you don’t pay at least 60 percent of an employee’s premium; 3) the plan you offer doesn’t meet the Affordable Care Act’s minimum standards; or 4) your insurance cost exceeds 9.5 percent of an employee’s household income.
•In 2015, you’ll need to provide information about full-time employee coverage and the cost of the benefits to the Internal Revenue Service.
Source: sba.gov, Avenue H