Health Care Reform: Businesses and Organizations

Helping Business and Civic Organizations Confront Their “Employer” Responsibilities

Understanding the intricacies of health care reform and how it affects an organization can be intimidating. BakerHostetler’s Employee Benefits team has closely followed all aspects of the Affordable Care Act since it was being debated in late 2009 and not only understands the nuances of the law, but also its regulatory shortcomings and the effect that it has had on the traditional state-based regulation of health care providers and health insurance companies. Armed with a systemic understanding of the health care reform movement, we can help clients make the best health care-related decisions for an organization and its workforce.

By combining decades of benefits counseling experience with the insight gained from closely following both the Affordable Care Act and the ways key stakeholders have reacted and responded to it, we help employer organizations of all sizes and backgrounds develop strategies to effectively respond to the many challenges posed by the health care reform movement, while taking advantage of the opportunities it presents.

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By understanding an organization’s unique circumstances, we develop customized, results-driven solutions and weigh the advantages and limitations of each strategy before presenting cogent and practical options and, if requested, a recommended action plan. Using this approach, we can help address and overcome the most vexing challenges posed by the Affordable Care Act and the wave of health care reform-related changes washing over health care providers and health insurance issuers involved in the delivery and financing of health care in America. Below are some of the many questions employer organizations have brought to us:

  • Should we continue to offer health insurance coverage to our full-time employees, or just pay the penalty—and will anyone in the organization be held personally liable if the penalty does not get paid?
  • If we simply “lease” employees from a professional employer organization (PEO), do we still have obligations under the Affordable Care Act, or do they become obligations of the PEO?
  • Can we cancel the coverage we traditionally have provided to our union retirees now that they can buy coverage on their own?
  • Are there changes we can make in our workforce structure to avoid having to offer health insurance coverage at all, or to help us control costs if we do decide to offer coverage?
  • Do we have to talk to the union before making any of the changes required by the Affordable Care Act starting in 2014?
  • Are there changes we can make in how our business is organized to avoid having to offer health insurance coverage to our minimum wage employees?
  • If we self-insure the coverage we provide, will that enable us to provide more cost-effective coverage—and if so, what are the downside risks?
  • We currently provide coverage through an association-sponsored plan –will we have to set up our own plan in 2014, and if the association-sponsored plan does not satisfy the current Affordable Care Act requirements, do we have to pay penalties or will that make it the association’s liability?
  • We are organized as a partnership, so not everyone in our organization is an “employee.” What, if anything, do we have to offer the partners?
  • We use a large number of independent contractors, to the point that we have more contractors than employees; what would happen to our organization under the Affordable Care Act if those contractors were to get reclassified as our employees?
  • What notices and disclosures do we need to communicate to employees and when? Do we have to communicate only with our full-time employees, or to everyone? What are the penalties for non-compliance?
  • What are our reporting obligations, to what agencies and what are the deadlines?

We diligently comb through and digest thousands of pages of regulatory guidance issued by federal and state agencies, such as the U.S. Treasury Department, the U.S. Department of Health and Human Services (and its Centers for Medicare and Medicaid Services), the U.S. Department of Labor, and a number of state insurance commissions and departments, to know and understand the law and the role such rulemaking plays in the larger reformation process. Our clients benefit from our approach, which enables them to act strategically as change continues to transform the nation’s health care delivery system, rather than simply react to specific regulatory changes and initiatives. This approach also reflects our larger commitment to providing solutions-oriented, value-added counsel and representation to clients, rather than just helping them trouble-shoot specific problems or spend limited resources complying with rules and regulations that are likely to be short-lived.

Keeping Clients Informed

Through our email alerts and articles, we share news and developments with clients, addressing key issues in greater depth and providing practical guidance as the health care reform movement continues to evolve.

We also offer topical and timely webinars, educational programs, and on-site presentations spurred by new developments in the health care reform movement or by client requests.

We are flexible in our approach, with the ultimate goal of enabling clients to understand and navigate the complexities of health care reform.

Select Experience

  • Conducted a worker classification assessment project for a large public company, helping to structure their workforce in a way that will enable them to cost-effectively function without incurring potentially substantial—and recurring—Affordable Care Act penalties.
  • Reviewing and correcting communication pieces prepared by consulting firms for various employers to ensure that clients comply with the disclosure obligations imposed by the Affordable Care Act without engaging in voluntary “Good Samaritan” disclosures capable of generating potentially substantial liability risk.
  • Counseling several service organizations regarding the Affordable Care Act’s “pay or play” coverage offer requirement when the organizations’ existing business models may be incapable of absorbing the added coverage costs.
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Experience

  • Conducted a worker classification assessment project for a large public company, helping to structure their workforce in a way that will enable them to cost-effectively function without incurring potentially substantial—and recurring—Affordable Care Act penalties.
  • Reviewing and correcting communication pieces prepared by consulting firms for various employers to ensure that clients comply with the disclosure obligations imposed by the Affordable Care Act without engaging in voluntary “Good Samaritan” disclosures capable of generating potentially substantial liability risk.
  • Counseling several service organizations regarding the Affordable Care Act’s “pay or play” coverage offer requirement when the organizations’ existing business models may be incapable of absorbing the added coverage costs.
  • Presented in-person, educational sessions to a large, national media company after passage of the Affordable Care Act to offer a thorough analysis of the effect health care reform would have on their organization.

Key Contacts