The following post is the first of a two-part series on ACA and the finance industry written by Steve Edney of TriNet Group, Inc.
Beginning January 1, 2016 every U.S. firm with 51-100 employees will be migrated to the “small group market” for healthcare benefits, as part of Affordable Care Act (ACA) mandated changes. Currently, in many states the small group market encompasses firms with 50 or fewer employees. But for policies that renew in 2016, this market will be expanded to include companies with up to 100 full-time employees.
Companies with 51-100 employees, who previously enjoyed the “economies of scale” benefits associated with being in the large group health care market, will become part of the small group market as of their first renewal on or after January 1, 2016. While this change will happen across the U.S., we believe its impact will be very significant in New York State.
What mid-size businesses can expect from ACA changes:
- Healthcare premiums, on average, will increase – potentially significantly – and the access to a wide-array of rich benefit plans these companies previously enjoyed is likely to be reduced. This is because New York State’s small group healthcare market is “community-rated,” which means the demographics (for example, average age of employees) at a firm have no impact on small group market healthcare pricing. New York State currently prohibits insurance rate variations based on the demographic characteristics of the firm. This is in stark contrast to the rest of the country, where firms are priced based on their employee “census”- thus taking into account their demographic characteristics. We believe this will result, on average, in significantly higher healthcare premiums – especially if the firm has a relatively young average age composition, as so many New York financial firms do.
- “Small group” market plans will be “canned,” meaning you will now have to select your benefits from a group of plans that the carrier offers – and plans cannot be modified. This will likely cause firms with 51-100 employees to lose some of the previous benefits they were able to offer employees. As a result, this change is likely to affect deductibles, out-of-network coverage, advanced infertility treatments and lower limits on certain services.
- Companies that have 51-100 employees and a relatively young demographic composition will likely be hit with significant healthcare premium increases, as the small group community rates will be much higher than what they currently pay. By my calculations, some groups could see premiums increase as high as 50 percent for plans similar to what they offer today.
A real example of how one mid-size business avoided the negative consequences of ACA changes: A New York City business of 79 full-time employees recently came to TriNet concerned about how upcoming ACA changes would impact their mid-size business. They knew they would be subject to the community rated small group plans and that their new rates would become effective with their first renewal on or after January 1, 2016.
TriNet conducted an analysis of what they could expect, using the New York small group rates that are available today. This particular employer would have seen a 48 percent premium increase starting January 1, 2016 – coupled with a reduction in benefits – when forced into the New York small group market.
Because TriNet provides small and mid-sized businesses with access to rich Fortune 500-level benefits at prices they can afford, we were able to not only help this NYC business avoid a premium increase in 2016 – but we were actually able to provide them with a 10 percent savings on their current rates.