This article originally appeared in the September 2014 issue of Workforce magazine, under the column Butler on Benefits, written by our editorial director Kelley Butler. Read more of her bimonthly columns at Workforce.com.
If there’s one thing you can say for certain about the Affordable Care Act, it’s that the health care reform law is the gift that keeps on giving. Attorneys, lawmakers, HR/benefits professionals, journalists and communications pros like me have all stayed busy and gainfully employed since the ACA was signed in 2010.
Several recent legal rulings brought the ACA roaring back into the headlines: First, the U.S. Supreme Court ruled that small, closely held companies with shared beliefs could opt out of the ACA’s mandate to cover contraception. Then, a pair of appeals court decisions split over whether users of public exchanges may receive ACA insurance subsidies.
Recently, the ACA offered yet another “gift” when a sting conducted by the U.S. Government Accountability Office revealed that 11 of 12 fake applicants to public exchanges were extended coverage—plus subsidies totaling close to $30,000.
According to NBC News, the GAO launched the sting to test the ACA’s checks and balances against counterfeit applications. Only one “applicant” was denied coverage because he was unable to provide a Social Security number.
This is tough news to discuss with employees, especially since the Kaiser Family Foundation finds 45 percent of Americans view the ACA unfavorably. Still, there are ways to communicate that put your benefit plans, if not the law, in a positive light.
Here are three messages to share:
Cheaters never win. Employees who hear about the GAO sting might be tempted to game the system themselves. If you have a workforce that’s leaning on the exchanges for coverage, remind them that people are sworn to tell the truth when applying for coverage through an exchange. There is a penalty for perjury (a fine of up to $5,000 and/or a jail sentence of up to 10 years, depending on your state). Plus, the U.S. Internal Revenue Service can—and likely will—ultimately take back illegally claimed subsidies by deducting them from future income tax refunds. Lastly, it’s just bad karma.
You already get gold-level coverage at a bronze plan price. For employees who really do their homework about what an exchange plan costs—in premiums and out-of-pocket costs — your company benefits have never looked so good. Spread that message far and wide so that every employee and dependent gets it: The ACA requires bronze-level coverage to satisfy the individual mandate, but many employer-sponsored plans offer gold-level coverage (the second-highest coverage tier available) or higher, all at bronze-level premiums.
Let employees know that you’ve done the research and price comparisons for them, and offer a plan that gives them the best benefit for their—and your organization’s—dollar. Assure them that as long as they’re on your plan, they have the kind of coverage the government requires them to have so they’ll avoid a penalty on their 2015 taxes. Once that message lands and takes root, I suspect you won’t have much to worry about when it comes to people trying to get improper coverage and subsidies.
Think of the bigger picture. Whether Americans dislike the ACA overall or don’t support certain provisions like the contraception mandate, remind employees that reform likely is here to stay for the foreseeable future. With that in mind, tell workers it’s better to spend time and energy making the law work as well as possible for everyone—for them, their families and for your company.
That means not sabotaging the exchanges by improperly claiming coverage and saving premium subsidies for whom they were intended: people who are unable to obtain or afford coverage elsewhere.
It also means engaging in smart, cost-effective preventive care. For some, that might equal contraception; for others, perhaps not. What’s most important is investing time and energy to get the best care and value from employee benefits. Emphasize to employees and their families that they need to be persistent and engaged in their health care, such as asking their doctors how much procedures will cost and whether there are alternatives to tests or treatments. That knowledge brings power that will increase awareness and decrease costs all around.
Let them know what tools you offer or are available externally to increase their health care literacy and education to help navigate the system. The more you can proactively communicate, the better value you will convey.