Affordable Care Act still poses concerns for small businesses, doctors

Sep 30, 2013

New York is one of the states that will be offering insurance for the Affordable Care Act (ACA) through state health exchanges. What is arguably the landmark feature of the law also known as Obamacare, the registration springs into action tomorrow when New Yorkers can begin shopping and buying health plans through a marketplace called New York State of Health. Implementation of the plan has had its bumps and bruises, but New York is ready to go, even if lingering concerns in certain sectors remain.

Among the organizations that have been opposed to ACA from the start in New York state is the National Federation of Independent Business. New York State Director Mike Durant, says the group's stand reflects the views of its members. On the eve of the exchanges, those members expect that uncertainty regarding the cost of the Affordable Care Act for business will affect hiring, according to the most recent survey.

"We did find that 80 to 90 percent are considering not hiring at all, shrinking hours, or maybe having to cut the workforce, so this is a major problem," Durant said.

For businesses with fewer than 50 employees, coverage will be available through the Small Business Health Options program, also known as the SHOP Marketplace. But there have been changes in rules as recently as last week, and Durant says that uncertainty fuels much of the wariness of the Affordable Care Act.

"What we are seeing is that every time there is a delay, a new glitch, a new problem, the phones ringing of the hook," Durant said. "They're sending emails because they have concerns, because they don't know how it applies to them. I think outside of everything, there are so many myths, falsehoods and half truths just rolling it out, and what it means for you as an individual and as a small business, is causing an enormous amount of headaches for a lot of people."

Many physicians are also wary of the business aspect of the new system. Maud White is executive director of the Health Alliance Physician Organization in Syracuse, which represents about 400 doctors. She says physicians are supportive of Obamacare for the most part, but because they are also running a business they worry about bad debt.

White says the basis for that is a rule that gives consumers a 90-day grace period to get services even if they haven't paid their insurance premium payments.

"The problem is that all of these physicians are being told by the insurers - all of them - that they are required, if the patient doesn't pay and the doctor provides services and submits the claim, that they are required to pend that claim and not pay the doctor," White said.

Those non-payments can quickly compound the problem, resulting in lost revenue.

"What if at the end of a quarter, a patient never pays for a premium," White said. "Maybe they're not able to. Legitimately, maybe something happens. Well, then they'll be canceled; at the end of the quarter the insurance company can cancel. And if they do that, then for sure, those claims will not be paid. So all those services physicians provided will be unreimbursable."

White says these things need to be cleared up, otherwise doctors might stop participating in the New York state exchange.

If that happened, it could be particularly bad news for Upstate Medical University Hospital, in Syracuse, where it is more difficult to attract physicians, especially family care doctors.

"Physicians who may find that they have significant issues in this area, it could turn them against the exchange because they can't afford to do it," White said. "That would be a terrible shame. Nobody wants that to happen. So we're trying to be proactive and say how can we address this problem now, so we don't have a lot of physicians at the end of the day who find after the first quarter that they have all this debt."

Durant says his group continues to work with the state to straighten out some of the concerns small businesses have. Ultimately, the federal government says health insurance premiums will drop in New York state under Obamacare. But Durant suggests that's not much consolation in a state that's seen premiums rise in the last decade.

"Health premiums will go down 50 to 52 percent in New York. But New York's health costs, the premiums have increased the last ten years almost 130 percent," Durant said. "So you're going from a Lamborghini to a Porsche."