Health care expert speaks

HOUGHTON – Local business owners heard a presentation Thursday morning on how they will be affected by changes in health care law.

Brett Williams of Michigan Consumers Healthcare Coalition gave a presentation at the Keweenaw Peninsula Chamber of Commerce’s Eggs & Issues forum.

While America probably has the most advanced health care system now, that’s not synonymous with being the best. The country lags behind other others in some key measures; it’s 37th in the world in infant mortality, for instance. Health care spending is projected to reach 30 percent of gross domestic product within 10 years.

Japan, which has a similar public-private mix of health care, costs an average of $2,700 per capita, compared to the U.S.’s $8,000. That’s of particular concern to Michigan, Williams said.

“When you have an inherent built-in cost that’s so much greater than your closest competitor, what happens to you?” he said.

The Affordable Care Act expanded Medicaid to 133 percent of the federal poverty line – $15,282 for a single person, $31,322 for a family of four.

In its ruling upholding the law, the Supreme Court said Congress could not withhold Medicaid funding to states that did not follow the expansion.

If Michigan expands its coverage, 470,000 people are estimated to join Medicaid.

People who are eligible for Medicare, Medicaid, Veterans Administration care, or Tricare are not counted as full-time employees; they also don’t get plans on the open marketplace.

For everyone else, they will be able to look for policies in a marketplace in which private insurance plans will compete.

For businesses under 100 employees, there’s the Small Business Health Option Program.

In Michigan, 14 companies will have bids on the private marketplace, Williams said. He compared the marketplace to a group of widget manufacturers. “Taking the colors away, how are you going to determine which one you’re going to buy?” he said. “Cost or quality – which one’s the best for your money, and which one’s going to cost less? That’s the way the marketplace works. It creates an avenue for competition.”

In most cases, people will not be forced to change insurance companies in 2014, Williams said. People also won’t be forced onto the marketplace if they like their current agent or broker.

Employees will have annual out-of-pocket spending caps. Monthly premiums are on an escalating scale based on salary. The person making $15,282 will pay 2 percent of their gross income, or $25 a month. For someone making $45,960, the premium is 9.5 percent, or about $364 a month. Some small businesses can receive credits towards income tax.

To be eligible, they must have fewer than 25 full-time employees, have average wages of below $50,000 and the employer must pay at least 50 percent of the premium cost.

Businesses with 50 or more employees will have new coverage requirements. For full-time workers, plans must pay at least 6 percent of expected costs and be affordable – no more than 9.5 percent of either family or employee income. To count part-time employees, add the hours by them in a month and divide by 120.

Chip Law of BHK Child Development said it was a well-done presentation.

“He took an extremely complex, dynamic issue and really pared it down to where any business person could walk away with a solid understanding of it,” he said. “He’s a very good speaker.”