This Post is the first in a set of two Posts looking at PPACA - Sometimes referred to as Obamcare or ACA.  

1) This first Post is to provide background on PPACA with Links to valuable information to answer questions for Brokers, Employers and Carriers.

2) The second Post will provide a Workable, Efficient, and Cost-Effective Strategy for Brokers and Employers to deal with PPACA/Obamacare for the 2013 Plan Year and Beyond.  The time to get started is now!  This will be Posted on Friday after your Thanksgiving!  We wish you a Happy and Joy Filled Thanksgiving!

A Little PPACA History -- Since March 3, 2010 when President Obama signed PPACA, the Patient Protection and Affordability Care Act, also known as Obamacare -  there has been a significant disruption change to the Group and Individual Health Insurance Markets!  The Supreme Court Ruling of June 28, 2012 further fueled the concerns about disruptive change to the Industry for Carriers, Brokers, and Employers.

Wikipedia provides the following -- "PPACA is aimed primarily at decreasing the number of uninsured Americans and reducing the overall costs of health care. It provides a number of mechanisms—including mandatessubsidies, and tax credits—to employers and individuals in order to increase the cverage rate. Additional reforms are aimed at improving healthcare outcomes and streamlining the delivery of health care. PPACA requires insurance companies to cover all applicants and offer the same rates regardless of pre-existing conditions or gender. The Congressional Budget Office projected that PPACA will lower both future deficits and Medicare spending."

With the re-election of President Obama, the changes are now inevitable!  For many reasons, most Carriers, Brokers, Consultants, and Employers had been reluctant to prepare - or implement strategies based on the lengthy PPACA legislation that did not provide many details.  Now there is no waiting!  Recently the Fed. - utilizing - published a timeline for the implementation of PPACA from 2010 - 2015.  This is a graphically rich resource for gaining a better understanding of what needs to be done when!

Where We Are Today with PPACA -- A great deal of time, energy, and money has been spent by the Insurance and Benefits Industries trying to defeat PPACA!  Unfortunately, there were only a limited number individuals and Organizations dedicating creative time, energy, expertise, and money on dealing with the realities of implementing PPACA.  The focus has not been on creating compliant strategies coordinated with a set of integrated Benefit/Insurance Plans.

The good news is that some specialists focused on their specific Market Sectors, ie. Individual Plans, Voluntary Plans, Technology, Enrollment, Administration, etc.  They were active creating Plans, Programs, and/or Services to take advantage of PPACA.

Healthcare Reform put a focus on only one part of the overall Benefits and Insurance needs of Employees and Individuals - the Health Insurance Component.  This focus was a major set-back for Strategic Benefit Planning.  A number of constituencies were directly impacted - They included:

  • Carriers - Were forced to expend  their time and energies in deciding whether or not to produce PPACA compliant Health Plans for Groups and Individuals.
  • Carriers - Were forced to focus on the new Medical Loss Ratios (MLRs).  The following is a Link to Federal MLR Guidelines
  • Brokers - Were forced to abandon or restructure their business plans as Health Insurance Carriers dramatically reduced commissions on traditional Group Health Plans to assist in compliance with MLR.  An AISHealth/Health Plan Week Article analyzed this trend.  An article In Life Health Pro by Allison Bell on June 15, 2012 about Brokers and PPACA was titled "Kaiser: 73% of Brokers Dislike; 20% Like It"!
  • Brokers - Were forced to continually take a "Wait and See" position for the Supreme Court Ruling and then the Election in making recommendations to their Employer Groups and Individuals.  While Brokers hoped to avoid the disruptive changes caused by PPACA, most new it was inevitable.  The dilemma was simple - What to do?  Employee Benefit Advisor described this dilemma in an article by Nelson Griswold on September 1, 2012 titled "2014:  Will your agency be ready?"    
  • Smaller Employers - Became reluctant to offer Health Insurance to their Employees or started to consider dropping their exiting plans.  With the details of PPACA unclear - and with a threat of additional plan costs - Employers saw offering Benefits as a threat to staying in business.  Health addressed these issues in a study titled "Helping The Bottom Line - Health Reform And Small Business". 
  • Smaller Employers - The original PPACA provided limited details on Exchanges, Tax Credits, and Penalties applying to a Small Business grappling with offering Health Insurance Plans to their Employees. in a news release titled "Small Business and the Affordable Care Act" provides details on how "The health care law provides tax credits and soon - the ability to shop for insurance in Exchanges...".
  • Larger Employers - Became equally confused about the ramifications of continuing to offer Health Insurance Benefits to Employees.  The law firm of Michael Best & Friedrich LLP published a lengthy outline about the effects of PPACA titled "Summary of Changes Affecting Employers Under the PPACA - Amended".  While helpful - this outline demonstrates the need for a Strategic Benefit Plan. 
  • Larger Employers - Who prefer longer-term Strategic Benefit Plans were confused by the potential penalties under PPACA with its lack of details.  The Congressional Research Service provided the following clarifications titled "Summary of Potential Employer Penalties Under PPACA (P.L. 111-148".  

What's Next? -- It's time for Carriers, Brokers, and Employers to take action!  Our next Post - "PART 2 - HOW TO CONQUER PPACA/OBAMACARE - A BATTLE PLAN FOR BROKERS, EMPLOYERS AND CARRIERS" will outline Workable, Efficient, and Cost-Effective Strategies for Brokers and Employers to deal with PPACA/Obamacare for the 2013 Plan Year and Beyond.  These Strategies that can be integrated or stand alone include:

  • Private Exchanges - For offering Core, Voluntary/Worksite, and Ancillary Plans, Programs, and Services!
  • Defined Contribution - For providing: Employers budgetary controls; Employees valued choices to meet their Needs and Price-Points; Brokers positioning as "Trusted Advisors" and new needed revenues; and Carriers enhanced Distribution Channels! 
  • Integrated Benefit Choices - For providing Employees the capacity to meet their Individual and Family Needs and Price-Points working with qualified Brokers - Choices including: Core, Voluntary/Worksite, and Ancillary Benefits!  
  • Integrated Support Technologies - For Employee Education, Communication, Enrollment and Data Distribution Management!
  • Inbound Marketing - For Shortening Selling Cycles, Reducing Marketing Costs, and Driving Revenues for Carriers, Brokers, and Service Companies leveraging the Power of the Internet, Search Engines, Social/Business Media and SEO! 

Working with Strategic Partners we have developed this Integrated Five Component Strategy.  Each of the above parts can be utilized on a stand alone basis or integrated to maximize the opportunities.  Visit our Introductory Chart to see how the above components fit together and what we will be discussing in Part 2 next Friday!

If you would like to discuss becoming a Strategic Partner by assisting in providing one of the above components, please contact

If you have Questions, Suggestions, or Comments please Email - or Call 216.577.5579.  We invite you to Join our Linkedin Groups, Insurance Forum, for more discussions.  

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