Insider speaks on ACA

Employer shortcuts undermine coverage

by Clay Neely - clay@newnan.com

The Affordable Care Act is hurting those who need it the most, and continues to have serious problems, according to an in-house compliance officer for the act.

Tom Yearian, who oversees implementation of the law for J. Smith Lanier & Company, also said employers are cutting employees’ hours to get around the law.

Yearian held a non-partisan lecture on the ACA Thursday at the Wyndham Conference Center in Peachtree City. “I don’t do politics, but there are some serious flaws in this bill,” Yearian said. “There are some unintended consequences that are starting to be felt in Washington, and those flaws are hurting the lowest income people in this country who cannot afford to be hurt.”

Yearian touched on a variety of factors, including how companies are cutting the hours of their employees and providing plans that aren’t feasible for an entire family, the disparity between those who earn too much for Medicaid but too little for premium assistance, and the partisanship involved with the law.

“The 30-hour definition is killing low income people,” Yearian said. “Millions of hourly workers have seen their hours cut below 30. These are the ones who are getting killed financially over the 30-hour provision.”

Yearian noted that there are currently two bills in Congress to change the definition of full-time from 30 hours to 40 hours.

“That’s the worst aspect of this bill. It’s hurting low income people,” Yearian said.

“You have an employer that says, ‘Here’s what I’m going to do. If they’re going to mess with me like that, you give me a 60 percent Bronze plan and I’m going to charge every single one of those rascals out there exactly 9.5 percent of pay and I ain’t paying a dime for their spouses and rug-rats.’ There are employers like that out there,” Yearian said. “I deal with them.”

“The low-income employee goes to the exchange and says, ‘I have to get my spouse covered. They’re charging me $1,000 a month for family coverage,’ and the exchange says, ‘Sorry, Charlie, they’re eligible to enroll in an employer sponsored plan that meets the affordability test of 4980h (U.S. health code provision),’ even though the employer isn’t paying a dime for those dependants. They’re stuck.”

One of the issues recently raised before the Supreme Court was that the ACA law required all states to raise the qualification level for Medicaid to 133 percent of the federal poverty level.

“Yet, most of the states decided not to raise it up to that level,” Yearian said. “Georgia has an insurance commissioner who said, point blank, ‘My job is to be an obstructionist.’ And let me tell you, he’s done a hell of a job.”

“Here we have a law that is officially the law of the land. It’s been tested before the Supreme Court and endorsed by the people of this country when the president was elected for the second time. The Republicans have passed their 50th repeal bill today that won’t go anywhere,” said Yearian. “This law is here to stay, so we have to work on fixing all the things that are wrong with it.”

Yearian also spoke on how the ACA has created a gap of eligibility for health care plans. The current law states that a person is eligible for premium credits if their income falls between 100 percent and 400 percent of the federal poverty level.

However, the qualifying income level for Medicaid in Georgia is below 100 percent of the federal poverty level.

“The AJC says there are 650,000 people caught in that gap in Georgia,” Yearian said. “They make too much for Medicaid and probably because they had their hours cut back, don’t make enough to qualify for premium assistance. Again, who is getting hurt the most by this? It’s the middle-to-lower income people.”

As the lead resource on the health care reform legislation, Yearian has worked on investigating the bill for four years. He said that the flaws he sees on the horizon are approaching quickly.

“You have this minimum essential benefits package that has to be offered and Georgia defaulted to the largest selling group plan in the state with his the Blue Cross POS,” Yearian said. “For some reason, we thought we were getting a federal definition of a qualified health insurance plan.”

While there are plans available to employers that comply with the PPACA (Patient Protection & Affordable Care Act), there are no limits on any essential benefits that are in the plan, annual or lifetime.

“Employers want to offer those plans to the lowest paid people in the company. These plans offer 100 percent first dollar coverage for wellness which are mandatory but do not come with any surgical or hospital benefits,” Yearian said.

“That’s insane,” muttered a member from the audience.

“I submit to you, there are some major unintended consequences that have happened,” Yearian said. “When they said 30 hours a week, those young attorneys in Washington probably thought employers would offer insurance to more people, but it’s been the opposite.”

A question was then posed, “Why isn’t there a spokesperson for this demographic that is getting hurt?”

According to Yearian, it boils down to the current climate of extreme partisanship in Washington, D.C.

“We need to get to a point where we can find just one Democrat and Republican that could actually sit down together, look at it and say, ‘Okay. We accept that this is the law of the land. It’s not going anywhere but there are plenty of problems with this and we need to fix them.’”

“People need to stop fussing about repealing it,” Yearian said. “The Republicans have been nothing but obstructionists for this law and the Democrats are just rallying around it, not wanting to admit any flaws about it. One of the biggest problems is that no one has been willing to come down from those high horses and get to work on it.”

The only solution to the ACA is that all parties must begin to work together and make sure this law works for everyone, according to Yearian.

“Someone asked me at a seminar, ‘Is this law going to fail?’ My response is, ‘It already has.’ Its intent was to provide affordable health care to all Americans and it’s failed to do that,” Yearian said. “Especially to those who need it the most.”



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