The Supreme Court spoke loud and clear almost a month ago when it upheld the entire Affordable Care Act (ACA) as constitutional in a monumental decision that will affect businesses and individuals alike.

Businesses in the Richmond area are now left trying to decipher and understand the complexities of the bill and how it will affect them and insurance carriers.

“Whether you represent small, large, public or nonprofit entities, we’re all going to be effected as employers and consumers,” Greater Richmond Chamber of Commerce and BB&T Insurance Services of Virginia executive Seth Roth said during a panel discussion about healthcare reform July 19 at the Anthem Headquarters in Henrico.

The discussion, hosted by the Chamber to address the changes that come with the ACA, involved four leading experts who spoke on behalf of various health-related businesses to assist in the understanding of what the decision means and what local companies need to do to move forward.

The ACA essentially will make going without insurance something that is taxable by the government, while enlisting new laws that employers must comply with or face penalties. Many of the ACA changes have started to take effect this year.

Employers now will be required to complete W2 reporting on the cost of employer-sponsored group health care coverage.

For the W2 reporting a section will be added to box 12 to include a new code “DD” that reports the costs of employee sponsored healthcare coverage.

Anthem and other health insurers in Virginia already are dealing with the new laws, as rebate checks are being mailed to customers for not spending enough of health premiums on medical costs under some health plans.

The medical loss ratio rebates issued to consumers require insurance companies to spend a certain percentage of premium dollars on medical care and health care improvement. The rebates have to be distributed as taxable income to employers, said Susan Maley Rash, vice president at BB&T Benefit Consultants of Virginia.

Employers also must cover specific preventative health services for women with exceptions applying to religious employers. Employers also must have offer a $2,500 maximum contribution to healthcare flexible spending (FSA) plans and enlist new Medicare taxes, which will be increased by nine percent.

There also will be a tax on unearned income for high-income individuals and couples.

Opinions on law split
One of the ACA decisions that already has been implemented and will remain in effect is the requirement to cover adult children until age 26 and the requirement of non-grandfathered plans to cover certain preventative care services without cost-sharing.

By 2014, people may no longer be declined for pre-existing conditions, and there will be a modified community rating for small groups and individuals.

The rates will be based upon family tier, age, geography and tobacco use. The change is designed to decrease insurance rates for those who are older and increase rates for insured younger people.

“The healthcare reform laws were needed,” said Mckinley Tucker, CEO of Risk and Identity Solutions, a Henrico-based small business.

“We are the only industrialized nation without healthcare and I think people should try to get some of the emotion out of the issue and look at the positives,” Tucker said. “My daughter is 23 years old and was in the hospital over 20 times between Feb. 14 and now, and she has more pre-existing conditions than you could imagine. As a retired teacher, I was thinking about taking a job to help her pay for her insurance because it would go up. But with the new law she can stay on my insurance until 26 and I can keep her on the plan for as long as I can.”

Not everyone is so optimistic about the ACA; larger companies of 50 employees or more may have to deal with penalties.

Beginning in 2014, there will be an employer penalty for not offering minimum coverage, as well as an employer tax for not offering minimum coverage and an annual insurer fee for fully insured businesses.

If companies have less than 25 full-time employees who each make an average of less than $50,000, there is a credit allowable for a two-year period but only if coverage is purchased through the exchange.

“We will probably benefit from the new law,” said Charles E. McCabe, president and CEO of People’s Tax in Glen Allen. “I have about 15 full-time and 20 seasonal employees so we’re below 50 employees and will not be affected by the penalties, and we pay 50 percent of the employees’ health care now.”

Tax credits will help small businesses and nonprofit organizations, and the credits currently total as much as 35 percent of the businesses’ health premiums but will increase to 50 percent in 2014.

However medium to large businesses - those with at least 50 full-time employees - will not benefit because the “pay or play” penalty will be enacted. Certain employers that either don’t offer health care or do not meet the law’s test for affordability will face penalties.

It is possible that changes could be made to the ACA through future legislation or court rulings; however, the health care reform law is currently in effect and employers should continue to prepare for ACA changes that will become effective in the next two years. For answers to many of the big questions, carriers and employers will have to wait until after the election in November.