1. Guidance from federal regulators, says David Gentile, is arriving in the Blue KC offices almost hourly, making uncertainty the only certainty about ACA implementation in 2014. | 2. “I look at this as a brave new world,” said Rick Kahle, who noted mixed results for the three main goals of health-care reform—improved access, lower costs and a modernized health-care system.


Overview

Co-chairing the assembly with David Gentile of Blue KC, Kahle teed things up by saying, “I look at this as a brand new world.” ACA, he said, had several objectives: to increase access, to control costs, and to modernize the health-care system.

“From an access standpoint, it is going to be successful,” said Kahle. He believes the ACA will broaden access through subsidies, through the removal of the pre-existing condition restraints, and through the guarantee of enrollment.

“From the cost standpoint,” Kahle continued, “the ACA is looking like it’s an absolute failure” for plan sponsors. Costs are going to go up, he believes, but not across the board; there will be winners and losers in the individual and small-group marketplace.

Modernization has received less attention, but Kahle believes that ACA has set the stage for both private and public innovation. He sees more potential in the large-group market, where reform encourages a focus on health and well-being.

On the small and individual group side, Kahle expects to see many among the younger and healthier part of the population opt out of coverage because the penalties are so modest.

What Kahle does not see in ACA is individual accountability. He argues that we have just created another enormous entitlement program that will be extremely difficult to fund, especially given the uncertainty over how many people will acccess the subsidies: “Can we afford the commitments we have made, especially in the way we have aligned the goals?”

Anxiety or Enthusiasm?

As a first question, participants were asked whether they looked forward to the Jan. 1, 2014, implementation of the ACA with anxiety or enthusiasm.

Danette Wilson, Blue Cross Blue Shield of Kansas City’s Group Executive for External Operations, leaned towards the enthusiastic side of that equation. “There are a lot of people who haven’t had heath insurance before,”
she said, “and so we’re excited about making them Blue KC members.”

“I’m enthusiastic about the opportunities that are there to improve the quality of care,” said Jessica Lea, president of Tria Health. Lea saw particular promise for improved continuity of care “if we can get past some of the hiccups and uncertainty.”

Christy Dienstbier, Human Resource Director at Bickford Senior Living, leaned towards the anxious side. “We’re trying to balance affordability and recruitment,” said Dienstbier. “In our business, that is a concern.”

Michael Avery, chief operating officer of ARMA International, put himself “on the anxious side” of the ledger as well. As COO of a small company, he is faced with the challenge of finding creative ways to comply with the new law and still provide high-quality benefits to attract and retain talent.

Most of the participants, however, chose some designation other than enthusiastic or anxious or, in some case, chose both. “I am excited and anxious,” said Ron Rowe, vice president for small groups at Blue KC. The excitement comes from helping the 299,000 uninsured in this area get insurance. The anxiety derives from having to communicate new rate information to small groups.

Blue KC vice president Wayne Powell expressed similar apprehension. Yes, he was excited about enrolling thousandsof uninsured—“a great opportunity”—but anxious about “the significant communications challenge.”

Sarah Osborne, a health-care actuary at Lockton, was pleased to have been able to help so many customers understand the ACA, but a little anxious in that “there are a lot of outstanding issues that we’re still waiting for guidance on.”

“I’m both enthused and anxious,” said Matt Condon, CEO of Athletic & Rehabilitation Center. “I’ve got a sign on my wall that says ‘at this moment, leaders in health care are not afforded the luxury of pessimism.’ I think that’s appropriate.”

“I would not pick either,” said Steve Best, director of compensation and benefits for J.E. Dunn Construction Co. “Yes, the [ACA] is going to impact our company in some ways that we would not have perhaps chosen, but we were already on a very sustainable path with our health-care costs.” He does, however, have concerns about how to implement many of these changes, especially with employees in the field.

Alan Salts, chief financial officer for KBP Foods, also rejected the anxiety-enthusiasm dichotomy. “We are much more comfortable than where we would have been a year ago,” he said, while complimenting Lockton for its guidance in analyzing the situation. The big challenge, he saw, was communicating the many options to the company’s widespread employee base.

Jonathan Cohn, CEO of the Yarco Companies, expressed a similar ambivalence. He was less anxious than he had been about the “incredible complexity” of the communications challenge, but still deeply concerned about benefit costs.