November 1 marked the beginning of open enrollment for The Affordable Care Act (Obamacare). Despite the Trump administration’s efforts to repeal the act, it remains the law of the land, and a source of confusion and angst for employers and employees alike.
To dispel some of the confusion, the Central Jersey Think Tank, a group of business leaders dedicated to improving the quality of commerce in NJ, held a roundtable discussion on the subject with local insurance professionals, an attorney and a tax accountant.
The primary speaker was Christopher Pang, an employee benefits specialist with Martin Insurance Group in Cranbury (https://immartin.com). Pang laid out some of the more confusing elements of the plan. He explained that the varying “metallic” levels of service have more to do with deductibles and less to do with quality of care.
He also made the only point that everyone agreed with: the ACA has not simplified things, nor has it produced better quality or more affordable health care.
Pang did hold out a ray of hope, though, referring to the OMNIA Health Alliance created by Blue Cross/Blue Shield of NJ.
“Most health care services in the state are paid for with a fee for service model. Providers are paid regardless of quality or outcomes,” he explained. “They are paid for every test and procedure regardless of necessity. It also pits providers against insurers.”
According to Pang, the alliance pairs BCBSNJ with the state’s largest hospitals and physician groups in an effort to lower monthly premiums and out-of-pocket costs.
“It is a pay for value system that rewards providers for efficiency and quality of care,” he said. “BCBSNJ will actually share savings proceeds with the health care providers.”
Pang said there has been a noticeable improvement in NJ health statistics based on an analysis of 2016 claims under this system. These reductions include a 3% lower total cost of care, 3% lower rate of ER visits and 3-5 % increase in breast cancer and colorectal cancer screenings. According to the survey, Horizon BCBSNJ members avoided more that 2,000 ER visits and more than 600 inpatient stays in 2016, he said.
But as with all health care debates, not everyone is in full agreement. Michael Rescinio, partner in Lawson, Rescinio, Schibell CPAs (www.LRSCPA.com) and sponsor of the Central Jersey Think Tank, took a counter position.
“The Alliance puts health care providers and insurers on the same side of the table with an overriding interest in cutting costs,” Rescinio explained. “There’s a built-in incentive not to order tests. Those short-term statistics are nice, but what is the long-term impact? It may lead to reduced quality of care.”
He continued, “Does a skipped test today lead to more catastrophic care in the future? If it’s my loved one on the examination table, I’d prefer to err on the side of more tests rather than less.”
Sal Schibell, who founded the Central Jersey Think Tank, and partner in Lawson, Rescinio, Schibell, also gave a brief update on Trump’s tax plan prior to the House Committee on Ways and Means’ release of the proposal.
Other panelists included Kevin McDonough, a principal of Dickstein Associates Insurance Agency in Tinton Falls (www.dicksteininsurance.com) and Gary Young, partner with Scarinci Hollenbeck, attorneys at law in Wall (www.sh-law.com). Both specialize in employee and group benefits, and expanded upon the many traps that lay in wait for NJ employers, including:
- The ABC test for independent contractors, that, according to Young, no one ever passes;
- Many 401K plans that leave employers open to employee lawsuits;
- Improperly completed I9 forms that can lead to thousands of dollars in fines for simple typos.
Schibell reviewed the employee vs independent contractor ABC test that New Jersey applies to classify employees. He also mentioned that this test is only applicable for New Jersey purposes and does not apply for federal applications.
In closing the monthly meeting, Young stated that one of the purposes of the Think Tank is to inform local business owners of the many risks they face.
“If you’re a business owner, you are a risk taker,” Young reminded the approximately 30 attendees. “One of the roles of the CJTT is to mitigate those risks through helpful information.”
The Central Jersey Think Tank is available for panel discussions at business and civic organizations on topics ranging for marketing and website development to accounting, financial planning, law, cybersecurity and more. There is no fee for the panel. The CJTT is sponsored by Lawson, Rescinio, Schibell. The group meets once a month. Contact Sal Schibell at [email protected] or 732-531-8000, ext. 225 for more information