The Affordable Care Act (ACA) is making the news again as a coalition of the Trump administration and GOP-led states are appealing courts to take it down  completely.

What’s at stake?

It depends on who you ask.

Many believe that the ACA lands squarely in the land of government overreach. Additionally, the act has its share of problems. Despite President Obama’s assertion otherwise, some people did lose coverage they liked. According to this article , many healthy people also saw “their premiums and out-of-pocket costs soar.” The same article identifies the “hardest hit ” as those “who earn just slightly too much to qualify for federal premium subsidies.”

Without the ACA, this USAToday article predicts drug prices will soar and rural care will suffer. Additionally, this article points to concerns about the 21 million people who are at risk of losing coverage, including those with preexisting conditions. For his part, President Trump tweeted his assertion that “Republicans will always support Pre-Existing Conditions” and that a replacement plan “will be on full display during the Election as a much better & less expensive alternative to Obamacare.”

Remind me about that penalty

It’s gone. While proponents of the penalty for not having health insurance say it’s a large part of making the ACA work, Congress declared the penalty unconstitutional in 2017. The new ruling goes into effect in 2019. That means taxpayers can go without healthcare or explore alternative options without seeing a ding on their tax bill starting next year.

How can employers prepare for the changes?

In the Fall of 2018, the Trump administration provided new ways for states to provide alternatives to the Affordable Care Act. So far, no states have taken the offer. Still, under new proposed rules, it’s not out of the question that employers may be able to stop offering group health care in the future. According to this article , the option could make way for employers to offer “employee health reimbursement arrangements (HRAs) for purchasing individual health insurance instead of providing group health coverage.”   

While there is virtually no limit to speculation about what lies ahead, there’s no need to jump into action prematurely. Even though it’s a hot topic and a political lightning rod, many analysts—including those at Littler, our go-to on subjects like these—don’t expect to see many significant changes in the near future.

Don’t mistake that prediction for a free pass to ignore the subject though. Political persuasions aside, the passing of the Affordable Care Act represented a major overhaul of the United States’ healthcare system. The question of how to move forward continues—whether the bill itself remains in some form or gets dismantled. One thing is certain: This debate isn’t going anywhere and the consequences of every decision are vast.

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If you missed open enrollment–either because you didn’t like your plan choices or because you wanted to take a nap every time you started the application–don’t fret. You still have options. Even if you are enrolled but aren’t happy with your coverage, you may find a solution in one of the less common approaches (read until the end!), which seek to provide an answer for many of the common gripes above.

Common gripes

Getting coverage–particularly for the untraditionally employed among us–can be a real downer. That’s because (a) it can be costly; (b) in-network providers can be inconvenient or ill-suited to your needs; (c) knowing what you qualify for isn’t always black and white.

What are my options?

Going uninsured: The big game changer of 2019 is that the federal mandate (which penalized people without health coverage) no longer applies, meaning you will not be charged for being uninsured in 2019. Young, healthy people who don’t have insurance through work may find this option appealing. Still, going uninsured is a big risk (as in–it could bankrupt you–no matter how little bank you have to rupt). It only takes one unexpected accident or illness to make a seemingly inexpensive choice a very expensive one indeed.

Special ACA enrollment/other state-funded options: If you lose coverage, move, get married, get pregnant, or have a change in income, you may qualify for a special enrollment period for the ACA. Just go to Healthcare.gov  and select “See if I can enroll.”  If you qualify, you can also apply for Medicaid or the Children’s Health Insurance Program (CHIP)  at any point.

Unregulated insurance: Some insurance options are not regulated by the Affordable Care Act, and therefore allow year-round enrollment. You may wish to look into private market insurers or short-term coverage. As always, read the fine print and do your research before deciding these less-common plans are right for you. 

Concierge medicine: For a monthly fee, you can essentially have unlimited access to Direct Primary Care (DPC) for all your regular needs. This is not the high-cost concierge medicine of olde. Instead, a monthly fee (sometimes as low as $50) gives you quick access to a doctor on call who, due to a smaller patient base, is highly familiar with your particular situation. Here’s an in-depth Consumer Reports rundown on the pros and cons of this approach. For those already paying insurance for a traditional approach, a DPC means an additional cost. For those foregoing traditional insurance (read on), this option gives access to higher quality care (at least in theory) while also offering cost savings.

Health cost sharing ministries: One of the first things they’ll be sure you know is that this decidedly NOT insurance and should not be thought of as such. However, some people find cost-sharing ministries a good alternative or supplement to traditional insurance. Even with subsidies, some only qualify for plans with high monthly premiums and/or deductibles, which means this option offers cost savings in many such cases. The fact that it allows you to choose your care providers based on factors that are important to you (such as healthcare philosophy, convenient location, specialization in your particular needs, etc.) also makes it highly appealing. The way these ministries operate varies, but the basic premise is that members pool monthly payments to share when someone has a medical need. While qualifying expenses are shared, members are technically self-pay and can therefore go anywhere that is accepting new patients. Here’s a Consumer Reports rundown on this approach.

Other cost-sharing services: While the well known cost-sharing options are considered ministries and therefore require some sort of statement of faith, at least one company is offering health cost sharing without any religious affiliation required. Being in the early stages (first memberships start in Jan., 2019) means information and testimonials are limited, but KNEW Health targets health-minded individuals and considers itself a “safety-net for large, unexpected medical costs.”

Combination of the above: Some find a combination of concierge medicine and some sort of catastrophic or health-sharing plan gives them access to the regular care they want while still maintaining peace of mind that they will not be buried in costs for accidents and unexpected illnesses. Here is some info from two people who use a combination of concierge medicine and health sharing ministries to get the care they want and save money, too. They talk about the costs, benefits in their unique situation, and their experience getting costs reimbursed.

The bottom line

You should always do your own research on big decisions–and healthcare is one of the biggest. What options work for you? Why? Once you’ve knocked this one off your to-do list, you will have earned that nap.

About PayReel:

At PayReel , we minimize the time and effort it takes to get you ready for your project. Rely on PayReel to assume all of the risk associated with worker classification and get back to the business at hand. We make sure everyone gets paid quickly and easily and have Client Relationship Managers on call around the clock to answer your questions. All you have to do is call 303-526-4900 or email us. The PayReel team makes live event, corporate media, and brand management payroll easier, faster, and seamless.

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