Small businesses weigh options under healthcare law

Tony Juliano, G.V.C.C.C. president, speaking at Tuesday’s rally, with Gary LaBarbera, a construction union leader, by his side.

BY ALBERT AMATEAU  |  The Greenwich Village-Chelsea Chamber of Commerce last week took a long look at the momentous changes in healthcare insurance that are looming as the 2010 federal Affordable Care Act begins to take effect.

At an April 19 small business healthcare forum, held at Google’s New York office, on Ninth Ave. at 15th St., G.V.C.C.C. brought together small business advocates, insurance and health system executives and consultants to anticipate the ins and outs of the legislation than has become known as “Obamacare.”

The changes in healthcare management coming online in the next two years are enormous, said Howard Gold, of North Shore-Long Island Jewish Health System, moderator of the panel.

“The massive and dramatic changes are an attempt to control the unsustainable costs and the enormous disparity in access to health coverage,” Gold said.

Healthcare costs are rising about 8 percent per year, according to Kabuchi Banfield, an executive with Aetna Small Group, which covers insurance options for small businesses.

The legislation is currently before the U.S. Supreme Court, with a focus on the constitutionality of the individual mandate provision, which requires all individuals, with some exceptions, to buy health insurance for themselves and their families.

Apart from whatever the court decides on the individual mandate issue, the greater part of the 2,200-page legislation is not likely to be overturned, according to Michael J. DeFelice, a financial planning consultant on the panel.

“But would we be able to afford it if not everybody buys into the pool?” Gold asked doubtfully.

Panelists outlined the health insurance options under the new law to help small business owners cover their employees. Federal and state tax credits, subsidies for low-income families and health-benefit exchanges are among the options that panelists discussed at the G.V.C.C.C. forum last week.

Exchanges, which analyze the complex insurance options and perform all the administrative tasks for a small business, will become widely available in the next two years.

“We simplify choice without taking away choice,” said Mark Kessler, an executive with HealthPass New York, an independent nonprofit exchange. Exchanges try to find the best options among a variety of plans for each business, determine who among the employees are eligible for what level of benefits and do all the administrative work, Kessler said.

Ben Geyerhahn, special projects director of Small Business Majority, said that under the federal Affordable Care Act, public exchanges would probably be established state by state and operate along with private exchanges.

Small businesses will be able to receive significant tax credits, and low-income employees would be eligible for subsidies through the various exchanges, Geyerhahn said.

The major change in the coming years will be a shift from payment for specific procedures to payment for wellness and prevention on a prepaid annual basis, Gold said.

“If you pay doctors for procedures, they’ll do procedures,” said Gold. “If you pay for health outcomes, you might catch conditions like diabetes early and prevent more serious complications later.”

The new legislation is intended to control redundant procedures and help prevent patients getting care they don’t need or the wrong kind of care.

Panelists also questioned whether people who fall through the cracks in the new health insurance system would continue to use emergency rooms as a primary-care resource.

Gold noted that emergency room care for uninsured patients contributed to the “meltdown” of St. Vincent’s Hospital, which closed in 2010 in Greenwich Village.

“Forty hospitals closed in New York City in the past 10 years and 10 more will probably close,” he added.

North Shore-L.I.J. Health System, where Gold is a senior vice president, includes Lenox Hill Hospital on the Upper East Side. The health system is also developing the Comprehensive Care Center and stand-alone emergency department being developed in the O’Toole Pavilion of the former St. Vincent’s Hospital.

“The Chamber is focused on helping the small business community remain on top of the changes to healthcare options as the Affordable Care Act takes effect,” said Tom Gray, executive director of G.V.C.C.C.

“Because the legislation is so complex, it is far too easy for small business owners to miss out on opportunities that the reforms create to help their businesses,” Gray said. “We’re happy to bridge the gap by drawing on partners from every corner of the industry to help our community.”