ACA 2017: Everyone is Asking the Wrong Question.

All across the country, individuals and businesses are asking themselves the same question regarding ACA in 2017: What will change under our new administration?

My answer is this: You’re asking the wrong question. Rather than focusing on what is most likely to change, instead focus your attention, and strategy, on what is most likely to stay the same.

The first thing that will not change is change itself. Even had the election outcome in November been different, changes still would occur.

Second: the drive toward profit will not change. Insurance carriers are no different. Why did so many carriers pull out of major markets as ACA continued to unfold?

Think about how the insurance companies make money: They assess the risk of the situation, then charge a premium that they feel statistically, by the law of large numbers, can’t lose. (Note: these rates are reviewed and approved by the state department of insurance and have limits and restrictions.)

Yes…they make a bet. And as the odds continued to look less and less favorable, they stopped betting. It’s that simple. Wouldn’t you do the same?

Consider that thought of what you would do. In this tradition, the fastest trend in the health insurance industry has involved allowing groups, like yours, to explore various levels of self-insurance. This is the insurance company sharing the risk with the plan member…a trend will likely continue amidst ongoing changes in Washington. The most benign (and safest) form it can take is a higher deductible–and we have already seen plenty of those under ACA (but without the lowered premiums that shared risk is supposed to provide).

Rather than focusing on what will change, instead focus your attention—and strategy—on what is most likely to stay the same.

Now, if one is to assume a larger deductible before insurance kicks in, it helps to have an additional financial component in place to absorb those up-front costs. After all, most employers don’t wish to “stick” their people with increased risk without something to ease that burden. That’s where Health Reimbursement Accounts (HRA) and Health Savings Accounts (HSA) came into play (which emerged under the Bush Administration). Employers liked these options because, when used properly, they could ease the impact of medical claims on an employee’s household budget.

Further, risk sharing gives health plan participants more ownership in a threefold relationship: the health care provider, the insurance carrier, and the patient. When all parties have a stake in the claim, it improves accountability all around.

Many of these plans and structures are still around, and will likely serve as the foundation for what unfolds in the months to come. Below is a list of these solutions in this eco-system (in increased order of risk-to-reward–see image):

  • Deductible Increase
  • Health Savings Accounts (HSA)
  • Health Reimbursement Accounts (HRA)
  • Association Plans
  • MEWAs (Multi-Employer Welfare Arrangement)
  • Level Funded Self-Insured
  • Partial Self-Funded
  • Fully Self-Insured

This begs the question: are you up-to-speed on all your options, and the facts pertaining to each? If so, have you considered each one as a possible solution?

Your answer to this question is likely “No.” That’s okay—but while it is important for you have a basic understanding of your options, it’s not your job to be the expert. That’s ours.

However, if you’ve already moved forward on crucial decisions regarding your benefits and bottom line without the guidance of someone who is aware of these myriad solutions, then you may be missing out on a better solution and not even know it.

For example, MEWAs (Multi-Employer Welfare Arrangement) were created as a solution for overall healthy employer groups to avoid the higher costs that result of being rated with groups of unhealthy plan participants (ACA’s “community rating”). It’s a way to take ownership and control back through the power of more traditional underwriting.

It’s not for requires a little work under the guidance of someone who knows the way. That’s where Spiralight comes in.

Fortunately, Spiralight has access to ACA-compliant, proprietary solutions that give the advantages of underwriting back to groups that can benefit from it the most. The CATCH: These solutions are are in limited distribution, and not available through all brokers. They are are customized to your company’s specific needs and objectives, rather than attempting to force a costly one-size-(doesn’t)-fit-all plan on your people.

To find out if you can save, first you’ve got to know your Benefits Savings Score. Download this fast, five-question worksheet and find out.

About the Author Matt Byrne

Matt Byrne has made a career helping people find affordable health insurance. He is the founder of Spiralight Group Benefits, a Dublin Ohio-based brokerage providing comprehensive insurance, HR consulting and compliance solutions for small- to mid-size businesses. Matt has a Bachelor of Arts degree from Boston University and holds a life and health insurance license. He also serves on the executive board of Columbus chapter of the National Association Health Underwriters. Mr. Byrne is a subject matter expert speaking frequently about Health Care Reform, Employer Health Plans Affordability Programs, Self-Funded Solutions and is frequently quoted in national publications such as the Money Magazine, U.S. News and World Report and The Wall Street Journal. Matt can be reached at (614) 300-1316 (assistant) or

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