Ashley Archibald, The Union Democrat


The Union Democrat

More than 30 small business owners from Tuolumne and Calaveras counties gathered recently to hear health insurance representatives discuss the new requirements for business owners that will take effect by October 2010.

The presentation, hosted by Ray Suess Insurance & Investments, delved into the timeline created by the more than 2,000-page bill that passed in March and mandates coverage for every American.

The bill is confusing for business owners who have to figure out the

implications of the complicated legislation on top of the day-to-day

pressures of running a small business, said Steve Smith, a regional

sales manager for Blue Cross.

"Many people don't have a clue what's going on," Smith said.

Whether they know it or not, business owners are already being affected by the bill.

Though it was passed in March, the bill included certain provisions

retroactive to January of 2010, including the creation of a

small-business tax credit and a payment to seniors for prescription


Ninety days after enactment, high-risk pools - patients with

critical illnesses that are costly to insure - and early retiree

insurance requirements came into effect.

By October, business owners have to offer insurance to children of

employees who are 26 years old or younger, even if they already have

coverage through an employer, school or spouse.

Before the bill, dependent coverage varied from provider to

provider, often ending by the adult dependents graduation from college

for 23rd birthday.

Providers will also be prohibited from caps on lifetime benefits or

discrimination based on salary or pre-existing conditions for dependent

children under the age of 19.

Providers will pay their first multi-billion dollar provider fee in

January 2014, as well as face changes in rating structures, competition

from state-based exchanges and cooperatives and a requirement to accept

people of all ages despite pre-existing conditions.

Although many of the changes do not directly impact small

businesses, changes in the structure of health care provision will

force rates upward according to Steven Vincent, vice president of

Anthem Blue Cross.

"There are no immediate changes to benefits, premiums, physicians

or hospital networks," Vincent said, referring to Blue Cross customers,

"but premiums could be impacted in the future."

At this point, the penalties for not having the mandated insurance

are much lower than the cost of providing insurance, Vincent said,

which encourages people to only buy insurance when they need it.

That defeats the purpose of pooling risk, and could pass on costs to businesses or individuals that choose to be insured.

The legislation also reduces payments to doctors from Medicare,

government insurance that insures the poor. That will shift costs to

private insurers, Vincent said.

Vincent left his audience with one assurance - very little in the

2,000 page document has been defined, meaning that the legislation is

fluid and will change as provisions get implemented over the course of

the next four years.

The presentation scared some clients, said Adam Suess, who runs the business with his brother.

"The part that they got a little concerned about was explanation of what will mean to them as business owners," he said.

The changes will roll in quickly through 2014, and Suess Insurance,

and brokers like it, will be saddled with the responsibility of

determining how changes will affect clients and what the best options


"It's not our job to dictate what the government should or

shouldn't do," Suess said. "We take what we're given and make it work

best for our clients."

According to Smith, legislators had a choice when they began to

write the bill - they could address the rising costs of health

insurance first, or the need to insure the uninsured.

Legislators chose to hand down a coverage mandate first, which

helps the estimated 40 million Americans without insurance, but that

only goes so far, Smith said.

"They're not doing anything to address the actual cost of insurance," Smith said.

Contact Ashley Archibald at or 588-4526.