Last month the Obama Administration pushed back the employee mandate under the Affordable Care Act by one year. Employers with 50 or more full-time workers now have until 2015 to either provide their workers with health insurance or face a penalty.
In states that are expanding Medicaid as part of the the new health law’s roll-out, businesses have more flexibility in deciding how to make sure their workers are covered. And though Louisiana is not participating, proponents of expanding Medicaid in the state see the delay of the employer mandate as a chance to rally some small business support.
One small business owner who really wishes Louisiana would expand Medicaid under the Affordable Care Act is Jacquelyn Blaney.
Blaney runs Independent Living Inc., a health care services company in Baton Rouge. Many of her workers make minimum-wage and so only 40 of her 185 employees can afford the company insurance plan.The employee’s share of the premium is about $200 per-month, per-person.
Proponents of Medicaid expansion say it would cover some 400,000 Louisianans who are currently uninsured. Blaney said Medicaid expansion would be a real benefit to her employees.
"Many of them are single parents," said Blaney. "The children might have LaChip, but the parents don’t have access, cannot even afford the insurance we offer. Medicaid expansion would have allowed them to be covered."
Sacrificing Health To Pay The Bills
Bertha Bethley is one of them. On a rainy Saturday morning, she’s taking care of a 25-year-old with cerebral palsy at his apartment in Scottlandville.
It’s Bethley’s job to care of all of Brett’s needs from 10pm to 8am, five days a-week. That includes making sure Brett takes all his pills on time. She shows me a plastic zip-lock bag full of Brett’s many, many medicines.
Brett – who cannot work due to his disability – has his some $700 dollars a-month-worth of medicine completely paid for by Medicaid. But Bethley, on the other hand, is uninsured - despite having a full-time job.
"I mean, it’s either afford health insurance or afford to eat, pay your light bill, your water bill or your house note," said Bethley.
Bethley said sometimes she can’t afford her blood pressure or cholesterol medicines and even now, she’s putting off ankle surgery for two years because of the inevitable hospital bill to follow.
"I keep declining to have it done, but they say it’s going to get worse and I’m not going to be able to walk on it," said Bethley.
An Employer's Dilemma
Under the Affordable Care Act’s employer mandate, Blaney must insure all of her full-time workers through a company health plan or face a penalty. She said the employer share of adding all those people to the plan would cost upwards of $300,000 and more-than-likely bankrupt her. Blaney said it's not like the restaurant industry where increased expenses can be passed off to customers. Instead, the fees she charges are set by the state Dept. of Health and Hospitals.
If Medicaid were to be expanded, Blaney said she’d take the penalty because it would still be cheaper than what it would cost to offer more affordable insurance in-house and her employees could enroll for the public insurance program.
An Issue Far From Over
State Democratic Sen. Ben Nevers, who owns his own electrical contracting company in Bogalusa, said the employer mandate delay has bought small businesses time to better understand and weigh their options.
"There’s been very little information, I think, provided to businesses across our state about the true impacts of the Affordable Healthcare Act," said Nevers. "It is the law of the land and unless there’s some repeal of it then small businesses are going to have to deal with it."
Nevers, who is in favor of Medicaid expansion, believes once small businesses have more information, they will come to the same conclusion as Blaney: that Medicaid expansion is good for them.
He plans to take some experts around to educate small businesses in his own district. Once the health care exchanges go into effect in October, Nevers said some state-wide initiatives are planned but there are no details yet.
But small business owner and state Republican Rep. Lance Harris said expanding Medicaid could make the business climate in Louisiana unhealthy. He said there are too many “what-if’s?”when it comes to Medicaid expansion like, its effects on cost-of-business and private insurance premiums.
"You put your capital at risk to build your business and if there are uncertainties out there, especially coming from the federal government, it really does curtail growth," said Harris.
Gov. Bobby Jindal has opted not to expand Medicaid in Louisiana, saying it's too expensive even though the federal government will pick up 100 percent of the cost for the first three years,and will cover no less than 90 percent from there on out. But reliable numbers on how much the state will save or not save have been hard to come by.
One thing Rep. Harris and Sen. Ben Nevers do agree on is that the discussion about Medicaid expansion is not going away. They both say they expect the issue to be brought up in legislative sessions to come.