As the President set a goal to pass a healthcare reform bill by the end of the year, small business owners, insurance companies and healthcare providers are keeping an eye on how reform could affect them.

The House version of the Affordable Health Care for America Act, which passed this November could extend health insurance coverage to millions of currently uninsured Americans. By prohibiting insurance companies from denying people insurance based on pre-existing health conditions to extending the length of COBRA coverage, many Americans stand to benefit. But, many small business owners, who may bear the brunt of the proposed insurance mandate are getting nervous.

“In the bill, [business owners] are extremely concerned about the employer mandate that requires employers to provide healthcare for full-time and part-time employees,” said Gregg Thompson, North Carolina director of the National Federation of Independent Business (NFIB). Employers are concerned about the cost of insuring all of their workers and how they will pay for it. Business owners with payrolls exceeding $500,000 would be required to offer their workers health insurance or face fines up to 8 percent of their payroll. “What I’m hearing, is that if they do that, I’ll reduce my workforce, which feeds unemployment,” Thompson said about the response he’s hearing from independent business owners.

For Wilmington businesses that hire seasonal workers for the peak summer months, insuring these part-time workers could be a burden that may break the bank. “The mandated part-time employee insurance is what the tourism members [of the NFIB] are really concerned about,” he said.

Insurance companies, such as United Health Care see the 45 million uninsured in this country as potential customers. “We think that’s a huge opportunity,” said Garland Scott, CEO of United Health Care’s Carolinas divisions. His company is looking at a variety of new insurance plans that could attract small businesses. About 5 to 6 million small businesses nationwide insure workers with United Health Care currently, Scott said. “We strongly support tax breaks and financial help to increase coverage,” he said. But so far, his company has not offered any new insurance plans or rates that would make it easy for small businesses to insure all of their workers.

“Part of our problem as a country is, as individuals get older, you’re going to spend more on healthcare,” Scott said. Changes to the healthcare system could have a significant impact on communities like Wilmington that have a sizeable retirement population. “For folks that are Medicare eligible, the big proposed changes are to plan
choices and reduced Medicare payments to providers,” he said. Most retirees who are not eligible
for Medicare are covered through employer benefits. But, the healthcare bill proposes additional taxing at certain benefit levels.

Although no one knows what will happen with healthcare reform yet, the largest local physicians group, Wilmington Health Associates (WHA) has already begun to change. “Even if nothing happens, then the things we’re doing should improve quality and lower costs,” said Jeff James, Wilmington Health Associates CEO. One such improvement is WHA has shifted to a model where patients who need immediate care can just come in rather than wait for the next available appointment. Another goal is to coordinate with other local providers to share best practices. “We very much desire to have a strong, like-minded relationship with the hospital in our market. We think that’s a very good way of improving the quality and reducing the costs,” James said.

However, New Hanover Regional Medical Center has not made any plans in anticipation to changes in the healthcare system. “Since the details of what will be in the final bill are still unclear, it would be premature for us to plan for what the legislation might be,” said Erin Balzotti, NHRMC media relations coordinator.

Although the proposed healthcare reform bill does not address the contracts between insurance companies and healthcare providers, Jeff James at Wilmington Health Associates believes that is one of the leading drivers of cost in healthcare. Providers, such as WHA, are required to sign confidentiality agreements when they enter into a contract with a specific insurance company, which prohibits them from disclosing how much that insurance company’s reimbursements rates are. “I can’t say whether insurance company A is higher or lower than insurance company B,” James said. WHA cannot ensure that the discounts they provide, which are meant to help patients are not being swallowed by the insurance companies as profit.

“I think there ought to be an absolute prohibition against confidentiality clauses in managed care contracts. I think data from the insurance companies ought to be more accessible to the employers,” he said. More transparency would increase competition amongst insurance companies to provide the best quality for the best price.

“I know who has the best deal. [But,] I know dozens and dozens and dozens of employers that are not taking advantage of it, because it’s not given to them,” he said.