New health care law changing options available to churches
There has been a sea change in the U.S. in terms of how health care is delivered. The three-year-old Affordable Care Act (ACA), nicknamed “Obamacare” by both its supporters and its detractors, has been phasing in a whole series of new provisions and conditions intended to make health care more affordable and accessible for most, if not all, citizens.
A key provision is about to kick in. As a result, Lutheran congregations are facing choices.
Beginning October 1, individuals will be allowed to sign up for coverage in a subsidized health insurance plan offered through a state-based health insurance exchange. Coverage through these cooperative plans will begin next January 1.
Since Lutheran church bodies already have plans in place to provide health coverage to their called and hired leaders (clergy and other professional staff), the new reality is causing church-sponsored providers to adapt and adjust.
There is an ongoing concern among Lutheran congregation leaders about the rising cost of health care.
The largest Lutheran church body in North America, the Evangelical Lutheran Church in America (ELCA), has approximately 10,000 congregations. All are required to provide health coverage for their leaders. The ELCA’s health provider is a non-profit organization known as Portico Benefit Services (previously called “ELCA Board of Pensions”).
A spokesman for Portico told Metro Lutheran the program has decided to change the way it serves congregations, which pay for clergy and lay staff health care. Says Brad Joern, Vice President for Products and Services at Portico, “We’re expanding 2014 ELCA–Primary health benefits from one option to four (called Platinum+, Gold+, Silver+, and Bronze+), and adjusting health contribution rates to reflect member age.”
The “+” sign, Joern explains, denotes the “plus aspect” of each of the options. The “plus aspect” refers to extras, including dental, prescription drugs, and a fitness center discount. These, he continues, amount to “a value-added bundling of benefits for our members that is unlikely to be available, or affordable, on the health care exchanges.”
Detailed information on the four plan options was mailed to all ELCA congregations in mid-August, about the time voting members at the denomination’s Churchwide Assembly in Pittsburgh, were learning the details for themselves.
According to Joern, in some significant ways things won’t look very different. “All four options will offer the same large network of medical providers and wellness-focused benefits, similar to today’s ELCA–Primary benefits.”
More options in benefits
So what will look and feel different? Says Joern, “The options differ in contribution amounts for sponsoring employers and costs for plan members. In addition, one benefit option (‘Gold+’) will be very similar to the current 2013 offering.”
There is an ongoing concern among Lutheran congregation leaders about the rising cost of health care. The impact on parish budgets has been significant in recent years. But Joern thinks ELCA congregations have been faring better than the national average. He says, “Because Portico exists for this church and not for profit, and as a result of our wellness focus, we have been able to hold health plan rates to a 15 percent cumulative increase over the past five years.”
That, he says, compares with an average 35 percent increase for the average U.S. employer plan. Joern calculates that, in 2013 alone, the ELCA saved its congregations over $20 million in potential health care costs.
A lay leader in an ELCA congregation may understandably worry about the growing complexity of health care choices. Leaders at Portico appear to have anticipated this. They are rolling out some resources to help with the inevitable tidal wave of questions: customized online cost reports, calculators, and educational Web pages and videos — along with a lot of printed resources.
The creation of “health care exchanges,” to which Portico’s choices represent an alternative, is just one of many changes the new Affordable Care Act has introduced. Other innovations include the following:
Effective in September 2010, dependents are now allowed to stay on their parents’ health plans until age 26; all new care plans must cover preventive care; Medicare is expanded to small, rural hospitals; all new insurance plans must cover childhood immunizations and adult vaccinations.
Effective in January 2011, insurance providers were no longer permitted to spend more than 20 percent of their income on administration and salaries (15 percent for large insurers); if they do, plan-holders must be paid rebates out of the overspent amounts.
Effective in August 2012, all new plans were required to cover preventive services such as mammograms and colonoscopies without charging a co-pay or a deductible amount from an insured patient.
Effective in January 2014, insurers will no longer be allowed to charge higher rates for people with pre-existing conditions.
For more information about Portico Benefit Services, visit www.porticobenefits.org.
Tags: ACA, Affordable Care Act, Brad Joern, dental insurance, ELCA Board of Pensions, Evangelical Lutheran Church in America, fitness center discount, health care, health insurance exchange, Michael L. Sherer, Obamacare, Portico Benefit Services, prescription drugs, President Obama