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Adjustment to Affordable Care Act going well for Jefferson County Insurance


The Jefferson County Insurance Department has taken changes from the Affordable Care Act in stride, though only time will tell if that trend continues.

“I think we’re doing very well keeping up with the changes, but I do expect more,” department Director Lisa M. Watts said.

The act, passed by Congress in 2010 and largely upheld by the Supreme Court in 2012, aims to reduce the number of uninsured Americans and bring down the overall cost of health care by compelling a vast array of modifications to the way insurance is paid for and provided. Provisions of the act are designed to take effect gradually over the next decade.

Since the county already provides health coverage for all of its employees, it has been able to make the transition to the new regulations with relative ease.

“Municipal plans are governed differently than private industry,” Mrs. Watts said.

The county, which is a “self-funded group,” uses a third-party administrator to service its policy. Instead of premiums, the plan is funded by “premium equivalents” — payments composed of contributions from both employees and the county, with the lion’s share coming from the county.

Mrs. Watts said compliance with the act has been positive in that it has brought mostly enhancements to the county’s policy, including more preventive services, such as immunizations, nutritional and dietary counseling and smoking cessation classes.

Children of county employees are now covered under their parents’ plans until age 26, and a $1 million lifetime coverage limit that restricted thetotal amount of health benefits an employee could receivehas been lifted.

The county now has to report the cost of insurance coverage on employees’ W-2 wage and tax statements.

The county rolled out the changes to its plan in January after completing collective bargaining negotiations with its four main unions.

The county was exempt from some of the changes thanks to a grandfather clause meant to give organizations time to adjust to the changes. Because of this, the county has only a month’s worth of claims to review to project what further impact the transition may have on its budget.

Asked if the act will drive up costs to the county, Mrs. Watts said, “Not that I’m seeing at this point. In the future we should have a better idea.”

The county also recently switched third-party administrators from GHI to POMCO Group. The change went into effect for management and deputy sheriffs in January 2012, for Jefferson Community College, corrections and dispatch employees in November and for rank and file CSEA members Jan. 1.

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