Healthcare Associations After the Affordable Care Act
By: Mark Athitakis
For Robert Fromberg, the timing of the Supreme Court's ruling on healthcare reform was—well, let's call it interesting.
Fromberg is vice president and editor-in-chief at the Healthcare Financial Management Association, which held its annual meeting in Las Vegas the last week of June. The high court was slated to deliver a decision that week about the constitutionality of the 2010 Patient Protection and Affordable Care Act (ACA), but nobody knew exactly when.
So every day during the meeting, HFMA's regulatory affairs expert sat backstage during morning keynote sessions with a laptop, ready to offer some real-time interpretation if the need came. Fromberg himself juggled three press releases, designed to respond to what the association figured were the three most likely rulings: The act is upheld, it's struck down, or the individual mandate portion of the act is struck down.
A lot of that work was wasted effort: None of those scenarios came to pass, as we now know. The court came up with a fourth option, upholding the individual mandate but striking down a provision in the law requiring states to expand their Medicaid programs or risk losing federal Medicaid funds.
For HFMA, worse than the unexpected outcome was that the ruling came down the morning after the meeting ended, as attendees and staff headed back home. Even so, the experience was largely positive. HFMA staff hustled out a press release, sold a video of a relevant conference session, and scheduled a webinar on the topic—which drew a large enough audience to attract a sponsor.
That success under less-than-optimal conditions, Fromberg says, is a product of what's now been a years-long process of working double-time to respond to member needs, parse the details of the ACA, and look for both advocacy and growth opportunities. "There's never been a time that members of a healthcare association have needed more guidance, more assistance, and more innovative kinds of assistance," he says. "It's a sobering responsibility."
Emphasis on Education
Healthcare associations have been reorganizing their activities around ACA ever since the bill was introduced in Congress in 2009. But the Supreme Court decision was a clarifying moment: Now that ACA is the law of the land, organizations have a better sense of how to focus their energies.
That doesn't mean members are clear on what it means for them, which is why distance learning has been booming for associations. "Webinars where we used to have 20 or 30 members, we now have 100," says Bruce Siegel, MD, MPH, president and CEO of the National Association of Public Hospitals and Health Systems (NAPH).
And webinars and email blasts aren't enough, says Justin Moore, PT, DPT, vice president for government affairs at the American Physical Therapy Association. APTA is spending more time holding in-person meetings with chapters and other stakeholder groups, both to deliver information about the best practices and advocacy efforts and to hear member concerns directly.
For NAPH, direct contact with state constituents is particularly urgent. The Supreme Court decision gives states the option to opt out of the Medicaid expansion, a ruling that may directly affect funding for NAPH member hospitals. "They're providing us with a huge amount of intelligence about what's happening in those states—how governors are approaching it, how legislators are approaching it," says Siegel.
Neither NAPH nor APTA have added staff in response to healthcare reform, but both have rearranged their staff responsibilities. APTA, for instance, now dedicates more staff time to regulatory affairs expertise and social media. And HFMA pursues more partnerships with other associations: Its Value Project initiative, for instance, is a research effort coordinated with 19 healthcare organizations with the goal of settling on best practices on improving healthcare quality in the wake of ACA while controlling costs.
How to Navigate?
The federal government expressed an expectation that associations will play a role in educating the public about the ACA, particularly in states where exchanges will be set up for residents who don't have medical insurance. "Trade, industry, and professional associations" are among the groups eligible for grants to raise awareness and inform the public about exchanges, according to the law.
Moore says associations should be mindful of the grant and public-education opportunities that ACA opens up, but not at the expense of the association's own public policy goals. "We really feel our first responsibility is to get the best policy, and then, when we get the best policy, to employ a communications and consumer-based initiative," he says.
Massachussetts, which launched its own universal-coverage program in 2006, provides a window into what the navigator role may look like. Promotion of the new law there was handled by a new state agency, the Commonwealth Health Insurance Connector Authority, which hired a public-relations firm that partnered with businesses, sports teams, and nonprofits for its education campaign. Among those participating was the Massachusetts League of Community Health Centers, an association that provided enrollment specialists at statewide events. (ASAE has asked the Department of Health and Human Services to include associations on its list of groups for states to consult when creating an exchange.)
As in Massachusetts, state employees will carry the bulk of the "navigator" role in Maryland, says Gene M. Ransom, CEO of MedChi, the Maryland State Medical Society. But the association is pursuing opportunities for its for-profit insurance agency to work with the exchanges. And it launched another for-profit subsidiary, MedChi Network Services LLC, in 2010 to educate members on federal healthcare changes—an initiative funded in part by federal dollars.
"This is one of the first times you've seen funds coming from the federal government that really affect the back offices of doctors," he says. "We've received significant dollars to do education and outreach."
"The trend in Washington is to have better partnerships with associations," says Moore. For instance, the Agency for Healthcare Research and Quality offered a grant specifically addressing dissemination of information by associations. To that end, APTA is looking at making grant-writing and grant analysis a part of its staffing mix as well.
New pieces of the ACA will be implemented through 2014, and adjustments to the law at the state and federal level will be inevitable. That means healthcare associations will face continuing pressure to respond to changes—and look for business opportunities. (And all associations will need to look at their own employee healthcare plans; see page 49.) The legislative tussling "is bound to go on for a while," NAPH's Siegel says. But associations no longer have to play games of what-if.
"The message now becomes a little more forceful or firm," says HFMA's Fromberg.
"Now it's, 'Take a deep breath, this ruling is here, and everybody has to be serious about continuing to implement the changes you've been implementing.' "
Mark Athitakis is a senior editor at Associations Now. Email: firstname.lastname@example.org
Reform and More
Healthcare reform and other hot topics are on the agenda at ASAE's Healthcare Associations Conference in Chicago, November 8-9, 2012.
What About Your Health Plan?
Base salaries at nonprofits don't always keep pace with those in the corporate sector, but associations often pride themselves on above-average benefits, including healthcare plans. So they need to be mindful of the changes the Affordable Care Act brings: Starting in 2014, employers that don't offer affordable coverage will be penalized, and in 2018 so-called "Cadillac" plans face excise taxes as well.
"You have to go through a process of talking with your HR department about the ACA," says Justin Moore, PT, DPT, vice president for government affairs at the American Physical Therapy Association. "We asked, 'Do we need to make any business decisions now about what our offerings are? If we're going to reduce them, what would we provide as additional benefits?' "
Small-staff associations will see the fewest changes, because penalties apply only to employers with 50 or more full-time-equivalent employees. Such employers that offer no coverage will pay $2,000 annually times the number of full-time employees, minus 30. A similar penalty applies in cases where the employer covers less than 60 percent of healthcare expenses for a typical population, or where the employee has to pay more than 9.5 percent of family income to receive employer coverage.
Employers that had healthcare plans in place by March 23, 2010, can consider their plans "grandfathered" in without penalties. But slight alterations to policies can remove a plan's grandfather status.
Moore recommends that association HR departments search beyond their providers for ways to keep healthcare plans affordable. Small-business tax credits may be available, as well as grants for workplace wellness initiatives.—Mark Athitakis
- "Healthcare Plan Management, Post-Reform," by Whitney Redding, Associations Now Guide to Insurance and Financial Services, March 2011
- "First in Massachusetts: What We Learned About Healthcare Reform and Our Members That Could Help You" [PDF], presentation at ASAE 2011 Healthcare Associations Conference
- "Grandfathered Health Care Plans" [DOC], ASAE white paper, June 2011
- "Healthcare Reform Redux: The Regulations," by James A. Woehlke, CAE, Association Law & Policy, August 2010
State Plans for Insurance Exchanges
|Associations may have an opportunity to build partnerships in states that plan to open health insurance exchanges in 2014.|
|Planning an Exchange||Will Not Create an Exchange|
|Source: Kaiser Family Foundation, August 1, 2012. States not highlighted are studying options or have no significant activity.|
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