Commissioners heard a presentation Monday about what the county is doing to comply with the new federal health care law.
Dr. Brent Myers, who runs Wake County’s EMS, set the stage like this:
“I have lived my life between the ACLU side of things and the Jessie Helms side and that’s where I feel like I am with this group,” he said. “Today, we’re going to try to stick to just the facts.”
Myers was referencing his parents’ opposing political beliefs, but his audience Monday was made up of three Democrats and four Republicans who have fought fiercely on hot-button issues that include gay marriage, school funding and environmental sustainability.
Political uncertainty was the theme of the presentation. Wake County has implemented the smaller steps of the ACA as they have been written into law books, but some of the major changes are still ahead and subject to desires of the next president and U.S. Congress.
Wake’s county government is tied to the ACA in two major ways: first, by the health benefits it provides to its more than 3,000 employees; second, by the various public health services it directly provides.
Myers said, barring major swings in the interpretation of the plan, that there shouldn’t be any fundamental change in the burden to the taxpayer when it comes to direct health care services provided by the county.
EMS, for instance, would only see a 2- to 4-percent swing in either direction on its current bottom line, he said, depending on how implementation shakes out.
Employee health insurance is where things get complicated.
If the county’s insurance turns out to be less efficient than a plan a county employee might find on the market place, the county will face a $3,000 fine per employee, per year.
It’s this group of people that county politicians will need to make decisions about moving forward.
It may turn out that the county could pay the fine, pay towards an employees’ private health insurance and both the county and employee would come out better financially.
People who meet a certain poverty level requirement — the exact amount hasn’t been hammered out yet, and won’t be until after this fall’s election — will be eligible to have their insurance partially subsidized by the federal government.
But only people buying on the private market are eligible for the subsidy, not those who receive health insurance from their employer.
“If they can take that government subsidy and go out on to the market place and buy a plan cheaper than we are charging,” Myers said, “there comes that notion of paying the $3,000 fine because the person is not getting the best benefit.”
Essentially, the county and the individual might benefit most, in a limited number of cases, by the county taking the $3,000 and paying towards an individual’s private plan.
“What we don’t want is to pay a fine and not provide the employee the best bang for their buck,” Myers said. “The only reason to pay the fine would be if that could work out cheaper overall.”
What Do the Commissioners Say?
Chair Paul Coble was blunt in an interview after the board’s work session. When asked what the ACA will mean for the county he simply said, “More money.”
When asked for specifics, he continued, “We’ve already seen it in the shared cost of contraception to now covering the full cost of contraception.”
The county, like all those who provide health insurance, will now have to cover the full cost of generic birth control, where before the county only covered part of the cost.
But the increase in cost to the county is just $30,000 overall, according to another county official.
Myers said it was a non-issue, considering the county spends $30.5 million on health coverage for its employees.
Coble also mentioned the cost to EMS. But during his presentation, Myers’ said, that the county could save money on EMS, depending on how legislation moves forward. Having to shell out extra, he said, is not a given.
“So long as there’s not a major change, we shouldn’t have to change our burden to the citizen,” Myers said. “Most likely … we end up with a wash or million to the positive.”
Democratic Commissioner Erv Portman also expressed a positive outlook.
“It doesn’t look as though it’s going to have any significant adverse effects to the county that I can see so far,” he said.
Still, Coble isn't so sure.
“There’s no question in my mind, there will be additional costs,” he said. “There’s always additional costs.”