ACA Optimal Health

Executive Summary

Studies have shown that over 50% of the public doesn’t understand the Affordable Care Act and its requirements for insurance—including the difficulty level of the ACA enrollment process, eligibility and where to find adequate information. That number is comprised primarily of non-English speaking Americans, low-income families, and those without any health care. Lack of ACA education also is a key barrier to enrollment for Medicaid, Children’s Health Insurance Program (CHIP), and Veterans Administrations (VA) Health programs. In a three-year study conducted by the Journal for Equity In Health, over 50% of African American and Latino families were unaware that they were eligible for either free or discounted health care. Further, 49% were not aware of their children’s eligibility to programs such as CHIP. Of that 49%, about 57% were Latinos; 40% African Americans. Perceived cost and language difficulties were other barriers.

Yet, these are the very programs which benefit the ones most impacted by such barriers, e.g., veterans, racial and ethnic minorities, women, families with children, individuals with health problems, and the less educated.

Employees typically have a very short open enrollment window to enroll into or decline the employer sponsored plan(s) offered by their employers. Such windows typically range from two weeks to a month. Also, if enrolled, these plans require a one-year commitment. If declined, these plans preclude enrollment for the remainder of the year until next annual open enrollment window. In 2015, 98% of larger companies offered one or more healthcare plans to some employees, with smaller companies averaging about 56%. The enrollment materials can be complicated to understand and generally don’t provide comparisons to alternative available programs. Yet what can employees do if they missed the enrollment deadline or don’t understand the benefits and costs associated with each of the applicable healthcare plans? With a narrow window for enrollment, often the employees select a plan other than the best option, including one that provides less benefits and/or imposes costs that could have been avoided.

Much of the working public struggles with the cost of health care deductibles and out of pocket payments. 37% of households do not have enough liquid financial assets to meet the lower deductible amounts, while 49% cannot meet the higher deductible amounts. In those households that fall between 100% and 250% of the Federal Poverty Line, 68% of those households cannot meet the lower deductible amounts, while 80% cannot meet the higher deductible amounts. Out of pocket costs are no better, as 52% of households do not have enough liquid financial assets to meet the lower out of pocket limits and 63% cannot meet the higher limits. In those households that fall between 100% and 250% of the Federal Poverty Line , 82% do not have enough liquid financial assets to meet the lower out of pocket limits and 89% are not able to meet the higher limits. And the costs are escalating, as high deductible plans are oftentimes the plans offered at companies. In 2012, a Harvard study concluded that 62% of bankruptcies filed were due to the inability to pay medical bills. One in three Americans even put off medical treatment for that very reason: medical bills. Yet, as far as existing health plans are concerned, many of these costs could be alleviated with an alternative plan. However, many Americans are unaware that they even exist.

It’s this lack of understanding that is not only detrimental to Americans who need health care, but also can lead to increasing tax penalties with every passing tax year for employers and employees alike. And where is help sought? Often, through ineffective automated assistance and website pages providing voluminous information without guidance. This is where Humanefits can help.

Humanefits as a platform enhances a standard Human Resources Information System, or Human Resources Management System (HRIS/HRMS), as a repository of information of employees on staff, prospective employees, and former employees. With the existing focus on business management and growth, Humanefits aggregates the massive data from disparate silos of information, to produce actionable, thoughtful, and progressive information to help both the company and its employees. It builds upon that very obligation to offer health coverage as an employer and to track such coverage.

Our new system, The Workforce Intelligence Solutions Engine (WISE) produces the optimal health care plan based upon the wide range of data Humanefits collects to check for points of cost, copays, dependents, salary, work status, background/experience, etc. WISE creates an efficient and automated means to identify workers who may be eligible for one or more alternative health insurance programs to give employees a choice and educate them on the benefits and costs of each program and assist them in enrolling onto the selected program. Our system is designed to automate the identification of available healthcare options, and provide a cost comparison of each option.

Many times, employees will receive a better plan overall by going through an ACA healthcare marketplace or other alternative governmental related program rather than on a company plan in regards to cost, coverage, and deductibles. Ultimately, WISE promotes the ideal coverage for optimal benefits to the employee at the lowest cost possible to the employee and the employer. In 2009, Harvard Medical School researchers suggested that about 45,000 Americans die each year from lack of health care. Based on the U.S. Census Bureau’s Population Projections from 2015-2020, that translates into 285,409 projected deaths. Such deaths may have been prevented with adequate healthcare coverage. Understanding your health care options can literally save your life, and Humanefits can help.

Key Findings

220,000 lives were lost due to a lack of health care in 2015

The ACA mandate has profoundly increased health care coverage.

Humanefits optimizes the Health of the Company and Workforce