Affordable Care Act means legwork for counties

There is going to be a substantial amount of legwork to implement facets of the Affordable Care Act for Chisago County and other counties across the state this year.

Officials in Chisago County said they’re prepared to address the enlarged workload.

However, Chisago County is one of the many counties nationwide that will have hire more employees to help sift through the anticipated spike in online health care applications and ones that are filled out the old fashioned way with paper and pen.

County Administrator Bruce Messelt said the county will likely have to hire five full-time employees to help review and process applications at the county level.

But those hires will likely be temporary. After the workload reduces, the county could release them and be relieved of their salaries.

Under the Affordable Care Act – otherwise known as Obamacare – MinnesotaCare, the publicly subsidized state program for those who do not have access to affordable health care coverage, could be disbanded.

Many of those who were receiving health care coverage under MinnesotaCare could apply for Medical Assistance, the state’s largest publicly funded health care program for low-income residents.

Others will find health care through the newly created MNsure, an “online marketplace where individuals, families and small businesses will be able to get quality, affordable health care that fits (their) budgets,” according to the MNsure website.

Counties are responsible for processing all those applications and determining eligibility.

In some counties, this mandate could adversely affect current county staff in the form of layoffs or denied vacation requests, but Chisago County officials don’t see that happening with their staff.

“We’re not going to be affected with our staff at this time,” Chisago County Human Resources Director Renee Kirchner said. “The only way we could be affected is if we start charging employees more for their health insurance premiums.”


Competing for employees

Chisago County Health and Human Services Director Nancy Dahlin said she’s going to bring a recommendation to the county board April 3 about the logistics of implementing the Affordable Care Act and how many employees will need to be hired.

She noted Chisago County will likely only need temporary staff, but some counties could hire many of those workers full time after their contracted positions expire.

She said Chisago County isn’t in a good position to do that, because it recently went through a wave of attrition (early retirements), so having the temporary financial employees flow into positions opened via retirement isn’t likely.

Messelt mentioned Chisago County is looking to be “ahead of the curve” when it comes to hiring, because it will be competing against all of the other counties in the state for the services of skilled financial sector employees.

“All the counties will be hiring at the same time,” he said.


Additional costs

Dahlin noted the federal government will be reimbursing counties for costs associated with hiring and training new employees, but only at a rate of 75 percent.

“Counties make up that difference in the percentage by local levy dollars,” Messelt said.

In addition to counties’ obligation to make up the difference, Messelt said auxiliary costs paired with the hiring of the employees is not reimbursable.

He said the new employees will need computers, their information will need to be processed by the county’s human resources department and the county is going to have to figure out where to put the additional staff.

“It’s not just people, it’s office space,” Messelt said.

He said he’s talked with Dahlin about having the employees work off site or work nontraditional hours so they’re not taking up room in the county’s government center, which is already tight on space.


The long-term outlook 

How the Affordable Care Act is going to affect future hiring and employee retention rates at counties is yet to be determined. Messelt said he’s read news articles that postulate the Affordable Care Act could spike insurance rates.

“When people are talking about 30 percent increases in premiums, that’s a big increase,” he said.

Kirchner noted “only time will tell” exactly how the act will affect providers and those who purchase insurance nationwide.

In Chisago County’s case, the Affordable Care Act has already affected the type of insurance the county is able to offer to its employees.

Under the act, the county’s top health insurance package for its employees was deemed a “Cadillac plan,” Messelt said.

“Our middle plan is now our top plan.”

Subsequently, the county nixed that plan because if it had held onto it, the county would have been monetarily penalized by the federal government.

Messelt explained the county will now have to reassess its health care plans every few years to ensure they’re in a range where they county won’t be penalized for offering too many health insurance perks to its employees.

If the options in Chisago County’s health insurance plans dwindle over the years due to the act and other factors, Kirchner said that would “absolutely” become a factor when it comes to hiring and retaining skilled employees.

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