Untangling the possible effects of Obamacare in Puerto Rico
The U.S. Supreme Court's approval, almost as is, of the Affordable Care Act (ACA), better known as Obamacare, may represent a respite from the barrage of opinions, possible scenarios, discussions and arguments that have left many confused about the law's effect, especially in the nation's various jurisdictions.
"One of the most pressing challenges is determining what does and doesn't apply to Puerto Rico," said Sandra L. Negrón-Monge, leader of the wealth benefits & Erisa (Employee Retirement Income Security Act) litigation practice team at McConnell Valdés LLC (MCV) & chairwoman of the Special Committee on Employee Benefits of the Federal Bar Association. She was one of the speakers at the roundtable "Patient Protection & Affordable Care Act from an Employer Perspective," held recently in Puerto Rico. "It's a challenge when there isn't anything clearly stating what applies [to the island] according to the government agencies."
The goal of the roundtable was to inform participants, which included insurance carriers, consultants and lawyers, about ACA's overall impact on Puerto Rico from the perspectives of legal, employer and benefits professionals and the law's cultural & insurance carrier dynamic.
Negrón-Monge and her colleague Luis E. Bacó, head of MCV's Washington, D.C. office & its Government Affairs Practice Division, discussed the legal aspects of ACA's impact. Bettye Baldwin, managing principal of Retention Strategies Solutions, a boutique benefits consulting and brokerage firm, addressed the effects of the law from the perspective of employers and benefits professionals. Marina Díaz García, the CEO of First Care of Puerto Rico, concentrated on the general cultural and carrier dynamics of ACA.
Bacó added that information is also a challenge because, while in the U.S. it is quite clear what applies and what doesn't, "in Puerto Rico, we have to sit down and search through [the law] to see what applies and what doesn't apply.
"Historically, regarding a federal healthcare policy for Puerto Rico, we haven't received equal treatment, as is the case with our other federal programs," Bacó said. "Even though we did well in the national healthcare reform enacted two years ago, the fact is that we're nowhere near equality, even though we received a huge Medicaid increase. The truth is we're nowhere near what we would be granted if [the U.S.] treated us like a state."
As an example, Negrón-Monge mentioned the individual mandate, where a person living in the continental U.S. will be required to have healthcare coverage, or must pay penalties in the form of a tax.
"However this isn't applicable in Puerto Rico, because it was determined island residents had the essential coverage required by law," Negrón-Monge said.
Baldwin reported the results of a study of a small sample of her clients to determine the concerns and activities generated by the passage, and the Supreme Court's upholding, of ACA.
"Businesses that have many part-time employees, who may gain benefits based on this law—and therefore significantly increase the costs of doing business—have been preparing diligently," Baldwin said. "Some businesses have even commented on the fact that the cost of their products will increase based on the implementation of these requirements."
The report reiterated what the MCV team described: While the law is confusing in the continental U.S., in Puerto Rico it is even more so because portions of the law, but not all, are applicable locally.
"Results are different by business segment, and the larger businesses, as well as the retail and hospitality sectors, are expecting a higher impact," Baldwin said.
However, some aspects of the health reform, implemented as far back as 2010, may already have had a beneficial impact on both employers and employees, Díaz García said, which is already transforming workplace culture.
"In terms of mental-health services, for example, you now can't have limits on the number of appointments an employee may require from a mental-health professional," Díaz García said. "The law has a big impact on employee assistance programs, but by ensuring people have more access to services to treat a condition helps avoid or reduces costs that an untreated condition implies, especially in a framework that includes prevention."