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Schools weigh Affordable Care Act cost

Published 8:24pm Tuesday, July 2, 2013

Annual fees approaching $180,000 and the possibility of penalties is the cost of the new health care law on Suffolk Public Schools, its finance director says.

Unlike many of us, Wendy Forsman doesn’t have the luxury of quietly ignoring the fine print of the Affordable Care Act — “a massive document,” she told School Board members this week.

The school district is subject to the act’s “pay or play” mandate because it has more than 50 employees, Forsman reported.

But it could get a yearlong reprieve. Late Tuesday, national media outlets were reporting President Barack Obama is expected to delay the implementation of the employer mandate until 2015.

When the mandate does go into effect, the district can either not offer coverage and pay $2,000 per employee annually, or provide coverage but pay a penalty for any qualified employee who uses the exchange the act requires states to establish, where individuals and businesses can select affordable plans.

Suffolk Public Schools appears to be going with the “play” option, requiring it to offer insurance covering at least 60 percent of average medical costs to employees working at least 30 hours per week for at least 90 days, Forsman said.

Also, the cost of coverage for employees making less than four times the federal poverty line cannot exceed 9.5 percent of their household income, and that poses the greatest risk for the district penalty-wise, Forsman said.

“We have no way of determining household income, so we have to look at individual income and assume that’s all they have,” she said.

If the assumption is wrong, the penalty kicks in.

“If we offer insurance and the employee goes to the exchange and are eligible for the exchange, we have to pay $3,000 as a penalty,” Forsman said.

The requirement to extend coverage to all employees working 30 or more hours a week, known as “fair access,” also could be problematic when it comes to substitute teachers, whose hours can creep above the threshold.

The district has taken steps to ensure employees working 30 or more hours a week and exceeding the income threshold are getting coverage, Forsman said.

Software handling substitute placements can also be set to ensure employees don’t exceed 29 hours, she said.

“We feel like we are in a good position to not pay that penalty,” she said.

Despite its efforts to avoid penalties, the district will still have to pay Transitional Reinsurance and Insurance fees to the Department of Health and Human Services, and Patient Centered Outcomes Research fees to the IRS, with an estimated annual cost of  $172,500 and $5,476, respectively.

It will also have to devote extra staff time generating several employee notices about the new options, Forsman added.

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