Given the glitches accompanying the first week rollout, many continue to be uncertain how a state health exchange some branded MN-UNsure and the Affordable Care Act (ACA) will work, much less affect their families and finances. 

Yet one key constituency whose support proved critical in passing health care reform has seen enough to issue a candid prognosis that the ACA’s cure may be worse than the disease for its members—truck drivers, masons, electrical workers, among many other unions.

“More Affordable Care Act (ACA) deadlines are quickly approaching, there are many unanswered questions,” said Doug Rubbelke, a top national labor health care official and executive director of the Upper Midwest Labor Management Health Care Coalition (LMHCC) in an email response.

The Twin Cities-based “multi-employer health fund” pools the resources collectively bargained by some 50 union locals to leverage high quality health benefits at an affordable cost for 187,000 members and dependents in Minnesota, North Dakota, South Dakota and Wisconsin. 

But look for those “Cadillac plans” to be on the table as union contracts come up for renewal--unaffordable or at least uneconomical for many employers because of a 40 percent ACA penalty on high end coverage. The penalty kicks in in 2018, but the impact starts now.

“It is important to know when your CBA (Collective Bargaining Agreement) expires, because workers under CBAs expiring within the next two years are most at risk for changes in coverage,” said Rubbelke. 

No chance of subsidized MNsure coverage either.  “If workers go on the exchange when offered employer coverage that is affordable and covers Essential Health Benefits, they will not receive a subsidy because they have an offer of employer coverage that fits the ACA,” said Rubbelke.

Meantime, non-union employers whose workers obtain subsidized coverage on state exchanges could gain a competitive advantage in bidding for projects. Companies with fewer than 50 employees are exempt from taxes for failing to provide medical coverage, while companies with fewer than 25 full-time workers can qualify for tax credits.

“Employers that have done the right thing, traditionally, by providing health coverage are now finding that their competitors can push their work forces to the exchanges and the employees receive subsidies,” said Rubbelke.

The “pay or play” tax penalties for employers who don't provide coverage are so weak "many will simply pay the penalty and be done with health insurance altogether."  If anything, it appears many union members and their families will pay because big labor decided to play. 

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