As Brown County works to implement the federal health care act, it's discovering that the measure is coming with no shortage of regulations, as well as some extra expenses.
County commissioners have occasionally discussed both since the reform act was signed into law in 2010. The subject always sparks questions to their Wellmark Blue Cross and Blue Shield representative.
Blue Cross and Blue Shield has long been the county's health insurance provider.
Despite the wealth of new information, implementing what's formally called the Patient Protection and Affordable Care Act has gone smoothly so far, said Andrea Sjomeling of the Brown County Auditor's Office.
One big factor that has helped is that the county already has a health insurance program for employees and pays the full premium of the base plan for its workers, she said. In that regard, she said, the county is already largely in compliance.
But there are still plenty of unanswered questions, said Duane Sutton, commission chairman. There are still undetermined implementation dates for some aspects of the health care act, and some implementation dates have already been changed, he said.
Sutton said he wonders whether implementation of the federal health care act might be further delayed by a recent scandal involving the Internal Revenue Service targeting conservative groups, including tea party groups, for extra scrutiny when they applied for tax-exempt status.
Regardless, he said, the county's human resources department will be charged with making sure the federal health care plan is properly phased in. With so many regulations and requirements coming in the next few years, the state's attorney's office also will likely be called on to ensure understanding and compliance, Sutton said.
One thing the county knows already is that the program will increase the amount of money the county has to spend on health care costs by roughly $35,000 a year if proposed fees remain unchanged, according to information from Wellmark Blue Cross and Blue Shield. Those fees kick in next year.
Some of that cost could be shifted to employees or the county could pick them up. There were also new expenses for health care providers, starting in 2012.
"I think it's almost a given (that the amount of tax money the county spends on health care will increase), and I don't know if anybody can accurately predict what those costs will be," Sutton said.
One other area the county needs to take a look at for the federal health care program is the definition of full-time employees. The county has offered full-time benefits to workers logging at least 32 hours a week, Sjomeling said. Under the Affordable Care Act, that drops to 30 hours, she said.
Sutton said that under the act, the last six months an employee has worked can be used to determine full-time benefit status. That's a regulation that doesn't sit well with him. It should be the prerogative of management — be it a private business or a county government — to adjust the hours of employees to fit the new rules, he said.
And, he said, there could be other, unrelated reasons that an employee would have his or her hours adjusted.
The county, though, will do what it needs to do to implement the health care reform regulations, even though there is confusion, Sutton said.
"In my opinion, there's still a lot of uncertainty" about the program, he said.
For now, the changes resulting from the Affordable Care Act have to be completely implemented by 2020, according to the federal government.