In many ways, 2014 was a pivotal year for PPACA, as most majorreforms came online in the past 11 months. Among the facetsimplemented were the Health Insurance Tax, subsidies, state andfederal exchanges, minimum standards, health care co-ops, Medicaidexpansion and new rules for wellness programs, minimum waitingperiods and several market reforms. There were lots of problems,and the government tacked on plenty of last-minute changes andextensions in an effort to smooth the implementation. It allresulted in a flood of negative press for PPACA. Public perceptionhas fallen so far that polls now consistently show that around 60percent of Americans don't favor the law.

It's fair to say that health care workers, insurance brokers andagents, consumers, government regulators and President Obama hope2015 will unfold more smoothly. On tap for next year is arelatively minor facet of PPACA set to start on Oct. 15—a 23percent increase in the Children's Health Insurance Program matchrate up to a cap of 100 percent, according to the Kaiser FamilyFoundation.

The main issues for Obamacare in 2015 revolve around howemployers and benefits professionals handle the employer mandateand related compliance issues. Also on their plate will be workingwith employers and employees struggling with canceling policies orcanceled policies as extensions lapse. And there are tweaks comingfor the state and federal exchanges, too.

Already delayed multiple times, the employer mandate—a criticalpart of the law's success—is set to begin in 2015. That meansemployers with more than 100 employees must offer health insuranceby January or pay a fine of $2,000 per worker. Companies thatemploy 50–99 workers have until January 2016 to begin offeringhealth insurance. (Companies with less than 50 employees areexempt.)

"The employer mandate is coming in 2015, and employers need tobe preparing for it," says Jessica Waltman, senior vice presidentof government affairs at the National Association of HealthUnderwriters in Washington, D.C. "Employers need to be acting rightnow and making coverage offers for Jan. 1. Those decisions need tobe made now."

Compliance

With new employers entering the health care marketplace becauseof the mandate and because the time frame to phase out noncompliantplans will expire, benefits professionals in 2015 will increasinglybe called upon to help clients come into compliance with PPACA.

"Most of the requirements were effective for 2014, but becauseof the way the administration allowed states and carriers tocontinue with noncompliant plans for another year, there'svariability across the country," Waltman says. "So you have someemployers who are compliant and other employers working on becomingcompliant. They have to document. It's not just 'I don't have to doit this year'; it's 'I have to fill out and document it.' A lot ofemployers were already offering coverage, but the new systems inplace are a compliance burden that may be as much work as offeringcoverage in the first place."

But compliance hasn't been easy, some industry insiders say, asemployers have been fearful over the law's penalties and continuingchanges. Aaron Davis, president of NextLogical Benefit Strategiesin Westminster, Maryland, says brokers have been busy working toeducate clients—as well as ease their concerns.

"What's happening is PPACA is just loaded with fear-inducingissues. So employers are freaking out," Davis says. "Plus the lawhas changed 30–40 times so far, so everyone is asking if they're incompliance. In health care, we call it the worry well. It createsstress, so brokers use that and deluge people with information.Within 24 hours of a change, we get the information. We keep up onit, but clients continue to freak out because they're scared ofmissing something. The IRS went out and hired a bunch of newauditors last year and started auditing health plans. And thosepenalties can be huge. People are going to continue to peddle fearand offer hope."

Exchanges

Benefits professionals and consumers will continue to see changein the federal and state exchanges as well. Some exchanges werereally clunky and inefficient, like Oregon's Cover Oregon. Othersseemed to work better, like Kentucky's Kynect. And no one needs tobring up the subject of the federal exchange on HealthCare.gov.Still, benefits professionals working with state-run exchangesquestion whether the marketplaces will continue to improve in thenext year.

"I haven't had a new training on the new exchange website inKentucky," says Zach Zinser of Zinser Benefit Service inLouisville, Ky. "We've just been told, 'You'll want to re-enrollyour clients in it.' I've contacted my clients, and I'm tellingthem I'm aware of what's going on. I don't know how much theybelieve me or I believe myself, but I'm doing what I can."

NAHU's Waltman adds that some states will complete theirexchanges in 2015, while other states, such as Idaho and NewMexico, will launch completed state exchanges to take the place offederal-state hybrids created for 2014.

According to the federal government, another 2015 change will bean increased number of carriers offering plans on the exchanges.The U.S. Department of Health and Human Services said in aSeptember statement that the number of issuers will increase by 25percent—with 77 new issuers. The federal exchange will have 57 moreissuers by itself. "When consumers have more choices, we allbenefit," HHS Secretary Sylvia Burwell said in a press release. "Interms of affordability, access and quality, [the news of morecarrier participation] is very encouraging. It's a real sign thatthe Affordable Care Act is working."

Even with all those new issuers, though, benefits professionalsmay not be getting all the information they need from insurancecompanies to help service their clients correctly andefficiently.

"As of right now, I'm pretty disappointed in the insurancecompanies," Zinser says. "On the individual side, we've had onemeeting with them. We've gotten some guidance from Anthem on whatthey're doing and moving people to plans. But who's going to begone and who's not going to be gone? Last year, we had a lot ofrenewals. In some of my states, like Indiana, they're discontinuingsome plans and rolling them into a new plan. Humana—one of themajor carriers in the individual market in Kentucky—hasn't told usanything at all. I'm hugely disappointed. There's been no guidance.We had a webinar and they let us know renewals are coming soon.That's where I stand right now."

Rates

There's no easy way to sum up what will happen to rates—they'regoing to go up for some consumers and they're going to go down forothers.

"My guess is that employers will continue to reveal to employeeswhat the law is costing them," Davis says. "We've got clients rightnow—midsize clients—that are paying $100,000 per year in fees. Oneof our clients went back and said, 'We want to tell our employeeswhat it's costing us.' The singles were paying an extra $150 peryear for single coverage and around $650 per year for a family.Employers are saying, 'We want people to know what this iscosting.'

"My customer-service people spend more than half their time on[PPACA] issues," Davis adds. "You take a broker business that usedto be profitable, and you take that staff and 50 percent of theirtime is spent on compliance. You have to ask yourself what's notgetting done—and that's all the really important stuff we do tohelp our clients control spending."

Cancellations

Throughout 2014, there were plenty of stories concerning planand policy cancellations. Politifact even called President Obama'ssales pitch—"If you like your plan, you can keep your plan"—the lieof the year in 2013. In 2015, the tide of cancellations isn'tlikely to subside as prices increase or employers stop offeringhealth insurance altogether.

"All of these people right now are getting renewal prices for2015, and the rate increases are enormous," Waltman says. "Sincesmall employers and large employers are starting to comply,employers are also making switches. They may no longer offercoverage to spouses or they may no longer offer coverage topart-time employees."

Davis agrees, saying he thinks cancellations are going tocontinue.

"That's part of what's going to drive individuals to theexchanges," he says. "Now, while it's a minimal fine for not doingit, that's going to increase over time. The IRS is going to look atthat over time, too. I would say you're going to see morecancellations and groups getting out of the business of providinghealth care."