Republican legislators have said that they are not giving up on repealing the Affordable Care Act, a statement that makes it difficult for health care and health care-adjacent professionals to plan ahead.
For brokers, the questions are numerous; but a key point to consider is how much time and money to invest in developing best practices around ACA regulations. While brokers have been complying with these regulations for several years now, the industry is quickly producing tools and technology to make their management easier, such as health questionnaire platforms or 1095-C reporting software.
Brokers are at a crossroads — will they be working within these regulations for the foreseeable future, incentivizing the industry to adopt tech tools to produce efficiencies and reduce errors? Or will Republicans manage to repeal the law, reducing the need for these tools?
Of course, no one can say for sure. But here are things for brokers to consider on a few of these potential investments.
With the ACA’s stringent requirements on what fully-insured group plans have to cover, more employers are moving toward self-funded strategies, or partially self-funded plans that have a lower stop-loss limit.
With these plans come health questionnaires to underwrite the self-funded group. A number of software systems streamline the questionnaire process; some are standalone services, and others integrate with benefits software or quoting engines.
Should brokers invest in developing online processes for these questionnaires? The ability to integrate with quoting software can make the proposal process easier, but how significant do you anticipate questionnaires being for your clients? If the ACA is repealed, and the essential health benefit requirements for fully-funded plans are eliminated, fewer employers may be willing to take on the risk of a self-funded plan.
However, the reduction of requirements on fully-funded plans could result in a return of questionnaires in that space, currently prohibited by the ACA.
Group plan reporting
A similar point of consideration is around 1095-C reporting requirements. The regulation requiring employers with more than 250 employees to file electronically has already led to many brokers adopting tech tools to manage the reporting.
But those who are still considering investing in standalone reporting tools should ask what the return on investment would be if 1095-C reporting is overruled through an ACA repeal.
The peril of standalone software
This is the big question of software developed to solve a specific challenge, particularly in an industry as highly regulated as health insurance. The rules are constantly changing, which can leave solution providers, and their customers, in limbo.
However, brokers may avoid this problem by seeking out more comprehensive tools that provide value beyond ACA compliance. There are a variety of benefits platforms that offer a suite of benefits and HR services, including but not limited to items like 1095-C reporting.
The benefit of more comprehensive software is less risk that changing regulations will render the solution void. The risk is that it is a bigger buy, and will require more investment in time and money.
Shelving a single-solution provider may not represent too much loss for your agency. Choosing the wrong benefits platform would represent a larger challenge.
Fortunately, as the benefits industry evolves, the risk of choosing the wrong platform has diminished. There are now a handful of commonly used benefits softwares, and any one of them will offer a smoother benefits enrollment process, in addition to other compliance and HR features.