In many ways, 2014 was a pivotal year for PPACA, as most major reforms came online in the past 11 months. Among the facets implemented were the Health Insurance Tax, subsidies, state and federal exchanges, minimum standards, health care co-ops, Medicaid expansion and new rules for wellness programs, minimum waiting periods and several market reforms. There were lots of problems, and the government tacked on plenty of last-minute changes and extensions in an effort to smooth the implementation. It all resulted in a flood of negative press for PPACA. Public perception has fallen so far that polls now consistently show that around 60 percent of Americans don't favor the law.

It's fair to say that health care workers, insurance brokers and agents, consumers, government regulators and President Obama hope 2015 will unfold more smoothly. On tap for next year is a relatively minor facet of PPACA set to start on Oct. 15—a 23 percent increase in the Children's Health Insurance Program match rate up to a cap of 100 percent, according to the Kaiser Family Foundation.

The main issues for Obamacare in 2015 revolve around how employers and benefits professionals handle the employer mandate and related compliance issues. Also on their plate will be working with employers and employees struggling with canceling policies or canceled policies as extensions lapse. And there are tweaks coming for the state and federal exchanges, too.

Already delayed multiple times, the employer mandate—a critical part of the law's success—is set to begin in 2015. That means employers with more than 100 employees must offer health insurance by January or pay a fine of $2,000 per worker. Companies that employ 50–99 workers have until January 2016 to begin offering health insurance. (Companies with less than 50 employees are exempt.)

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

Compliance

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

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

But compliance hasn't been easy, some industry insiders say, as employers have been fearful over the law's penalties and continuing changes. Aaron Davis, president of NextLogical Benefit Strategies in Westminster, Maryland, says brokers have been busy working to educate clients—as well as ease their concerns.

"What's happening is PPACA is just loaded with fear-inducing issues. So employers are freaking out," Davis says. "Plus the law has changed 30–40 times so far, so everyone is asking if they're in compliance. In health care, we call it the worry well. It creates stress, so brokers use that and deluge people with information. Within 24 hours of a change, we get the information. We keep up on it, but clients continue to freak out because they're scared of missing something. The IRS went out and hired a bunch of new auditors last year and started auditing health plans. And those penalties can be huge. People are going to continue to peddle fear and offer hope."

Exchanges

Benefits professionals and consumers will continue to see change in the federal and state exchanges as well. Some exchanges were really clunky and inefficient, like Oregon's Cover Oregon. Others seemed to work better, like Kentucky's Kynect. And no one needs to bring up the subject of the federal exchange on HealthCare.gov. Still, benefits professionals working with state-run exchanges question whether the marketplaces will continue to improve in the next year.

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

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

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

Even with all those new issuers, though, benefits professionals may not be getting all the information they need from insurance companies to help service their clients correctly and efficiently.

"As of right now, I'm pretty disappointed in the insurance companies," Zinser says. "On the individual side, we've had one meeting with them. We've gotten some guidance from Anthem on what they're doing and moving people to plans. But who's going to be gone and who's not going to be gone? Last year, we had a lot of renewals. In some of my states, like Indiana, they're discontinuing some plans and rolling them into a new plan. Humana—one of the major carriers in the individual market in Kentucky—hasn't told us anything 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're going to go up for some consumers and they're going to go down for others.

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

"My customer-service people spend more than half their time on [PPACA] issues," Davis adds. "You take a broker business that used to be profitable, and you take that staff and 50 percent of their time is spent on compliance. You have to ask yourself what's not getting done—and that's all the really important stuff we do to help our clients control spending."

Cancellations

Throughout 2014, there were plenty of stories concerning plan and policy cancellations. Politifact even called President Obama's sales pitch—"If you like your plan, you can keep your plan"—the lie of the year in 2013. In 2015, the tide of cancellations isn't likely to subside as prices increase or employers stop offering health insurance altogether.

"All of these people right now are getting renewal prices for 2015, and the rate increases are enormous," Waltman says. "Since small employers and large employers are starting to comply, employers are also making switches. They may no longer offer coverage to spouses or they may no longer offer coverage to part-time employees."

Davis agrees, saying he thinks cancellations are going to continue.

"That's part of what's going to drive individuals to the exchanges," he says. "Now, while it's a minimal fine for not doing it, that's going to increase over time. The IRS is going to look at that over time, too. I would say you're going to see more cancellations and groups getting out of the business of providing health care."

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What 2015 means for PPACA

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