Vicki Head, co-owner of Hilton Head Auto Body, and about 40 other Beaufort County business owners turned their heels on sunny, warm weather on a recent Tuesday and instead piled into a dark conference room.
Their hope: figure out what new federal health care changes will mean for them and others.
"It's scary, and there's so much uncertainty about what it will mean for us," said Head, who provides health care coverage for her 24 employees at two Hilton Head locations. "Our employees work hard. They're on their feet all day. They're bent over. They need and deserve good coverage. But we need information on how to do it with all of these changes."
Business owners across the state echo the sentiment Head and others voiced during a seminar in Bluffton by Beacon Insurance Group, a local agency. With the reelection of President Barack Obama and talk of a quick overturn of federal health care reform muted, business owners are scratching their heads over the new health care law that many deem complicated and possibly costly.
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There's still time for them to figure it out.
Some provisions have already taken effect, but the major changes will be phased in starting in 2014, according to state health care experts working with the S.C. Department of Health and Human Services.
Those changes will create winners and losers, according to the president of Carolina Care Plan, one of the presenters at the seminar Head and others attended.
"We'll see premium rates that increase for some and will decrease for others," Carson Meehan said.
The number of employees and the age of those employees are among the factors that dictate just how much the new law affects a business, Meehan added.
SMALL BUSINESS VS. BIG BUSINESS
Although many of the state's small businesses are sweating the changes, those with fewer than 50 full-time equivalent employees will not be subject to penalties if they do not offer their employees health care coverage.
They will, however, pay new fees charged to insurance companies and passed on to businesses. That includes money for research to determine which medical procedures are appropriate for various diagnoses.
Meehan estimates the new assessments and fees could total about $110 per person in 2014.
Companies with 50 or more full-time employees, on the other hand, must offer their full-time employees coverage considered affordable by the federal government. Among the services it must include are maternity leave, mental-health and substance-abuse coverage, and dental and vision coverage for young children.
States are working out details of many of these standards, such as the number of mental-health visits that must be covered by the plans.
"Ultimately, it will be a little different in different states," Meehan said.
Large companies have another option. They can choose to not provide coverage and pay a penalty ranging from $2,000 to $3,000 per employee per year -- an amount likely to be much lower than the cost of providing employees coverage, according to state officials working to implement the plan in South Carolina.
MANY COMPANIES TO DROP INSURANCE PLANS
Companies big and small have another big question to answer: Should they provide coverage or give employees money to seek their own policies?
Experts believe many S.C. businesses will choose the latter. They include Paul Houchens, an Indianapolis-based actuary helping the state understand the new law.
New federal rules on setting premiums are drastically changing the landscape, he said.
For example, insurance companies will not be allowed to consider an employee's gender or medical history when setting a premium. And a new formula used to calculate premiums means rates for older employees will decrease while younger employees will experience increases, Houchens said. To help offset new costs, the federal government is offering premium subsidies for many workers if they choose to purchase coverage through a health care exchange, an online marketplace where insurance companies will compete for customers.
Many S.C. workers are expected to qualify for the subsidies, which are based on a worker's household income, Meehan said.
The lure of those subsidies, coupled with an expansion in the number of people who qualify for Medicaid, will likely mean many S.C. businesses drop the coverage they currently offer employees and instead give them money toward coverage they can spend on the exchange. That's particularly true of companies who employ many low-wage workers who will qualify for the subsidies.
The upshot for the businesses: A significant portion of health care premiums would be paid by the federal government.
The advantage for workers: a less expensive alternative than their current plans.
"That's where I expect many businesses to end up," said Meehan said. "It makes sense for a lot of businesses and employees."
HEALTH CARE EXCHANGES
S.C. workers can apply to the federal exchange in October, according to state officials. It is unclear how many insurance companies will participate.
Gov. Nikki Haley decided not to set up a state exchange, calling the health care law a "public-policy disaster" that does not give the state adequate flexibility and will cost too much.
"As we've said from day one, and as the governor continues to make clear: ObamaCare is terrible for South Carolina, and (she) will fight its implementation at every stage," said Rob Godfrey, Haley's spokesman. "Gov. Haley has long been on record opposing Obamacare's exchanges, and she remains committed to keeping them out of South Carolina -- just as an independent committee that studied exchanges concluded we should do."
Instead, Haley, along with the state's Department of Health and Human Services, is looking for ways to change the state's health care system to make it more efficient and affordable.