Affordable Care Act prescription for bar associations and members: Take in information daily, update frequently

Vol. 38 No. 3

By

When the National Association of Bar Executives Program Committee began discussing session topics last year for the upcoming Midyear Meeting in Chicago, one subject quickly rose to the top, according to committee member Mark Mathewson: the Affordable Care Act.

“It was near-unanimous,” says Mathewson, director of publications for the Illinois State Bar Association. “We know that a lot of our members are hungry for information.”

It is a hunger, Mathewson and others say, that spans bar associations from coast to coast. With deadlines looming and nationwide publicity exploding as the ACA began rolling out amid a host of difficulties this fall, bars and other membership associations began fielding more and more inquiries from concerned members—most of them solo and small-firm practitioners.

While many bars have been talking to members about the ACA for several months, going back to its initial passage into law in 2010, the information campaign has ramped up in recent weeks. Magazine articles, blogs, CLEs, e-mail blasts and Q-and-A forums are part of the arsenal that bars have been using to get more information into their members’ hands. It comes at a time when associations themselves are also gathering data and exploring ACA-related issues for their own employees.

As deadlines arrive—and often change—many bars say they will keep the lines of communication open with their members, while also trying to gauge what effect the new laws are having, or will possibly have, on the bar association as an employer. Most believe it will take several months, if not longer, to measure those effects. It is a continuous effort that makes sense, they say, to address a complex program that continues to unfold on a regular basis.

Small bites for small firms

Known popularly as Obamacare, the Affordable Care Act is expected to have a wide-ranging impact on health insurance pricing and options for millions of American workers. Among the people seeing some of the biggest changes are those who are self-employed or who work for firms of 50 or fewer. And for most bar associations, that demographic covers the majority of their members.

“About 60 percent of our members are solo and small-firm practitioners. We’re sensitive to their needs,” says Charity Anastasio, practice management advisor for the Washington State Bar Association’s Law Office Management Assistance Program. “We haven’t had a huge flood of information requests, but what I’m getting from people is confusion about what is in a [health] plan, what about deductibles, and how cost-sharing works.”

Sensing that many attorneys are “late adapters” to the insurance changes, Anastasio launched an eight-part blog series in November, “Navigating the Affordable Care Act.” The weekly blog explains different areas of the ACA, how they affect solos and small firms, and what those lawyers can do to successfully obtain health insurance.

“It was a way to push out little bits of information that were easily digestible but needed to get out quickly,” Anastasio says. “Most [members] are keen about what’s going on and are doing careful research on [the ACA] before they decide what they’re doing. I’m focusing on that group that’s less than 25 employees.”

In addition to the blog, Anastasio says the bar is also planning to publish an in-depth article on the ACA by a knowledgeable health care attorney, in addition to developing a series of health care CLE sessions aimed at solo and small firms.

Building on existing relationships

Offering multiple CLE opportunities is also a key part of the approach of the 5,600-member Bar Association of Metropolitan St. Louis, according to Chuck Ramsay, the bar’s communications director. A November CLE session featuring insurance brokers attracted more than two dozen attorneys. Similar CLEs—all free—are expected over the next several months, he adds. At the same time, the bar also launched a health insurance option for members through USI Insurance Services/USI Affinity, giving them access to health insurance counseling and plans.

“Kudos to the [St. Louis] bar association for offering these CLEs,” says John Kirk, the Employee Retirement Income Security Act (ERISA) attorney for USI Midwest in St. Louis. “More bar associations need to do something like this, where they can get a local ERISA attorney in there to let them know, ‘Here’s what’s going on.’ Any education you can provide at this point would be well received.”

In Pennsylvania, an 18-month project among USI Affinity and three bars that use the brokerage for member insurance—the Pennsylvania Bar Association, the Philadelphia Bar Association, and the Allegheny County Bar Association—was critical in getting ACA information out to thousands of affected attorneys throughout the state, according to ACBA Executive Director David Blaner. Several “lunch and learn” sessions that brought members and USI brokers together were popular at the ACBA, Blaner adds, while brokers have been working directly with members on individual insurance issues. The three bar associations also developed similar portals to USI Affinity on their websites.

“I think they’ve done a pretty good job in getting us ready,” Blaner says. “We have a 50-year relationship with them. [Insurance coverage] is annually one of the top four or five benefits we offer.”

(Note: Among other useful data from bars associations across the country, the 2013 State and Local Bar Membership, Administration and Finance Survey from the ABA Division for Bar Services offers detailed information regarding which bar associations offer health insurance to their members.]

The broker-bar relationship has also been important for the New York City Bar Association, where several hundred solo members stand to lose their coverage through the bar due to insurance changes prompted by the ACA, says Alan Rothstein, the bar’s general counsel. Marsh, the bar’s broker, is working with the bar and insurance companies to secure coverage for all members needing it by April 1, he says.

“We’re working with them to route our members to coverage,” Rothstein notes. “The quality of that coverage is another issue. Our members are very concerned, understandably.”

To help with the uncertainty, the bar has a link on its homepage that provides regular updates on the insurance situation, Rothstein adds.

For the Illinois State Bar Association, ACA updates and the free flow of information about insurance have also been occurring online via interactions among members on the bar’s website, according to Mathewson. “Some of the most important discussions are happening spontaneously in our discussion groups,” he says.

The ISBA, like other bars, also recently published an article in its member magazine, Illinois Bar Journal, providing more detailed information on the ACA and its potential effects on members. But keeping members up to date has been a test of patience, Mathewson says. “It’s been a real frustration for us, since it’s a constantly shifting story,” he explains. “But it’s a story that needs to be told. We know that our members are hungry for information.”

What about the association itself?

The need for information is not just limited to bar members. Many bar associations, small employers themselves, have been learning more about the ACA for their own staff.

“We worked with the same broker [as our members], and we were able to enhance some coverage for our employees,” Blaner says. “It’s good for me, because I have some sort of idea about what’s happening out there. It gives me a good barometer.”

Jim Clarke, senior vice president of public policy for the American Society of Association Executives, agrees with the assessment of many bar executives who say they are in similar positions to the members they serve. The next few months, he says, will be closely watched by association leaders as the ACA gradually rolls out.

“We’re in that period of adapting to changes, and I’m looking for advice, myself,” he says. “Employers and employees need to keep their eyes and ears open. We’re looking out for best practices. We’re all riding this wave together.”

Another potential impact of the ACA on associations and small firms, Clarke adds, is how it will affect staff recruitment and retention—particularly at small associations where coverage is not required. Associations that don’t offer affordable insurance, forcing employees to get their own coverage on the open market, may find themselves at a competitive disadvantage, he says.

“Health care coverage is such an integral part of an employee’s compensation,” Clarke says. “The question is, ‘Will small businesses and associations work closely with their employees on insurance?’”

The bar association as curator

Despite all the publicity surrounding the troubles with the ACA rollout, there is still concern about what solo and small-firm employees know—and don’t know—about the ACA’s impacts. Dan Arell, vice president of employee benefits for USI Midwest, saw that first-hand when he met with several lawyers at the BAMSL CLE. “I think a lot of attorneys did not keep up with what has been going on,” he says. “There is still a lot of confusion in the marketplace.”

But it’s not just limited to lawyers or bar associations, says Kirk, who also works with other professional associations, such as those for accountants, real estate agents, and colleges.

“I’m still surprised by the lack of knowledge that’s out there—and I’m talking about the basics,” he says. “They say, ‘HR will tell us,’ but HR people are overwhelmed. A lot of people are listening to Fox News and MSNBC, and that’s all they know about health care.”

That is why Mathewson and other bar leaders say the most important role they can have in the coming months is to keep providing updated information and resources to their members.

“Our role is to be a curator of the information, pulling it together and pointing members to places to get even more information,” Mathewson says. “We realize there’s a lot of information out there, and what we have is just a small piece of it.”

Special health exchange for ABA members

For ABA members, a new health exchange from American Bar Insurance Plans Consultants Inc. (ABI) can help them assess their situation, find out whether they qualify for subsidies, shop for plans on and off the Public Health Insurance Exchanges, and apply for a health plan—in time for the March 31, 2014, deadline. ABA members can access the health Insurance Exchange for ABA members online or call (866) 860-1989 to speak with a licensed and certified Exchange Specialist. The exchange, admininstered by JLBG Health, includes such carriers as Blue Cross, Aetna, Humana, and many others.

Need more information on this important topic? Please attend “The Affordable Care Act – A Bar Exec’s Guide” on Wednesday, February 5, 2014, 12:55 to 1:55 p.m., at the NABE Midyear Meeting in Chicago. Also, see “Affordable Care Act: Where to fill your information prescription."

(Note: This article has been edited to include new information about the health Insurance Exchange for ABA Members.)

 

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