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Crowdstaffing featured as Rising Star and Premium Usability HR platform in 2019

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May 13, 2019

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How Health Care Becomes a Diversity Issue for LGBTQ Talent

No matter where you stand on the political spectrum, you must recognize that the provisions and entitlements under the Affordable Care Act (ACA) will change over the next few years. Since January, the new U.S. administration and its supporters in Congress have pledged to “repeal and replace” the landmark healthcare legislation. This has left insurers, subscribers and businesses confused about the future outcome. For contingent workforce leaders, the already complicated issue could become even muddier. Some may see the elimination of the mandates as a boon to the bottom line. Others may worry about the welfare of talent covered under ACA. There’s one very important topic that’s often ignored in the debate. Although we may not readily associate health insurance with diversity, the reality is that repealing the law could severely impact the LGBTQ professionals in our workforce.

The Affordable Care Act’s Rocky Start

The Dawn of the ACA

As we wrote in June 2014, the ACA’s introduction presented both opportunities for labor market progress and understandable concerns. Whether bedlam or benefit, opinions of the ACA really boiled down to an “eye of the beholder” outlook.

In March 2010, President Obama signed into law the federal statute known as the Affordable Care Act, which represented the most radical regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965. Enactment of the ACA aimed to increase the quality and affordability of health insurance, lower the uninsured rate, and expand both public and private coverage while reducing costs to individual subscribers and government agencies.

Four years after the ACA’s passage, more than 10 million Americans had enrolled in coverage under the ACA, including over 8 million individuals who had selected insurance through exchanges and another 3 million who had enrolled in Medicaid.

Workforce Driver

Mike McKerns, founder and CEO of Mamu Media, predicted that long-term gains would far outweigh upfront cost increases resulting from implementation of the ACA. With the shortages in critical skills and glut of unfilled job openings that plagued 2014, labor markets were extremely competitive. By giving workers independent access to affordable healthcare coverage, they no longer exhibited the same reliance on full-time positions. Today, this seems evident in the momentum of the flourishing gig economy. According to McKerns’ research, there were several drivers enabled by the ACA:

  • Workers no longer needed to prioritize health benefits when job hunting.
  • Highly skilled workers became increasingly receptive to signing on for temporary assignments.
  • Staffing agencies that didn’t offer benefits were no longer constrained by this perceived disadvantage when recruiting talent.
  • Working through a staffing agency was more appealing to top talent seeking flexibility.
  • Staffing firms reported seeing higher retention rates because skilled employees weren’t jumping ship for the first full-time position with benefits that came along.

ACA Concerns

Still, concerns about ACA implementation, particularly around costs, abounded. Under the law, staffing providers with over 100 employees were required to offer health insurance or pay penalties. When working in MSP/VMS programs, where bill rates and margins are lower than when contracting directly with clients, some staffing firms worried that the ACA would have detrimental financial impacts.

There were additional concerns among the supplier community, particularly small suppliers with little historical data to provide to insurance companies for underwriting these benefits. Some progressive MSPs stepped up to help shoulder these burdens by sponsoring unique benefits options for participating suppliers that did not meet these criteria, leveraging insurance partners and third-party administrators to assist with plan selection, enrollment, coverage, record keeping and auditing.

Affordable Care Today

In January 2017, Congress passed a budget resolution that called for substantial changes to the law, which have been planned for a subsequent bill. Even though the process allows them to pass this bill without votes from the opposing Party, senators and representatives remain deadlocked in deciding what the reforms should look like. As NPR reported:

First of all, they won’t be able to repeal everything in one go, which counters a lot of the rhetoric coming out of the election. And they would be limited in what parts of the law they can replace.

That said, the Trump Administration has taken some action, but no concrete changes – yet. In January, Trump signed an executive order calling for federal agencies to “waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the act” that would “impose a fiscal burden” on states, individuals, healthcare providers, and others in the health industry.

For its part, the IRS announced that it would not strictly enforce the “individual mandate” that requires most Americans to have health insurance. However, the agency also acknowledged that this rule persists under the law.

More Favorable View

The latest Kaiser Health Tracking Poll reveals that more people today view the ACA in a favorable light, as compared to the opinions voiced in 2010, the time of the act’s inception. The Daily Press summarized the report’s findings:

“Forty-eight percent of the people surveyed had a favorable view of the ACA, while 42 percent viewed it unfavorably, the poll shows. In a Kaiser Foundation poll conducted in January, 43 percent viewed the Affordable Care Act favorably while 46 percent viewed it unfavorably. The shift in attitudes was led by independents, 50 percent of whom said they now view the law favorably. According to the foundation, the margin of error for both polls is 3 percentage points.”

During the 2016 open enrollment period, more than 9.2 million people signed up for coverage.

New Concerns

Although the members of Congress who are championing the repeal effort disagree with a replacement strategy, every proposal shares a set of common elements. We would likely see a dramatic reduction in the cost of premiums. However, economists point out that this benefit could be accompanied by an equally significant increase in the consumer’s out-of-pocket expenditures, such as deductibles and copays.

The tax credits currently subsidizing the premiums could be cut. And authors of the replacement law will seek to alter premiums by age. For younger workers, those costs would shrink. For older talent, the costs would jump. In analyzing the net financial impact of modifying or repealing ACA, contributing economists reached these conclusions in a comprehensive article published by Vox.

  • The average annual cost for an individual under a new plan would grow to $1,744.
  • For workers 55 to 64, those costs would rise to $6,089.
  • For low income families at specific earning levels, insurers cover about 75 percent of the costs. That amount would be slashed, potentially imposing a financial burden that would lead families to abandon coverage altogether.
  • All proposals endorse removing the requirement that insurers cover 10 “essential benefits,” such as prescription drugs, maternity care, mental health care, and pediatric dental and vision care.

For any business to thrive, its workforce must be healthy and productive. The absence of wellness causes economic constraints from growing absenteeism, an increase in accommodations as more disabilities manifest, low engagement, high attrition and huge declines in performance. According to a Willis survey, 93 percent of organizational leaders said healthier employees consistently produced superior results. In short, a healthy workforce means a healthy bottom line.

What many people may not realize are the ongoing struggles for health that LGBTQ talent confront. As the Kaiser Family Foundation explains: “Lesbian, gay, bisexual, and transgender (LGBT) individuals often face challenges and barriers to accessing needed health services and, as a result, can experience worse health outcomes. These challenges can include stigma, discrimination, violence, and rejection by families and communities, as well as other barriers, such as inequality in the workplace and health insurance sectors, the provision of substandard care, and outright denial of care because of an individual’s sexual orientation or gender identity.”

7 Reasons Why ACA Matters to LGBTQ Talent

The Human Rights Campaign (HRC) is a leading advocacy group for members of the LGBTQ community. In a recent blog post, Kat Skiles describes seven key issues that could affect LGBTQ individuals if the protections granted them under the ACA disappear.

  • Under the Affordable Care Act, state marketplaces, health plans, and their employees can’t discriminate against LGBTQ people -- and insurers can’t charge more if you have a pre-existing condition, such as HIV or cancer.
  • Since the LGBTQ community is less likely to have health insurance, the Affordable Care Act makes new coverage options available to all -- including those without access to coverage through a domestic partner or employer and those with pre-existing health conditions.
  • The Affordable Care Act not only provides access to care, but it also addresses health disparities that currently exist in the LGBTQ community and provides critical preventative care.
  • Without protections guaranteed by the Affordable Care Act, many could lose coverage for lifesaving treatment for HIV and AIDS and be left vulnerable to insurance industry abuses.
  • The Affordable Care Act makes considerable strides in addressing the barriers to obtaining care from qualified providers that people with HIV and AIDS face, helping them get the treatment they need.
  • Insurers cannot limit or deny coverage for services used for gender transition when those services would otherwise be covered if treating a non-transition related health condition.
  • Under the ACA, a plan can't limit a preventative service like a pap smear, mammogram or prostate exam based on an individual's sex assigned at birth, gender identity or their recorded gender.

LGBTQ professionals define diversity. Sexual orientation and gender identity are not restricted to races, ethnicities, countries of origin, religions or any other diversity category: they span the gamut. And if the ACA is repealed, they could suffer the most. This year, diversity will be one of the hottest topics in the contingent workforce solutions industry. We must continue to champion an inclusive workforce regardless of politics, policies or changing legislation. To compete and grow, we as diversity heroes must push to help clients develop the most innovative, progressive, insightful and healthy business cultures possible.

The health and wellness of LGBTQ talent, and all talent, is a critical success factor. I believe contingent workforce leaders should continue to stand as the inspirations, voices and proponents of the diverse. As I wrote in January 2015, MSPs rushed to help their staffing partners come up with a host of creative solutions to assist with ACA compliance and costs. As the new rules unfold, perhaps presenting some new challenges, I believe we can conquer any obstacle together.

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