Since the inception of the Affordable Care Act (ACA), we’ve heard plenty of its opponents vow to “repeal and replace” the landmark healthcare legislation. This has left insurers, subscribers, and employers confused about the future outcome. A couple of weeks ago, this already complicated issue got a bit fuzzier when the Trump administration announced, as NPR explained, that it would halt “billions of dollars of payments designed to help insurers meet the Affordable Care Act requirement that they provide coverage regardless of whether a person is healthy or sick.” Although we may not associate health insurance with inclusion efforts, the reality is that hobbling the law could severely impact diverse members of our workforce, especially LGBTQ talent.

The Dawn of ACA and Its Rocky Start

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, including over 8 million individuals who had selected insurance through exchanges and another 3 million who had enrolled in Medicaid.

Health Care as 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.

ACA Under Attack...Again

Since January 2017, Congress has attempted to pass substantial changes to the law through budget resolutions, alternative proposals, and executive orders 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.

Despite a lot of effort and false starts, the ACA’s detractors never gained much traction. But on July 8, 2018, President Trump tried a different tactic, as covered by NPR:

The administration said it was withholding $10.4 billion in the so-called "risk adjustment" payments, citing a district court ruling from earlier this year in New Mexico. While the administration says it is required to stop payments because of the court decision, insurers say the move could result in higher premiums for millions of individuals and small businesses.

The risk adjustment program plays an important role in the ACA by pooling risk for insurers, transferring funds from insurers who enroll healthier members for relatively less, to those that take on higher costs in order to enroll sicker members. The idea is to insulate insurance companies from the cost of enrolling people with pre-existing conditions, while removing the incentive for insurance companies to cherry pick healthy people.

All the bluster and fervor to rid America of affordable health care seems really bizarre. It would be one thing if everybody hated the benefits or suffered more because of them. But that hasn’t been the case. The Kaiser Health Tracking Poll last year revealed that more people viewed 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. For the 2018 open enrollment period, that figure climbed to nearly 12 million people.

Affordable Health Care Affects Diversity

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 explained: “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 devastated, they could suffer the most. Diversity continues to 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.