Late last week, the Department of Labor’s Employee Benefits Security Administration (EBSA) released guidance detailing notices that must be provided to employees regarding employee health coverage options under the Affordable Care Act (ACA), in addition to an updated model election notice under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).

The guidance requires employers to notify new employees, as well as current employees, no later than March 1, 2013:

1. Informing the employee of the existence of the Marketplace (referred to in the statute as the Exchange) including a description of the services provided by the Marketplace, and the manner in which the employee may contact the Marketplace to request assistance;
2. If the employer plan's share of the total allowed costs of benefits provided under the plan is less than 60 percent of such costs, the employee may be eligible for a premium tax credit under section 36B of the Internal Revenue Code (the Code) if the employee purchases a qualified health plan through the Marketplace; and
3. If the employee purchases a qualified health plan through the Marketplace, the employee may lose the employer contribution (if any) to any health benefits plan offered by the employer, and that all or a portion of such contribution may be excludable from income for Federal income tax purposes.

In January 2013, EBSA delayed the March 1, 2013 compliance date because a definition of the minimum value had not yet been established. The Department stated they expect the timing of the notices to be late summer or fall of 2013 to coordinate with open enrollment for the Marketplace. (Open enrollment is expected to begin October 1, 2013, for coverage effective in 2014.)

Employers must provide the notice if they are subject to the Fair Labor Standards Act (FLSA). In general, the FLSA applies to employers who have one or more employees and an annual sales volume of at least $500,000. Employers must provide the notice to each employee, including part-time employees

For the full guidance text, visit http://www.dol.gov/ebsa/newsroom/tr13-02.html.

In a survey conducted in March 2013, 56% of small businesses showed little understanding of how health reform will impact their business. In a poll of small businesses with fewer than 50 employees, 32% mistakenly believe they will be required to offer health insurance in 2014. Another 24% were under the impression if they don’t offer health insurance they would be required to pay a fee.

When it comes to the health insurance marketplaces, it seems there is even less understanding among small business owners. Health reform legislation requires businesses to inform their employees about the availability of health insurance and subsidies through the marketplace, but business owners don’t have much confidence they have the knowledge to do that. Sixty-two percent said they could not confidently define or explain how Health Insurance Exchanges – or marketplaces – work, and 20% said they had only a vague idea.

Small businesses are looking to health insurance brokers to explain the Affordable Care Act (ACA) to them and help guide them through the requirements and regulations. When asked who they trusted MOST to provide answers to health reform questions, an overwhelming 72% cited their health insurance agent/broker.

Covered California – the state’s new health insurance marketplace – has hired a new Information Technology (IT) chief to oversee implementation of their computer system in the wake of the arrest and resignation of former IT chief James Joseph Brown, Jr.  Brown left Covered California on March 25, the day he was arraigned on felony conflict of interest charges stemming from his service as bureau chief of information systems for the Justice Department in 2009.

In order to minimize any disruption to implementing Covered California’s online marketplace, Karen Ruiz – an IT project director at the California Public Employees’ Retirement System (CalPERS) – has been hired to replace Brown.

Covered California’s Dana Howard said Brown’s departure has caused no delays in implementing California’s insurance marketplace, “Building of the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) is ahead of schedule.”

A study released last week showed that 80 million Americans – 43% of working-age adults – don’t go to the doctor or get medical care because of the cost. The figure is a considerable increase from 63 million reporting in 2003.

Surprisingly, it’s not just those without insurance who postpone medical care. Twenty-eight percent of working-age adults with good insurance also avoided getting treatment because of the cost.

Almost three in 10 didn’t visit the doctor and more than 25% said they didn’t fill prescriptions or skipped tests their doctors recommended because they couldn’t afford to pay for it.

The study also revealed the number of people who were uninsured, or considered underinsured because of high out-of-pocket expenses, rose from 61 million in 2003 to 84 million in 2013.

On a positive note, the number of young adults age 19 to 25 who were uninsured fell from 48% two years ago to 41% this year, mostly due to the Affordable Care Act (ACA), which lets children remain on their parents health insurance coverage until age 26.

While officials both inside and outside the federal government have acknowledged health reform faces a rocky road to implementation, a new poll reveals one of the biggest hurdles facing the Affordable Care Act (ACA) may be making Americans aware of the law – and what it means to them.

A poll conducted by the Kaiser Family Foundation shows that 42 percent of Americans still don’t know the ACA is now in effect – 12 percent believe it was repealed by Congress, 7 percent think the U.S. Supreme Court overturned it and 23 percent aren’t sure of its status.

Many critics say President Obama and those implementing the ACA haven’t done much to promote the benefits to the public. Supporters are concerned without public support of state health insurance exchanges (also known as insurance marketplaces), there won’t be enough consumers in the insurance pool to lower rates.

In the Kaiser poll, 49 percent say they still don’t have enough information on the law and how it will impact them.

President Obama is beginning a “push-back” campaign to quiet critics who say the implementation will raise insurance rates, cost the government billions and generally be filled with problems. In a press event last week, Obama attempted to calm any fears about the law, saying, “Despite all the hue and cry and ‘sky is falling’ predictions about this stuff, if you’ve already got health insurance, then that part of ‘Obamacare’ that affects you, it’s pretty much already in place.”

He continued by saying the main changes will come for the 10 to 15 percent of Americans who don’t have health insurance, adding, “What we’re doing is we’re setting up a pool, so that they can all pool together and get a better deal from insurance companies. And those who can’t afford it, we’re going to provide them with some subsidies. That’s it.”

The U.S. Department of Health & Human Services (HHS) has released a three-page form to be used by individuals applying for health insurance coverage through state and federal insurance exchanges (or marketplaces) run by the federal government. The new short form replaces the 21-page draft version released earlier this year to loud criticism from consumer and health advocates. People applying for family coverage will need to provide additional details on an 11-page form.

The form asks for personal information such as Social Security Number, citizenship, job and income details and current health coverage. These items will be verified by the Social Security Administration, Homeland Security and the IRS.

Beginning October 1, 2013, consumers can choose to submit a paper application or apply online or over the phone. HHS says applicants will receive a response within two weeks telling them whether they are eligible to receive Medicaid coverage or subsidies through their state Health Exchange.

The form will be used in the 33 states utilizing the federal insurance marketplace model and is also available to the other 17 states that chose to run their own online insurance marketplace.

For a look at the HHS form, visit http://cciio.cms.gov/resources/other/index.html#hie and click on the April 30, 2013, bullet “Marketplace Consumer Application.” You can then view the Individual, Family and Individual without Financial Assistance applications.

Scammers who prey on the elderly are not in short supply – from sweepstakes scams to real estate schemes to faulty financial investments. And health reform is not immune as a tactic for scammers.

Law enforcement agencies are reporting an uptick in health insurance scams across the country as fraudsters take advantage of the confusion by a majority of Americans on what is coming with health reform. A recent study found that two-thirds of the uninsured don’t understand what the Affordable Care Act (ACA) provides and aren’t sure what their obligations, benefits or resources are for implementation.

James Quiggle, communications director at the Coalition Against Insurance Fraud in Washington, D.C., says, “Crooks are playing on that confusion. Confusion is a crook’s best friend.”

Seniors are often targets of these scams, receiving calls saying their Medicare information needs to be verified or updated from people requesting personal information such as Social Security Numbers, bank routing numbers and more.

Fraudulent callers also offer fake health insurance plans including fake health reform coverage and stripped down policies masquerading as real coverage.

Lois Greisman, who is in charge of marketing practices at the Federal Trade Commission, says she and her team are working to take down the scammers, but there seems to be an almost endless supply, “a program as vast as the health care overhaul makes for a dangerous twist on the regular scams.”

Experts advise against taking calls out of the blue; the best course is to talk to a health insurance professional who can tell you what your benefits are and help you find a real health plan that will provide you with real coverage.

Jonathan Gruber, professor of economics at Massachusetts Institute of Technology (MIT), told a conference of health journalists it may take up to a year to “fully straighten out the messes involved in implementing this,” speaking on the Affordable Care Act (ACA). The surprising turn is that Gruber is a big supporter of the health reform law.

Gruber tempered this message by saying the public – and the media – need to take a long-term view of health reform and remember every major federal health program including Medicare, Social Security and Medicaid, has faced problems at the beginning.

“This is a massive change that will take time to get right,” he said. Complicating the issues even further is that January 1, 2014 – implementation deadline for much of the ACA – is also the start of an election year. This means any problems that come out of implementation of state and federal Exchanges will be front-page news in political battles.

Those implementing health reform have a tough job ahead – convincing the public any problems are only short-term glitches that will be worked out given time.

In a recent interview, Bob Graboyes, health care economics expert for the National Federation of Independent Business, is urging small businesses in California to stay on top of health reform developments.

Saying that “California is probably doing a better job than just about any other state,” at launching the state health Exchange for small businesses, Graboyes qualified his optimism with some reality, “if we don’t get it right at the rollout, it will only get worse.”

Many small business owners have no idea what to expect from health reform and Graboyes says it’s not their fault. Many of the rules have yet to be developed or communicated to small businesses about what they need to do and how the Affordable Care Act (ACA) will impact their business.

Two areas that seem to be causing a lot of confusion are how staffing and wage levels in 2013 will affect subsidies in 2014, and how seasonal employees are going to be handled.

Graboyes says for small business owners, the best course of action is to use your accountant, attorney and insurance broker as invaluable resources. He adds, “and if you talked to them last month, do it again, because the rules may have changed.”

A top federal official says that American taxpayers are not being adequately informed about the financial and tax consequences they could face if they don’t have health insurance beginning January 1, 2014.

J. Russell George, the US Treasury Inspector General for Tax Administration, says the IRS should be doing more to educate the public about the tax implications of the health reform law. In a recent interview George said, “Many Americans do not realize the extent that the Internal Revenue Service will be involved in the implementation of the Affordable Care Act.”

David Gamage, who worked at the US Treasury Department drafting parts of the new law says that consumers may be unaware of the tax penalties they may incur by not carrying health insurance until it’s too late. “On your tax forms you will have to certify that you have insurance that qualifies from some source. And if you don’t, you will be assessed a penalty,” said Gamage. He continued, “If you don’t pay it there are a variety of enforcement techniques that the IRS can use, one of which is to subtract that from your refund you would be owed on your existing taxes.”

The IRS had not comment on the statements made by the inspector general.