Yahoo Small Business Advisor’s article, ” The Affordable Care Act Five Years On: How it Affects Small Business,” features comments from Powers Principal Jim Pyles. Read the excerpt below.
Jim Pyles, a healthcare attorney and partner with the Washington, D.C.-based law firm Powers, Pyles, Sutter & Verville, said an integral goal of the ACA was to have insurance plans compete for business and open access to a broad pool of customers so their costs would not rise too much. “It’s worked somewhat well, particularly in states with multiple health plans in states with healthcare exchanges,” Pyles said. “It has not worked as well in states with little competition. In those states plan costs have tended to rise more quickly.”
Pyles said that insurers have reported enrolling more people, but those new customers were sicker and required more services, leading to higher than expected costs.
“The question is whether we can keep healthcare costs from rising so much that they become a crushing burden on small businesses,” he said.
Pyles said because of those unexpected high medical costs, health insurers are at risk.
“They’re trying to figure out if they can survive and how to do that with wide open liability and limited income,” he said, explaining that is why so many health plans are merging.
He said that some health plans have figured out that the costliest patients are those with multiple chronic conditions. Learning how to treat those patients more effectively to avoid emergency room treatments and hospitalizations through better prevention, disease management and education help control costs.
Read the full text of the article here. For more information, contact Jim Pyles at Jim.Pyles@ppsv.com.