Pasadena Now Article And Interview With Raphy Timour About The Affordable Care Act

Reprinted from with permission from Pasadena Now,  this Business Article was titled:

How Is The Affordable Care Act Affecting Small To Mid-Sized Businesses In Pasadena?

The institution of the Affordable Care Act and its effects on business owners and their employees is one of the biggest national stories of 2014. Pasadena Now wanted to break down the implications of this national story by understanding what is happening on a local level. To illuminate how the ACA changes are affecting small to mid-sized businesses in Pasadena, Pasadena Now spoke with Raphy Timour of Pontrelli, Timour & Associates, Inc.

Like most insurance brokers that handle employee benefits, Raphy Timour recommended that most his clients take the early renewal option. As a result, their current plans will stay in place until December of 2014. Most companies will not experience major changes until the end of the year. When those changes come, however, Raphy Timour told Pasadena Now what will happen:

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Raphy Timour on ACA

“The fourth quarter is going to be a real wake-up call for most employers. There are going to be a lot of shocked and surprised people. Most plans had to bulk up to meet the minimum essential coverage requirements of the ACA. These new comprehensive plans are both less flexible and more expensive. I believe the middle class in Pasadena are going to be hit the hardest. They won’t qualify for the low-income subsidies and employers will pass off most of the new expenses onto their employees. They will have higher premiums, and higher out of pocket costs when they go to seek services. Healthcare reform will make life harder for a lot of people.”

What exactly is meant by the new coverage requirements? Won’t healthcare reform be beneficial for most people? Aren’t the new essential health benefits a positive thing? When asked this question, Raphy Timour shook his head in frustration:

“You would think that would be the case, but it actually is the opposite. If you currently offer your employees a small group health plan in California that was established or renews in 2014, your plan is mandated to include 10 categories of essential health insurance benefits. Some of these essential benefits make perfect sense like the preventative services that include both annual screenings and wellness visits, inpatient hospital services, emergency services, and prescription drug coverage.  On the other hand, so-called essential benefits now also include the following: acupuncture, pediatric dental and vision services, and a host of other specialized items. These specialized services increase the costs for everyone.  People should have more choices; one size does not fit all.”

Wanting to know more, Pasadena Now asked for a concrete example of how a small business could be affected by these rate increases. Raphy Timour responded by telling us a story about one of his Pasadena-based clients:

“We do the benefits for a small local restaurant and the owner is a woman in her early 60’s. She chose not to early renew. Over the years, to help offset the rising cost of healthcare, she moved to  a higher deductible PPO plan. Although the out-of-pocket costs were greater, she chose to pay less each month in premiums. Her group benefits plan renews in March 2014 and her individual rate is going from $532 a month to $925 a month!  Yes, her benefits are more extensive, but nowhere near justifying a 74% increase over last year. Why should a woman in her 60’s with adult children be required to have a plan that covers maternity and pediatric dental and vision?”

By removing the ability to choose what should be covered, ACA is adding significant costs. Moving forward, what is the best choice for small to mid-sized businesses to make in regards to health insurance? Should they go on the Covered California exchange? Raphy Timour answered these questions with a resigned honesty:

“Healthcare reform is a very complex issue with many perspectives and market forces. Right now, the group insurance market is still the best choice as opposed to the exchanges and the individual policies. There are significantly more options and carriers available with the off-exchange group insurance market, including the largest network of hospitals and medical providers. What is frustrating is that all of the options under the Affordable Care Act seem to be more expensive and less helpful. They tried to squeeze everyone into the same little box. When it comes to healthcare, one size simply is not enough.”

Raphy Timour

About 

Co-Founder at Pontrelli, Timour & Associates, Inc.

A California native of Pasadena, Raphy Timour began his career at Automatic Data Processing as an outside sales representative, achieving President Club status each and every year at ADP. Wanting to provide clients with a more customercentric approach, Raphy Timour started Pontrelli, Timour & Associates, Inc. in 2003 with his childhood friend Chris Pontrelli. Raphy Timour has a Health & Insurance License from the California Department of Insurance.

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