What to tell your employees about health care reform: Key topics, messages and timing for your benefits communication

It has been more than three years since we first told you what to tell employees about health care reform. We’ve gone on a roller coaster ride since then, but the Affordable Care Act is moving full steam ahead, and 2014 is a big year for benefits. We’ve said from the beginning that we can use this as a strategic opportunity to get employees and their families engaged. This is your year to do just that!

Here’s our guidance on what you should say, how to say it, and when. And grab a cup of coffee, because we all have a lot to do!

So first, why communicate?

Well, for one thing, you have to (but we’ll talk more about that later.) Another important reason to communicate now is that the current media attention and upcoming onslaught of consumer advertising dedicated to the Affordable Care Act mean health care is in the national dialogue like never before. But, if anything, that is making people more confused, not less.

We’ve been conducting focus groups with employers from Utah to New Hampshire, and one theme is clear: People don’t get it. “It” being their health care benefits, health care costs or health care reform. It doesn’t matter if we speak with highly paid PhDs or individuals working two minimum-wage jobs. Everyone has similar questions, misunderstanding and a sense of being overwhelmed about health care.

But don’t just take our word for it. There’s plenty of current poll data that reveal the exact same thing. For example, according to the Aflac Workforces report, 74% say when thinking about their benefits choices, they sometimes, rarely or never understand everything that’s covered by their policy options—particularly when it comes to health coverage.

Just as troubling are stats from a recent Kaiser Tracking Poll that show 42% of Americans are unaware that ACA is still the law of the land, including 12% who believe the law has been repealed by Congress, 7% who believe it has been overturned by the Supreme Court, and 23% who don’t know whether or not the ACA remains law. About half the public says they do not have enough information about the health reform law to understand how it will impact their own family.

When it comes to where they are getting information about the law, Americans most commonly cite friends and family, “newspapers, radio news or other online news sources,” and cable news. Only one in 10 say their employer. 

This confusion is, at a minimum, going to create more work for your HR group. Plus, it can negatively affect how employees perceive your benefits and result in them making poor benefits decisions. Employees already make mistakes with their benefits—mistakes that cost money. Aflac finds that 76% of employees who make decisions about their benefits coverage say they’ve made mistakes selecting benefits options; 42% say they’ve lost money because of those mistakes.

So, help your employees—and yourself!—and communicate the right way.

Here are your rules of thumb:

• Focus on what matters now. Don’t overwhelm employees with what happens four years from now or random “What if?” scenarios. Only focus on what matters now. Trust us, you’ll have plenty to talk about! See our long list below.
• Plan for ongoing communication. Don’t pile it all on at once. And don’t think that one time is going to fix everything. Use ongoing channels and make sure you’re giving people many ways to interact with the information.
• Do the work to make this simple for your employees. And make no mistake, it is work. This stuff is complicated, confusing and full of nuance. You need to be the source of clear, simple, unbiased information.
• Use social media, videos, tools, examples and real stories to make this come to life. Health care topics will always be emotional. A less formal tone and some interactivity work to bring your employees closer to your message. Your blog is perfect for a series of posts on health care and health care reform. Want a bit more oomph? We are doing some gorgeous custom videos and creating a stylish interactive modeler. And our friends at Jellyvision have this cool tool.

What to tell your employees this summer

Yes, you need to get your health care reform communication out this summer. That will get you ahead of the consumer marketing and state-led exchange education. Plus, it will give you time to tell your employees what is important in small bits—not all at once. This is what you want to cover:

1. Tell employees ACA is the law of the land and part of massive changes that our whole health care system is going through. All aspects of health care are going through major change—driven, in part, by health care reform and, in part, by all of the things that are broken about our current system.

If you haven’t communicated along the way, explain what health care reform law already has done. From expanding coverage to removing limits, ACA has already done a lot. If you need a short overview, we really like this summary from BCBS of Michigan.

And yes, the new requirements cost you, the employer, money. You can and should be transparent with employees about what those additional costs are and how you have implemented new requirements so far.

2. Tell employees what’s coming next: Health insurance will soon be a new ball game. Explain that starting January 1, 2014:

• Sick people can get insurance. Insurance companies will accept everyone who applies for coverage, regardless of health status.
• Employers must offer insurance. Employers with at least 50 employees must provide health care benefits or pay a penalty. Lots of rules are in place to make that health insurance valuable and affordable—or employers pay penalties.
• Everyone must have insurance. This is the “individual mandate.” Everyone will have to be covered by health insurance or pay a fine; those who can't afford insurance will be eligible for assistance.
• There are lots of other new requirements that place more burden and costs on employers. You can bore your employees with the communications requirements, reporting requirements and new fees. But, chances are, this is more detail than they want or need. You can also explain the penalties, if they will have a big impact on your company. Overwhelming employees with details is not important; clearly explaining the impact to your company is. If you can use real cost figures, even better.

3. Tell them a lot about the exchanges. Any health care reform information you share over the summer must include a simple-to-understand explanation about public health care exchanges. Although you aren’t required to do this until October 1 (when you must get the official notice out), waiting that long is going to create a headache for you, your HR team and your employees.

First, explain what the health exchanges are—a marketplace where people can easily buy health insurance. Be sure to tell employees where they can get additional information and guidance. For now, that is healthcare.gov, but we’re sure that will change as the state exchanges come online. For example, Covered California is already up with a simple cost modeler.

Second, explain the government subsidies and what makes someone eligible or—in the case of most of your employees—ineligible for a subsidy.

Then, give clear direction to employees about what they should do. This direction and guidance really depends on your employee population and your benefit strategy. Here are the most common examples:

Is 2014 business as usual as far as eligibility and coverage? This is the case for most of our clients, and chances are you offer good coverage that meets all the requirements. That means your employees aren’t eligible for a subsidy, and the main message is easy: Your benefits are the best deal in town, you don’t need to do anything outside the usual enrollment period. Still, some of your employees are going to be curious to compare your plans to what’s out there. Make this easy—they may finally understand the value of their plans!

Skim over this, and you risk two things: employees wrongly enrolling through an exchange (and arriving at your door mad when they realize they weren’t eligible for the subsidy after all!), or losing your young and healthy participants and driving up your costs.

Will the exchanges be a good thing for a segment of your employees? You may have a part-time workforce, seasonal employees, summer interns, pre-65 retirees, or temporary workers who don’t qualify for your health plan but whose engagement is important to you. If that’s the case, you’ll want to direct them to the exchanges and show them how the subsidy works.

Even employees who stay on your health plans may have friends or family who would benefit from the exchanges. Although it’s not your duty to educate them about these scenarios, the value for caregivers will be tremendous. It also helps illustrate value of your coverage.

Could families benefit from the exchanges? If you have a spousal surcharge or you minimally subsidize family coverage or simply don’t offer it, you’ve faced tough questions in the past. You’ll face more if you don’t proactively suggest that the exchanges are a viable alternative for many of your employees’ families.

It’s a careful dance, no doubt. Likely, you’ll still meet the legal requirements of offering affordable care, but some employees may feel the pinch. Why not help them through the application process with some thoughtful context and advice?

Will some of your employees be eligible for a subsidy? If your workforce includes employees whose income levels would qualify them for tax subsidies, you’ll want to arrange targeted communications that emphasize the importance and availability of public health care exchanges. Work with your actuarial team to find out who may qualify for the subsidy, get their demographic profile and target them.

What to tell employees during enrollment

What’s left to say during enrollment if you did all of the above over the summer? Plenty! Enrollment shouldn’t be the first time employees hear about health care reform—if you plan for that, the media and advertisers will beat you to the punch.

Let enrollment reinforce the messages from the summer, add more detail in key areas and focus on your benefit choices for 2014. You’ll still have plenty to say:

• What’s changing and what it will cost. This is always everyone’s first question during enrollment. Don’t hide it!
• Why you’re making changes. If you’re making major plan changes, rolling out new wellness programs, introducing HSAs or other new plan features, explain the strategy behind those changes. And don’t just say “due to health care reform.” Also, let employees know that change is the new normal—and it isn’t all bad. New plan features can be positioned as benefit enhancements even amidst rising costs. 
• All about the exchanges (again) and the requirement to have insurance. Repeat the messaging (perhaps targeted) that you started over the summer. Most likely, employees  don’t need to do anything with the exchanges. Let them know that your plans meet the requirement to have health insurance or “minimum essential coverage” as they may hear.
• Tell them your plans are self-insured. If you’ve never explained that your plans are self-insured, you’ve done a disservice to your benefits. You have a great opportunity to set the record straight this fall.  
• Explain key terms that will be splashed all over the media. Minimum essential coverage, subsidies, gold, silver, bronze, exchanges, marketplaces. Health care reform has added a whole new chapter to the book of health care jargon. Get those glossaries updated!

Do you talk about the Cadillac tax?

Yes. But not necessarily right now. And certainly not as a headline topic. For most of our clients, the Cadillac tax will be mentioned in FAQs only—not as a prominent component of education or a looming threat in the future.

Here’s why: Creating health care behavior change requires getting people motivated and feeling capable of making changes for themselves and their families. When you roll out a CDHP, you want people to enroll because they understand the cost equation, feel capable of managing their expenses and see the long-term value in your HSA contribution.

You’ll kill the buzz if you threaten them with, “We have to get our benefit cost down or we won’t be able to afford this huge tax that is way off in the future.” Similarly, when you ask people to participate in your wellness program, you’re promising better health and probably some cash as well. Saying, “Do this or our plans will trigger this huge tax in the future, and we’ll have to figure out how to deal with it” also is a confusing buzzkill.  

Instead, stay focused on what matters now. Of course, your company plans to adjust the structure of its “Cadillac” plans to avoid the tax. Everyone will be doing that. This is why reinforcing that change is the new normal is so important. However, you don’t need to use scare tactics to do that.

What to tell employees in January

January is always an important time to communicate, and this year will have the new element of consumer marketing flooding your employees. We’ll follow our own advice and not overwhelm you with details on this now. But be sure your communications plan doesn’t stop on December 31.

Okay, that’s a lot—and that’s just what to tell your employees! More soon on addressing your leaders, COBRA folks, new hires and more.

Do you think this is as big an opportunity as we do?

We are really proud of the work we’ve done and continue to do with health care reform. We believe this is a tremendous opportunity to engage people in their health and their benefits. If you want to take full advantage of this opportunity, we’d love to help. We are nearly booked for project work the remainder of the year, but we will be able to support a handful of new clients with health care reform communication. If you’d like to discuss the possibility, please contact us.

Common sense caveat that keeps our lawyers happy: This article is from Benz Communications, an employee benefits communication consulting firm. We know benefits. We know what your employees care about. We know how to help you bridge the two. We are not attorneys, and nothing in this constitutes legal advice or anything coming close to it. In addition, as we all know, the legislation and regulations are in flux. This information is accurate at the time it was published, but you should consult the HHS website or other sources for the most up-to-date information at the time you communicate to employees.