When Jason Leverant co-developed the Affordable Care Act (ACA) Cost Calculator for the American Staffing Association (ASA) on a 6-person team, he was thrilled when the interactive tool – a worksheet to help firms determine whether they should “play or pay” and includes several cost recapture scenarios – became available in 2012.
“It’s aimed at helping staffing companies calculate potential costs under healthcare reform,” said Leverant, president and COO of AtWork Group, a national staffing firm with revenues of $257 million annually. “It’s been well received, with a few updates since then to keep up with changing regulations.”
Leverant, named to the Staffing Industry Analysts’ most influential “Staffing 100” list for the past two years, has now turned his attention to the impact of full, open enrollment in staffing large health systems.
“Now that both the individual mandate and the employer mandate provisions of the Affordable Care Act are in full force, open enrollment was a hectic time for all of us,” admitted Leverant. “The enrollment process caused an ‘all hands on deck’ moment, where team members in our staffing organization had to ensure we were compliant in our offering of coverage to all full-time employees.”
As a staffing firm that supports large health systems, Leverant knew this was a critical benefit that many nurses were seeking, and he wanted to do it right.
“In 2015, we ended up offering a 3-tiered health benefit offering to our employees, a low-cost fixed-indemnity plan, which provided base benefits – but wasn’t ACA-compliant due to coverage limits – and a Minimum Essential Coverage (MEC) option, which allowed employees to accept a very low cost ACA-compliant solution to meet their individual mandate requirements, and a full Minimum Value Plan (MVP) to provide our employees with a robust benefit package. As to be expected, though, we didn’t have a tremendous amount of people enroll in this coverage -- less than 1 percent of our workforce. This confirmed our initial thoughts that people don’t approach staffing firms for their benefit packages. They’re looking for a gateway into one of our client partners, or they’re looking for a pay check. Moving into 2016, we’re adapting our compliance strategy knowing this fact, and look forward to what the year has in store for us.”
Since the advent of the ACA, a key issue faced when it was introduced was a lack of available benefits, said Leverant.
“Major medical health insurance was never a benefit that staffing firms concerned themselves with because of the inherent nature of staffing – it's temporary,” he explained. “The mindset has always been that if someone was interested in major medical health insurance, they’d look for a position that was ‘temp-to-hire’ and the client company would offer those benefits to the those employees when an associate transitioned to their payroll.”
Under the ACA, staffing firms have had to work closely with benefit providers to create plans that made sense for the staffing industry, said Leverant.
“One of the primary challenges that needed to be taken into consideration was the issue of group participation,” he said. “In the past, if a staffing firm attempted to offer a traditional ‘fully-insured’ health plan to their employees, the insurance carriers required a minimum participation of at least 75 percent or more of the workforce, but the reality is that most temporary employees aren’t approaching staffing firms for a robust benefits package. They’re looking for a paycheck. Fortunately, we have some great vendor partners who were able to work with the major health insurance carriers to build out plans that have very minimal participation requirements, some as low as 1 percent. These have truly been a great resource for us in our quest to remain compliant with this complex law.”
The ACA has significantly impacted internal costs for staffing firms, Leverant said.
“As with anything that requires additional products, tracking, reporting, support, and so forth, our overhead costs have increased,” he pointed out. “Based on the already competitive nature of the staffing industry, many firms weren’t able to fully absorb these costs, which means they had to work directly with their client partners, passing through some of the increased costs to their clients. These have been challenging conversations for the most part, but our clients have understood that we’re not alone in the increased costs of doing business in this current legislative and economic climate.”
Leverant emphasized that staffing firms have been hindered by a skills gap in the healthcare industry.
“With the passage of the ACA, this is only going to increase,” he said. “As we see more and more people gaining access to affordable health insurance, we’re going to see increased patient populations at facilities across the country. This demand is going to strain an already short workforce even further. We continue to see demands in our primary fields of staffing - nursing, with a tremendous shortage for trained and experienced RNs experienced working in an acute-care environment.”
Health IT (HIT) is a growing staffing sector, Leverant noted.
“The increase of cybercrime has expanded the need for qualified professionals to create better security systems, while advancements in HIT systems are pushing hospitals and physicians to find qualified interoperability experts now more than ever before,” he said. “This job outlook will grow in the next few years.”
From a trending perspective, staffing firms continue to see U.S. employers leaning more frequently on staffing firms to help them build “contingent workforces,” including healthcare facilities.
“This is because of the inherent value we bring to the table to these entities, including time savings, flexibility, cost savings and risk mitigation,” he said. “That fourth ‘value-add’ – risk mitigation – seems to stand out as one of the most valuable. As a staffing firm, we’re the ‘employer of record,’ which means that we carry insurance liability on all fronts for our employees – their workers compensation, general liability, professional liability and unemployment. This value has increased exponentially, based on the ACA and post-recession economic conditions.”
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