"ObamaCare/Patient Protection and Affordable Care Act," by Jeremy M. Evans ’11, SDCBA New Lawyers Division CLE Co-Chair

On Thursday, November 7, 2013, the New Lawyer's Division of the San Diego County Bar Association (SDCBA) and Labor & Employment Division of the SDCBA hosted a Continuing Legal Education (CLE) course on the recent updates and issues with ObamaCare/the Affordable Care Act, at the new ‘Bar Center at 401’ in Downtown San Diego. Thomas Jefferson School of Law (TJSL) graduates and NLD Co-Chairs of the CLE Committee, Jeremy M. Evans '11 and Amanda L. Thompson ’07, organized the event with Moderator and TJSL Professor Susan Bisom-Rapp. The panelists were top attorneys Kitty Juniper, Partner with Hooper, Lundy & Bookman, and Gregory E. Knoll, President and CEO of the Legal Aid Society of San Diego and Consumer Center for Health Education and Advocacy.

The purpose of the program was to discuss affordable health care from the perspective of labor and employment, consumer, health and policy, and economics. Overall, the program participants discussed the changes coming via ObamaCare/PPACA, educating employers, employees, and consumers, specifically the attorneys who represent them, so we can better represent and advocate for our clients, and addressing the economic impact of the PPACA and what introduction and enforcement means for businesses, employers, individuals and attorneys.

Event Moderator Professor Bisom-Rapp began the program and introduced the two panelists. Professor Bisom-Rapp is an internationally known scholar in the field of comparative workplace law, who writes about globalization, equal employment opportunity, occupational safety and health, and the rights of migrants. She is the co-author of a recent path-breaking casebook, “The Global Workplace: International and Comparative Employment Law - Cases and Materials.” Professor Bisom-Rapp is a distinguished and well respected Professor by her colleagues and students alike.

Professor Bisom-Rapp explained that the ACA is a very complex law, and provided helpful information and websites available to employers/businesses, employees/consumers, and labor unions in making sense of this large and complicated legislation. “She added that in academia among her professor colleagues, the prevailing issues revolve around the definition of a full-time employee under the ACA versus federal law, one says 30 hours, and another says 35 hours for statistical purposes, the individual mandate and penalties, and the use of the insurance exchanges, which has been under some controversy recently.”

Kitty Juniper represented the business perspective as an attorney who assists health-related clients with regulatory issues and developing new opportunities with health care reform. As a partner at a boutique health law firm, she assist clients in navigating the lands of ACO's and health care reform, strategic partnerships and collaborations, managed care and the current wild, wild health care industry west. She has over 24 years of private, government and corporate legal experience as well as positions in management and government relations.

Juniper discussed a few of the biggest challenges facing employers/businesses, employees/consumers, labor unions, and regulators as different aspects of the Affordable Care Act (ACA) are phased into the community. Both Juniper and Professor Bisom-Rapp noted that the incentives for employers/businesses and employees/consumers built into the ACA may cause employers to seek to avoid coverage (although SProfessor Bisom-Rapp provided statistics that such employment numbers were mostly unchanged), for example, by reducing the number of workers employed or lowering the hours that employees work. Employees, on the other hand, have an incentive to seek coverage from employers rather than to be compelled to buy it on their own or face a penalty.

Juniper also added some parody to the discussion by offering a Jimmy Kimmel poll where Americans were asked if they supposed or opposed ObamaCare or the Affordable Care Act (note: it is same legislation). People supported the ACA more than ObamaCare. The crowd had a good laugh. Juniper added some insight as to her appreciation of the insurance exchanges because consumers and businesses can compare plans to see what is best for their circumstances. Juniper also noted that the estimates of the uninsured will go down by 25 million people nationwide by 2016 under the ACA.

Greg Knoll oversees 120+ employees as the President and CEO of the Legal Aid Society, which provides legal services to low income individuals & disadvantaged communities for a variety of legal problems, including consumer, family disputes, welfare and health benefits, immigration and poverty law issues such as landlord/tenant disputes, disability support and family benefits payments. Greg is also a Board Member and Vice President of the San Diegans for Health Care Coverage.

Knoll discussed the two different and important aspects of the ACA that have been delayed until 2015, the employer mandate requiring large employers to offer health insurance to full-time employees (he states had to occur because the term and definitions in the ACA, specifically as to what is a full-time employee, need to be clarified and defined), and the limit on out-of-pocket costs (not applicable in California), which caps the costs that individuals and families can be compelled to spend on their health care. Knoll also commented on the reasons for the delays and the political and economic implications of the delays.

In terms of political and economic implications, Knoll noted that healthcare costs is the only industry where the cost on a graph continues to rise and suggested that something needed to be done about it (the ACA has nine titles, 400 sections, and 900+ pages of law and policy). Knoll added that when we look back on this time, we will laugh and wonder why it took so long to implement a healthcare program that every other major industrialized country in the world had done it years prior. Knoll pointed out that it took France, which ranks internationally as number one in the world in terms of healthcare provided, 25 years to figure out its national healthcare program (the United States ranks 46th right in front of Iran, at no. 47). He closed by stating that the success of the ACA will be in the U.S. Department of Health and Human Services ability to see problems and fix them with the existing ACA legislation in place.

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