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Two years in: Health reform complex, uncertain

ST. PAUL -- The Patient Protection and Affordable Care Act may simply be called "Obamacare," but no one calls it simple.

And despite its name, Americans should not expect health-care costs to drop any time soon.

The law was signed two years ago, but most who would be affected waited to see what the courts and voters decided before digging too deeply into it. Those issues have been resolved and, with a deadline looming in 10 months, the scramble is on to implement Obamacare.

"Uncertainty" and "complexity" are two main traits of the federal law, said Kate Johansen of Minnesota Chamber of Commerce.

More than 10,000 pages of rules help define the 900-page law, Johansen said, with more to come.

"It was largely overwhelming," she said about how businesses viewed the law, which among many, many other things may change how they handle employee health insurance.

The term "affordable" in the law's title may be misleading to those expecting insurance costs to dip.

"Insurance will be more comprehensive than what is on the market today, so coverage will be more expensive," said April Todd-Malmlov, who is coordinating establishment of a health-care exchange that will provide Minnesotans a new way to buy insurance.

On the other hand, she added, Minnesota is trying to increase competition among insurers in the hope that keeps premiums down. Estimates are all over the board about Obamacare's cost, but even many of the law's supporters admit costs may not drop right away.

"We are going to slow the rate of growth," said state House Majority Leader-elect Erin Murphy, DFL-St. Paul. "In some cases, people's cost will go down. But in most cases, I think we will finally see an opportunity to slow the rate of growth in health care costs."

Subsidies will be available for people up to 400 percent of the federal poverty rate, meaning a family of four making up to $88,000 a year would get federal help to pay for insurance. That helps explain a Massachusetts Institute of Technology study indicating that today's figure of 500,000 uninsured Minnesotans will shrink to 110,000 by 2015 under the law.

One of the most controversial provisions of the 2,700-page law requires most Americans to carry health insurance within a few years or pay a penalty. It places a penalty on many businesses that do not offer their workers insurance.

The law also expands the number of poor people who will receive federally funded health care, and it makes other changes as varied as allowing young adults to remain on their parents' insurance plans to prohibiting insurance companies from discriminating based on gender or pre-existing health conditions.

When Obamacare was debated in Congress, it garnered a lot of attention in splitting Americans between those who want more government involvement in health care and those who want to get government out. Discussion resurfaced during the presidential campaign, but it is not on the front burner for many Americans.

"I think people still don't understand what is going to happen." said Professor Lynn Blewett of the University of Minnesota School of Public Health.

The law makes massive changes in many parts of the health-care system, but Blewett said that many Americans may not notice.

Workers with employer-supplied health insurance should be the least affected, she said.

Minnesota is among the states with the highest rate of employer-provided insurance, and that is not expected to change.

"There still is a cultural expectation that a health insurance benefit is something people want," Johansen said.

Businesses will be affected big time, Johansen said, but even two years into the law many don't know what they will do, what their options are or how much those options might cost.

"We know slightly more every day," she said.

Many employers waited to make sure Obamacare was here to stay before investing much time figuring it out. Now, Johansen said, "there is a huge demand for information on how to comply."

Businesses "really are in a bind," she added, in some cases not even knowing what tax form to use.

As penalties for businesses not providing insurance to workers begin to come on line, employers are calculating whether it would be cheaper to pay the penalty or continue providing insurance.

Pappa John's pizza restaurants and Jimmy John's sandwich shops are among the most famous examples of what could happen.

Pappa John's officials say customers should expect prices to jump 5 percent because of higher insurance costs. Jimmy John's officials say they will need to trim hours so fewer workers qualify for benefits.

Blewett suggested that workers ask their employers about their plans soon: "If I lived in a small town and I worked for a small employer ... I would be saying, 'Are you paying attention to health care? Do you have information? I am interested in what is going to happen to my health care.' "

Nothing appears simple in the new law.

Perhaps Johansen best summed up the upcoming changes in a recent tweet: "Here's what you should know about health care: It's complicated, important and did I mention complicated?"