Cottage industries always crop up after the passage of major legislation, and the 2010 Affordable Care Act is no exception, notwithstanding GOP predictions that it will be a job-killer. Businesses are hiring lawyers to interpret new rules, consultants to advise them on how to adapt to new regulations, and even dinosaurs to tromp around drugstores.
Green Cross Insurance came up with the dinosaur idea when it was trying to figure out how to recruit millennials to sell insurance to their peers—the young, healthy, and cheap-to-cover demographic that is the top target for insurers. The brokerage wanted to create a viral recruiting video but lacked inspiration. When a client showed up at the company’s Salt Lake City offices with two life-sized dinosaur costumes that he used for parties and events, “we were like, we totally need those in our videos,” says Christine Willmore, the firm’s vice president of marketing. “A lot of people think insurance is archaic anyway.”
The result: a two-minute, 15-second video featuring two people dressed as dinosaurs marauding around a Rite Aid and learning about the law’s new insurance provisions from a GCI agent manning a table at the store. Star Wars-style text accompanies the video: “Somewhere in a place not far from you … actually, just around the corner at your local pharmacy, is the opportunity of a lifetime!”
People whose job it is to take “the scary out of health care”—the title of the Green Cross promotional video—or, for the more skeptically minded, to make a buck off a confusing and hopelessly complex piece of legislation, will be in good company this year. Craigslist searches in U.S. cities pull up hundreds of Obamacare-related jobs, nearly all of which are for insurance-agent or “navigator” positions created by the law to help customers enroll for coverage using the new online marketplaces, or exchanges, required under the Affordable Care Act. There are less-conventional job listings, too. Employers are looking for people to answer questions about Obamacare at the mall, to drive a Ford E-250 van and trailer around on behalf of an insurance provider, and to post blog entries about the health care law’s provisions. Obamacare will require techies to run the exchanges and the federal data hub, as well as employees to answer customers’ questions while they’re shopping for insurance through the state- and federally run marketplaces. There will be fraudsters, too—but that’s another story.
CRUSHING JOBS, CREATING JOBS
Despite the GOP’s rhetoric about the Affordable Care Act being a ruthless job-wrecker (“It’s the biggest job-killer in this country, and it is hurting Americans, millions of Americans, who are losing their jobs,” Sen. Ted Cruz, R-Texas, said in a recent and typical statement), the law is unlikely to push the nation’s 7.3 percent unemployment rate very far in either direction. That’s because of a tension in the ACA’s provisions, according to a 2011 paper by Urban Institute economists John Holahan and Bowen Garrett. On one hand, the tax penalties facing businesses with 50 or more full-time employees if they fail to provide coverage for the people on their payrolls who work over 30 hours each week could reduce demand for labor. The penalties could prompt employers to drop their workers’ hours under that 30-hour threshold, reduce wages or other benefits to compensate for the new coverage requirements, or employ fewer workers altogether. The law’s reduction in Medicare spending could also lower demand for employees in the health care sector.
On the other hand, the expansion of coverage through a larger Medicaid program and subsidies for Americans to buy insurance through the online exchanges will likely increase demand in the health sector for providers to treat the millions of Americans the Congressional Budget Office predicts will gain health insurance. “Whether slightly positive or slightly negative, the ACA should not have a significant impact on overall employment,” Holahan and Garrett wrote. Holahan and other Urban Institute colleagues revisited the question of whether the ACA was a job-killer in a paper last October that drew the same conclusion—it wasn’t and would have “little impact” on overall employment—based on the experience of Massachusetts after the state passed its 2006 health care law.
Still, businesses’ moves to cut part-timers’ hours are grabbing headlines and have been interpreted as a response to the law’s requirement to provide health coverage for workers who clock in for 30 hours or more per week. SeaWorld Entertainment, which runs theme parks, told The Orlando Sentinel earlier this month that it will reduce part-time staffers’ weekly hours from 32 to 28. Wisconsin’s WKOW in Madison reported that retailer Lands’ End would drop hours to 29 a week or less, and Fox News obtained a memo from movie-theater operator Regal Entertainment Group explicitly tying a reduction in its part-time workers’ hours to the health reform law. Each of these moves has provided fodder for critics of the Affordable Care Act.
The cottage industries are part of the “on the other hand” narrative. They fall into three general buckets:
•The coverage-oriented category, which includes call centers set up to answer questions about the law and in-person navigators and “assisters” who will help sign people up for insurance coverage. (The law requires all states to have navigators; assisters are required only in the seven states that are running exchanges in partnership with the federal government. Both are government-sanctioned helpers tasked with spreading awareness of the law and helping people enroll for coverage; they perform basically the same tasks, although states have some flexibility to define the roles and required training for each.)
•The technology jobs needed to launch insurance exchanges, manage the federal data hub, and provide better digital performance measures for health care providers.
•The typical cottage industries that follow any major piece of legislation: the lawyers, consultants, and former administration and congressional staffers who are now advising companies on how to deal with the new rules and regulations.
Melissa Pappas, president of Athena Consulting, a Maryland-based staffing and executive search firm that specializes in state and local health and welfare services agencies, says the run-up to Oct. 1 has been “wild” in her office. Athena won a contract months ago to hire health insurance navigators and assisters for Maryland and assisters for Delaware. The company will also help staff Maryland’s statewide Affordable Care Act call center. But the firm couldn’t actually make offers to anyone to work as a navigator or assister until mid-August, when the Health and Human Services Department awarded $67 million in navigator grants to organizations across the country. Now, Athena is sprinting to get ready for Oct. 1. The firm is interviewing hundreds of applicants by phone, and each of its recruiters is conducting 10 to 12 in-person interviews every day, working to hire as many as 100 people in that short amount of time, including 22 navigators. “We actually had to hire three additional recruiters in the last three weeks just to help us get through this, because we couldn’t handle the volume,” Pappas says.
While Pappas is operating on a compressed timeline, the health IT sector has had a longer ramp-up to this fall. Adnan Ahmed, the head of Client Network Services, a Maryland-based health IT company, estimates he has hired 150 people in the past year and a half to keep up with demand. “[Obamacare] could be considered a Y2K of health IT,” he says, referring to the tech-job-generating millennial fear that computers would malfunction at midnight on Dec. 31, 1999. By putting an increased emphasis on quality measures and accountability in the health care sector, the ACA will bring a “major transformation” to his industry, Ahmed predicts. The law contains provisions that require performance feedback and metrics from providers. Beneficiaries and payers also want information in real or near-real time. “That is putting a lot of pressure on organizations to ensure that their data is accurate, secure, and readily available,” Ahmed says.
Data security has become a politically sensitive topic of late, as Republicans have asked for the law to be delayed until the government proves that personal information will be adequately secure on the exchanges, and they have introduced legislation in the House and Senate that would require the government to confirm it has stronger safeguards in place before rolling out the law. The administration says it will be ready for open enrollment by Oct. 1 and has released a fact sheet defending the security of the federal data hub, which was established by the law to verify consumers’ eligibility for subsidies and enrollment (it is a target of GOP criticism as well).
While the law, which President Obama signed on March 23, 2010, was an obvious boon to the health IT sector, some insurance brokers worry that the online exchanges—designed to make it easy for customers to compare health care plans—could make them as obsolete as travel agents in an era of online booking. As Oct. 1 approaches, many insurance agents are seizing on the law as a way to reach new customers, signing them up for health coverage and then trying to sell them other insurance products. Green Cross Insurance is one example; peruse any job-listing website and you’ll find many more. “We have an opportunity as an insurance industry to either embrace the change and become fluent with what’s going to happen—and be a part of the positive change—or we can fight it. We’ve decided to be part of the positive solution,” says Green Cross’s Willmore.
Others are offering their advice as insurance agents and consultants. An eye-catching Craigslist advertisement on this front: “As a result of [Obamacare] we are in a wind tunnel full of $100 bills, and we are grabbing them. You can come along and help or stand on the sidelines and look.” No license is required for this position selling insurance and helping companies and individuals comply with the law, for which “A Boat load of money!” is promised as compensation. The author of the ad did not respond to National Journal’s e-mail requests for an interview.
One entrepreneur who did talk to NJ is John Finnessy, who used to work in mortgage banking. Now he’s selling his services—and those of GoSmallBiz.com, a small-business consulting firm started by former NFL quarterback Fran Tarkenton, and LegalShield, a sort of insurance plan providing firms with access to lawyers—as a kind of ACA business adviser. “You know how the navigator points you to Obamacare?” he asks. “I point the businesses to the people they’re going to need. I’m a business navigator.” Finnessy, who finds plenty of fault with the health care law, says he has seen small-business owners tear up in front of him out of concern for their future under the ACA. He currently has four full-time members on his sales team and is looking for more, although he jokes he doesn’t want to cross the 50-person threshold; that’s when the law’s mandate to provide coverage for employees kicks in.
With any complicated new piece of legislation comes demand for legal advice. Jeffrey Lowe, global-practice leader at recruiting firm Major, Lindsey & Africa, sees parallels with the financial-regulation law passed nearly a decade before the Affordable Care Act. “The securities lawyers joke that the implementation of Sarbanes-Oxley was kind of like the Full Employment Act of 2001 for securities lawyers,” says Lowe, who sees the ACA as the Full Employment Act of 2010 for health care lawyers. Michael McDonald, a product manager at Kelly Law Registry, a legal-staffing firm, says he’s seen estimates of a 20 percent increase in health care specialists in the legal field by 2018, or 600 new experts in health care law nationally.
Some of those experts helped write the Affordable Care Act. The New York Times recently studied the revolving-door phenomenon—the dozens of people who helped write the law and are now working in related private-sector jobs. Among those who have walked through that door are Liz Fowler, the Senate Finance Committee’s former chief health counsel, now at medical giant Johnson & Johnson, and former White House “health czar” Nancy-Ann DeParle, who is a partner in a private-equity firm that deals with health care investments. The Center for Responsive Politics found that health care lobbyists make up the largest share of those who came from government.
While the health reform law has created jobs analyzing and consulting on the ACA, it will also hasten hiring trends in the medical community that predated 2010. “We would see increased demand for all kinds of health care professionals, and a shortage—even without health care reform. Health care reform just puts an accelerator on that,” says Susan Salka, the chief executive of AMN Healthcare Services, a California company that does health care staffing and consulting with a focus on medical staff. As more people gain health insurance, more people are expected to seek medical care, exacerbating the current physician shortage (this is where the political rhetoric about waiting in line for days to see your doctor comes from). But the law is also expected to increase demand for certain specialized types of health care workers, such as case managers. These positions existed before 2010, but with the penalties the law will slap on hospitals with excessive readmissions, they are poised to be in higher demand.
Obamacare has generated work for many consulting firms. Salka has seen increased interest in AMN’s new “managed-services program” offerings, in response to pressure on providers to become more efficient and outcomes-oriented. “We’ve hired people because of the new workforce solutions that our clients want to better manage their staff because of the implications of the ACA,” she says.
INTO THE FUTURE
Green Cross Insurance, the Utah-based company that produced the dinosaur video, isn’t sure what the future will hold. The company, which is working with Rite Aid, was established in its current form earlier this year to help customers sign up for coverage under the health reform law. The firm had to staff up quickly, having formed less than a year before the Affordable Care Act’s open-enrollment period was set to begin and with an agreement to provide a representative in up to 2,000 stores nationwide starting Oct. 1. Green Cross is hoping to expand beyond the initial 2,000 agents and use them to sell other products, such as life insurance, to the previously uninsured. It’s hoping for more alliances with trade associations, employer groups, and retailers.
It is impossible at this stage in the ACA’s implementation to quantify just how many opportunities it will create, or how many will be lost as employers find their footing in the new health care world. Most staffing firms couldn’t provide national data on the expected ACA employment trends, but they all agree a shift is taking place in major industries related to health care. Health care and social-assistance jobs currently make up 12.7 percent of the nation’s nonfarm employment; 1.1 million people are working in legal services, and about the same number are in management and technical consulting. An additional 294,000 work for staffing firms. The law has been good to the consulting and staffing firms so far, and to the call-center workers and navigator-grant recipients. Some of these jobs will be short-lived (the in-person assisters, for one, won’t necessarily be needed after open enrollment ends in March, at least until the next sign-up period). Others, such as the health IT specialists, are likely to be in demand for years to come.
The public is so divided over the ACA that any jobs added here and there are unlikely to get much attention. According to the latest Kaiser Family Foundation tracking poll, 42 percent of respondents have an unfavorable view of the health care law. Headlines are much more likely to stem from employers such as SeaWorld cutting hours than the hiring of consultants to interpret the law. And even if dinosaurs help persuade some millennials to become health insurance agents, public opinion is not likely to swing in the law’s favor until Obamacare produces what it promised: lower premiums, broader coverage, easy insurance-shopping experiences, and expanded access to quality care. Those are the types of changes that will convince Americans that health reform is working.