Obamacare Is Creating Jobs — Yes, Really

The verdict is still out on the health care law’s net impact on employment. For now, though, it’s offering some opportunities.

Taking the scary out of Health Care
National Journal
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Catherine Hollander
Sept. 26, 2013, 4:20 p.m.

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.


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.


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.


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