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.

National Journal
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.

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.

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.

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