COEUR d'ALENE - Josh Sears is a Boise attorney and an expert on the Affordable Care Act.
"I want to talk about ponies, though," he said to an audience of more than 150 employers Thursday at the Helbling Benefits' health care forum at the Hagadone Event Center. "Because ponies have two things going for them."
No. 1, he said, they're just adorable. No. 2, they have nothing to do with national health care reform.
Sears was the keynote speaker at the forum, which drew employers from throughout North Idaho.
The comic relief worked well as he waded into a contentious and complicated subject for more than an hour without putting anybody in the large conference hall to sleep. (As a father of a young daughter, he has learned a few things about ponies, too.)
Sprinkled in with quizzes about ponies, Sears slipped in meaty and meaningful chunks of health care reform detail.
For example, if an individual doesn't have health care coverage and they want to avoid a fine, they don't have to rely only on a government health care exchange to acquire it, he said.
"One caveat," Sears said. "If you want a subsidy, you do have to use the exchange."
Idaho has a state-based model, although right now the state is leaning on the federal www.healthcare.gov website instead of one of its own.
For individuals who aren't covered and are worried about it, there are multiple places to acquire insurance.
Sources include, to name a few, employers, Medicare, Medicaid, Tricare, any federal plan, government exchanges, and the private sector health care market.
"This is America still, you can buy insurance somewhere else besides where the government tells you," he said. It might not be sold exactly as it always has been, but it's still available, he said.
He took a moment to address what he called the "kerfuffle" over Americans losing their health insurance plans despite repeated promises they wouldn't.
If someone's "non-grandfathered health plan was canceled because it didn't comply with the fancy stuff that 'Obamacare' said it had to comply with," they might get a one-year pass, Sears said. Whether they get a pass depends on what Idaho Department Insurance director William Deal decides.
"As of 9:41(a.m.), which it is right now, director Deal has not said whether he is going to allow this or not," Sears said.
People losing their insurance "sucks," Sears said, but the fact that it happened shouldn't have come as such a recent surprise.
"We knew these plans were not going to be grandfathered in, we knew they were not going to comply and we knew before 2013," he said.
A lot has been said about the individual mandate, he pointed out, while much less has been said about the employer mandate, which starts in 2015.
He told the employers if they have 50 or more full-time employees, they must offer their people affordable coverage or pay a "tax."
He also took a minute to define a 'full-time employee.'
For 2015, an employee would be counted as full-time if they worked an average of 30 or more hours per week in a defined period of three to 12 months in 2014, he said.
From the employers he has talked to, he said, moving a number of employees down to part time to get under the 50-full-time-employee threshold doesn't pay off.
"This can be dangerous," he said.
That strategy would only work if a business was already close to 50 employees and had "lots of weird inefficiencies," he said.
"The loophole is basically closed because of the way that the counting (of full-time employees) works," he said.
Employers who don't comply - by not offering coverage or offering unaffordable coverage or coverage that doesn't provide "minimum value" - will pay penalties, he said.
The annual tax for not complying with the employer mandate is $2,000 or $3,000 per employee.
"But, I know we all really just want to talk about ponies all day," he said.
He quizzed the audience with his final piece of pony trivia.
"How much is the most expensive My Little Pony (toy) I could find on the Internet?" Sears asked.
It turns out it's $1,000, well short of the annual tax for employer noncompliance.
"Her name is Rapunzel," he said.
In addition to Sears, the forum featured speakers Mark Woodworth and Louann Schneidmiller.
Woodworth, a consultant for Helbling Benefits, has spent 18 years working in employee benefits. He discussed strategies to help employers apply the Affordable Care Act to their businesses.
Schneidmiller, a certified public accountant for Magnuson, McHugh and Co., specializes in individual and business taxation. She discussed taxes, penalties and credits for employers under the health care reform law.