Thank heavens the windows were sealed because our recent Inc. Business Owners Council "New Member Invitational" on the subject of healthcare reform's impact on business owners was positively depressing. 

Expertly led by Andrew Torelli of e3 Financial, a benefits consultancy based in Orange County, California, we spent about an hour going through the various challenges and opportunities created by the Affordable Care Act.

As you can see from this chart above (source: e3 Financial) going through 2018, each year a few new initiatives creep in to the employer's domain, leading to new policies, new fees and new regulations. It's enough to make you jam your hands in your pockets the next time your management team recommends a new hire.

What's even more disturbing is how little clarity there is on any of the regulations which will determine so much of our approach to benefits with our employees. For example, at various stages of the legislation's implementation, the employer is required to provide a sufficient level of benefits but the legislation does not describe what a sufficient level is. At this point, I swear half the audience of business owners was ready to move their business to the Isle of Man.

On a positive note, we learned that the NY-NJ-CT area, much like other "high tax" states like California, already have in place many of the requirements and regulations that the federal Affordable Care Act requires. Other states, such as Louisiana and Mississippi, which have not historically provided the same level of safety net, will have much, much farther to go in order to be compliant with the new law.

But it's important to view this legislation as a work-in-progress. When you add millions of people to the insurance rolls through a collection of public and private programs, it's going to make some waves. Whether it's the threat of a shortage of medical talent or a slew of new fees and taxes, the system is going to be strained.

I suspect this important piece of legislation will be fought over for several decades to come. Thanks to Andrew Torelli, we now understand the basic issues as the federal government slowly pivots the nation's struggling healthcare system in a new direction, like a giant ship turning in the ocean. All that remains is to find out if we're on the Titanic or a Carnival Cruise.

Our thanks go to Rothstein Kass for hosting such an important discussion and to Andrew Torelli of e3 financial for such expert guidance about a complex topic.