Recently there has been much in the news about employers shedding their health insurance administration burden when PPACA is fully implemented in 2014. One side of the political aisle says this won’t happen and the other side says it will. Neither side has any idea of what these new regulations will accomplish.
Before we discuss the employer mandate and how it will dramatically change we must first explain why the shift will be so easy. In 2014, PPACA will offer four things for individuals that will make employer plans obsolete. Guaranteed issue, no preexisting conditions, and community rating all will take effect. Simply put, you will be guaranteed the ability to purchase health insurance at any time and not be subject to coverage exclusions due to health issues. Your rates will be based on the pool of people and will only differ based on age (3 to 1 ratio), tobacco user (1.5 times regular rates), and geographical region. The fourth thing for individuals is that they will be eligible for subsidies if they purchase insurance on a Government exchange. Subsidies will be available for anyone earning up to 400% of the Federal Poverty Level. People who earn roughly $44,000 for single and $92,400 for a family of four will all qualify for some form of a subsidy on their insurance premiums. There is a fifth item that some believe will force people to purchase insurance. PPACA created a new tax that will be levied on individuals who choose not to purchase insurance. However, the fine for not purchasing in 2014 will be $95 for a single person ($695 for a family of four) or 2.5% in additional income tax, whichever is greater. As you can imagine, the high premium costs will send more people onto the roles of the uninsured as paying the tax will be drastically lower than purchasing a plan.
Essentially someone will be allowed to purchase insurance when they are in a situation when they need it and drop it when they don’t. Imagine purchasing hurricane damage insurance two minutes before your home is destroyed then being able to drop it once your settlement check has cleared and your new home is complete. In the world of property insurance many companies simply aren’t writing insurance on homes within a certain distance of the coast in Florida. Under PPACA the Government is forcing insurers to continue to write these policies even though the outcome of adverse selection is clearly there. Simply put, there is no way that this system the Government has designed will survive because…
Employers WILL drop insurance plans.
In private industry profits are the ultimate goal. The bigger the profit the better the company can grow. The bigger the profit the greater the dividend shareholders receive. The bigger the profit the more stability for the employees.
Employer sponsored health insurance premiums are one of the highest costs a business incurs. Most employers pay a fairly high amount of the premiums for their employees. The last several years companies have seen premiums increase on average of 10%+ per year. With the costs continuing to rise and no end in sight, many employers are looking for ways to exit the insurance business. Aside from premiums, employers also face added costs of administration. Some of these costs include: HIPAA and COBRA compliance, new hire and termination processing, employee communications, and in some cases, claims administration. Add to these costs the upcoming MLR rebates and many other PPACA reform regulations and most employers are looking at increased overhead simply to maintain regulatory compliance.
With the individual mandate and corresponding subsidies, many employers will see this as an opportunity to relieve themselves of the costly burden of providing health insurance. They see this as a way to shed one of their highest line item expenses and can sell their employees on it through wage increases and the promise from our Government that insurance will be available to them with a potential subsidy.
Through real case examples we can show that employers will come out ahead by discontinuing benefits and instead increasing wages to their employees. The pros of offering insurance to employees aren’t close to the actual cons of dropping it. The two main pros are the advantage of tax deductible premiums and the other is that offering a solid plan with contributions in many cases gives employers a leg up in the hiring process. The big con is that if you have more than 50 full time equivalent employees you will have a fine to pay the Government if you don’t have a “qualified” plan offered to employees. If you are under the 50 employee threshold then there is absolutely no reason to continue to offer benefits. Cut your costs and give employees more in wages. They can have flexibility to purchase a plan through the Government exchanges and be eligible for subsidies without the employer having to deal with the ongoing administration and cost increases.
Here is a real example of a small group who can save significantly by eliminating their current insurance plan. Savings and Loan limited has 34 employees and offers two comprehensive benefit plans to their employees. They pay 80% of the premium costs for employees and 70% of the dependent costs. There are 17 single contracts, 8 two party contracts, and 9 family contracts. Based on average premiums of $4500 for single, $8200 two party, and $12,000 for a family (extremely conservative figures) this employer will spend $157,970 annually. Subtract tax savings out (34% corporate rate) and the actual cost to the employer is $104,260. If the employer were extremely generous in a “fair” way and gave all of the savings back to the employees each one would receive an equal amount of $3066.
In the 50+ employee segment the fines will be $2000 per employee but you get to subtract the first 30 employees from the equation. The real example here is Dr. Death’s Specialty Care. They employ 120 people and contribute 80% of the single cost but only 50% of the two party or family cost. They have 57 single, 33 two party, and 30 family contracts. Based on average premiums stated above here is how there scenario will work out. The premiums work out to $633,900. Tax savings are $215,526 for savings of $418,374. Then we subtract the fines payable to the Government for not offering a plan. We take total employees minus 30 and multiply by $2000. This works out to a fine of $180,000. Actual net savings will be: $238,374!!! Passing all of this along to employees would generate an annual wage increase per person of $1986.
The savings can be immense. These figures don’t include the reduction in administrative costs and the unknown future insurance premium increases.
One last thought: If you really think an employer is going to pass the entire amount along I have a bridge to sell you.