Checking up on health insurance reform

health care reform puzzleWill “Obamacare” batter or bolster your bottom line?

The federal Affordable Care Act comes at a time of rising health insurance costs for business owners. Annual premiums for employer-provided family coverage grew to just less than $16,000 in 2012, a rate some 4% higher than 2011, according to a report from the Kaiser Family Foundation.

Will the new federal law help put a cap on rates? If you have 50 or fewer employees, you have a good chance of turning the new federal law to your advantage.

“Generally speaking, the law is more favorable to smaller businesses,” says Shawn Nowicki, director of health policy at Northeast Business Group on Health, a coalition of 175 employers, unions and health care providers headquartered in New York. Nowicki points to a number of advantages geared toward smaller operators. These include competitive statewide insurance exchanges, premium reform and tax credits.

Key positives

Here is a rundown of some of the Affordable Care Act’s key provisions:

Competitive exchanges Competition is good. That’s the theory behind the new statewide health insurance exchanges, designed to allow small businesses—and individuals—to shop for plans from competing carriers. These exchanges will be available for employers with 50 or fewer workers in 2014.

“To understand how the exchanges will work, imagine navigating a travel website that aggregates airfares,” says Karl Ahlrichs, benefits consultant for Indianapolis-based insurance broker Gregory & Appel. “You type in your parameters and the site sorts your options and you pick what you want. That’s what employees will be doing with the exchange sites.” Under the best of conditions, the new exchanges also will help trim human resources overhead by providing a host of robust administrative services.

“Businesses that send employees to the health insurance exchanges will be getting out of the health insurance management business,” Ahlrichs says.

Premium reform Small businesses have long been the targets of prohibitive premium hikes when one employee is hit with a costly illness. The new law levels the playing field.

“Starting in 2014, insurance carriers will not be able to set premiums based on health status, sex or claim history,” says Julie Stich, director of research at the International Foundation of Employee Benefit Plans, a research organization based in Brookfield, Wis. “That will help small group plans where one catastrophic claim can cause health costs to go up.”

Penalty exemption If you have 50 or fewer full-time employees, you will be exempted from penalties for not providing health insurance. If you have more than 50 employees and your employees themselves purchase insurance from the new state exchanges, you will pay a fine of $2,000 per employee who does so, excluding the first 30 employees from the assessment.

Tax credit The law provides for a tax credit for businesses with 25 or fewer employees if the company pays at least half of employee premiums.

Downward pricing pressure The law also may encourage more transparency in the area of fees for medical services, Ahlrichs says. In consumer-driven health plans people will be given a set amount of money with which they can shop for services. They will be able to go to a website, enter a service such as “appendectomy” and get a list of physicians that perform that procedure, a quality rating and a cost.

“Comparison shopping should put downward pressure on prices,” Ahlrichs says.

Transparency Do you know how much your broker is being paid for arranging your insurance? Today, such commissions are buried in your premiums. This may change under the new law as pressure mounts to reduce administrative costs. Brokers may start charging fees for their services, which may well dampen overall costs while promoting accountability and performance.

Employee mobility

There is another hidden benefit the new law may provide smaller businesses: access to higher quality personnel.

“Larger employers there are many high-quality, midcareer professionals who are frustrated because they cannot be very entrepreneurial,” Ahlrichs says. “They would love to join a smaller organization where they can try things out, or they might want to band together and start something.”

In the current system, Ahlrichs says, if such people quit their current jobs, there’s a good chance they will be uninsurable.

“They may have a daughter or wife who is a diabetic or cancer survivor. Or they themselves may have some chronic condition,” he says. “As a result, they are handcuffed to their desks because of health care.”

When the exchanges come online, the handcuffs will come off.

“There will be a significant shift in high-performing talent out of the larger organizations and into smaller ones,” Ahlrichs says. “This could be a huge benefit to small entrepreneurial organizations that position themselves as places where talented people can exercise some freedom.”

Decision time

Many business owners are upset about the minimum level of benefits required by the new law. In some cases those levels are higher than what currently is being offered in the workplace. That means greater expense in the form of higher premiums.

Will employers, as a result, drop health insurance coverage completely and opt to pay the fine? Ahlrichs thinks some will be tempted.

“A lot of chief executive officers may want to tell their employees, ‘I want out of the health care business. Go to the exchange and I’ll pay the $2,000 fine,’ ” he says.

Employers who decide not to offer health insurance should realize there are additional ramifications, Ahlrichs says. The first problem is that the $2,000 fine is not tax deductible. The second problem is that the employees who go to the exchanges find out insurance is not free.

“Maybe the premium for a family is $8,000 annually. Who pays it? If the employer wants to keep the employees, the employer may want to give them the $8,000 needed to pay for their insurance,” Ahlrichs says.

The story doesn’t end there, Ahlrichs adds: Premium payments are now taxable, so paychecks have to be “grossed up” to around $10,000 (in the above example) so the employees can pay premiums out of after-tax dollars.

Put it all together and ending a health insurance program can backfire, Ahlrichs says.

Realistically, though, the decision to retain or drop health insurance might depend less on the costs of noncompliance than on what other businesses in the same employment market are doing. No one wants to lose top talent to other employers offering better benefits.

As a result, many businesses seem to be playing a waiting game.

“We keep hearing statements such as, ‘We are afraid to be the first one to drop coverage, but we are not afraid of being the second or third,’ ” Nowicki says.

Maybe that’s why most employers say they will continue to offer health insurance.

“Employers see health insurance plans as important tools for employee satisfaction and retention and for attracting talent in the future,” Stich says. “In our surveys only 1% or 2% of employers say they will not provide health insurance coverage.”

Act now

What steps should you take today? Start getting up to speed on the opportunities and requirements of the new law. Then take steps toward compliance.

“Now is the time to get some education,” Nowicki says. “Meet with your broker or health insurance advisor and learn what is coming down the pike from the perspectives of benefits and taxes.”

Employers need to take a look at their current health insurance plans and make the changes required to be in compliance. Then communicate these changes to employees and revise the plan descriptions and handbooks.

As for the decision whether to continue or drop coverage altogether, you will need to tackle that one before the end of this year. The so-called “play or pay” provision will activate in 2014. That means employers with more than 50 employees must either offer health insurance with minimum requirements or pay a fine.

“It’s not too early to look at this area,” Stich says. You will need to determine if your company falls over the 50-employee threshold. That can be more difficult than it seems. You will need to calculate how many part-time and seasonal workers fall into the category of “full-time equivalent” employees.

As you tackle the vagaries of the Affordable Care Act, keep in mind that the entire law is very much a work in progress. The federal government will continue to issue regulations that interpret the law for real-world operations. State governments will jockey to set up exchanges of various kinds or opt to let the federal government do the job. Finally, companies competing for your employees may or may not set up attractive health insurance programs.

Perhaps the only thing that’s certain is that change is on the way. Now’s the time to get a handle on how the marketplace is changing. Then design a health insurance program that maximizes employee satisfaction while minimizing costs.

Figuring the tax credit

Answer the following questions: Do you have 25 or fewer full-time employees? Are their average annual wages less than $50,000? And do you contribute more than 50% to your employees’ total premium costs?

If your answers are “yes,” you may well receive some assistance with your health insurance premiums under the federal Affordable Care Act. You may be entitled to a tax credit of up to 35% of your contribution toward your employees’ health insurance for this tax year. The credit will increase to as much as 50% for the tax years 2014 and 2015.

For 2013, the full tax credit is available to employers with 10 or fewer employees whose average annual wages are $25,000 or less. The tax credit gradually scales down as workforce sizes and average wages increase.

Here’s an example. Suppose your business employs 10 full-time workers and the average wage is $25,000. If your annual employer health care costs are $70,000, you’re entitled to a $24,500 credit in 2013. Starting in 2014, the credit will be $35,000.

For help calculating your own credit, check the guidance recently posted on the website of the Internal Revenue Service. Go to and click on “Affordable Care Act Tax Provisions,” then click on “Small Business Health Care Tax Credit.”

Or check Go to “Healthcare Tax Credit” in the upper right-hand corner, then click on “Go to Calculator.”

Get some help

Knowledge pays. That goes double for a vast piece of legislation such as the Affordable Care Act. Want to learn more? Check these resources:

    • The U.S. Department of Health and Human Services has launched a website to provide information about the health care reform legislation. See
    • The Kaiser Family Foundation has created an outstanding compendium of documents summarizing the health reform legislation. Go to
    • The Small Business Administration has posted information on how health care reform will affect small businesses. Check
    • Mercer, the New York-based consulting firm, has mounted a useful site with documents and guidance about health care reform, geared primarily toward larger employers. Visit

How carriers are responding

The success of the federal Affordable Care Act will depend on the cooperation of insurance companies. Will they come through with competitive offerings in the statewide exchanges? So far the feedback is positive.

“Insurance carriers want to offer coverage in the exchanges,” says Robert Zirkelbach, spokesman for America’s Health Insurance Plans, a Washington, D.C.-based trade association representing the health insurance industry.

“Our members have made significant operational changes and responded to the new rules and regulations. Despite the short time period, carriers are doing everything they can to be ready when open enrollment begins in October.”

Other sources agree.

“Health insurance carriers have generally been cooperative and have put forth a number of ideas to make the exchanges successful,” says Shawn Nowicki, director of health policy at Northeast Business Group on Health, a coalition of 175 employers, unions and health care providers based in New York. “They are likely to participate because of the huge new market opportunity. The law may account for some 16 million new covered individuals nationwide.”

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