Brokers Leaving Market, Groups Falling Out

I have posted an excerpt from a short article posted online at truthonthemarket.com and written by Thom Lambert. It goes over exactly this. Great site too, the contributors are law professors and/or economists specializing in business/corporate law with a libertarian slant.


Do Your Low-Wage Employees a Favor: Drop Their Health Care Coverage

Thom Lambert — 12 November 2012

...It is well understood in labor economics, and a vast body of empirical research demonstrates, that employee benefits are a one-for-one substitute for salary. When an employer purchases benefits for an employee, she normally reduces the employee’s take-home pay by an amount equal to the amount she spends on the benefit. The employer thus faces a “wage or benefits” decision whenever she sets up a employee’s compensation package, and she should settle on the combination that provides the most total benefit to the employee.

When the employer buys health insurance for her employees, they receive an effective subsidy from the federal government because compensation paid in the form of health insurance benefits, rather than salary, is not taxed. The amount of the effective subsidy is the sum of the payroll tax rate and the employee’s marginal income tax rate times the policy price paid by the employer. Because marginal tax rates increase with income, the effective subsidy for high-wage earners is much greater than for low-wage employees. (For most lower-income workers, the effective subsidy will be 22.65% * the policy price. That assumes a 7.65% payroll tax (1.45% Medicare + 6.2% Social Security) and a marginal income tax rate of 15%.)

If, but only if, an employer declines to purchase ACA-compliant insurance for her lower-wage employees (those earning up to 400% of the Federal Poverty Level), they may purchase federally subsidized insurance on a state exchange. The amount of the subsidy available on an exchange is greater at lower-income levels. It generally swamps the effective subsidy for employer-provided health insurance, especially at lower wage levels.

Because higher-wage employees (1) receive relatively higher effective subsidies for employer-provided health benefits, and (2) are not eligible for ACA subsidies on state exchanges, it makes sense for their employers to continue providing them with health insurance benefits. Lower-wage workers, by contrast, are better off if their employers stop compensating them with health insurance, for which only relatively small subsidies are available, and thereby enable them to take advantage of the large subsidies available to employees without employer-provided health care coverage.

An example may help here. Suppose an employer wishes to provide $40,000 in total compensation to a 40 year-old employee who is the head of a four-person household. If the employer purchases a family policy for the employee (approximate cost $12,000/year), it will pay the employee $28,0000/year. The employee will pay no payroll or income tax on the component of her compensation provided as health insurance, so she receives an effective federal subsidy of $2,718 (22.65% * $12,000). If the employer were to drop health care coverage, the employee would receive all her compensation — all $40,000 — as take-home pay. On the incremental $12,000 paid as cash rather than benefits, she’d have to pay $2,718 in tax, but she would now be eligible to purchase her own insurance at a subsidized rate. The ACA would limit her out-of-pocket insurance expense to 4.95% of annual income ($1,980), which means she would receive a whopping $10,020 subsidy on the $12,000 family policy. This employee is $7,302 better off if her employer drops coverage (costing her $2,718 in foregone tax subsidy) and allows her to access the more generous subsidies available on state exchanges (benefiting her by $10,020).

In a competitive labor market, we can expect all sorts of employers seeking to attract lower-wage workers to follow this ”pro-employee” practice. We can also expect ACA-proponents and a compliant press to pillory such employers. The real culprit, though, is the group of policymakers who forced upon us the perverse set of incentives known as the Affordable Care Act. Sadly, it seems it’s here to stay.
 
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The ACA has made offering group health insurance to employees financially irresponsible regardless of the employees income level. Anyone who sales group health insurance please explain to me what happens if an employee gets so sick they can't work. Can they keep there insurance?

That's a pretty big assumption. I work in both indy and small group. My small groups that have kept their benefits have done it because they want to be that kind of employer. None of them are SHOP eligible. Some have chosen the indy route, mainly because they are predominately blue collar and it is a better deal for their employees to go on the exchange, especially for their dependents, who become subsidy eligible.

If an employee gets sick and goes on FMLA, they would be eligible for COBRA (or state continuation) for the duration of the illness. (This depends on the company. Some companies pay for health insurance during FMLA) However, they are still employed, so they are not subsidy eligible on the Exchange.

The network issue is actually state specific. The PPO indy plans on and off the exchange with the colored company are using the same network as my groups. Its the HMO network that's different (and terrible!)

Hopefully you have figured out at this point that there is NO cookie cutter answer. Its group by group, person by person.

Having said that, I believe the small group business will be almost extinct by 2016,
 
As the math proves, and the article I posted expands on, low wage employees receive a windfall if their employers drop their coverage, whereas higher wage employees will not receive tax credits for their premiums and will balk. Since higher wage employees tend to demand better and more costly insurance, the money spent on their coverage with paying payroll tax is relatively more economical than what would be saved on payroll taxes for lower wage employees. Does that make sense?

Guru Dave: Why are you telling people with low incomes that medicaid is terrible? Kids are expensive and make lots of claims. If people qualify, especially in states with more reasonable medicaid limits than CA, then there's a reason and if the client would be burdened by cost sharing they should go medicaid if they get no subsidy or CSR. I believe the 90/10 rule applies here: 90% of your time is spent dealing with people who aren't on the right plan.
 
Well this is good feedback. I have yet to see an argument that address the original question. Why an employer would not transition the funds he was paying for health insurance premiums into HSA accounts that the employees purchase themselves. Oh wait that's one way
For employers to get tax dollars to employees. Yes my spelling and grammar have tons of errors. But the math is spot on. I guess if you can't answer the question one could just whine and name call. Hell I'm looking for an intelligent argument to come on my radio show and I have yet to find one.
 
Well this is good feedback. I have yet to see an argument that address the original question. Why an employer would not transition the funds he was paying for health insurance premiums into HSA accounts that the employees purchase themselves. Oh wait that's one way
For employers to get tax dollars to employees. Yes my spelling and grammar have tons of errors. But the math is spot on. I guess if you can't answer the question one could just whine and name call. Hell I'm looking for an intelligent argument to come on my radio show and I have yet to find one.

Ever heard of discrimination testing? Unless EVERY employee chooses an HSA, the employer can NOT fund individual HSA's. You'll always find a small % of employees will want a traditional copay plan.

So, here is you original question:

The ACA has made offering group health insurance to employees financially irresponsible regardless of the employees income level. (we proved this wrong) Anyone who sales group health insurance please explain to me what happens if an employee gets so sick they can't work. Can they keep there insurance?
(and we answered this one too, they can keep it via Cobra, or they can move into ACA plan with SEP)

Sounds like having choice is a better option for this sick person. In the old insurance world, I would agree with you that owning your own personal policy was the best strategy to avoid higher costs of Cobra and then a guaranteed issue policy. But ACA made that issue go away.
 
Well yes I have heard of discrimination testing and an employer can fund an employees Individual HSA account as long as the employee has a qualifing HDHP. It is not discriminating if the employee choose not to have a HDHP. Irs publication 969 .As far as proving anything I haven't seen any examples that would justify me changing my opinion. And yes you did answer the question and it was no. They can't keep there health insurance. If they take cobra it is still a short term plan. More than likely they will move into an ACA compliant plan. Again that's not keeping there original plan. This is one of the good parts of the
ACA law, eliminating job lock. Obviously there are several problems that need to be fixed but I think this is a start. I don't think we will ever go back to underwriting health insurance plans. I'm a republican and a20year life and annuity agent . I sold my brokerage firm a few years ago and now host a radio show. Honestly I'm looking for ammunition to hold these politicians both republican and democrats feet to the fire. If I as an employer chose to give my employees with families $6550 a year into there individual HSA or $3300 if they are single and the employees choose not to qualify for that benefit by purchaseing a qualifing HDHP plan then I would have to look at not havering that employee around anymore because there is an IQ problem.
 
Well yes I have heard of discrimination testing and an employer can fund an employees Individual HSA account as long as the employee has a qualifing HDHP. It is not discriminating if the employee choose not to have a HDHP. Irs publication 969 .As far as proving anything I haven't seen any examples that would justify me changing my opinion. And yes you did answer the question and it was no. They can't keep there health insurance. If they take cobra it is still a short term plan. More than likely they will move into an ACA compliant plan. Again that's not keeping there original plan. This is one of the good parts of the
ACA law, eliminating job lock. Obviously there are several problems that need to be fixed but I think this is a start. I don't think we will ever go back to underwriting health insurance plans. I'm a republican and a20year life and annuity agent . I sold my brokerage firm a few years ago and now host a radio show. Honestly I'm looking for ammunition to hold these politicians both republican and democrats feet to the fire. If I as an employer chose to give my employees with families $6550 a year into there individual HSA or $3300 if they are single and the employees choose not to qualify for that benefit by purchaseing a qualifing HDHP plan then I would have to look at not havering that employee around anymore because there is an IQ problem.

In a small group world, eliminating group coverage to allow for exchange/subsidy eligibility and funding an HSA isn't a horrible idea. It would even work for some companies. However, you are looking for a "one size fits all" answer and it doesn't exist. Thank goodness. If it did exist, I would be out looking for a new career.

Based on your comments, I would assume you are on the right side of the spectrum and so is your audience. Explaining HSA's to that market and the dollars is a different conversation that when talking to an employer, who may be on the right, but has several lower paid employees he wants to keep happy. And explaining to the group how HSA's work without copays is a nightmare. (I've tried!) Unless he is funding it to the max and debit cards are used, this is a very tough sale to the employees. Plus, if he's doing this, he probably doesn't like the individual plans to begin with.

Right now, one of the biggest issues is convincing the public that the individual plans now offered are similar to group plans. (Again, this is state specific). There is a 70 year history of people thinking if you don't have coverage through your employer, than you have BAD coverage. That's no longer accurate, but you can't change the country's opinion in 3 months.

Good luck with the show!
 
The ACA has made offering group health insurance to employees financially irresponsible regardless of the employees income level. Anyone who sales group health insurance please explain to me what happens if an employee gets so sick they can't work. Can they keep there insurance?

The comic relief of this thread is immeasurable. Thank you guys so much.

I must agree with the general sentiment against your argument. To say that PPACA has made offering group health insurance to employees “financially irresponsible” regardless of the employees income level is just an “irresponsible” statement.

I am 57 with spouse coverage. The premium rate on my company group plan is under $2,200 per month, of which I contribute $400. Benefits are; $500 deductible, 100% thereafter, $25/35 office visits, RX of $25/35. An obvious rich plan of benefits for a group. I just checked options available to me on the exchange. Low cost is a $6,350 deductible and $979 per month cost to me. I am not eligible for any tax subsidy.

Based on this example, how would my employer be financially irresponsible by continuing the group plan? And please do not state that I am an anomaly, because it is not true. Most (90% or more of the employees) will fall into the same situation of having to pay more, for less coverage.

By the way, if you would like to strengthen your position you may want to consider improving your communication skills.
 
The comic relief of this thread is immeasurable. Thank you guys so much.

I must agree with the general sentiment against your argument. To say that PPACA has made offering group health insurance to employees “financially irresponsible” regardless of the employees income level is just an “irresponsible” statement.

I am 57 with spouse coverage. The premium rate on my company group plan is under $2,200 per month, of which I contribute $400. Benefits are; $500 deductible, 100% thereafter, $25/35 office visits, RX of $25/35. An obvious rich plan of benefits for a group. I just checked options available to me on the exchange. Low cost is a $6,350 deductible and $979 per month cost to me. I am not eligible for any tax subsidy.

Based on this example, how would my employer be financially irresponsible by continuing the group plan? And please do not state that I am an anomaly, because it is not true. Most (90% or more of the employees) will fall into the same situation of having to pay more, for less coverage.

By the way, if you would like to strengthen your position you may want to consider improving your communication skills.

Well looking at your numbers you are saying you like The Employer paying $21,600 in premiums so your out of pocket is $500 vs $6350. You also contribute an additional $4,800 in premiums. You as an individual are risking worst case every year. (out of pocket $500 + $4800 = $5,300) if you get sick. Now the Employers stops offering the insurance and instead of giving $18,000 to the insurance company takes $6,550 and deposits it into you HSA. You as an individual go and buy your insurance for $979 x12 or $11,748 . This increased your risk by $6448 if you get sick and use your plan and hit the max out of pocket. However you are also getting $6,550 deposited every year. So if your unhealthy and hit your max out of pocket every year and spend all the funds in your HSA you would still come out ahead by $102
Yes I think the employer would still be irresponsible for offering a group health insurance plan. I think they should pay you $6,550 instead of $18,000 to the insurance company. Don't you think you would be able to spend those dollars more wisely than the insurance company.
 
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