New Benefits Math: Calculating ACA’s Impact

By Ben Sutherly
From the January 2014 issue of Columbus CEO

From the boardroom to the “mom-and-pop” store on the corner, the Affordable Care Act has spurred deliberation and debate about an employer’s role as a source of health benefits.

For some companies, the law has been chiefly a matter of compliance. For others, it has led to corporate soul-searching: Does it still make sense to offer health coverage in a changing regulatory and health-care landscape? If so, how can those benefits be sustained without breaking the bank?

In 2015, larger businesses with the equivalent of at least 50 full-time employees will have to offer their workers health coverage or pay penalties.

Companies are minimizing the number of workers who would trigger such penalties, said Tom Wagoner of Accelerated Benefits in Dublin, a local brokerage firm. Others are dropping employee spouses who can get coverage through their own jobs.

And firms are preparing for 2018, when a tax takes effect on “Cadillac” plans—high-cost, employer-sponsored health coverage. About 17 percent of organizations have begun to redesign their plans to avoid the tax, according to the International Foundation of Employee Benefit Plans.

Companies have been doing the math to see if they should send workers to new government-run marketplaces to shop for health coverage.

It’s likely that employers who pay at least 75 percent of their workers less than $15 per hour will find it’s prudent to do so, even if that decision triggers a future penalty, Wagoner said.

That’s because, depending on their income, some people would qualify for tax credits that would make coverage through a marketplace plan more affordable than what they can get at work.

“Why would a company pay (the majority of a worker’s premium) … if the government will pay it for them?” Wagoner said.

Whether they feel coerced by the health law or not, many businesses have realized it’s in their best interest to be strategic about their benefits.

“There’s a growing recognition that, for the amount of money that businesses are investing in their employees’ health benefits, there needs to be a stronger accountability that they’re getting a return for those investments, similar to any other investment,” said Jeff Biehl of Access HealthColumbus, a local health-care-improvement organization. “In both the public and private sector, instead of paying for claims, now they’re starting to act more like purchasers.”

It’s fair to say that the Affordable Care Act has been a catalyst for change in Ohio’s public and private sectors, Biehl said. Earlier this year, as a result of the law, the state received a $3 million grant that will be used to develop and test new ways of paying for and providing health care. The work has brought together both the public and private sectors, including companies such as Bob Evans, General Electric and Procter & Gamble.

The project will focus at first on primary care and payment for specific medical procedures like joint replacement. Its five-year goal: have up to 90 percent of Ohio’s population—including those with employer-sponsored coverage—enrolled in some kind of “value-based” payment model.

In the meantime, some employers are making their health benefits more sustainable by defining how much they’ll pay per employee for health care and sending workers to privately run health-insurance marketplaces to shop plans. Other common choices: charging workers extra to cover spouses who can get health benefits elsewhere, and health promotion programs that often include risk assessments and biometric screenings.

Whether the health law compels them or not, some business owners ultimately offer health coverage because it’s key to retaining talent.

“None of the voluntary reasons to offer insurance has disappeared,” said Paul Fronstin of the Employee Benefit Research Institute.

Though not required to do so, Victoria Hink recently decided to offer health benefits to her 10 full-time workers at The Angry Baker in Columbus’ Olde Towne East neighborhood. One reason for the decision: She had lost a key employee because the bakery didn’t offer that coverage. That worker has since returned.

“I have employees that have been with me for over two years now, people I want to continue to work for me as I grow,” Hink said.

Ben Sutherly is a reporter for The Columbus Dispatch.