An interesting story in the Wall Street Journal discusses how larger employers are looking to comply with the Affordable Care Act by offering bare-bones coverage that does not even cover hospitalization, surgery, X-rays, or maternity care. Insurance brokers are now marketing these stripped-down products, particularly to employers in low-wage industries.
As Prof. Timothy Jost and others have pointed out, large-group plans (i.e., those for employers with more than 100 employees) and self-insured plans are exempt from one of the most important provisions in the ACA--the requirement to cover a package of "essential health-benefits" including ambulatory and emergency services, mental health care, and maternity and newborn care. Large-group and self-insured plans are only required to cover preventive health services, such as immunizations, well-child visits, and various screenings. By contrast, small-group plans (i.e., those for employers with 100 or fewer employees) must cover the full package of essential health benefits.
This is a major loophole in the ACA that has at least two negative consequences. First, it puts small- and medium-sized businesses at a competitive disadvantage against larger businesses that can offer stripped-down coverage and still avoid penalties under the ACA. Smaller business, meanwhile, must either offer more expensive plans with generous benefits or pay potentially hefty penalties.
This flaw in the ACA also hits low-wage employees of those large employers who decide to offer only the kind of bare-bones plans described by the Wall Street Journal. Employees in this situation likely would be better off if the employer had offered no coverage at all. If an employee chooses to accept the bare-bones coverage, he and his family would not really have what we think of as health insurance. If the employee is seriously injured in an auto accident, the low-benefit insurance would not cover the ambulance ride, would not cover the surgery, would not cover the hospital stay, and would not cover the rehabilitation. The employee could be left holding a bill on the order of tens of thousands of dollars.
On the other hand, the employee could decline the employer-sponsored coverage and go out and purchase coverage on one of the new Health Insurance Exchanges (or Marketplaces). However, assuming the bare-bones coverage offered by the employer was affordable and offered minimum value (as set forth in the ACA), the employee would not be eligible for a premium tax credit when he buys insurance on an exchange. For low-wage workers, the premium tax credit would otherwise cover a large percentage of the cost of premiums. But for the unlucky worker whose employer offers bare-bones coverage, he will have to pay the full sticker price if wants to buy health insurance with real benefits.
I welcome your comments on this issue, which appears to be a major structural problem with the ACA.
Monday, May 20, 2013
Thursday, May 9, 2013
Monday, May 6, 2013
WSJ: Employers Push Back on Health Law's Insurance Trigger
This story by WSJ discusses lobbying by the National Restaurant Association and others to raise the threshold (now 30 hours per week) for the definition of full-time employees under the ACA. A couple corrections/clarifications: It states that "Under the Affordable Care Act, employers must provide health insurance to employees working an average of 30 hours a week or more. If they don't, the employer faces fees starting at $2,000 per worker annually." But it should also note that this requirement only kicks in for "large" employers with 50 or more full-time employees or full-time equivalents, and even those businesses are not subject to a penalty for their first 30 full-time employees. I also have a nit-picky correction: large employers do not actually have to "provide" insurance to full-time employees, they only have to "offer" coverage to those employees to comply.
Wednesday, May 1, 2013
New IRS Proposed Rules on Affordability and Minimum Value
On April 30, 2013, the IRS released new proposed rules addressing certain questions about when employer-sponsored coverage is "affordable" and when it provides "minimum value."
This Health Affairs Blog post provides an excellent summary. Among other things, it discusses various safe harbors that the IRS has proposed to establish that a plan has minimum value. For instance, minimum value would be established for a plan with "a $3,500 medical deductible, $0 drug deductible, 60 percent medical cost sharing, a $10/$20/$50 copay tiered drug plan, and a 75 percent coinsurance for specialty drugs."
This Health Affairs Blog post provides an excellent summary. Among other things, it discusses various safe harbors that the IRS has proposed to establish that a plan has minimum value. For instance, minimum value would be established for a plan with "a $3,500 medical deductible, $0 drug deductible, 60 percent medical cost sharing, a $10/$20/$50 copay tiered drug plan, and a 75 percent coinsurance for specialty drugs."
Subscribe to:
Posts (Atom)