Upload
melissa-vonderhaar
View
85
Download
0
Embed Size (px)
Citation preview
[cover story]
C S P Apri l 201442
C S P Apri l 2014 43
Saving grace or socialism? Law of the land or doomed
to fail? Capitalism or big government?
The polarity and confusion surrounding President
Obama’s Affordable Care Act (ACA) have run rampant since
health-care reform was signed into law four years ago on March
23, 2010.
Mila Spencer knows firsthand. Brought on as benefits man-
ager for La Crosse, Wis.-based Kwik Trip just after the law took
effect, she has had to navigate its mandates while upholding
the chain’s hard-earned reputation of taking care of its people.
“It’s compliance-driven,” Spencer says of the law. “We’ve
always managed our plan well, but now with all the regulations,
it may stop feeling like a Kwik Trip health-care plan.”
Even for a company with resources to address the issue,
Spencer’s job is complicated, she says, particularly regarding
part-time employees working more than 30 hours a week, who
under the ACA are deemed full-time employees.
“We’ve always had part-time benefits and a considerable
number of employees in that 30-plus range, so the potential
increase in cost is a concern to us,” Spencer says.
Also, Kwik Trip is self-insured, which adds to the impending
burden. “We have a 40% profit-sharing plan, so when you look
at a significant increase like that, it impacts the entire work-
force.” She declined to share a dollar amount for the increase.
C-store operators as large as Kwik Trip—which has 11,000
employees and 450 stores—all the way to single-store mom-
and-pops have suffered the extremes of frustration and ambigu-
ity over the new law, with only one thing for certain: The June
This Might Hurt a Little
An examination of what the Affordable Care Act means to your business
By Angel Abcede and Melissa Vonder Haar || [email protected], [email protected]
C S P Apri l 201444
2012 upholding of the ACA by the Supreme
Court and the President’s November 2012
victory over Republican hopeful Mitt Rom-
ney suggest that “Obamacare” is here to stay.
“There has been a tremendous battle of
sound bites over health-care reform,” says
Nick Tate, deputy heath editor for Newsmax Media and author
of the New York Times best seller “ObamaCare Survival Guide.”
“What’s happening now is some of the practical implications are
starting to play out.”
Tate himself embraced the moniker “Obamacare” because
while opponents initially used the name to demonize the law
and forever tie the reform to its No. 1 backer, he believes it’ll be
Obama’s legacy if history proves the program a success.
Speculation aside, Tate says the law has its pluses and minuses.
On the plus side, certain individuals are clearly ahead: Those
with pre-existing conditions won’t be penalized when obtaining
insurance; those younger than 26 can stay covered under their
parents’ policies without penalty; and several advantages play
out for seniors.
Businesses with fewer than 25 employees can take advantage
of new tax breaks, while those with fewer than 50 employees can
sign on for what may be less costly plans via government options.
But for businesses with 50 employees and more, the picture is
less rosy. Tate admits that in many cases, premiums will rise and
employers will have to make active choices about how to react
when mandates fi nally settle out.
Tate’s advice is to stay calm and focused. “You’ve got to get
beyond the political debate,” he says. “Whether you’re a small,
medium or large business, you can make smart choices to maxi-
mize tax breaks, federal subsidies and other protections to mini-
mize the fi nancial impacts. But you can only do that if you’re an
informed, savvy individual or business.”
It’s not easy, thanks in part to the shaky rollout of the site
healthcare.gov and the program’s initial online enrollment, as
well as the law’s numerous updates and delays.
Some of the most pressing questions include:
▶ With so many delays and changes for both businesses and
individuals, what will the law actually look like when it’s fully
implemented?
▶ Allegedly, 7 million individuals needed to enroll by the
March 31, 2014, deadline for the ACA to be a success. While
numbers have yet to fi nalize, what happens if it falls short?
▶ Should naysayers hold out hope for a repeal or replacement?
Since 2010, retailers have examined any number of ways
to avoid the cost increase the law could bring. In late 2012, the
Huffington Post reported that Royal Farms,
a 155-store chain based in Baltimore, made
efforts to shift all its store-level staff to part-
timers. The chain did not respond to requests
to confi rm the status of its efforts or comment
on that report.
While others have taken less dramatic approaches, the post-
ponements and ongoing uncertainty are keeping everyone on
edge. Some chains, such as Cumberland Farms, Framingham,
Mass., are tapping Obamacare as an employer-of-choice oppor-
tunity, shifting toward a full-time employment plan. In the case
of Tulsa, Okla.-based QuikTrip, it’s improving an already-robust
benefi ts plan.
“Our employees follow the news, they hear about other
companies cutting back hours—QuikTrip’s not doing that, so
it’s a huge morale booster,” says company spokesperson Mike
Thornbrugh. “The only reason QuikTrip is successful is because
of our employees. We’re going to take care of them regardless of
what the federal government does.”
Gus Olympidis, president and CEO of 60-store Family
Express, Valparaiso, Ind., says, “Our strategy, our inclination
is [to] stay the course, to differentiate ourselves by delivering
a package that is better than average. Obamacare creates an
equalizing effect on a certain level. How are we going to be better
than the better players, who are also in search of better people?
At this point, we’re currently putting everything on hold. We’ve
got time now. No decisions have been made at this point.”
Meanwhile, others are seeking a balance between cost and
employee turnover.
“Going forward, we will look at health care and its costs every
year,” says David Crawford, vice president of operations for Las
Vegas-based Green Valley Grocery, which to date has offered
health care to full-time employees. “We’ll try to do what is best
for our employees, our business and our customers.”
You Are HereThe ACA is defi nitely a moving target. A quick review of just a
few ongoing developments at press time show the numerous
and seemingly arbitrary changes occurring with each passing
week, touching on the fl ux in deadlines, the program’s tenuous
progress and even the elements within the law itself.
Easily the most c-store-relevant adjustment has been the
fl uctuating deadlines for the employer mandate. Businesses with
more than 50 employees were initially told they’d have to offer
coverage to anyone working more than 30 hours a week once
the majority of health-care reform went into effect Jan. 1, 2014.
You’ve got to get beyond
the political debate.” “
C S P Apri l 2014 45
That deadline has now changed
multiple times. The fi rst delay came last
July, when the Obama administration
announced it was pushing the employer
mandate back by one year.
In a written statement on the Trea-
sury Department’s website (where the
delay was fi rst announced), the admin-
istration said the decision was made to
accomplish two goals: “First, it will allow
us to consider ways to simplify the new
reporting requirements consistent with
the law. Second, it will provide time to
adapt health coverage and reporting sys-
tems while employers are moving toward
making health coverage affordable and
accessible for their employees.”
That date was further pushed back in
February 2014, when it was revealed that
companies with 50 to 100 employees will
have an additional year (until January
2016) to offer coverage, and companies
with more than 100 employees would
have to cover only 70% of workers in
2015 (as opposed to 95%). It was also
announced in February that employers
would have to provide certifi cation that
they did not drop workers in order to
avoid providing coverage.
Of course, by the time January 2016
arrives, retailers could be dealing with
a drastically different law—and costs—
than what’s on the books today. Other
updates are occurring as news about the
ACA’s execution emerges and measure-
ments of success become known.
Measuring UpThough there are plenty of “back-ups” in
place to ensure Obamacare works, regard-
less of signups, the Congressional Budget
Offi ce (CBO) originally had set the goal of
7 million insured by the end of the open-
enrollment period on March 31, 2014. That
fi gure later dropped to 6 million and, as the
deadline approached, the administration
Calculating the Scope of ObamacareThe Affordable Care Act (ACA) has probably been one of the most divisive and con-
troversial pieces of legislation to come about during President Obama’s administration.
Here are a few statistics collected by the Associated Press that explore that divide, as
well as its potential.
81% Young Democrats who approve of the Aff ordable Care Act, according to
a December 2013 poll by Harvard’s Institute of Politics
58%Young Democrats who approve of “Obamacare,” which is the same thing
55 millionEstimated number of uninsured in America
31 millionRemaining number of uninsured in America in 2016, when most of the law’s provisions
will take hold, according to federal projections
14States that set up their own health-insurance exchanges
36States that refused, leaving the federal government to do it
Source: Associated Press
Young Democrats who approve of “Obamacare,” which is the same thing
C S P Apri l 201446
backed off the goal altogether.
Shying away from that number is
understandable. As of late February,
about 2 million more people would have
needed to sign up in order to be deemed
“a success.” Part of the slow reception can
be attributed to the disastrous rollout of
healthcare.gov’s online system, which
experienced multiple crashes and frustrat-
ingly long wait times in its first months.
Beyond the potential failure to hit the
broader goal of 6 million to 7 million (the
final figure had not been reported as of
press time, though by early March signups
were said to be above 4.3 million) is the
deeper concern about who has signed up.
For the system to work properly, it’s crucial
that a decent percentage of younger, health-
ier individuals are enrolled and enrollees are
actually paying their premiums.
The age ratios are at best concerning,
and at worst disastrous.
According to U.S. Department of
Health and Human Services (HHS) data,
only 24% of Americans who enrolled in
ACA plans during first three months of
enrollment were in the coveted 18-to-
34 age bracket; by comparison, 55% of
enrollees during that time were 45 to 64,
an age bracket just shy of Medicare eligi-
bility and significantly more risky.
Knowing the 18-to-34 bracket would
be more difficult to attract, both because
of generally better health and feelings of
invincibility, ACA ads targeting this set
flooded the market in 2014. That led to
a 65% increase in January signups, but
healthy, younger individuals still only
accounted for roughly 25% of the 4 mil-
lion ACA enrollees.
As troubling as the age gap may seem,
measures such as risk corridors, reinsurance
and risk-adjustment programs have been
built into the law to ensure that—at least
in the early years—healthy individuals are
not paying increased premiums to cover the
high cost of older or sicker enrollees.
No, analysts say the more important
metric in the early success of the ACA
is one that is not yet measurable. In a
February interview with USA Today,
Washington and Lee University law pro-
fessor and health policy expert Tim Jost
suggested that the true impact health-
care reform will have on insurers will be
known only once officials have a better
idea if new policyholders are actually pay-
ing for their insurance plans.
“If nobody shows up, that will have
serious consequences in the risk pools,”
said Jost.
To date, the HHS has data only on
how many people have enrolled, not how
many have paid. Jost believes that 2015’s
premium rates will provide a better pic-
ture of how well the ACA is working.
“Are there insurers who drop out of
the exchange because they can’t make a
go of it?” he said. “Or do insurers jump
in if things look pretty good?”
Repeal, Replace?The questions don’t end there. Bigger
changes may surface as different parties—
some within Congress, others on the state
level—attempt to repeal, replace or amend
the law. These efforts include:
▶ Repeal: In Congress, a Republican
majority continues its attempts to repeal
or derail Obamacare. March 5, 2014,
marked the 50th time the GOP passed a
bill doing just that. Previous attempts have
failed, though Republicans have vowed
to make Obamacare a centerpiece of the
midterm elections. A full repeal may seem
unlikely, but could a Republican landslide
in 2014 change the discourse?
▶ Replace: Republicans are also look-
ing to put forward a more conservative-
friendly alternative to the ACA. House
Speaker John Boehner hinted at the impor-
tance of a Republican plan for health care
during a January House GOP retreat, and
the House Ways and Means committee had
initiated an effort at press time.
▶ State Battles: When the Supreme
Court ruled in favor of the ACA, it also
ruled that states could opt out of the
Medicaid expansion part of the law.
Many red-leaning states have done just
that (though a number of states who
once refused Medicaid expansion have
reconsidered, thanks to the hearty federal
funds to support the expansion). Other
states have passed strict laws about health
exchanges, making it exceedingly difficult
for individuals to sign up. It’s a situation
that varies from state to state and will
undoubtedly continue to evolve.
Inevitably, each individual result could
affect local retailers. “I tell everyone: Hope
for the best, plan for the worst,” says Tate.
Fundamentally SpeakingThe much-publicized, bottom-line
requirement of the law is that employers
with 50 or more full-time workers will have
to pay for health insurance or drop their
coverage and pay a fine of up to $2,000 per
worker per year to the federal government.
What’s probably less known are the
many standards to which these employer
plans must comply to be sanctioned by
the government. Tate has outlined a few
of what he considers “strict” criteria:
▶ Minimum Actuarial Value: Com-
pany insurance plans must have a mini-
mal “actuarial” value of 60%. This means
60% of an employee’s medical expenses
must be covered under the insurance
policy offered. So of all the dollars going
to an insurer, that insurance company
will have to cover at least 60 cents of every
dollar of a person’s medical expenses as
part of holding those policies.
▶ Deductible Limits: For individual
and small-group plans, the law limits
deductibles to $2,000 for an individual
C S P Apri l 201448
and $4,000 for a family.
▶ Affordability: Premiums can’t be
higher than 9.5% of the worker’s total
gross income (i.e., not household income,
as the law originally stated).
If plans don’t meet these criteria,
employers face a $3,000 penalty (higher
than the $2,000 per worker if the company
offers no plan at all) for every worker who
buys insurance from an Affordable Insur-
ance Exchange and gets a federal subsidy.
Some stipulations come in the form of
added taxes, basically addressing perceived
inequities in how companies cover certain
employees. Here are a few of those cases:
▶ Companies offering expensive
“Cadillac” health plans will pay new
taxes on them, starting in 2018. Under
the law, an employer offering a plan with
a premium that costs more than $10,200
for an individual ($27,500 for a family)
will pay a 40% excise tax on the amount
exceeding the threshold.
▶ High-wage earners will face
increases in Medicare taxes and net
investment income. Under the new law,
the Medicare Part A (hospital insurance)
tax rate rises by 0.9% (from 1.45% to
2.35%) on wages of more than $200,000
for individuals and $250,000 for married
couples filing jointly. Obamacare also
imposed a new 3.8% tax on net invest-
ment income (exempting home sales for
a primary residence) as of Jan. 1, 2013.
▶ Tax-free fl exible spending accounts
offered by many companies will face new
restrictions, including a $2,500 cap per
calendar year. Those with health savings
accounts will also pay higher penalties
for using that money for non-medical
emergency expenses, making them less
desirable (with the tax penalty rising from
10% to 20%). Health-care deductions will
also take a hit. Taxpayers will have to docu-
ment out-of-pocket medical expenses that
are at least 10% of their income to itemize
those expenditures on their taxes. Folks
who exceed the new ACA limits on capital-
gains taxes will also pay more in taxes.
Other mandates cover dependents of
workers, seniors and young people under
26 who can find alternative coverage,
fi nes for companies that “cushion” their
plans to account for workers with pre-
conditions and even a tax on companies
that purchase “fully insured products.”
Opting In, Up and OutOne of the effects of Obamacare will inevi-
tably be higher enrollment in whatever
plan a company provides, Tate believes.
The very nature of the policy encour-
ages it, with the main driver being the indi-
vidual mandate. Under the new law, every
American is required to have insurance
through some means as of Jan. 1, 2014, or
pay a tax to the Internal Revenue Service.
That tax amounts to $95 per year or 1%
of modified adjusted gross income per
individual next year, whichever is greater
(up to a maximum of $285 per family).
In 2015, the tax rises to $325 or 2% of
income per individual (maximum fam-
ily penalty: $975). And in 2016, it scales
up to $695 or 2.5% income per indi-
vidual (maximum per family: $2,085).
The government will likely collect the
money by deducting it from people’s tax
returns, Tate says.
The ultimate goal is to encourage
people into preventive care. People who
are insured are more likely to manage their
health care better, heading off the likeli-
hood of costly treatments later. It’s a strong
argument, says Tate. Other countries with
similar national policies spend far less on
health care than the United States does.
Thornbrugh says QuikTrip—which
not only offers health-care plans to full-
time workers but also has onsite wellness
centers for any employee (and their fami-
lies) and provides 30 different prescrip-
tions free of cost—has already reaped the
benefi ts of encouraging preventative care.
“The cost benefi ts are huge,” he says. “If
we can catch a lot of problems or illnesses
early, it not only helps the employee, but
they get back to work quicker.”
While analysts expect millions will
remain uninsured, even with the full
implementation of Obamacare, most
say these provisions will result in 95% of
legal residents having insurance by 2016.
For employers offering health benefi ts,
Tate says that day will have brought with it
a surge in enrollment and increased costs.
The larger intent was to lower overall
costs, but for businesses, that may not
be the case. Tate says the law contains no
cost-control provisions that will reduce
health-care expenditures or hold down
premiums in the short run. In fact, two
independent studies of health-care
spending and insurance premiums indi-
cate both have continued to rise since
Obamacare was signed into law in 2010.
In 2011, spending on health care rose
“The only reason
QuikTrip is successful
is because of our
employees. We’re going
to take care of them.
“
C S P Apri l 201450
4.6%, up to $4,547 per person on average,
says Tate, citing the nonpartisan Health
Care Cost Institute. It rose again in 2012
by a similar amount and was projected to
increase by about the same level in 2013.
In terms of employer-sponsored insur-
ance, an individual policy averages about
$5,884, with the individual’s share $999
and the employer’s $4,885, according to
the latest projections.
At the same time, insurance premiums
climbed 9% on average for a family in
2011—double the rate of wage growth—
to $15,073 in 2011 for employer-provided
plans, according to the nonpartisan Kaiser
Family Foundation. In 2012, they rose by a
more modest 4% to $15,745. And last year,
Tate says, they’re up, to about $16,351.
Giving a bit of context, the cost-of-
living increases annually calculated by the
U.S. Social Security offi ce run far below
these health-care increases: 0% in 2011,
3.6% in 2012, 1.7% in 2013 and this year
projected at 1.5%. Simply put, health-
care costs are rising two, three, even four
times as fast as the nation’s standard cost
of living.
For Spencer of Kwik Trip, the law in
many ways “encourages businesses to get
rid of employer-sponsored plans,” which
from the employee feedback she has heard
means confusion and worry. “They’re con-
cerned in that they always relied on the
Kwik Trip health plan being here.”
She credits the company for continu-
ally communicating with its employees to
calm those fears. And now that the govern-
ment has delayed the compliance date, the
company has time to continue to evolve
its plan. Since 2010, the chain has worked
with a third-party actuarial fi rm to better
address its full- and part-time options.
Small-Company ComplianceThe picture is different for smaller com-
panies. Obamacare provides employers
Creating a Healthy CultureAs some retailers look to cut back full-time employees to manage the impending
employer mandate of the Affordable Care Act (ACA), others have gone in the other
direction, putting employee-driven health and wellness programs at the center of their
company culture, regardless of what the government requires.
Cumberland Gulf Group: “It’s not just a smart thing to do—it’s the right thing
to do.” This is what Ari Haseotes, president and COO of Framingham, Mass.-based
Cumberland Gulf Group, said of the decision to offer more than 1,500 employees
health-care coverage beginning Oct. 1, 2013—more than a year before the 600-store
retailer needed to do so under the ACA.
QuikChek: “We are committed to being a great place to work … and part of that
investment is to have a wellness strategy to achieve a healthy workforce,” says Quick-
Chek CEO Dean Durling. The Whitehouse Station, N.J.-based chain offers its full-time
employees medical, dental and vision plans; fi tness-center reimbursement; discounts
on fruits and salads to encourage healthy on-the-job meals; free fl u shots; and a “Fit
for Life” wellness program that encourages employees to improve their health through
risk assessments and annual physicals in exchange for a discount on medical plan costs.
Kwik Trip: “Our co-workers are our No. 1 asset, and if they are your No. 1 asset,
then you make sure that you put your time and resources into taking care of those
people,”said Kwik Trip corporate communications manager John McHugh of the
January 2014 opening of an on-site health clinic, just the latest commitment in caring
for its employees, and perhaps reducing the company’s health-care costs at the same
time. Located at Kwik Trip’s La Crosse, Wis., headquarters, the clinic will service about
3,000 area employees, with online resources for 8,000 additional team members.
Sheetz: “With escalating health-care costs, we were looking for a way we could
provide a program for our employees that could help control health-care costs.
Our goal is to create a culture of ‘Shwellness,’ ” says Bill Young, Sheetz’s director of
compensation, benefi ts and risk. The 10,000-square-foot, $3.5 million Sheetz Health
and Wellness Center in Altoona, Pa., offers employees and their families primary care,
health assessments, lifestyle coaching, disease management services and an impressive
4,300-square-foot fi tness center.
QuikTrip: “We don’t ask what it costs. … The bottom line is everyone is healthier, and
the cost to us is irrelevant on the back side.” This is how Mike Thornbrugh, spokesper-
son for the Tulsa, Okla.-based retailer, responded in the wake of the 2009 opening of
QuikTrip’s second on-site employee health clinic—nicknamed “Doc in the Box”—in
Belton, Mo. “No matter what Congress decides, we’re going to do this,” he said. “No
offense to elected offi cials, but at QuikTrip, we think we know what our employees
want and expect, so we’re going to go forward with what we’re doing regardless.”
C S P Apri l 201452
with 25 or fewer workers new tax breaks
if they cover their health insurance. The
credits amount to 35% of what employ-
ers now pay for health-care premiums.
That tax credit rises to 50% in 2014.
Small companies—those with fewer
than 50 employees in 2014 and fewer
than 100 in 2016—will be able to take
advantage of new Small Business Health
Options Programs (SHOP), offering
lower-cost health insurance plans as part
of the Affordable Healthcare Exchanges.
The SHOP plans are projected to have
lower premiums than small businesses
have historically been able to negotiate,
once they become fully operational in all
50 states. Currently, only one such plan
exists, giving rise to speculation of further
deadline delays, Tate says.
All plans offered through the exchanges
are required to meet specific “essential
health benefits” designated by the fed-
eral government in 10 broad categories,
including maternity care, mental-health
services, prescription drug coverage,
pediatric care and hospital treatment. The
plans come in four varieties: Bronze plans
have the lowest premiums, but also offer
the lowest amount of coverage at 60%
of medical costs on average; Silver, 70%;
Gold, 80%; and Platinum, 90%.
An estimated 26 million people will
also qualify for federal tax credits to
help defray the costs of those plans. For
instance, families and individuals who
earn too much to qualify for Medicaid
but less than 400% of the poverty level
will qualify for a subsidy next year.
All that said, small businesses will
certainly feel the heat in the bigger pic-
ture, says Tom Robinson, president and
CEO of 34-store Robinson Oil Co., Santa
Clara, Calif. Those with fewer than 50
employees will still have to compete in
the labor pool with companies with bet-
ter health-care packages, he says. In addi-
tion, talks at the state and federal level to
increase minimum wage is among many
other issues hitting small businesses on
top of Obamacare.
“We keep wondering why the jobs
market doesn’t get better as fast as we
expect it should,” he says.
Ultimately, Robinson says he wants
Obamacare to work. “I’m not against the
idea of improving coverage, cost contain-
ment, better quality insurance at a better
price. … That would be ideal,” he says.
“I’m not negative—just not terribly opti-
mistic I’m going to get the desired effect.”
Knowing Where You FallFor retailers hoping to make sense of the
C S P Apri l 2014 53
law, the best place to start is knowing
what category of employer a retailer falls
into—25 or fewer workers, 50 or fewer, 50
to 99 and 100 or more.
That delineation may sound straight-
forward, but of course, details of the
law are never simple. The complexity
shows up in two areas: the definition of
a full-time employee and the concept of
full-time “equivalent.” So far, full time
has meant any employee working more
than 30 hours a week. However, at press
time, the House Ways and Means Com-
mittee approved a bill to define full-time
employees as working an average of 40
hours a week. How far the measure will
go to affect the law is unclear.
In the meantime, being clear about
the 30-hour requirement is an impor-
tant detail, because there are gray areas.
In some cases, an employee’s hours can
fluctuate week by week. In that instance,
an average over 12 months is a good
measure, says one health-care con-
sultant. If over the year the employee
works more than 30 hours on average,
then he or she is full time.
The real concept to grasp is that of
a full-time “equivalent,” says Jeff Kirke,
vice president of Holmes Murphy and
Associates, a health-care broker based
in Des Moines, Iowa. An employer may
have less than 50 full-time workers and
several part-timers. But two employees
working 15 hours can add up to a single
full-time person, thus triggering the full-
time “equivalent” scenario and bumping
the employer into the next bracket.
Whatever the case, “employers will
have to make a decision,” Kirke says. “But
it’s a core-beliefs discussion. You don’t
have to offer benefits today, but a lot are
because they want to be an employer of
choice.”
Indeed, for many businesses, the
new law merely laps up against formi-
dable packages they’ve already imple-
mented. In Honolulu, for instance,
employer mandates have been in place
for years, so Aloha Petroleum officials
say they already provide coverage to all
full-time employees. “This does raise
our costs,” says Richard Parry, president
and CEO of Honolulu-based Aloha.
“But it provides a valuable benefit to
our employees.” n