What The Health Care Decision Means for Your Small Business
The Supreme Court decision Thursday upholds the Affordable Care Act. But as a small-business owner, you may wonder what that means for you.
Most of the law's key provisions are set to take effect roughly two years from now, on January 1, 2014.
Based on the ruling, all individuals -- including small-business owners -- must have health insurance starting in 2014, or pay a penalty.
Certainly, the cost of health insurance has become a significant issue for small firms over the past decade.
Overall, about 71% of firms with 10 to 24 employees offered health insurance in 2011, compared with 77% in 2001, according to a 2011 Kaiser Family Foundation survey. Of firms with three to nine workers, just 48% offered insurance in 2011, compared with 58% in 2001.
The high-profile decision is a blow to the National Federation of Independent Business, a Washington, D.C., lobbying group that joined 26 states in fighting the mandate. The NFIB argued that small businesses would suffer if the owners of those entities had to pay for their own health insurance. The NFIB spent more than $1.2 million on the lawsuit in 2010 alone, according to disclosures.
Here's a look at how you might be affected:
Q. What if I am a one-person business?
A. The impact for sole-proprietors and others with no employees will be much like the impact on individuals.
For people in this group, the crux of the 2014 roll-out is the individual mandate, which requires all U.S. citizens and legal residents to have health coverage or pay a penalty.
You, as a one-person business, would buy insurance through your state's benefits exchange that will roll out in 2014.
There are some exemptions, however, such as those from certain religious backgrounds and those who are eligible for the so-called "hardship exemption" if the cost of the annual premium exceeds 8% of household income.
There are penalties intended to ensure compliance. The top penalty for individuals, once fully phased in, for not having insurance is $695 or 2.5% of income -- whichever is greater.
Q. I have employees or may be hiring. What provisions impact me?
A. If you have employees, the health-care provisions are a bit more complicated.
Since 2010, firms with fewer than 25 full-time equivalent employees have been eligible for a tax break if you cover at least half the cost of health insurance. (Full-time equivalent is the number of employees on full-time schedules plus the number of employees on part-time schedules, converted to a full-time basis.)
But only if you have fewer than 10 full-time equivalent employees and average salaries of $25,000 or less is your firm eligible for the full credit. Today, that full credit is 35% of your contribution toward an employee's insurance premium. As your firm size and average wage amount goes up, the tax credit goes down. And once your business hits 25 full-time equivalent employees or $50,000 in average salaries, the credit is completely phased out.
Q. What happens to the tax credits going forward?
A. In 2014, the state-based Small Business Health Options Program Exchanges will be open to small firms. And getting insurance through those exchanges could bump the maximum tax credit to 50% of your contribution, up from the current 35%.
But the tax credits won't last. The credit is only available for a maximum of five years and only two years once the exchanges are up and running.
Q. Will I have to provide health insurance to my employees in 2014?
A. No firm is mandated to provide insurance, but in 2014, only the smallest businesses will be exempt from penalties if they don't.
Q. What are the penalties and under what circumstances would I be exempt?
A. Once your firm reaches 50 full-time equivalent employees, a penalty will kick in if you fail to provide coverage for employees who average 30 or more hours a week in a given month. The penalty is $2,000 for each full-time employee in excess of 30 full-time employees. There are no penalties if part-time employees are not offered coverage.
A key factor in calculating the penalty is that the equation isn't based on full-time equivalents, but rather on actual full-time employees. That means some businesses that are subject to the penalty may end up owing nothing.
Here's a basic example: Say your firm has 25 full-time employees and 50 half-time employees that, combined, equal 25 full-time equivalents. Your firm, in effect, has 50 full-time equivalents and would be subject to the penalty if you don't provide health-care coverage. However, your penalty cost likely would be zero because the $2,000 tally starts at the 31st full-time employee and you only have 25 full-time employees.
Q. What should I know about getting insurance for my employees?
A. You can't just buy any old insurance to avoid the penalty. You have to provide so-called "minimum essential" and "affordable" coverage. Minimum essential coverage means covering 60% of the actuarial value of the cost of the benefits. And affordable means the premium for the coverage of the individual employee cannot exceed 9.5% of the employee's household income.
If the coverage you offer is unaffordable, qualifying employees can get subsidized coverage through the tax credit on the state exchanges. In such a case, you will have to pay the lesser of $3,000 per subsidized full-time employee, or the $2,000-per-employee penalty after the first 30 full-time employees.
Young Americans get Health Insurance, Still have debt
Source: eba.benefitnews.com
By Anna Yukhananov
June 11, 2012
Fri., June, 8, 20120 12:01am EDT WASHINGTON (Reuters) — Health care reform likely enabled about 6.6 million young adults to join their parents' health insurance plans last year, a report found on Friday, though problems with medical bills and debt remained an issue.
President Barack Obama's 2010 health care reform law allowed young adults — who previously had the nation's highest uninsured rate — to stay on their parents' private insurance plans through age 26.
This provision is perhaps the single most popular element of the Affordable Care Act, the nation's most sweeping healthcare legislation in nearly 50 years and Obama's signature domestic policy achievement.
Polls show Americans are sharply divided about the law ahead of a Supreme Court ruling on its constitutionality by the end of June.
The Commonwealth Fund, a nonprofit organization that analyzes healthcare issues, polled 1,863 adults between the ages of 19 to 25 and found 47% of them joined or remained on their parents' plans between November 2010 and November 2011.
This would translate into about 13.7 million young adults in the broader population.
Of those, 6.6 million would likely not have been able to be on their parents' plans before the law's passage, as they were not enrolled in college full time or had already graduated. Most insurance plans already allow full-time college students to stay on their parents' plans.
The results compared to a U.S. government survey that last year found about 21.6 million young adults had private health insurance — either through their parents, their jobs or other means — which was 2.5 million higher than before the law was passed.
But the Commonwealth Fund also found 36% of young adults between the ages of 19 and 29 — a slightly bigger group — had trouble paying medical bills or said they were paying off medical debt. And among those without insurance, this group rose to 51%.
Sara Collins, one of the study's authors and vice president at the Commonwealth Fund, said some young people need maternity coverage, which is often expensive but may not be provided by insurance plans.
Young adults also have the highest rate of injury-related visits to the emergency room - even above children and the elderly — and may have other health conditions such as HIV or the human papillomavirus.
The survey, conducted online, has an average sampling error margin of 3 percentage points.
IRS Provides Guidance on Health FSA $2,500 Limits
In a recent Notice, the IRS provided guidance on the effective date of the $2,500 limit on salary reduction contributions to health flexible spending arrangements (“Health FSAs”) and on when plans should be amended to comply with the limit
Background. Under the Patient Protection and Affordable Care Act (“PPACA” or “Health Care Reform”), the annual contributions permitted for an employee under the Health FSA component of a Cafeteria Plan will be capped at $2,500. This is effective for “taxable years” beginning after Dec. 31, 2012.
New guidance. Notice 2012-40 provides the following guidance and clarifications regarding the $2,500 limit.
- The $2,500 limit does not apply for plan years that begin before 2013.
- The term “taxable year” refers to the plan year of the cafeteria plan (and not the tax year of the employee or employer). This means the period for which salary reduction elections are made.
- If a cafeteria plan has a short plan year beginning after 2012, the $2,500 limit must be prorated accordingly.
- The $2,500 Health FSA cap does not apply to any other “flex credit” offered under a Cafeteria Plan (such as dependent care assistance).
- Plans may adopt the required amendments to reflect the $2,500 limit at any time through the end of calendar year 2014, provided that they otherwise operate in accordance with the new limit requirements.
- In the case of a plan providing the optional grace period, unused salary reduction contributions to the health FSA for plan years beginning in 2012 or later that are carried over into the grace period for that plan year will not count against the $2,500 limit for the subsequent plan year.
- If one or more employees are erroneously allowed to elect a salary reduction exceeding the Health FSA limit, the Cafeteria Plan will not lose its qualified status if: (1) the terms of the Plan apply uniformly to all participants, (2) the error was a reasonable mistake and not due to willful neglect, and (3) the excess amount is paid to the employee and treated as taxable wages.
How do you size a 401(k)?
BY DAN COLE
April 30, 2012
Source: Benefitspro.com
In 2010 there were 362,757 401(k) plans with more than zero dollars in reported assets. All told, they added up to around $2.8 trillion.
But how do you slice up that market? And which end do you try to eat?
There are the outliers. More than 7,000 401(k)s held more than $30 million in assets. On the opposite end of the scale, the same number held less than $15,000. I don’t care how many participants you have, $15,000 is not a good amount to have saved for retirement.
But more likely you’re right in the middle: $698,971 is the median (i.e. 50th percentile) 401(k) asset value, with more than 132,000 plans falling within one standard deviation (ooh – statistics!).
It’s a good bet that you’re not farming plans at all ranges of the curve. As in all things, there are fewer of the best than there are of the rest: that’s what makes them the best.
There are only 719 “mega” 401(k)s: those with more than $500 million in assets. However, that handful accounts for more than half of every single dollar invested by a 401(k). Plans with under $1 million in assets account for 60 percent of all 401(k)s, but only 3 percent of the assets.
Micro, small, mid, large, mega… Sure you’re more likely to snag a minnow, but your family will eat better if you manage to take down a megashark.
Interest in health insurance exchanges grows
More say they would shop for coverage through a health insurance exchange
BY KATHRYN MAYER
More people looking to buy health insurance say they would shop for coverage through a health insurance exchange if they had the opportunity, according to a J.D. Power and Associates health plan study.
A majority of health plan members who purchase insurance on their own say they would likely use one of the state health insurance exchanges (55 percent), while 39 percent of those covered under an employer-sponsored program indicate they would shop for insurance through an exchange if it were available.
And more, the study finds there’s an increased level of interest in state-sponsored health insurance exchanges compared to last year. In 2012, 37 percent of health plan members say they wouldn’t likely use an exchange, compared with 50 percent in 2011 who expected to continue obtaining coverage at work.
The level of interest among those who obtain health insurance through work is an important implication for the future of employer-sponsored care, says Rick Millard, senior director of the health care practice at J.D. Power and Associates.
The study also finds substantial interest among health plan members in private health insurance exchanges, in which an employer might provide employees with vouchers for purchasing health insurance independently. Roughly 41 percent of employer-insured health plan members indicate they would use this approach if it were available.
Not as Simple as Paying or Playing
By Jenny Ivy
With roughly half of employers saying they'll definitely be offering health coverage even after insurance exchanges begin, speculating with certainty (a bit of an oxymoron) that it's only a matter of time before companies drop health coverage is a futile argument.
Likewise, it's fair to say that there are several legitimate reasons for companies (particularly the bigger ones) to keep offering coverage, but we're only assuming the status quo won't change dramatically once health reform is in full effect. All you have to do is look at the numbers that are already dropping, and dropping hard. [See: Reform driving up health plan costs]
Studies, including the one released last week by Towers Watson and the National Business Group on Health, show there is a commitment among employers to do what they can to keep offering coverage in the near-term. Beyond 10 years, however, is when things get debatable. According to their employer survey, only 3 percent of employers are somewhat to very likely to discontinue health care plans for active employees in 2014 or 2015 without providing a financial subsidy. By the same measure, 45 percent of employers are somewhat to very likely to offer coverage to only a portion of their work force and direct the others to the exchanges.
While most employers will remain focused on sponsoring the design and delivery of their health care programs through 2015 (77 percent), they are much less confident that health care benefits will be offered at their organization over the longer term. Less than one in four (23 percent) companies are very confident they'll continue to offer health care benefits 10 years from now, down from a peak of 73 percent in 2007.
Unless there's a revolutionary way of delivering health insurance, employers will be circulating through all the options to combat high health care costs. The Towers Watson/NBGH survey shows health care costs per employee are expected to rise 5.9 percent this year, as compared to 5.4 percent in 2011. Health care costs per employee averaged $10,982 last year, and is expected to rise to $11,664 in 2012. Employees’ share of costs increased 9.3 percent during this period, to $2,764. This amount represents a 40 percent increase in costs from just five years ago, as compared to a 34 percent increase for employers over the same time period.
“As employers try to maintain the balance between containing costs and offering competitive total rewards packages, they are realizing that their future health care benefit choices are not quite as simple as ‘paying or playing,’” says Ron Fontanetta, senior health care consulting leader at Towers Watson. “In fact, there is a wide spectrum of design choices that will allow employers to develop a health care strategy that matches their unique objectives and workforce demographics.”
Besides actually cultivating healthier employees, the survey shows there are several emerging tactics they plan to use to control their costs:
- Spousal and dependent coverage surcharges: Roughly half of the companies (47 percent) increased employee contributions in tiers with dependent coverage, and about a quarter (24 percent) are using spousal surcharges, with another 13% planning to do so next year.
- Growth in Account-Based Health Plans (ABHPs): Nearly one in six companies (59 percent) are offering an ABHP today, and another 11 percent plan to do so by 2013. ABHP enrollment has nearly doubled in the last two years, from 15 percent in 2010 to 27 percent in 2012.
- Changing pharmacy landscape: Six in 10 companies have added or expanded step therapy or prior authorization programs, and 21 percent reduced pharmacy copays last year for those using a generic with a chronic condition (with another 16 percent planning to add this feature in 2013).
- Vendor management and transparency: Three in 10 companies (30 percent) have consolidated their health plan vendors in the past two years, and 11 percent plan to do so next year.