OP-ED

What If the Supreme Court …

Consider these two scenarios.

What if the Supreme Court:

1). Strikes down the requirement that everyone buy insurance, or pay a penalty (a.k.a. “the individual mandate”), but leaves in place the rule that insurers are required to insure everyone — including those who are suffering from a preexisting condition?

or 2). Throws out both the individual mandate and the provision which says that insurers cannot either deny coverage , or charge higher premiums, if someone is already sick?

Begin with the first scenario: you are not forced to buy insurance, but when you get sick, insurers will be forced to cover you, charging the same rates they charge healthy people in your community (a.k.a. “community rating”).

What would happen?

History suggests that some insurers would simply get out of the business, and those that stayed would lift premiums to unaffordable heights. The Center for American Progress reports on the results in eight states that passed “community rating laws,” without imposing a mandate that everyone purchase coverage:

Kentucky: Forty insurers left Kentucky’s market by some estimates, and only two remained before the law was repealed.

Maine: Thirteen of Maine’s 18 major insurance carriers stopped issuing new individual policies. Many also doubled their premiums.

New Hampshire: New Hampshire’s insurance law left it with nearly no carriers in its individual insurance market.The state enacted an emergency tax to compensate insurers for the costs of the law, which was repealed in 2002

New Jersey: Premiums rose as much as 350 percent in New Jersey after its pre-existing conditions law took effect. Even HMO plans, which tend to resist premium increases, nearly doubled in price]

New York: The percentage of nonelderly New Yorkers without insurance grew 21 percent, with premiums increasing as much as 40 percent per year.

Vermont: Vermont fared better than other states with similar laws, but its premiums spiked an average of 16 percent in two years.

Washington: Non-managed care options disappeared entirely from Washington’s individual market. Eventually, entire counties had no private individual insurance options at all.

In other words, some insures either fled or stopped selling new policies, while those who stayed hiked premiums to reflect the cost of caring for an insurance pool filled with sick or disabled patients. (Without a mandate, many healthy patients are inclined to stay out of the pool until they fall ill.)]

Keep in mind that, even with an individual mandate, the insurance industry, as we know it, is not likely to survive another decade. Not long ago, Aetna CEO Mark Bertolini startled an audience at a Las Vegas conference by declaring that, for all purposes, the industry is a dinosaur on the verge of extinction.

And he wasn’t just poor-mouthing, says one of the industry’s sharpest and most knowledgeable critics, Wendell Potter, a former insurance executive turned whistle-blower. Is it “Time to sing, ‘Ding dong the witch is dead’”? asks Potter. “Not quite, but the day when most Americans get their coverage from what we think of as an insurance company is close at hand. It won’t be long before most of us get coverage through either a state or federal government-run plan or a local nonprofit company. The big investor-owned corporations like Aetna and the companies I used to work for, Cigna and Humana, know that the days of making a killing off of basic medical insurance policies are over. While Bertolini was by no means predicting that Aetna and its competitors were about to close their doors and get the hell out of our lives, he most certainly sounded the death knell for the standard business model insurers have followed for many years — actually insuring people.”

“’The system doesn’t work. It’s broke today,’ Bertolini said. ‘The end of insurance companies, the way we’ve run the business in the past, is here.”

A combination of Wall Street’s demands for big profits combined with the spiraling cost care has caused insurers to raise premiums to a point that insurance has become all but unaffordable for more and more individuals and small companies. Large employers are self-insuring and paying insurance companies only to administer their plans. Insurers know that if they keep on lifting premiums, they will only lose more customers. Meanwhile, the underlying cost of drugs, procedures, hospital care and doctors’ visits continues to climb.

In a recent New York Times Op-ed Ezekiel Emanuel and Jeffrey Liebman, both former advisers to the Obama administration, agreed that the demise of the industry is drawing near: “By 2020,” they write, “the American health insurance industry will be extinct. Insurance companies will be replaced by accountable care organizations — groups of doctors, hospitals and other health care providers who come together to provide the full range of medical care for patients.”

And that, Bertolini, Emanuel and Liebman say, is what will happen if the health reform legislation remains intact, and the individual mandate stands. Even then, over time, the insurance industry will wither away. This suggests that if the mandate is repealed, but community rating remains the law, the industry won’t gradually disappear: it could crash and burn.

In that case, anyone who is not protected by a large, generous employer who self-insures will be hard-pressed to find affordable insurance. Presumably, the subsidies for lower-income and middle-income Americans embedded in the health reform legislation would remain, but would they be rich enough to cover the new pricing? Probably not.

A More Optimistic View –Even if the Court Nixes the Individual Mandate, There are Remedies . . .

–Let People Opt Out of Insurance. Paul Starr, author of The Social Transformation of Social Medicine, has suggested that we let individuals opt out of the new insurance system, without a penalty, by signing a form on their tax return acknowledging that they would then be ineligible for federal health insurance subsidies for a fixed period — say, five years. http://www.nytimes.com/2010/03/04/opinion/04starr.html “During that time, if they had second thoughts and decided to buy health insurance, they would have no guarantee that they could find a policy or that it would cover pre-existing conditions. In other words, they would face a market much like the one that exists now,” he writes. “And while that’s hardly a desirable position to be in, they would have made the decision themselves, and the option to step outside the system would relieve Republican concerns about government mandates.”

I greatly admire Starr. If you want to understand what went wrong with our health care system, read his book. But if we tried his solution, what would happen to the children of those who decided to opt out? In our society, we would not turn our backs on them, even if their parents could not afford to buy insurance when they needed it. The children would receive care. Presumably, if the parents were in a car accident, or diagnosed with cancer, they, too, would be hospitalized and cared for, even if they couldn’t scrape together to money to purchase insurance. In other words, you and I would wind up covering them, and “free-ridership” would be alive and well.
Moreover, we need the premiums from the healthy, younger Americans who would be most likely to sign the opt-out clause. Without their dollars we won’t have the funds that we need to subsidize the care of sicker, poorer, and older Americans. To fund universal coverage, we need those premium dollars today, not twenty years from how. Eventually, (perhaps sooner rather than later, depending on the accidents of fate), the young and healthy will become sicker and older, and will find themselves on the receiving end of the subsidies. At some point, we all die, and getting off this planet tends to be expensive. In effect, healthy Americans would be setting aside money to pay for their future care. This is how insurance works.

This idea is appealing: carrots instead of sticks. It sounds like an easy way to persuade healthy people to jump into the pool. .As economist Mark Paul explained to Ezra Klein in a 2011 interview: “My fix would be to simply say raise everyone’s taxes by what a health insurance policy would cost — Congress definitely has the power to do that — and then tell people that if they obtain insurance, they’ll get a tax break of the same amount. So instead of a penalty, it’s a perfectly legal tax break.” http://voices.washingtonpost.com/ezra-klein/2011/02/an_interview_with_mark_pauly_t.html

Pauly, Klein explains, can be seen as the “father of the individual mandate.” Back in 1991, “he was the lead author of a Health Affairs paper attempting to persuade President George H.W. Bush and his administration to adopt a universal health-care proposal that would keep the government from eventually taking over the sector. ‘Our view is that excessive government intervention will make matters worse,’ wrote Pauly and his co-authors. ‘Our strategy, therefore, is to design a scheme that limits governmental rules and incentives to the extent necessary to achieve the objectives.’ At the heart of that strategy was the individual mandate,” Klein adds, “which would go on to be promoted by congressional Republicans, the Heritage Foundation, and Massachusetts Gov. Mitt Romney before being adopted by Democrats and becoming a bete noire of conservatives.”

It sounds like a perfectly reasonable proposal.

But here’s the catch. In order to generate the revenues needed to pay for the credit, Congress would have to raise taxes, or cut services. Given the stalemate in Washington, do you see legislators crossing the aisle to agree to a compromise that would do one or both? Even after the election in the fall, when no doubt voters will throw out some of the die-hards, it seems unlikely that liberals and conservatives will join hands. I hope I am wrong, but I suspect it will take at least two to four years before we have a working Congress.

In part 2 of this post, I will consider what will happen if both the individual mandate and the rule requiring insurers to take all applicants disappear.

For some of us, this is not the worst-case scenario. Premiums would not rise as rapidly. And some suggest, we could insist that the uninsured pay for their own care at point of service. In that way we could eliminate the “free rider” problem.
Meanwhile, reform would continue to move forward in ways that could lift the quality and lower the cost of health care in America. Some of the very best ideas in the Patient Protection and Affordable Care Act would remain in place. Those who believe in reform should not despair. .

I agree. But millions would remain uninsured. They be the big losers. And, in the end, all of us would wind up paying for their care, even if what they received was too little, too late, and exorbitantly expensive.

Finally, in part 2, I will ask: if the Court decides that the Affordable Care Act is unconstitutional, why not move directly to a single-payer system? While some question whether the constitution can force Americans to buy a product sold by private sector companies, we know that it is constitutional to ask everyone to pay a tax to support government health care. We call it Medicare.

Livongo’s Post Ad Banner 728*90

54
Leave a Reply

20 Comment threads
34 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
10 Comment authors
HabibilhfJohnnyDr. MikeNate Ogden Recent comment authors
newest oldest most voted
Habibi
Guest

There are a handful of intriguing points at some point in this posting but I don

lhf
Guest
lhf

These are huge problems to overcome, these and unnecessary tests and procedures. Two very good books on the latter problem are Overdiagnosis and Rethinking Aging. You’ve probably read them.

You left out things like gym memberships covered by Medicare Advantage, for example.

John Ballard
Guest

Thanks.

No, I haven’t read them, but in my post retirement work for eight-plus years in the so-called “senior care” sector I have watched and lived them. It has made me an evangelist for advance directives and palliative/hospice care.

My observation is that the problem lies more with family members in denial than the people running up the bills. It’s not always the case, but more often than not all that keeps old people hanging on is that those closest to them refuse them permission to leave.

Johnny
Guest

The insurance companies gotta be doing a better job with their plans. We need cheaper and more reliable plans right now, the current ones are way too expensive and a lot of them aren’t able to protect you when an emergency actually happens.

John Ballard
Guest

The insurance companies are not in a position to carve away the non-healthcare dollars embedded in every bill from hospitals, clinics, doctors and pharmacies. The medical-industrial complex has only one revenue stream — charges to patients. I’m posting my laundry list again here and will continue to do so until someone besides me decides to shift the discussion to actual costs for professional services and actual medical expenses. If Medicare and other medical expenses are to be lowered the answer lies not with rationing or tweaking the insurance industry, but with the reduction of the numerous non-medical expenses sucking the… Read more »

Maggie Mahar
Guest

Dr. Mke– Thanks for your comment. I’m really not a defender of the heatlh insurfance industry. I basically agree with Wendell Potter (see my comment on Potter above.) I think we all agree that for years, health insurers have shunnded the sick, cherry-picked healthy patients, and tried to avoid paying legitimate claims. There are some non-profits that are very good– The Health Care Cooperative in the state of Washington, Kaiser Permanent in Northn California and Colorado, Gesinger . .. . But the for-profits have tended to put profits ahead of people. My only point is that, in recent years, they… Read more »

DeterminedMD
Guest
DeterminedMD

Well, my interpretation of this comment is that you do not see a future for FOR profit enterprise as insurers. We agree on something, that random chance 5% moment has arrived. But, you have to extend it to eliminating FOR profit in all elements of health care to drive out the antisocial/narcissistic participants that just drag the profession down. Yes, that includes a percentage of doctors as much as any other part of health care, but it has to include all. Even the role of government that tries to profit as well. But, we diverge at the end when you… Read more »

Nate Ogden
Guest
Nate Ogden

“I think we all agree that for years, health insurers have shunnded the sick, cherry-picked healthy patients,” No people that actually know the business do not agree. And every time your challenged on these BS claims you never once back them up. How do insurers shun the sick? HIPAA and small group refrom laws make this impossible. The sick that can be shuned are in the individual market. Are you making this sweeping statement about insurers based on the smallest sliver of the market? Back your BS up or stop making irgnorant claims. How do insurers cherry pick healthy patients?… Read more »

DeterminedMD
Guest
DeterminedMD

Sorry Nate, I have to agree with the premise that insurers do their best to cherry pick. You lose me in arguing otherwise.

Nate Ogden
Guest
Nate Ogden

How? People make this claim all the time but no one ever comes up with an explanation of how they do it. On the other hand you ahve peopel such as myself that on a daily bases place cases full of sick people. We call them max loaded groups and they are written every single day. Cherry picking, which is not a fair way to frame it to start with has been gone for over a decade, it does not happen but in the rarest of cases. I have done three renewal in the past 60 days with pending transplants.… Read more »

DeterminedMD
Guest
DeterminedMD

Well, all I can say is I hear colleagues and patients describe situations that support my assessment. Maybe some insurers are responsible, but let’s be honest, not all are.

Quite the thread tonight with Ms Mahar’s latest post, eh?

Nate Ogden
Guest
Nate Ogden

I would love to hear specifics because the majority of the time its not the insurance company’s fault. It is easy for people to blame the insurance company seeking sympathy. I can’t count the number of people that have come to me looking for insurance because they were about to have expenses. And these are people that could have afforded insurance all along. People rather by a biiger car, go out to eat more, or spend their money on immediate satisfation then invest in their health or long term financial security. When something happens though they don’t want to take… Read more »

Nate Ogden
Guest
Nate Ogden

“Meanwhile, most large corporations have begun to self-insure, ”

http://aspe.hhs.gov/health/reports/2011/LGHPstudy/index.shtml

Percentage of large groups that self fund

1999 66.2%
2002 77.5%
2004 83.4%
2009 82.1%

in 1990 according to NYT

“58 percent for those with 1,000 to 4,999, and up to 82 percent for companies with more than 40,000 employees. ”

Just starting to Maggie? Just another one of your lies.

John Ballard
Guest

Nate, I can understand why you find the term “cherry picking” offensive.I don’t think it means what you think. It doesn’t mean that specific individuals are selected or denied insurance, but that insurance by its very nature IS ALREADY a deselection product. In the same way that words like politician/ statesman…wingnut/ extremist…challenged/ retarded…etc. carry different messages for different people, one person’s deselection is someone else’s cherry-picking. The reason for open enrollment periods, suicide exclusions for life policies, arson exceptions for fire insurance is simple. Those rules create boundaries against what what some call “gaming the system” or adverse selection (same… Read more »

Nate Ogden
Guest
Nate Ogden

Thank you, I would agree that insurance by its nature is selective, it has to be to protect the system from people gaming it. I would still take issue with people targeting for profit insurers as cherry picking as Medicare does the same thing, if you don’t sign up when your suppose to there are consiquences. I think it is a disengenious and misleading argument to make and the majority of the time those that make it are not making it honestly. If I accomplish anything on here it would be that people read comments like yours and have a… Read more »

Maggie Mahar
Guest

On Wendell Potter : Iin the health insurance industry (as in Pharma and many other U.S. industries) being VP of corporate communication is a top postiion. Marketing is extremely important to the industry, and Potter was in on all of the meetings with top exectuives discussing corporate strategy.. He knew what was going on. Below, from TIME magainze on Potter The former head of corporate communications for health-insurance giant Cigna, Potter turned against his old colleagues in June to testify before a congressional committee about what he viewed as the health-insurance industry’s “duplicitous” behavior in the current health-reform debate. In… Read more »

Nate Ogden
Guest
Nate Ogden

pitching corporate strategy to the media is not maker him familiar with the nuts and bolts of the insurance industry. He knew how to pitch what he was given, that doesn’t mean he had any understanding of how it got there. From your Liberal time link this gem; “An old acquaintance helped usher Potter out of obscurity. Avram Goldstein was once a reporter for Bloomberg News ” Interesting, old friend of yours? Seems the lefty media has gone out of their way to make Potter into an expert even though he has zero qualification. That would explain why you shower… Read more »

DeterminedMD
Guest
DeterminedMD

Alright, so the comments are viewed as toxic. Isn’t pure partisan rhetoric equally offensive when the tone is basically, “this legislation is golden, who the hell are you people to challenge it and prevent it from being implemented.” And that is not directed solely at Democrats, but the system at hand. Maybe it is time for the extremist Left and Right to realize there is a substantial amount of voters who don’t have a party allegiance. Health care needs to be fixed, that has been said in my comments since day 1 commenting here. It won’t benefit the population as… Read more »

Dr. Mike
Guest
Dr. Mike

True, toxic comments are not helpful, but I am actually quite curious why insurers are so often defended on this blog. Why is it that so many here are livid about criticism of legislation designed to enrich the insurers? I can think of at least half a dozen ways to provide for the health care of those without insurance, and NONE of them require anything more from the insurance companies than possibly a major medical policy. We’ve spent four years off on this tangent when we should have been debating how to set up a health care system for the… Read more »

Maggie Mahar
Guest

Someimtimes a blog thread can be shut down by just two or three people who are ranting, often in a personal way, taking over the thread.

Others just don’t want to engage with their anger.

I undrerstand this.

But I hope that readers who are interrested in the issues will ignore the toxic comments and weigh in with whatever they way to say.

DeterminedMD
Guest
DeterminedMD

Sorry, perhaps this is rude, but, this broccoli thing deserves the coming pun: Is Ms Mahar a plant for the Democrats? It would be inappropriate to call her a vegetable. It is amazing to watch the Democrats start to circle their wagons and start just shooting figuratively at anything that moves that could damage their alleged prized efforts 2 years ago, interestingly, before the public voted them out of office as a majority? You know, if I was part of a wonderful legislative effort to improve the country, I would want people to know what I did. And yet, no… Read more »

BobbyG
Guest

Juvie crap.

John Ballard
Guest

Okay everybody. Break time.
Go take a few minutes to read this.

http://onhealthtech.blogspot.com/2012/04/hypothetical-tofu-at-broccoli-court.html

Margalit Gur-Arlie is the next JK Rawling.

Nate Ogden
Guest
Nate Ogden

that picture is disgusting. There should be a NSFW warning before people open it.

Nate Ogden
Guest
Nate Ogden

A former health insurance insider turned whistleblower says that he was not only surprised at how “easy” it was to manipulate members of the news media over the years, but also reveals that he routinely “wined and dined” reporters from major news outlets – including the New York Times and the Wall Street Journal – in return for favorable coverage. Potter went further, revealing that he lunched with reporters at major media outlets for years – including journalists at the New York Times and the Wall Street Journal – as well as those from local and regional media, in most… Read more »

Nate Ogden
Guest
Nate Ogden

“most knowledgeable critics, Wendell Potter, a former insurance executive” Please stop the lies Maggie. Vice President of corporate communications, i.e, PR Hack. He doesn’t know anything about insurance except sending our press releases. Perfect example of how big of an idiot he is; “but the day when most Americans get their coverage from what we think of as an insurance company is close at hand.” 13% get it from Medicare. 18% uninsured. 12% other government programs. roughly 34% self funded plans. Only 23% of the population get their insurance from an insurance company. The moron doesn’t even know basic math.… Read more »

steve
Guest
steve

When we explored this, it was going to cost more. We have lots of young women of child bearing age. We would need to re-insure. In a small group, our admin costs would have been relatively high.

Steve

Nate Ogden
Guest
Nate Ogden

this is where it gets tricky; stop loss traditionally has been an historically underwritten risk, they look at past claims experience and base rates on that. Fully insured ir prospectivly underwritten, they rate based more on what they think will happen next year. It can be very hard to make that initial move. the carrier is looking for claims experience and the group has none. Fixed cost is usaully attractive but the claims liability is more then fully insured premium. Carrier is looking for the employer to take the risk first year instead of them. Groups hardly ever hit that… Read more »

Nate Ogden
Guest
Nate Ogden

Where you at can have a huge impact when it comes to pregnancies. I see some that still only cost a few thousands to some of your teaching and big names can get over 20K for a normal delivery with no complications.

If we can limit patients to certain hospitals the cost of high percentage of women of child baring age drops immensely.

Maggie Mahar
Guest

John–

Sorry, my reply should have begun “The problem is that the “

John Ballard
Guest

Got it.
I’m looking forward to Part Two.

Maggie Mahar
Guest

John– The is that the average American family has just $3,500 in savings. 25% have no savings. (This is largely because joint median income is relatively low and the half of families who earn less are barely scraping by This assumes, of course, that they are employed..) I’ll be writing about this in part 2 of the post. So people don’t just need insurance to cover expsenses past a high threshold– they can’t afford 1 day in the hospital. Most people just don’t realize how poor the lower-middle class is. Their wages have stagnated for so long, while expenses (particuarly… Read more »

Maggie Mahar
Guest

John– The difference between your story and what would happen if people were able to opt out of health insurance is that the rest of us don’t have to pay for the little holes that now encircle your property. And if you had been hit by a fire or hurrican and hadn’t purchased home i nsurance, we wouldn’t have to rebuild your home. But if your child was diagnosed was cancer, if your wife or daughter unexpectedly became pregnant, or you were in an auto accident, we wouldn’t let any of you die on the sidewalk outside the hospital. We… Read more »

John Ballard
Guest

Good point. It’s too bad there is so much animus against federalism. One straightforward remedy would be to handle high-cost medical claims in the same way that high-risk flood insurance is covered. Most people don’t know it but that program is not underwritten by the companies that sell it but by the federal government. (Again, I hear the screams… Ron Paul supporters and Libertarians, calm down, please.) I’m sure someone in the insurance business is more informed that me, but I think that’s how the people along rivers that continue to flood from time to time continue to rebuild their… Read more »

steve
Guest
steve

I am not aware of any animus towards federalism in health care. The problem is that most states have not addressed health care, or have done so unsuccessfully, as illustrated above.

Steve

John Ballard
Guest

Federalism for politicians is the new third rail of politics. Conservatives and states rights advocates have succeeded in equating it with Socialism and as a result Progressives are too frightened to bring it up. If you aren’t aware of any animus toward federalism now you will be be between now and November.

Generally you’re right. Ordinary people really don’t worry about how laws or taxes originate as long as they have enough left to buy an occasional lottery ticket or eat fast food.

steve
Guest
steve

Could be. I dont generally read or correspond with the nutty left or right. Among those who write more seriously on health care, I think I can safely say that they wish the states had been making more of an effort to find what could work.

Steve

Nate Ogden
Guest
Nate Ogden

basically the government loses billions every year to pay people to rebuild in areas prone to flooding. Not uncommon for people to collect multiple times. The reason the government backs it is because it loses so much money. Also very regressive. The average value of the property replaced trends heavily to the rich. The poor basically pay for rich people to have ocean from mansions. Originally Medicare was suppose to be just such a plan, wont get into why it didn’t happen that way. Catastrophic reinsurance was part of PPACA for pre 65 retirees. Plan comes with many problems, fraud… Read more »

John Ballard
Guest

The average value of the property replaced trends heavily to the rich. The poor basically pay for rich people to have ocean from mansions.

Interesting.
And true.
Refreshing! You been reading from the OWS library?
~~~~~~~~~~~~~~~~~~~
I’ve heard of reinsurance but don’t know what it really is. It sounds suspiciously like miniature credit default swaps. CDSs + securitized mortgages + derivatives = Meltdown of 2008.
Scary stuff.
Please tell me reinsurance is not like that. (Readers Digest version only if possible.)

Nate Ogden
Guest
Nate Ogden

Simplest way of explaining it is insurance for insurance companies. Fully insured carriers use it to protect themselves from large claims, in this case it is also referred to a pooling charge. $70,000 or so is a common pooling point. It also helps stabilize a pool. If you have a $10,000,000 pool of business a million dollar claims alone would be 10% loss ratio. By reinsuring the risk and pooling claims over 70K then only the first 70K counts against the pool. In relation to this discussion it is important to remember 60% of group insured are in self funded… Read more »

Nate Ogden
Guest
Nate Ogden

if you were a large self funded group without reinsurance your fixed cost would be around $40 PEPM. Assuming 2.6 members per employee the PMPM admin would be $15.38, the rest would all go to claims. Annually your looking at $190 out of $3500 going to admin. That is roughly 5.4% for admin and 94.6% going to claims.

John Ballard
Guest

I think I got the gist of it. I had to look up PEPM (per employee per month). Thanks. When I read terms like “100 life employer” or 500 life employer” I guess it means the number of employees times the maximum coverage up to the point where someone dies. Kinda the health insurance equivalent of totaling out an automobile after an accident, right? (Although I heard last week a reference to “total replacement value” which is different from the depreciated amount of a car. No such thin]g, I’m sure, for people who die.) So how does all this puzzle… Read more »

Nate Ogden
Guest
Nate Ogden

Sorry I forget to use common lingo sometimes. Correct PEPM is per employee per month PMPM is per member per month. This is important when comparing private insurance to Medicare. A 100 life employer refers to a company with 100 employees. Since those 100 employees cover family members the actual number of belly buttons on the plan is higher. An acceptable average is 2.6 which means every employee has 1.6 dependents. Number of employees is important in insurance as laws vary based upon that number. Employers with less then 20 lives, meaning 20 employees not 20 people covered, are secondary… Read more »

John Ballard
Guest

Insurance is a can of worms. It makes it seem much easier to plan and serve two thousand meals a day for years on end. Did you mean to say “PPACA penalties apply to employers with less then 50 employees”? I thought penalties will apply to those with more than fifty employees, and even then if at least one is certifiably eligible for a federal subsidy (under 400% of FPL, I think) to purchase insurance. (As for my chef, he was a treasure, but he got transferred to another unit. Unfortunately he was morbidly obese and died a few years… Read more »

Nate Ogden
Guest
Nate Ogden

in this case less = more, sorry about that. If you have 50 employees or more. Which is a mightmare to figure out. I was trying to help a confectionaire figure out where they fall. Around the holidays, 4-5 times a year they have 250+ employees, the rest of the year 40. We had to start counting days and hours worked. From my business perspective every time they pass a law like this it is a new revenue stream, not good for employers but good for business. There are companies now doing penality analysis for $400+ per pop. They look… Read more »