Monday, July 22, 2013

A CEO's-Eye View of ObamaCare

By Andrew Puzder

Why did the Obama administration earlier this month delay enforcement of the Affordable Care Act's employer mandate until 2015? The administration claims that it needed more time to get the mandate right. Some have suggested that politics—the concern that negative effects of the mandate might kick in before midterm elections in 2014—may have influenced the decision.

My own hope is that the administration acted because it is beginning to understand that portions of the ACA are unworkable despite its drafters' good intentions. For example, if my experience running CKE Restaurants Inc. is a guide, there could be serious problems with the law's financing mechanism.

We currently offer all of our more than 21,000 full- and part-time employees at our Carl's Jr. and Hardee's restaurants access to health insurance. At least since 1999, we have offered all of our crew employees access to affordable plans with an annual benefit cap. We currently offer these plans under a waiver from the Department of Health and Human Services, as the ACA prohibits plans with benefit caps.

For restaurant general managers, we offer a more extensive plan where the company pays 60% of the premiums. However, only about 6% of crew-level employees and 60% of general managers sign up for health-insurance coverage.

These low participation rates surprised me. So over the past couple of years I have asked CKE employees what motivated their decisions. Our crew-level workers tend to be younger, and perhaps unsurprisingly some told me they were unconcerned about illness or injury. Others already had insurance through a spouse or parent. A significant number said they declined coverage because they could get medical treatment "for free at the emergency room." Among those who had signed up, many said it was because they were concerned about developing a medical condition (perhaps due to a family history of illness), and then being unable to get affordable coverage due to this pre-existing condition.

These kinds of responses are why I question the ACA's viability. The new law's success depends on young, healthy people who are lower-risk signing up for health insurance to offset the costs of insuring individuals who are at higher risk. If predominantly high-risk individuals sign up, health insurance is going to be very expensive. Yet, even after the ACA takes effect, people will still be able to get medical care at the emergency room. Further, the ACA prohibits insurers from denying coverage because of pre-existing conditions. In other words, individuals will no longer have much incentive to get health insurance as a hedge against the possibility of developing a medical condition.

The ACA's incentive for young workers to pay for coverage is a penalty (or tax) on uninsured individuals. The penalty in 2014 is $95 or 1% of household income, whichever is greater. It increases in 2016 to $695 or 2.5% of household income, whichever is greater.

Our company currently plans to offer all employees who work more than 30 hours per week coverage that meets the ACA's requirements. We are choosing to do that rather than send our employees to the ACA's health-insurance exchanges and, if the workers qualify, the federal subsidies to help them pay for it.

On average, our general managers earn $50,000 per year. Should they decline insurance coverage, they will be subject to an initial annual penalty of $500 and a maximum penalty of $1,250. We estimate that their share of paying the health-insurance premium through our company plan will range between $2,000 and $3,000 per year, well in excess of any potential penalty.

The lowest-paid employees who qualify for ACA coverage (as opposed to Medicaid) earn about $11,500 per year. They would be subject to an initial penalty of $115 and a maximum penalty of $695. We currently estimate that their share of health insurance premiums will be $1,091.55 per year—again, well in excess of any potential penalty. So, in the first year, our employees' insurance costs likely will be four to 10 times more than the ACA's penalty on the uninsured.

This is why I am concerned that the ACA could actually cause the number of our covered employees to decrease, particularly in the first year. The penalty for declining coverage will be low compared with the cost of coverage; and employees will know that if they happen to get sick, they can get insurance after that. So the economically rational decision for young people, like our crew employees, is to pay the penalty and forego the insurance. Despite what the government may believe, our employees are smart enough to figure this out.

Read the rest here.

1 comment:

  1. I had a dream last night that Congress, in a moment of clarity and sanity, repealed the Affordable Care Act. All of it. And then they took all the other federal mandates concerning the delivery of health care, and consigned them to the dustbin too.

    Imagine a world in which there was a real doctor-patient relationship again with real prices and competition determining costs. Consumers would economize because they were paying out of pocket for routine procedures, where insurance was limited to unexpected and catastrophic injuries or illnesses. You know, REAL insurance!

    Alas, it was only a dream. I woke up and realized that we're going to endure many more years of stupid, self-defeating central plans from clueless, meddling bureaucrats who couldn't find their arse with both hands.