Employee Benefit Views

PPACA: Play or pay? 7 reasons why ‘pay’ is not the easy answer

Posted January 15, 2013 by By Thom Mangan at 10:57AM. Comments (3)

Today’s guest post is from United Benefit Advisors CEO Thom Mangan, who offers up seven reasons that the decision to pay or play may not be as cut and dried as employers might think. Enjoy, and as always, share your thoughts in the comments. —Kelley M. Butler

With every day that goes by, the nation’s employers move a step closer to having to make a decision: Do I play or pay?

Employers now have just a little more than one year to prepare themselves and their workforces for the arrival of the core of the Patient Protection and Affordable Care Act, which requires employers with 50 or more full-time employees to offer medical coverage or pay a penalty. Although a year might seem like ample time, the decision isn’t an easy one, and it’s fraught with financial, legal and competitive implications.

Some employers assert that the play-or-pay mandate will raise their costs and force them to make workforce cutbacks. As a result, a number are considering eliminating their health care coverage altogether and instead paying the penalty on their full-time employees. While the “pay” option might be worth considering, there are strong reasons why employers should look carefully at all of their options and do their best to calculate the actual outcomes of each.

Here are seven issues employers should consider before deciding to pay rather than play:

1. There are lost tax advantages. Employers that eliminate health care coverage or opt not to offer it to full-time employees will be missing out on tax breaks (as will their employees). Employer contributions for health care coverage are not considered taxable income to the employee (and are deductible by the employer).  Employee premiums that are paid through a Section 125 plan reduce the employee’s taxable income, which reduces both the employer’s and the employee’s FICA tax.

2. Reporting burdens remain. Employers that don’t offer health care coverage will still face federal reporting requirements, in part so the penalty amount can be determined. In addition, employees who are not offered coverage are likely to go to the exchanges for coverage. These exchanges will require a variety of employee data from employers, particularly for employees who may be eligible for the premium tax credit, which means employers may have to deal with a significant number of inquiries from exchanges (staff time, effort, costs).

3. Recruitment and retention challenges may be exacerbated. Employers who opt not to offer health care coverage could be doing long-term damage to their employment brands, making it difficult to attract top talent in the future. Even worse, they could lose current employees to organizations that do provide coverage. And the damage to the brand could be even greater for employers that once offered coverage but elect to eliminate it in favor of paying penalties. Not offering coverage could tarnish the employment brand and disrupt business in another way: Employees who are forced to use exchanges — especially untested or insufficiently staffed exchanges — could feel undervalued or abandoned by their employers.

4. Counting employees can be complex. What constitutes a full-time employee?  Answering this question can be tricky; in late August 2012 the IRS issued 18 pages of rules that only partly answer the question. Employers that believe they won't face penalties for dropping or not offering coverage because they have fewer than 50 employees may have calculated incorrectly. If that happens, the results could be costly. Be certain you know how to count full-time and full-time equivalent employees and what your obligations are.

5. The cost of coverage can be adjusted. While employers may have to cover more people, they do have options for reducing the costs of this coverage. For example, employers could reduce their lowest-cost coverage to stay just above the 60% minimum value threshold; they could reduce workers’ hours below the “full-time employee” level; and they could consider paying targeted penalties.

6. There are other financial implications. Employees may demand additional compensation from employers that elect to drop coverage to cover the cost of health care they must now purchase with their own, after-tax dollars. Employers who haven't properly budgeted for nondeductible penalties may compound their financial burdens, especially if they don't make long-term plans for penalty increases.

7. Carriers will address plan designs. Insurance carriers will become experts on coverage requirements out of sheer necessity, so the myriad of plan design criteria won't likely be a burden on many employers. In addition, carriers will implement a variety of tools to communicate with employees, helping to keep business disruptions to a minimum.

These play-or-pay decisions actually represent just one aspect of PPACA, and there are obligations and implications attached to both sides of the argument. Again, employers would do well to consider all of their options and calculate the outcomes as accurately as possible

Thom Mangan is CEO of United Benefit Advisors, an independent employee benefits advisory organization with more than 270 offices throughout the U.S., Canada and the U.K. This entry originally ran on EBN’s sister site, Voluntary.com.


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Posted by: Gurava M | January 17, 2013 7:06 AM

Is this not too much of Cost Benefit Analysis for an employer to evaluate the options.This is more like valuation of both Offering Benefits and Not doing so. Probably, most likely - they will be looking for a tool which is comprehensive enough to address the weightage of each of the above components mentioned in order to come up with the cost of doing something Vs not doing so.Good opportunity for the vendors in this line.

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Posted by: Rachel S | January 15, 2013 1:35 PM

This is what I've been saying all along. The only missing information is that those who don't take coverage now is also likely behavioral. Just because it's offered doesn't mean that they will elect or use the coverage.

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