How the Affordable Care Act is helping this small business and its employees.

[CMD]

The right seem to hate ObamaCare, claiming that it's anything but affordable and that it hurts small businesses... but for one small business, Simonetta's Collision Repair Center, a small auto-care business in Pennsylvania, ObamaCare has been nothing but a godsend. See for yourself:

In case the embed feature doesn't work: http://youtu.be/UuA2_P-m4Sk

[Cow Poke]

yowza

[Sam]

Under the ACA, employee contributions to health care plans are supposed to be capped at 9.5% of income. In the news report, Judy's premium was reported to increase to $1,316 . . . which would mean an income of at least ~$166,000/year. Likewise, Christy's premium is said to be $895/month, which would mean a salary of ~$110,000.

Without knowing further details of the plans and salaries, it's impossible to say exactly what's gone wrong with the broker, the ACA and this company. As reported, however, the numbers don't appear to be adding up. It's possible that small businesses are exempt from the premium cap, though I haven't read anything to suggest that. It's possible that the insurer is utilizing a loophole that hasn't been closed by HHS where companies might be able to offer more expensive plans to families so long as they offer an individual plan that's capped to 9.5%. Or it's possible that someone in this chain is getting scammed. But, as stated, the numbers don't add.

—Sam

[Mountain Man]

That's great for this small business, but in the meantime, millions more people have lost their insurance or seen their premiums skyrocket thanks to Obamacare, not to mention the millions of workers who have been laid off or had their work hours reduced as a direct result of the law. Furthermore, the Congressional Budget Office recently estimated that Obamacare will lead to 2.5 million people forced out of the labor market over the next decade. It further estimated that 30-million people will continue to remain uninsured which is a mere 25% reduction over current figures.

http://www.breitbart.com/Big-Governm...5-Million-Jobs

No matter how you look at it, Obamacare is a disaster.

[Cow Poke]

Under the ACA, employee contributions to health care plans are supposed to be capped at 9.5% of income. In the news report, Judy's premium was reported to increase to $1,316 . . . which would mean an income of at least ~$166,000/year. Likewise, Christy's premium is said to be $895/month, which would mean a salary of ~$110,000.

Without knowing further details of the plans and salaries, it's impossible to say exactly what's gone wrong with the broker, the ACA and this company. As reported, however, the numbers don't appear to be adding up. It's possible that small businesses are exempt from the premium cap, though I haven't read anything to suggest that. It's possible that the insurer is utilizing a loophole that hasn't been closed by HHS where companies might be able to offer more expensive plans to families so long as they offer an individual plan that's capped to 9.5%. Or it's possible that someone in this chain is getting scammed. But, as stated, the numbers don't add.

—Sam

Hey, Sam -- glad you survived the crash!

I'm curious where you're getting your information, and does it take into account all the changes/delays/modifications Obama has made along the way?

[Sam]

Hey, Sam -- glad you survived the crash!

I'm curious where you're getting your information, and does it take into account all the changes/delays/modifications Obama has made along the way?

Well, somewhat, at least. I very much doubt I'll have the same level of activity as before. But time will tell!

Not sure what you're asking for regarding information; the information used regarding caps comes from the legislation, no changes to premium caps have been made, and the only delay that's likely to have affected this business is the SHOP exchange — the voluntary marketplace where small businesses (< 50 employees) can compare group insurance plans. I suppose that since small businesses get extra tax breaks for providing group insurance under the ACA through SHOP that the delay in getting that exchange online would also delay the tax breaks but I seem to remember reading that the incentives would still be applied this year to businesses that do not use SHOP.

—Sam

[Cow Poke]

Well, somewhat, at least. I very much doubt I'll have the same level of activity as before. But time will tell!

Not sure what you're asking for regarding information; the information used regarding caps comes from the legislation, no changes to premium caps have been made, and the only delay that's likely to have affected this business is the SHOP exchange — the voluntary marketplace where small businesses (< 50 employees) can compare group insurance plans. I suppose that since small businesses get extra tax breaks for providing group insurance under the ACA through SHOP that the delay in getting that exchange online would also delay the tax breaks but I seem to remember reading that the incentives would still be applied this year to businesses that do not use SHOP.

—Sam

I know it's probably a right wing source, Sam, but I've seen a number of lists of 25 to 27 changes that have been made to ACA apart from Congressional action. And my experience in the HR world tells me that the laws, and the manner in which they apply, are OFTEN widely different for companies with fewer than 50 employees. I tend to think that there's a lot more gray area than you're allowing.

[Sam]

I know it's probably a right wing source, Sam, but I've seen a number of lists of 25 to 27 changes that have been made to ACA apart from Congressional action. And my experience in the HR world tells me that the laws, and the manner in which they apply, are OFTEN widely different for companies with fewer than 50 employees. I tend to think that there's a lot more gray area than you're allowing.

It's possible! Like I wrote at first, without more specific information, it's impossible to tell exactly what's going on with this company's experience with the ACA. But I'm unaware of any changes to the ACA that require Congressional authorization (the executive branch has a pretty broad authority in implementing the laws) and, other than the SHOP delay, I'm unaware of any changes to premium caps or other regulations that would affect this circumstance. If such information is out there, I'd be glad to read it, of course.

—Sam

[Cow Poke]

It's possible! Like I wrote at first, without more specific information, it's impossible to tell exactly what's going on with this company's experience with the ACA. But I'm unaware of any changes to the ACA that require Congressional authorization (the executive branch has a pretty broad authority in implementing the laws) and, other than the SHOP delay, I'm unaware of any changes to premium caps or other regulations that would affect this circumstance. If such information is out there, I'd be glad to read it, of course.

—Sam

I think we're going to disagree on this, Sam, but this is not the hill I want to die on.

Have a great day.

[Sam]

Well, I've been checking back on this story now and then and it seems like there's a bit more information to make a determination a little clearer.

Folks over at The Daily Kos have been doing some work figuring things out. One commenter actually called Simonetta's Body Shop and reported that the company was unaware of the tax credits available under the ACA's SHOP exchange. Simonetta's reported seven employees, plus the owner. The insurance broker, Charles Moore, turns out to be pretty ardently opposed to the ACA which would not necessarily count against him if there wasn't some pretty big discrepancies with the numbers. For example, Moore has defended his brokerage's chosen plans by relating that Judy -- who featured prominently in the piece above as the "hardest hit" employee -- has a husband along with her son that requires coverage. But a quick look at the individual exchange plans on Healthcare.gov (in Simonetta's county) shows that she could be saving in premiums while at the same time reducing her deductible:

Moore's Plan for Judy (UPMC)

Premium: $1316/month
Deductible: $4,000

Example UMPC Gold Plan on Healthcare.gov

Premium: $1229/month
Deductible: $2000

Example Alternative Gold Plan on Healthcare.gov

Premium: $1072/month
Deductible: $3000

Example Silver Plan on Healthcare.gov

Premium: $904/month
Deductible: $3000

The example Silver Plan has an out-of-pocket annual cap of $12,700/year, which is why it looks like a relative bargain compared to the plans above, which (on the exchange, at least) have annual caps of $6000 - $8000 per family. But, given what Judy is paying for Moore's plan, she could afford the sole Platinum plan being sold on the exchange in her area:

Platinum Plan on Healthcare.gov

Premium: $1304/month
Deductible: $1000
Out-of-Pocket Max: $3300

So Judy, by purchasing the highest-tier plan on Healthcare.gov for her family, could save $12 per month compared to the plan she got from Moore. She would also have a deductible one-quarter of his plan. And, ironically, she would never even pay as much as the $4000 deductible she has to fulfill under Moore's plan. These numbers change, of course, if her husband is significantly older than she is or if either one of them are smokers and so we can't draw definitive conclusions here. But if the numbers were odd at the beginning of this news report, they're seeming downright suspicious now.

--Sam

[Sam]

Getting very much speculative, one can throw semi-arbitrary enrollees at Healthcare.gov and see what Simonetta's might be paying if it chose to enroll in a small business plan under the ACA. Notably, this estimate doesn't include any smokers -- a category that insurers still can rate-adjust for. To add to the ambiguity, I assumed ages for about half of the enrollees (skewing them towards late 40's and 50's, as they appeared in the news report), assumed that each was married to a spouse of the same age and, for the six employees whose dependent status I was unaware of, assigned each couple either two children or three children -- for a total of 35 enrollees. The Platinum plans under these assumptions were estimated as:

Platinum Plan 1

Premium: $8630/month
Deductible: $0
Out-of-Pocket Max: $1500

Platinum Plan 2

Premium: $9515/month
Deductible: $500
Out-of-Pocket Max: $2000

Platinum Plan 3

Premium: $9617/month
Deductible: $0
Out-of-Pocket Max: $2000

Platinum Plan 4

Premium: $9667/month
Deductible: $0
Out-of-Pocket Max: $2000

Split evenly -- that is, assuming the company pays no portion of each employee's premium -- the monthly cost per employee (eight of 'em) would range from ~$720/month to ~$805/month. For each employee whose premiums and deductibles are mentioned, that represents considerable cost savings to premiums, deductibles, or both.

Again, this estimate assumes a lot of missing data -- the number of tobacco users, the age of all enrollees, and the number of dependents, primarily. But there's more than enough data available to see that something is afoul with the insurance options that employees of Simonetta's auto body shop were offered when even the most expensive plan on the exchange comes in significantly less expensive than what was apparently offered.

--Sam

[seanD]

They just delayed the mandate again until next election lol. And... cue Sam.

[Sam]

They just delayed the mandate again until next election lol. And... cue Sam.

Not exactly; for 50-99 employees, the mandate is waived for 2015, with the caveat that larger employers can't cut staff just to duck the mandate in 2015. Over 100 and 70% of employees need to be covered in 2015 and 95% in 2016.

I'm not particularly happy with that, personally. But I don't see how it's something you could really be criticizing effectively. Do you want the mandate applied immediately and on schedule? Hey, welcome to the club! Do you want the ACA repealed in its entirety? Hey, you've got a couple more years until the employer mandate kicks in full swing. That's fewer people benefiting from the ACA — people whose health insurance you'd have to take away when repealing. And now that millions of people are getting health insurance thanks to the ACA (tens of millions soon enough), you'd need every advantage you could get to force repeal.

Mostly, the talk I hear about stuff like this is some sort of myopic schadenfreude. And, hey, if that's your thing, go for it. When Republicans or Conservatives or Libertarians actually get to the point of having a score-able alternative reform bill, that's about the time I'll take notice of the snickering.

For now, though, I'm interested in the thread topic.

—Sam

[Cow Poke]

I'm not particularly happy with that, personally.

—Sam

Wow, then it must be a HORRIBLE thing.

[Catholicity]

My issue? That's a huge expense on businesses that don't bring in a lot of money anyway. For some small businesses that is 1/4 of their profit. I don't like those numbers and it can force the businesses to close.