is part of the Division of Informa PLC

This site is operated by a business or businesses owned by Informa PLC and all copyright resides with them. Informa PLC's registered office is 5 Howick Place, London SW1P 1WG. Registered in England and Wales. Number 8860726.

What's wrong with the PPACA?

I have a confession to make. While I've been self-employed, I've never owned a complex enterprise like a manufacturing business. Which means that I have to look to those of you who do for insight into the details and challenges involved.

I'm not a fan of paperwork, especially of the administrative variety that goes hand-in-hand with employing a lot of people, or meeting regulatory reporting requirements. But from my limited entrepreneurial experience, I can certainly imagine the expense, frustration, resignation, or even anger, that might be engendered by a new set of rules.

On the other hand, I'm also aware that while the mechanisms may be unwieldy or burdensome, the intent is usually laudable, if, perhaps, misguided. As I once was told, the road to a certain infernal destination is paved with good intentions.

One thing that most people seem to agree with is that the U.S. healthcare system, specifically how we access and pay for it, needs some kind of fixing. Skyrocketing premiums have translated into a significant cost to employers and workers. With universal coverage politically off the table, which is likely only attainable via government sponsorship of a single-payer plan, some sort of public-private hybrid health insurance system seems inevitable. And with a majority of workers having their coverage provided by their employers, the model seems to indicate either increased cost to some degree for businesses, some degree of cost-shifting to employees in the form of decreased benefits, higher co-pays, co-insurance percentages, and increased deductibles, and some degree of decoupling coverage from employment. All of which are addressed in some fashion by the Patient Protection and Affordable Care Act (PPACA).

The thing I'm curious about is what provisions within the act are leading some business owners who already offer healthcare plans to their employees to indicate that they'll be looking at dropping insurance and paying the penalty. (I'm also curious as to why healthcare was offered in the first place when it wasn't mandated. Is it the right thing to do, a competitive advantage in finding and retaining employees, or a little of both?)

One assumes the sticking point is the presumed cost of policies that meet the minimum requirements, given the questions about exactly which policies will be grandfathered in. Which, with the insured base greatly expanded and the individual mandate putting more young and healthy people into the insured population, seems to really be an issue with the private insurers that's being forced to a head by an attempt to stem the rising cost of healthcare access. Will employees be better off shopping for their own insurance, with an expanded set of guaranteed benefits and controls in place to address rising costs, via the exchanges? Will their paychecks get a bump that reflects the difference between the employer's previous contribution and the penalty?

I've heard the "job-killing" argument about a 49-employee company not wanting to hire that 50th employee. And, I can see logic in that, depending on what the the trajectory of the business looks like, and what that 50th employee means to the business and how healthy the business's profit margins are.

Then again, we've had a number of stories lately about different molders and moldmakers expanding, adding machinery, personnel, and facilities like cleanrooms regardless of the uncertainties in this particular legislation, or that of the medical device tax. There's also plenty of debate about that tax, and its consequences, although medical seems to retain a positive outlook to Wall Street analysts.

Of course, an overhead cost, like health insurance for employees is a different proposition. That's a cost incurred prior to any increased revenue or profit, and for those that don't currently offer insurance, and have no plans to do so, represents an increased cost either through offering coverage or paying the penalty. Naturally, individuals declining to purchase insurance also face a penalty, which, in both cases, is intended to offset cost-shifting.

So. What's wrong, or right, with the PPACA in terms of your businesses?

Please let us know via our LinkedIn group, here, or by sending us your thoughts here. We'll follow up by reporting what you tell us, and naturally, anonymity is ensured.

Hide comments


  • Allowed HTML tags: <em> <strong> <blockquote> <br> <p>

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.