Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Obamacare’s effect on small business: An unintended consequence?

Brad Wright, PhD
Policy
November 4, 2013
Share
Tweet
Share

For employers, the Affordable Care Act takes two distinct approaches.

First, for small employers (those with 50 or fewer full-time employees), the ACA does not penalize, but rather incentives the purchase of insurance with subsidies available through the Small Business Health Options Program (SHOP). Second, for large employers (those with 51 or more full-time employees), the ACA does very little. Recognizing that the overwhelming majority of these large employers already offer good coverage, the government merely wants to keep it that way.

In essence, the “pay or play” mandate is simply designed to prevent “crowd out” the businesses dropping coverage to save money because their employees can get federally-subsidized coverage via the health insurance marketplace.

But what about a small business that already provides its employees with excellent coverage? Well, in that case, the incentives and penalties get weird, and the window of opportunity for unintended consequences to enter the picture opens wide.

I know of a small business with between 10 and 20 employees that offers excellent benefits. The health insurance coverage has no deductible and no coinsurance. There is a $30-$40 co-pay for physician visits, but that’s it. And, on top of that, the employer pays nearly 100% of the premiums for each individual employee (about $6,000). The catch is, the employees are fully responsible for the cost of dependent (i.e., family) coverage. Given the generous nature of the coverage, this is not inexpensive (about $11,000). In other words, the total cost of this family coverage is approximately $17,000, with the employer paying for $6,000 of it.

On the health insurance marketplace, family coverage in the part of the country where this business is located runs between $7,344 a year for a bronze plan and $10,560 for a gold plan. Even the most expensive gold plan was less expensive that the company’s current coverage. And the coverage could be even cheaper, but because the employees have access to affordable coverage through their employer, they are not eligible for federal subsidies.

However, given that this is a small business, as defined by the ACA, the employer could simply drop coverage without penalty and instruct its employees to shop for subsidized coverage on the exchange. Doing so would save the employer $6,000 per employee and could save the employee anywhere between $0 and $3,700 a year, albeit with somewhat less generous insurance coverage.

So, if this was your company, what would you do? Or, if you were the employee who was told you were no longer getting coverage through your work, but that you could get it more cheaply on your own, how would you react?

Brad Wright is an assistant professor of health management and policy who blogs at Wright on Health.

Prev

Should smokers pay higher health insurance premiums?

November 4, 2013 Kevin 56
…
Next

A solution for clinical guideline overload

November 5, 2013 Kevin 1
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
Should smokers pay higher health insurance premiums?
Next Post >
A solution for clinical guideline overload

ADVERTISEMENT

More by Brad Wright, PhD

  • If your hospital closes, does patient care suffer?

    Brad Wright, PhD
  • a desk with keyboard and ipad with the kevinmd logo

    We have the power to prevent disease. But we’re not using it.

    Brad Wright, PhD
  • a desk with keyboard and ipad with the kevinmd logo

    The uninsured rate has fallen, but it may soon rise

    Brad Wright, PhD

More in Policy

  • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

    AMA Committee on Economics and Quality in Medicine, Medical Student Section
  • Who gets to be well in America: Immigrant health is on the line

    Joshua Vasquez, MD
  • Online eye exams spark legal battle over health care access

    Joshua Windham, JD and Daryl James
  • The One Big Beautiful Bill and the fragile heart of rural health care

    Holland Haynie, MD
  • Why health care leaders fail at execution—and how to fix it

    Dave Cummings, RN
  • Healing the doctor-patient relationship by attacking administrative inefficiencies

    Allen Fredrickson
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 17 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Obamacare’s effect on small business: An unintended consequence?
17 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...