February 16th, 2013

A Few (More) Remarks about the Affordable Care Act: the Ouchiness of the Stick

My previous post regarding ACA involved the crunchiness, color, juiciness and palatability of the carrot (the incentives for individuals who do not receive health benefits from their employer to go out and buy some through the exchanges). This post is about the stick from employers, or what happens if they have more than 50 full-time-equivalent employees (hundreds of part-timers or 50 actual full time) and don't offer (adequate) health benefits. This is not about smaller companies.

At healthreform.kff.org/the-basics/employer-penalty-flowchart.aspx, the Kaiser Family Foundation supplies a helpful flowchart.

An employer who does not offer coverage, has at least 50 FTE AND "at least one employee receive[s] a premium tax credit or cost sharing subsidy in an Exchange" will get dinged. "The penalty is $2000"/year X (number of FTE - 30), or a minimum penalty of $40,000. Remember, this is 50 FTEs: if you hire one day labor person every day, or 4 groups of 12 (and a half) contractors every quarter, you may have hired more than 50 people, but you didn't have 50 FTEs and so it doesn't apply.

Let's say the employer offers coverage, but it is unusually crappy (pays less than 60% of average expected health care costs -- worse than silver). This makes the employees eligible to buy on the exchange, so if any of them do, "The penalty is $3000 annual for each full-time employee receiving a tax credit, up to a maximum of $2,000 times the number of full-time employees minus 30. The penalty is increased each year by the growth in insurance premiums." In the case of an exactly 50 FTE company, the maximum penalty here is equal to the minimum penalty in the previous case. However, a much larger company offering crappy health insurance could be hit by a much bigger dollar amount with this fine than a smaller company offering no health insurance.

I don't know what the law says, but the flow chart at least suggests that if you none of your ACTUAL full time employees (vs. FTEs) goes out to an exchange, you're in the clear. So, crappy health care is going to persist, especially in companies that have full time workers who are paid well and get one kind of benefit, and part time workers who are paid crappy and get crappy benefits. There may be other regulations/rules/laws to deal with this, but I doubt it.

The same penalty applies if the offered coverage is unusually expensive, costing more than 9.5% of family income to pay for the employed person's coverage. Self-only -- but family income as the basis? Really? That seems wrong. I wonder if the law is really written that way.

I may update this.

I'm not sure to what degree a $40,000 fine is going to motivate a company to improve their health care coverage -- it probably won't. I also don't know if a $40,000 fine will prevent a company from dumping people from their coverage to the exchanges, if they think they can maintain their ability to hire and retain attractive employees in the face of this clearly appalling behavior. OTOH, these are not the only carrots and sticks involved; there is a substantial tax break for companies which offer health benefits to employees, and ACA adds to that (with a tax credit, no less). I think a company with more than 50 FTEs that doesn't at least consult with a company that can provide detailed, specific to the company advice on this subject is a company that deserves what it gets. Honestly, they ought to at least have someone working at the company spend part of their time for a week or two to run the numbers to figure out what makes sense for them.

My guess is that if it makes sense to offer health insurance now, it will make more sense after 2014. If it is right on the edge, it's going to tip a little more in the direction of offering health insurance. It is NOT going to tip in the direction of dumping employees.

But I guess we'll find out in a couple years, right?

ETA: I feel like in a lot of ways, this whole thing is designed to deal with the health care equivalent of Wal-Mart employees collecting food stamps, or welfare authorities that provide some assistance to children and their custodial parent or other caregiver, and then go track down the missing parent(s) and attempt to claw back some of the money they spent. All of this, in turn, tends to remind me of the Poor Laws, all of which tends to annoy me. I'd prefer a more universal system that didn't go through the employer, on the other hand, after having heard about the most recent NHS scandal, I'm not sure I'm in a hurry to make a big change.

Public Policy by Body Count

I've got a new theory, essentially, that public policy in the United States over the last hundred-ish years has been largely driven by how we think we can most easily reduce death. This is heavily informed by having just read two books about transportation policy in the late 19th/early 20th century. While it was hard to get people to do things that wouldn't make money/would cost a ton of money with no return, it was possible if everyone could be convinced that death rates (due to tuberculosis and other diseases, accident, etc.) would go down.

So I got to thinking about the current round of Let's Do Something About All These Guns. I looked at list of causes of death for various ages and genders and so forth. And I concluded that my theory is Not Wrong. It's getting harder and harder to meaningfully reduce death due to heart disease, cancer, etc., and accidents is a biiiiiigggg category (we've done a lot there, to, mind you). We've pushed hard on smoking and drinking. We're currently tangling with foodways, which is a tough, er, nut, even if that weren't the industry that all the people who used to push tobacco had gone when that horse was ready to die under them.

By contrast, if you look at how many gun deaths are suicide -- and how many successful suicides involve guns -- you cannot help but think, hey, if there were fewer guns lying around, it'd be a lot harder for people to kill themselves. We may be talking about Newtown and other mass tragedies, but at least some of the make-it-harder measures are more likely to reduce impulsive actions than planned mass murder.

And that sounds a lot like policy by body count.

I'm in favor.

Today's Activities Include: Paint!

Over the last few days, I picked up several sample cans for the kitchen and the rest of the downstairs. We have settled upon Benjamin Moore Honeybell for the kitchen:


We're pretty sure we're going to do Benjamin Moore Orange Burst for the playroom (which will one day become a dining room again):


We're debating what the hallway and living room will be. Current contenders include:





I picked tamarind at the store and we haven't gotten the sample up yet. I also picked:


for the hallway, which we also haven't put up on a wall yet.

I'm leaning towards fairviewtaupe on the long wall, butternutsquash on the short walls, unknown on the other long-ish wall, and olivebranch in the hallway. But I could easily be talked into eliminating olivebranch in favor of butternutsquash in the hallway.

There's no rush. The kids are home for February vacation week next week so no painting will be happening. We may not get this done for a month or so. The good news is, it looks like we'll be able to come to some kind of agreement on what colors to use.

Rosetta working once again

In the decluttering exercise, I found the headset for Rosetta, and I've been cleaning up my laptop. So I thought, hey! I should start working on Dutch again, since I might need it in a few months.

Alas, Rosetta got stuck in a sad update loop. So I sent a message to support. And after twoish days, they sent me a link to an update. I wasn't optimistic, but I think it actually works and remembers where I was, when I last used it. Around this time in 2011. Yikes.

Still! Happy!

ETA: Well, T. isn't happy. He doesn't want me and the computer talking to each other. Good news, however, is that I finally tracked down the settings for making the sound come through the headset. The mike was working, but it was really annoying that the headphones weren't. Wheee!

Sounding a little manic there. Hmmm.

The kids are both sick today; they have coughs but no fever. But neither has any desire to leave the house.

Heh, heh, heh: Don't Take Calcium Pills edition

My mother was (presumably still is) a huge believer in vitamin supplements. I spent my 20s discovering things like, hey! Some vegetables taste really great, especially when they aren't covered in sick-inducing (for me, anyway) dairy products! Also, I _love_ vinegar and thus a whole bunch of salad dressings that my mother never let any of us experience because she hates the stuff. Etc.

Anyway. Long story short, I quit taking the vitamins (C, a general and calcium was pressed upon me when I started really cutting the dairy out), started feeling _way_ better and ate a whole lot more vegetables. Life was good.

I periodically got sucked back into the whole calcium thing, but I'd take a new one for a while (liquid, food-based, with tons of magnesium, etc.), and then get annoyed with it and quit again. I've recently concluded that taking calcium supplements, like virtually all vitamins, seems to just make me queasy and feel awful.

Needless to say, running across this made me chuckle:


I'll dig for a better link to the original study later; my son wants me to read more of his home log to him.

ETA: This might be it:


From the Introduction:

"The serum levels of calcium are strictly regulated and an insufficient calcium intake is met by a more efficient intestinal absorption and renal conservation of calcium. Calcium is also mobilised from the skeleton, which can lead to bone loss1 and subsequent risk of fractures."

I've always focused on the idea in the first of those two sentences; my mother was obsessed with the second. Really, what we're dealing with is trust in the body's mechanisms vs. trust in a bunch of pills someone is selling you by making you fear yourself. This isn't a hard choice to make, at least not for me.

ETAYA and then I'm going to stop. I feel like we've had decades of recovering from old ideas about who died of heart attacks. For a long time, the classic heart attack was a middle-aged, overweight, never exercised, smoking man who suddenly engaged in a bout of exercise (shoveling snow being the big one). Even as various components of this changed, the identification of heart disease with men lasted a long time, even while heart disease remained the biggest killer of women. It took us forever just to recognize that heart attacks looked really different in women than in men, and we're still slowly working through the backlog of whether the stuff that was studied in men applies to women and whether it needs to be adjusted or not. Big news story there being, of course, that dosage REALLY matters, and all the doses tested in college aged, healthy men are wrong for elderly people, especially women. But whatever.

This study is Yet Another Example of someone suddenly realizing, hey! We're in a forest! Forget those two trees over there -- this is a forest! All that calcium crap was there to justify a dairy industry and/or do something about osteoporosis that didn't involve exercise, sunshine and reducing protein consumption generally. Meanwhile, the real issue wasn't really osteoporosis: it was heart disease.