The Skinny on “Skinny Plans”

Recently there has been a trend among business owners to ask about how they can do as little as possible and still be compliant within the word of the law when it comes to PPACA. I came across an article in the WSJ “Employers Eye Bare-Bones Health Plans Under New Law” and was really taken aback. I know I should not have, I mean, the legislation has been filled with several oops moments but this one is a little bit different in that some businesses are actually looking at this as an opportunity to “game” the law. I would first start by saying that each company is different, and their specific work force is unique so I am not going to go into the validity of “skinny plans” as a viable course of action without having time to look at the workings and issues of each company. What I will do is speak to the facts that should be looked at when making a decision for your company.

With the  recent release of regulations from the IRS and the Department of Health and Human Services, administration officials confirmed to Wall Street Journal reporters that large employers will not have to meet all the generous standards for health insurance plans offered on the state exchanges, but can offer minimal health insurance to avoid penalties.

According to the law employers have to offer “minimum essential coverage.” This turns out to be substantially less generous than the “essential health benefits” required for plans sold to individuals and small businesses. To get a grasp on what is happening here we need to refer back to the penalties that can be imposed.

For employers greater than 50 full time employees – If the employer does not offer coverage, and at least one full-time employee receives a premium tax credit or cost-sharing reductions, the business must pay $2,000 for each full-time employee, not counting the first 30 employees. If the employer does offer coverage, and at least one full-time employee receives a premium tax credit or cost-sharing reductions because the coverage offered is determined “inadequate” or “unaffordable,” the employer will be required to pay $3,000 for each employee who receives assistance or $2,000 per full-time employee (not counting the first 30 employees), whichever is less. This penalty is per worker, not for the workforce as a whole. In most cases the $2,000 penalty will be less, which, if in effect, would apply to the entire workforce after the initial 30-worker exemption. Yes that is some crazy PPACA arithmetic!

So as you can imagine it did not take a long time for some employers, with less skilled work-forces, to look at this and determine that it can make sense to offer a plan that covers minimal requirements such as preventive services, but often little more. Some of the plans wouldn’t cover surgery, X-rays or prenatal care at all. Does offering these types of plans that meet minimal medical benefit make the grade? The answer right now is yes. The meet the letter but not the spirit of the law.

Employees are free to go to a health insurance exchange if their employer offers them a plan they do not like. They can get a premium subsidy if their employer fails to offer coverage that: (1) is affordable; or (2) provides minimum value. A plan’s minimum value is measured with reference to benefits covered by the employer that also are covered in any one of the essential health benefit benchmark plans adopted by a state.

Allen Greenberg with BenefitsPro has it exactly right when he says “employers that try to pass off bare-bones coverage as real health plans without smirking are kidding themselves… regulators (and a lot of self-respecting brokers) aren’t likely to view skinny plans as anything but a sleazy tactic that will draw plenty of scrutiny, raise eyebrows and evoke guffaws. Employers that go this route would be smart to have a Plan B ready.”

That being said skinny plans have become an option for restaurant and retail chains that are too big to fit in the small employer category or employers that up until now have offered no coverage. These types of business have a workforce that is typically made up of young and healthy workers that may find the bare bones option more attractive from a financial standpoint.  They most likely will stay in these types of plans until they actually get sick or injured and need real care. As Dennis from TWGS points out, “In most cases where an employer is seriously considering the skinny plan option, employees are not going to lose something they already have…[this segment of the employee population] doesn’t expect to get it, doesn’t care about it, cannot afford it, or for various other reasons doesn’t take it because it isn’t paid for by someone else.”

A question many will surely ask will be “is this really health insurance?” Rather than calling it insurance I find it is more of a payment plan for small maintenance care. Insurance is needed to protect people from expensive needs that befall the unlucky insured party. With all the exclusions that come with these skinny plans, it is difficult to see them as true health insurance plans.

From everything we have been told, the government’s initial intent was for employers to continue to sponsor full health benefits. This was to prevent consumers from being stuck with catastrophic bills that then become a drag on the economy. I’m curious how long it will take, before a plan that is so at odds with that intent, to catch the ire of the government. As some legal scholars watching the issue have noted, we will eventually find out whether the Obama administration will attempt to use nondiscrimination arguments to put a stop to skinny plans. All the more reason to have that “Plan B” ready.