How the Employer Mandate Delay Thwarts the ACA’s Insurance Exchanges and Ignores the Main Problem With the Act’s Mandate/Subsidy Scheme

Thom Lambert —  3 July 2013

Has a piece of legislation ever been subject to as much cynicism-inspiring manipulation as the Affordable Care Act?  It was rammed through Congress, on a totally partisan basis, via an unprecedented use of the reconciliation process.  Its passage required blatant vote-buying with such unjust goodies as the Cornhusker Kickback and the Louisiana Purchase.  Its proponents sold it with bald-face lies that nobody with any sense believes (e.g., “It will reduce the deficit.”), and they credit it with successes for which it is obviously not responsible.

Now the Obama Administration has decided to delay a key, but unpopular, provision of the Act—the so-called “Employer Mandate” that fines firms with 50 or more employers if they fail to provide qualifying insurance to employees working at least 30 hours per week—until after the mid-term elections.  Never mind that the Act itself doesn’t permit the Administration to waive these requirements.  This is “Obamacare,” after all, and that means The Big Guy gets to decide how it’s implemented.  He sure as heck doesn’t want it generating a bunch of lay-offs and hours-reductions right before mid-term elections!

Many in the business community are cheering the one-year delay.  It does, after all, hold off a provision that has been causing firms to reduce workers’ hours, thereby raising the  administrative costs of keeping businesses properly staffed.  But this delay is going to cause huge problems for implementation of the ACA and does nothing to address the biggest problem inherent in the Employer Mandate scheme.

IMPLEMENTATION PROBLEMS

The reporting system connected to (and delayed along with) the Employer Mandate is integral to the ACA’s subsidized health exchanges.  As Michael Cannon has explained, it’s hard to see how the exchanges could possibly work without the reporting system:

. . . Obamacare offers tax credits and subsidies to certain workers who don’t receive an offer of acceptable coverage from an employer. The law requires employers to report information to the IRS on their coverage offerings, both to determine whether the employer will be subject to penalties and whether its employees will be eligible for credits and subsidies.

The IRS both delayed the imposition of penalties and “suspend[ed] reporting for 2014.” As the American Enterprise Institute’s Tom Miller observes, without that information on employers’ health benefits offerings, the federal government simply cannot determine who will be eligible for credits and subsidies. Without the credits and subsidies, the “rate shock” that workers experience will be much greater and/or many more workers will qualify for the unaffordability exemption from the individual mandate. Either way, fewer workers will purchase health insurance and premiums will rise further, which could ultimately end in an adverse selection death spiral. The administration can’t exactly solve this problem by offering credits and subsidies to everyone who applies either. Not only would this increase the cost of the law, but it would also lead to a backlash in 2015 when some people have their subsidies revoked.

Now, the IRS hasn’t yet released its “formal guidance” detailing how the Employer Mandate/reporting system delay will operate.  It’s possible that regulators have come up with some way to offer selective subsidies absent the reporting system.  But given ACA proponents’ heretofore lack of concern about the practicability of the health care law, I wouldn’t hold my breath.

IGNORING THE BIG PROBLEM WITH THE MANDATE/SUBSIDY SCHEME

Putting aside the apparent political motivation for and practical difficulties created by the Employer Mandate delay, the main problem with the delay is that it simply ignores the huge problem created by the ACA’s mandate/subsidy scheme.

The Employer Mandate ostensibly aims to increase employer-provided health insurance coverage by encouraging employers to provide such coverage as an element of their employees’ compensation.  If a covered employer fails to do so, it faces a $2,000 annual penalty for each of its employees who purchases insurance on a subsidized exchange.  When implemented along with the rest of the ACA, however, the Employer Mandate is unlikely to enhance health insurance coverage for lower-income employees.  Here’s why:

  • The ACA subsidizes purchases on the insurance exchanges by individuals whose employers do not offer qualifying insurance at an affordable rate.  The subsidies are inversely related to income.  They are quite generous at lower income levels and reduce to zero once income exceeds four times the federal poverty level.
  • The only subsidy for employer-provided insurance, by contrast, is an implicit tax subsidy resulting from the fact that compensation paid in the form of insurance benefits, rather than wages, is tax-free.  The dollar value of that implicit tax subsidy for any individual is the sum of her marginal tax rate and the payroll tax rate, times the price of the policy.  (For most lower-income workers, the effective subsidy will be 22.65% * the policy price. That assumes a 7.65% payroll tax (1.45% Medicare + 6.2% Social Security) and a marginal income tax rate of 15%.)
  • Absent the penalty provision of the Employer Mandate, the best outcome from the worker’s standpoint would be for the employer to provide health insurance only if the effective subsidy from getting the insurance benefit tax-free exceeds the subsidy the worker would receive if she purchased her own insurance on a subsidized exchange.  Because lower income workers (1) are subject to lower tax rates and therefore receive a smaller tax subsidy from employer provided insurance, and (2) are eligible for large subsidies on the insurance exchanges, they would typically be better off if their employers dropped coverage and thereby enabled them to access the subsidized exchanges.
  • The penalty provision of the Employer Mandate alters this calculus.  Because an employer that fails to provide health insurance must pay $2,000 per year for each employee that purchases insurance on an exchange, a covered employer that cut its health insurance would be willing to raise its employee’s salary by only the amount the employer would have paid for the policy (the price it doesn’t have to pay) minus $2,000 (the amount of penalty it now has to pay).  Thus, in the face of the Employer Mandate, an employee would prefer that its employer provide health insurance coverage only if the effective tax subsidy from getting insurance tax-free exceeds the subsidy available to the employee on an exchange less $2,000.
  • Because the subsidies available to lower-income workers on the insurance exchanges far exceed — by way more than $2,000 – the effective tax subsidy from employer provided health insurance, most lower-income workers will prefer that their employers drop insurance coverage, pay them more in cash, and allow them to take advantage of taxpayer-financed subsidies on the insurance exchanges.

An example may help here.  Suppose an employer wishes to provide $40,000 in total compensation to a 40 year-old employee who is the head of a four-person household.  If the employer were to purchase a family policy for the employee (approximate cost $12,000/year), she would pay the employee $28,0000/year in cash.  The employee would pay no payroll or income tax on the component of his compensation provided as health insurance, so he would receive an effective federal subsidy of $2,718 (22.65% * $12,000).  If the employer were to drop health care coverage and thus drive the employee to an exchange, the employer would have to pay $2,000 and would therefore reduce to $38,000 the total amount she would pay the employee.  The employee would then receive all his compensation — all $38,000 — as take-home pay.  On the $12,000 that otherwise would have been paid as benefits, he’d have to pay $2,718 in tax, but he would now be eligible to purchase insurance on his own at a heavily subsidized rate. The ACA would limit his out-of-pocket insurance expense to 4.52% of annual income ($1,718), which means he would receive a whopping $10,282 subsidy on the $12,000 family policy.  This employee is $5,564 better off if his employer drops coverage (costing him $4,718:  $2,718 in foregone tax subsidy plus a penalty-induced compensation reduction of $2,000) and allows him to access the more generous subsidies available on state exchanges (benefiting him by $10,282).

This is the huge problem with the ACA’s Employer Mandate/subsidy scheme:  The scheme as a whole creates incentives to dump lower-income employees on the subsidized exchanges.  The Obama Administration’s politically expedient delay in implementation of the Employer Mandate does nothing to alleviate this difficulty.  But it might help Nancy Pelosi get her old job back.

Thom Lambert

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I am a law professor at the University of Missouri Law School. I teach antitrust law, business organizations, and contracts. My scholarship focuses on regulatory theory, with a particular emphasis on antitrust.

One response to How the Employer Mandate Delay Thwarts the ACA’s Insurance Exchanges and Ignores the Main Problem With the Act’s Mandate/Subsidy Scheme

  1. 
    northfork investor 3 July 2013 at 12:25 pm

    As biased and unscientific as this post is against the ACA (consistent with Prof Lambert’s previous posts and articles on this subject), I do agree it probably was delayed for the most cynical and partisan reasons. I believe I’ve seen the numerical example before. The biggest flaw is the thinking that the insurance policy on the exchange will cost and provide benefits anything like the policy designed by the employer.