By Gary L. Miller
A recent statement issued by the U.S. Conference of Catholic Bishops sounds the alarm that various government
entities are passing laws and rules that are eroding our religious liberty.1
One of the threats cited in the document pertains to the U.S. Department
of Health and Human Services (HHS) contraceptive coverage mandate that many
faith-based employers find morally objectionable and that may cause some
Catholic colleges and universities to discontinue their group medical plans. This
column explores cost and HR issues that could be experienced by employers choosing
to go down this path.
A Brief Background
To counter the generally unsustainable trend of
rapidly rising healthcare costs, as well as curb the growth in the number of
citizens without medical insurance, the Patient Protection and Affordable Care
Act (PPACA) was signed into law in March 2010. Buried within this incredibly
complex law is a provision that group health plans provide coverage for
preventive care without cost-sharing by employees if the health plan is not
grandfathered.
This seemingly innocuous requirement has become a
source of serious controversy for many faith-based employers. The commotion does
not stem from the likely effect that the preventive care requirement will
increase health plan premiums or from the administrative burden it creates by
forcing employers to amend their group plan documents and clearly communicate
these changes. Rather, the contention comes from the guidelines that require
group medical plans to cover contraceptive services, which include certain
abortifacient drugs and sterilization.2
Another twist is that HHS allows an exemption from
the contraceptive mandate for religious employers but uses a very rigorous
standard for qualification as a “religious employer.” As a result, most
Catholic employers, such as Catholic hospitals and universities, do not qualify
for the exemption and will therefore have to comply with the mandate. For these
organizations, mandate enforcement will start when their plan years begin
following August 1, 2013.
Instead of expanding the definition of a religious
employer, HHS proposed an alternative method of funding the contraceptive
coverage. The alternative—that insurers and third-party administrators, rather
than employers, pay for the objectionable provisions—still requires the
contraceptive provision to be included in faith-based organizations’ group
medical plans, and also fails to make accommodations for self-insured entities.
Barring a change to the contraception requirement or
an expansion of the exemption, the HHS mandate will force Catholic colleges and
universities to subsidize, or at least facilitate access to, products and
services many consider morally objectionable. The broader concern of religious
liberty comes into play because such a mandate inhibits the free exercise of
religion: Many religiously affiliated organizations serving the common good as
an expression of their beliefs and values will be forced to support activities they
consider morally reprehensible just to be able to fulfill their mission.
An HR Perspective
Because the PPACA does not require employers to
offer health plans, faith-based employers with a moral objection to the mandate
have the liberty not to offer medical benefits at all, thus avoiding having to
provide contraceptive coverage. Those that drop their plans won’t be alone. Surveys
have generally found that between 2 percent and 20 percent of employers plan to
drop coverage beginning in 2014.3
The adverse consequences of dropping a group medical
plan would be huge. The 2011 Kaiser Family Foundation (KFF) Employer Health
Benefits Survey reported that the value of this benefit to employees is
substantial: $10,944 for those with family coverage and $4,508 for those with
single coverage.4 The
government makes this benefit even more valuable because employees receive the
employer-paid portion of the group plan premiums tax free. Further, the portion
of the premiums that faculty and staff pay can reduce, dollar for dollar, their
taxable compensation.
So, out of concerns for fairness combined with the
need to be able to attract and retain valuable employees, Catholic colleges and
universities that proceed with dropping their plans may want to make faculty
and staff “whole.” Making employees whole entails adjusting total compensation
so that other benefits and cash compensation are increased enough to offset the
loss of the value of the group medical plan. However, executives who are considering dropping these
benefits should face one uncomfortable truth from the onset: It won’t be possible
to make all employees whole because any attempt to do so would be extremely
expensive with inequitable and possibly discriminatory results. Further, an
employer that drops its group health plan before 2014 would
impose substantial non-monetary costs on certain employees.
The Cost of Making Employees Whole
Truven Health Analytics analyzed the cost-effect of
dropping medical coverage for 33 large employers with a total of 933,000
employees.5 Truven found that the average cost to these employers to
make their employees whole—after factoring in the savings from no longer
subsidizing premiums in the group plans—would be an additional $8,786 per
employee per year. What constitutes this cost?
First, there is the cost of the insurance itself. Ideally,
the cost of providing faculty and staff additional pay to help with exchange-purchased
medical insurance would be essentially the same as the cost of the premium
subsidies provided in the group plan; however, the Truven study found that the
exchange-purchased insurance would actually cost more than the group insurance.
Beyond the cost of the exchange insurance itself, the
Truven study discovered additional expenses. First, faculty and staff would
need additional cash compensation to offset the extra taxes associated with
their increased pay. Using the KFF healthcare reform calculator to estimate the
cost of insurance purchased through the exchange for a 45-year-old single
employee in the 25 percent tax bracket, the additional compensation to cover
these taxes would need to be roughly $4,000. This figure would rise for
employees purchasing family coverage, for employees in higher tax brackets, and
for older people because the exchanges will be allowed to vary premiums with
age.
Also, beginning in 2014, the PPACA imposes a penalty
of $2,000 per full-time employee (not counting the first 30) on any employer that
does not offer medical coverage and
has 50 or more full-time equivalent employees. The penalty will be assessed
only if at least one employee purchases insurance on an exchange and receives a
government premium subsidy, which is entirely likely.
For employees whose earnings are under the Social
Security wage cap, the employer would also have to pay additional payroll taxes
of 7.65 percent on the make-whole cash payments to their employees. Further,
employer benefit and insurance costs could increase for benefits that are
salary-based, such as defined contribution retirement plans, group life
insurance premiums, workers compensation, and disability insurance. The Truven
analysis also factored in other costs, making it easy to see how an employer’s expenses
related to dropping a group health plan and making employees whole could add up
to $8,000 or more.
Additional Considerations
The high price of dropping coverage and making
employees whole by increasing their cash compensation may be cost-prohibitive
for many colleges and universities. But even if a college or university could afford
this additional expense, it would likely not be possible to make employees
whole without discriminatory results. Title VII of the Civil Rights Act and the
Equal Pay Act both require equal pay for the same work. To make employees whole, different amounts of
increased compensation would be necessary for different employees. For
instance, higher-paid employees with family coverage would have to receive more
make-whole compensation than lower-paid employees with individual coverage. Family
coverage is more expensive than single coverage and lower-paid employees would
be more likely to be eligible for exchange-purchased medical insurance government
subsidies. The end result would potentially be having individuals in the same
job with similar performance and seniority levels being paid at significantly
different rates. These disparities could expose the employer to the possibility
of unacceptable discriminatory gender or racial pay differences.
Therefore, faith-based employers that drop their
medical plans are not likely to be able to make their employees whole, given both
the expense and the legal restrictions prohibiting discriminatory pay. The best
that a college or university could do may be to take the value of the employer
premium subsidy formerly provided to employees and distribute that amount equally
to all employees as a percentage of pay. Faculty and staff could then use this
additional pay to help them purchase exchange-based insurance. Some employees
would come out ahead (such as those who obtain coverage through a spouse’s plan
and those who receive a government subsidy for exchange-purchased insurance)
and some would be worse off. But this would be the most fair, affordable, and
legal approach for a college or university that opts to discontinue its group medical
plan.
End Note: What Happens in 2014?
The importance of access to affordable comprehensive medical insurance for employees cannot be overstated. Given the ability of individual market insurers to deny coverage or charge higher premiums to people with pre-existing conditions, employer-based healthcare provides a lifeline for many. As of 2014, however, the value of a group medical plan as a key component of total compensation dramatically decreases for one primary reason: Employer group coverage will no longer be the only way for employees to secure access to high-quality, affordable healthcare. The PPACA requires the establishment of state-based insurance exchanges through which people can purchase individual policies. As of January 1, 2014, all medical plans—including those on the state exchanges—will not be able to impose pre-existing condition restrictions or vary premiums on the basis of the purchasers’ health conditions. Additionally, exchanges will offer a wide array of quality choices to healthcare consumers, with clear descriptions of benefits. For those who cannot afford coverage, their exchange-purchased plans will be subsidized by the government.
While the healthcare law may be weak in provisions that control costs and improve quality, it does an outstanding job in guaranteeing access to high-quality affordable coverage (except for Medicaid-eligible individuals). Thus, beginning in 2014, an employer that chooses to drop its group medical benefits will not greatly diminish the value of its total compensation because of insurance access issues.
The
opinions expressed in this column are the author’s alone and do not represent
those of DePaul University or the Association of Catholic Colleges and
Universities. This article does not provide legal or tax advice on the matters
discussed above. Any issues involving employment, group benefit plans, or
taxation should be discussed with appropriately qualified counsel.
References
1
United States Conference of Catholic Bishops Ad
Hoc Committee for Religious Liberty. (May 17, 2012). Our First, Most
Cherished Liberty, A Statement on Religious Liberty.
2
Salganicoff,
A. & Ranji, U. (February 21, 2012). Insurance
Coverage of Contraceptives. The Henry J. Kaiser Family
Foundation Health Reform Source. Retrieved on August 25, 2012.
3
U.S.
Government Accountability Office. (July 13, 2012). Patient Protection and Affordable Care Act: Estimates of the
Effect on the Prevalence of Employer-Sponsored Health Coverage.
Retrieved on August
27, 2012.
4
All plan contribution and premium information was
taken from the Kaiser Family Foundation and the Health Research &
Educational Trust. (2011). Employer Health Benefits 2011 Annual Survey.
5
Justice,
C. (July 2012). Modeling
the Impact of “Pay or Play” Strategies on Employer Health Costs.
Truven Health
Analytics.