Tuesday, October 23, 2012

The costs of health services regulation outweigh benefits by two-to-one and cost the average household over $1,500 per year…

The Cost of Regulation


It has been estimated that the Obama administration is on track to implement over 3800 new regulations this year.  Business owners and managers can’t even begin to understand the impact of laws we don’t know about.  This all feels like the magician’s trick – watch this hand, while the other hand takes your wallet!  PPACA is ready to make a huge impact on our collective business system, and while we watch American politics degenerate into TV sound bites, more and more magical regulations keep appearing. 

The challenges for small and medium sized business seem overwhelming at times.  For the longest time the cost of government regulation were hidden costs of doing business.  Costs were only identified in terms of hard dollars directly related to some operational or physical plant change.  The impact of OSHA compliance on the work place was easy to see.  There would be a physical change to the structure, personal protective equipment, training expense – these were items we could clearly see on the P & L. 

But now a much more insidious cost has penetrated our collective balance sheets and latched on to the blood stream of entrepreneurial and corporate America.  Over reaching and uninformed regulators have taken a one-size fits all approach to their thinking.  Now – keep in mind – legislators and regulators are people that do not have to live with the rules they pass.  For example:
1.  Congress and Senate do not participate in Social Security.
2.  Government employees are allowed to have “comp” time where they can trade over-   time hours for paid time off (for-profit business cannot do this).
3.   Reduction in agency operating budgets have turned protection agencies into revenue enhancement agencies needed for their own survival.
4.   Agencies like EBSA and OSHA are graded and evaluate on how much financial penalty is assessed against free-market businesses.
5.   Pension plans and health benefits for life are passed by the same legislators that determine how much tax we pay.
6.   New regulatory agendas that target small and medium sized businesses.

You get the idea!

Only now are we beginning to understand the real cost of government regulation and how this insidious penetrator is manifesting inside our health care delivery system and dramatically impacting the cost.

The outcome for all federal regulations and all business sectors is that regulations cost small firms an estimated $7,647 per employee annually.  Regulations cost medium-sized firms $5,411 per employee and large firms $5,282 per employee. Overall, the cost per employee is 41 percent higher in small compared with medium-sized firms and 45 percent higher in small than in large firms.#2 

Health insurance is on everyone top-ten list. What was the cost of health care regulation before PPACA?
…..  


Unfortunately, a lot of this information regarding the cost of regulation seems to be available, but in no way connected so as to get an understanding of the real cost to the consumer.  Therefore, one is required to sort through all the various data points to find something that is not politically motivated or biased from the source provider.  Therefore, we read and study to help sort this out for our clients.

The various sources are given credit for the data, but we get the credit or blame for the speculation and trying to show the connectivity of the information. 

“All told, cost-related insurance regulations provide a net cost of $10.7 billion. It should be noted that to represent the burden of health services regulation accurately, the Employee Retirement Income Security Act is excluded.

ERISA allows companies that are self-insured for health coverage to be excluded from a number of regulations.  ERISA laws produce a $46 billion net benefit from blocking the costs that state regulations (state benefit mandates, premium taxes, etc.) would otherwise impose on these insurance plans if they were covered through a traditional carrier.  Currently, it is estimated that self-funded employer health plans cover over 120 million Americans.

Since those would-be costs are not entered on the cost side to include the benefits ERISA provides, by blocking them effectively would credit ERISA with creating $46 billion in benefits when in fact the law merely returns these health plans to a pre-regulation status quo ante" #3 

And for the final blow to our regulator mindset, The Institute of Medicine, Care without Coverage, has estimated that 18,000 uninsured Americans die every year due to lack of coverage.  In other words, over 4,000 more Americans die every year from health services regulation than die due to a lack of health insurance.  This is information from a historical perspective prior to PPACA (Healthcare Deformity) legislation. 

The winds of political change are blowing, but yet we don’t know if the wind will bring life giving rain or a flood of biblical proportion.  Let’s hope for a gentle rain.

#1  The U.S. Census Bureau reports a total 109,297,000 family and nonfamily households in
2002. U.S. Bureau of the Census, “Table HH-1. Households, by Type: 1940 to Present,” http://
www.census.gov/population/socdemo/hh-fam /tabHH-1.pdf, June 12, 2003, p. 1.

#2 The Impact of Regulatory Costs on Small Firms, by W. Mark Crain, Lafayette College, Easton, PASBA Office of Advocacy Sept 2005

#3  Health Care Regulation, A $169 Billion Hidden Tax, Christopher J. Conover 2004

Healthcare Reform Target Dates

Healthcare Reform Target Dates
The table below list dates that may be relevant if the Patient Protection and Affordability Care Act is allowed to remain intact.
W2 Reporting Requirements of aggregate value of employer sponsored coverage
2012
Standardized summary of benefits and coverage
Sept 2012
Group plan reporting to HHS and participants about efforts to improve
When regs are written
Auto enrollment options
When regs are written
60 day advance notice requirement of material changes
Sept 2012
Nondiscrimination rules for fully insured plans
When regs are written – expected Jan 2014
Maximum FSA deduction for employees of $2500
Jan 2013
Increase in Medicare tax on wages
Jan 2013
New Medicare tax on investment income
Jan 2013
Increase is medical expense threshold limits to be deductible to 10% of adjusted gross wages
Jan 2013
Exchange eligibility
Jan 2013
National Health insurance exchange begins
2014 - 2016
Health insurance premium assistance credit
Jan 2014
Individual mandate
Jan 2014
Play or Pay penalty
Jan 2014
No PreX limitations
Jan 2014
No annual plan limits
Jan 2014
Cadillac plan tax of 40% for excess cost of plan
Jan 2018


Are you aware of these upcoming Tax Hikes?

Below is a listing of some of the tax changes that are scheduled to happen. 

The following tax hikes will occur January 1, 2013:
Personal income tax rates
10% now increases to 15%
25% now increases to 28%
28% now increases to 31%
33% now increases to 36%
35% now increases to 39.6%
Capital gain rates rise from 15% to 23.8%.  The top dividends tax will rise from 15% to 43.4% in 2013.
Death Tax:  currently 35% any estate over $5M, in 2013 rate hike to 55% any estate over $1M
PPACA:  There are twenty new or higher taxes, penalties that have been project to cost us over $31 BIL in the coming years.  This mean everyone!
Medicare payroll hike - wages exceeding $200K ($250K married) rate increase from 2.9% to 3.8% (under $200K will still have 2.9%)
Flexible Spending Accounts (FSA) - cafeteria plans – These pre-tax saving accounts allow you to pay for health care, child care, and other items with non-taxable income.  The amount is being capped at $2500 per year.  This will cost tax payers over $10 MIL in new income taxes each year.        
Medical schedule A tax deductions.  Now medical deductions are allowed for medical expense dollars that exceed 7.5% of your adjusted gross income, this is being raised to 10% cut off.
Alternative Minimum Tax (AMT) - this used is a BIG change.  AMT used to impact just a few high income taxpayers, now over 31 million taxpayers can be hit with AMT - this adds to the ordinary income tax rates
Business owners no longer will have bonus purchase incentives - they used to be able to deduct half of the costs of new purchases now that will disappear and go back to the regular depreciation deductions


Small business is getting killed by over-reaching government.  New taxes, new regulations, new fines, additional government enforcement at every level…… we need to wake up to the mess created in Washington DC.  Our leaders are screwing things up!