PRN hours decreased because of the ACA

IrishIzCPNP, MSN, RN, APRN, NP · Jan 20, 2014

How is this related to ACA?

Jolie, BSN · Jan 20, 2014

AYes, I am experiencing this as an employer.

Obamacare requires employers with 50 or more FTEs (full time equivalent employees) to provide employer based insurance to employees who work 30 or more hours per week. The law mandates comprehensive coverage but limits the amount of money the employee can be charged to help pay for this coverage, placing an onerous financial burden on the employer to pay for insurance to employees who did not previously receive it.

We own a small family business. 5 years ago, we risked everything we own to open it. For about 3 years, we had almost no income as the business slowly grew, stopped losing money, them finally became profitable. Even now, we can't afford to purchase insurance for our employees. To do so would exhaust the money that we need to pay our household expenses, and also re-invest in maintenance, updates, education, and improvements. We currently employ about 35 people, some FT, some PT, some inexperienced 16 year-olds, some highly educated professionals. We would like to invest in an expansion that would nearly double our capacity, but to do do would require a staff of over 50 FTEs, putting us in the position of having to absorb health insurance costs of roughly $100,000/year, which we can't afford to do. Those are costs that we can't recoup or share with employees. So because of Obamacare, we won't build a new building, purchase new durable equipment, hire additional legal or accounting consultants, purchase additional advertising or hire 30 new people.

That is the effect that Obamacare is having on one small business. Imagine the collective effect nationwide on jobs and the economy.

ArtClassRN, ADN, RN · Jan 20, 2014

We currently employ about 35 people, some FT, some PT, some inexperienced 16 year-olds, some highly educated professionals.
That is the effect that Obamacare is having on one small business. Imagine the collective effect nationwide on jobs and the economy.

I call BS. If you could expand and hire 30 new people, you would do it in a heartbeat, ACA or not.

The ACA doesn't affect your company by your own admission.

Conservatives have been claiming "I can't expand because of " for many years before the ACA was implemented.

The reasons are usually:

1. I don't want to pay taxes.

2. I don't want to abide by occupational or environmental safety laws.

ArtClassRN, ADN, RN · Jan 20, 2014

How is this related to ACA?

It isn't. Just more conservatives trying to make political hay out of expanded access to healthcare.

Esme12, ASN, BSN, RN · Jan 20, 2014

How is this related to ACA?

It is not BS......

These regulations will vary depending on employer size. Businesses classified as a “Large Employer” are determined to have more than 50 full-time equivalent employees, whereas “Small Employer” businesses have less than 50 full-time equivalent employees. Under the ACA, employees that work an average of 30 hours per week (130 total monthly hours) are considered full-time.

The ObamaCare employer mandate / employer penalty, originally set to begin in 2014, will be delayed until 2015. The ObamaCare "employer mandate" is a requirement that all businesses with over 50 full-time equivalent (FTE) employees provide health insurance for their full-time employees, or pay a per month "Employer Shared Responsibility Payment" on their federal tax return.

The employer mandate is officially part of the Employer Shared Responsibility provision. Under the Affordable Care Act, the federal government, state governments, insurers, employers and individuals are given shared responsibility to reform and improve the availability, quality and affordability of health insurance coverage in the United States.

As a per-diem/casual employee the employer does not offer benefits...they will have to beginning 2015......many facilities will be doing this to save money.

[h=2]The Employer Mandate Fee / Employer Shared Responsibility Payment[/h] The annual employer mandate fee (officially called an Employer Shared Responsibility Payment) is a per employee fee for employers with over 50 full-time equivalent employees who don't offer health coverage to full-time employees.
• The employer mandate is based on full-time equivalent employees, not just full-time employees.
• The fee is based on whether or not you offer affordable health insurance to your employees that provides minimum value (explained below).
• The annual fee is $2,000 per employee if insurance isn't offered (the first 30 full-time employees are exempt).
• If at least one full-time employee receives a premium tax credit because coverage is either unaffordable or does not cover 60 percent of total costs, the employer must pay the lesser of $3,000 for each of those employees receiving a credit or $750 for each of their full-time employees total.
• The fee is a per month fee due annually on employer federal tax returns starting in 2015. So the per month fee is 1/12 of the $2,000 or $3,000 per employee.
• Unlike employer contributions to employee premiums, the Employer Shared Responsibility Payment is not tax deductible.
• The Internal Revenue Service has more information about the Employer Shared Responsibility Payment.
The employer mandate fee is officially referred to as a "shared responsibility payment", as the fee will help to go to help fund marketplace subsidies and to compensate for unreimbursed emergency health care provided to the uninsured.

It affects the over all cash outflow where there was not one before...so yes I can see facilities doing this to save money.

Esme12, ASN, BSN, RN · Jan 20, 2014

It isn't. Just more conservatives trying to make political hay out of expanded access to healthcare.

That will cost more money from employers......

That calculation determines whether you are mandated to offer coverage, not which of your employees are eligible for coverage, says Marcus Newman, a registered health underwriter and chartered benefits consultant at brokerage GCG Financial in Chicago. “If you are mandated to offer coverage, you’ll have to cover employees working 30 or more hours per week on average, starting 90 days after they are hired,” he says. Story: For Obamacare to Work, Small Employers Must Embrace Exchanges
Part-timers under 30 hours and seasonal employees who work fewer than 120 days annually do not have to be covered even if your company falls under the mandate. To avoid penalties, employers under mandate must offer insurance to eligible employees that covers at least 60 percent of the actuarial value of the cost of benefits; the employees’ share must not be more than 9.5 percent of their income.

http://info.kaiserpermanente.org/html/hcr_ca/employer-shared-responsibility.html

IrishIzCPNP, MSN, RN, APRN, NP · Jan 20, 2014

It is not BS...... The ObamaCare employer mandate / employer penalty originally set to begin in 2014, will be delayed until 2015. The ObamaCare "employer mandate" is a requirement that all businesses with over 50 full-time equivalent (FTE) employees provide health insurance for their full-time employees, or pay a per month "Employer Shared Responsibility Payment" on their federal tax return. The employer mandate is officially part of the Employer Shared Responsibility provision. Under the Affordable Care Act, the federal government, state governments, insurers, employers and individuals are given shared responsibility to reform and improve the availability, quality and affordability of health insurance coverage in the United States. As a per-diem/casual employee the employer does not offer benefits...they will have to beginning 2015......many facilities will be doing this to save money.It affects the over all cash outflow where there was not one before...so yes I can see facilities doing this to save money.[/quote']
The original poster is a per diem employee. This doesn't affect him/her as they are now a full time employee no matter how many hours they worked. The poster is per diem.
In the end...I can't say I care. My daughter with a "pre-existing condition" who last year had cheap year of $22,000 in medical expenses will continue to have medical coverage...for life.
Employers need to figure it out. Maybe those who are overpaid at the top need to find a way to take a reasonable pay.
My husband owns a small company. So we are facing this on many sides. And overall....we find that the ACA can be a positive and worked with if people are willing to open their minds and if businesses are willing to accept the need to be reasonable. So big change for many...open minds and being reasonable doesn't always come easy. So maybe bumpy for some initially but life saving for MANY...forever.

Jolie, BSN · Jan 20, 2014

Thank you, Esme, for a well written, fact based discussion. It is disheartening to find fellow healthcare professionals so ill informed of the requirements of this law that they fail (or refuse) to recognize its implications, and resort to throwing out emotion-laden accusations that have little basis in fact.

No where in my post did I say that the law was 100% bad. It does have some positives. Nor did I claim that it will irreparably harm all businesses. I clearly indicated that I was posting about the experiences of one small business about which I am thoroughly knowledgable. And despite naysayers arguments to the contrary, I can assure you that our decision to let our letter of intent expire stemmed from a thorough review of the financial implications of an expanded staff (to the extent possible, given the constant changes in the implementation of Obamacare.) Costs involved in building, equipping, stocking, hiring and training staff can be recovered, as we have proven with our original business. Insurance costs associated with Obamacare can only be minimally offset, leaving us with approximately $100K in losses in the first year of expansion. We can't justify taking that risk. If unsuccessful, we would not only lose our business, home, retirement and kids' college funds, we would put our current 30-some employees out of work. So, although some posters here won't believe me, our decision, in large part, stems from a sense of responsibility to the employees we already have. Kind of like not having more kids when you're unsure of your ability to feed and clothe the ones you already have.

Reasonable people can and do disagree about the risks and benefits of this legislation, but unsubstianted arguments like those posted above do nothing to further the discussion and, in my opinion, diminish the stature of our profession by demonstrating the failure of some members to inform themselves (even to the most elementary level) about legislation and current events that are intimately tied to our profession. I would liken it to a geographer emotionally shouting at the top of his/her lungs that the earth is indeed flat. Such ignorance is an embarrassment to fellow professionals.

I hope that the information provided is helpful to the original poster.

RainMom · Jan 20, 2014

The original poster is a per diem employee. This doesn't affect him/her as they are now a full time employee no matter how many hours they worked. The poster is per diem.

Per diem according to the employee/employer relationship but ACA redefines that based on avg hrs per week. So no matter what you want to call it in the past, if an employee works 30+ hrs weekly on avg, that person by ACA regulations is required to have healthcare insurance provided by the employer. Thus she is now a per diem employee being scheduled under 30 hrs in order to avoid the extra expense to the facility. Considering that she already has insurance anyway, it would be great if a waiver for coverage would be allowed & no changes would have to be made to her hrs.

wooh, BSN, RN · Jan 20, 2014

So jolie, who should pay for your employees' healthcare?

IrishIzCPNP, MSN, RN, APRN, NP · Jan 20, 2014

Thank you Esme, for a well written, fact based discussion. It is disheartening to find fellow healthcare professionals so ill informed of the requirements of this law that they fail (or refuse) to recognize its implications, and resort to throwing out emotion-laden accusations that have little basis in fact. No where in my post did I say that the law was 100% bad. It does have some positives. Nor did I claim that it will irreparably harm all businesses. I clearly indicated that I was posting about the experiences of one small business about which I am thoroughly knowledgable. And despite naysayers arguments to the contrary, I can assure you that our decision to let our letter of intent expire stemmed from a thorough review of the financial implications of an expanded staff (to the extent possible, given the constant changes in the implementation of Obamacare.) Costs involved in building, equipping, stocking, hiring and training staff can be recovered, as we have proven with our original business. Insurance costs associated with Obamacare can only be minimally offset, leaving us with approximately $100K in losses in the first year of expansion. We can't justify taking that risk. If unsuccessful, we would not only lose our business, home, retirement and kids' college funds, we would put our current 30-some employees out of work. So, although some posters here won't believe me, our decision, in large part, stems from a sense of responsibility to the employees we already have. Kind of like not having more kids when you're unsure of your ability to feed and clothe the ones you already have. Reasonable people can and do disagree about the risks and benefits of this legislation, but unsubstianted arguments like those posted above do nothing to further the discussion and, in my opinion, diminish the stature of our profession by demonstrating the failure of some members to inform themselves (even to the most elementary level) about legislation and current events that are intimately tied to our profession. I would liken it to a geographer emotionally shouting at the top of his/her lungs that the earth is indeed flat. Such ignorance is an embarrassment to fellow professionals. I hope that the information provided is helpful to the original poster.[/quote']
And sometimes it isn't about the profession but about the individual first. The ACA has protected my child. I'll take that. The rest...stuff I think can be dealt with. My profession isn't my main priority in life.
The ACA comes with amazing benefits. Sure there are negatives but not everything is always perfect. People need to learn to find a way to work with the new system and accept it. My husband is a small business owner. The company doesn't believe their employees should ever be without insurance and has always provided high quality health insurance. So the ACA...is something they pretty much agreed with from early on when it comes to the idea of providing insurance for employees.