Firms find ways around state health law
By Alice Dembner, Globe Staff | December 23, 2007 - The Boston Globe
To comply with the new state insurance law, a Burger King franchisee in
Boston expanded coverage from just his salaried staff to all full-timers.
To control his costs, he halved the share he pays. Only three of the 27
newly eligible employees took the insurance; others say they can't afford
it.
A large human service provider toughened eligibility for coverage in
response to the new law, requiring employees to work 30 hours a week to
qualify. That took away the option of work-based coverage for nearly 100
low-wage workers, but made them eligible for cheaper, state-subsidized
insurance. It could reduce the company's costs while increasing the
state's.
Another employer split his firm into separate corporations, each with
fewer than 11 full-time employees, according to his insurance broker. That
way he does not have to offer insurance, nor pay a fine.
Businesses from Boston to the Berkshires are responding to the state's
landmark health insurance initiative in ways that could help it succeed -
or stumble.
Policy makers are watching and waiting, but said they will act if many
employers dodge their obligations.
In the first nine months of this year, according to the latest state
figures, about 45,000 workers and their families gained insurance because
employers picked up part of the tab. That number represents a small but
significant chunk of the 293,000 newly insured state residents, a total
that puts Massachusetts between half and three-quarters of the way toward
its goal of covering nearly every resident.
Yet some employers are taking actions that could shift costs to the
state or leave more people uninsured, potentially upsetting the delicate
balance of responsibility on which the initiative rests, according to
interviews with more than 20 companies, insurance brokers, and trade
organizations.
When drafting the universal insurance law, "we purposely did not raise
employer taxes" to pay for insurance, said Senator Richard T. Moore,
cochairman of the Legislature's Committee on Health Care Financing, who
plans oversight hearings within a few months.
"We thought we were treating employers fairly, and I commend the
overwhelming number of employers who are doing the right thing," he said.
"If some are not going to respond fairly, we'll find ways to structure the
law so the loopholes get closed."
Businesses with 11 or more full-time equivalent workers are now
required to offer insurance or pay a fine. The law also bars employers
from offering higher-wage workers better health benefits than low-wage
employees. In addition, workers with access to employer-subsidized
insurance are now barred from getting state-supported coverage, and will
be excluded from the state's free care program starting in April.
The provisions were designed to ensure that as many workers as possible
get coverage through their employers in a state where about 70 percent of
the 200,000 businesses offer insurance benefits.
For years, Doug Barlow and his business partner had paid 100 percent of
the insurance cost for 11 full-time salaried workers at their three Burger
King restaurants in Boston. The new law's antidiscrimination provisions
led them to offer insurance to 27 hourly employees. But the potential cost
- nearly $1,100 per month for family coverage - pushed them to cut the
firm's contribution to 50 percent.
"I was prepared for a lot more people coming into our plan, but it
didn't happen," said Barlow. Other employers said they are seeing the same
pattern - expanded eligibility that does not lead to many more insured
individuals.
"For most working-class people, regardless of whether the company pays
part of the premium, it's very expensive," Barlow said. "Some full-time
people said they'd done the math and it is cheaper for them to pay the
state penalty than pay their half of health insurance."
The law requires individuals to obtain insurance by Dec. 31, if the
state deems it affordable, or pay a penalty of $219. Next year, the
penalty will rise.
Rebecca Posada works the counter at the busy Burger King in Center
Plaza. Although she's been uninsured for the five years she's worked there
and would like coverage, she is refusing Barlow's offer.
"I don't make enough" to pay $46 a week in premiums, said Posada, 26,
during a morning break. She hopes to continue getting free care at the
East Boston Neighborhood Health Center, and may be able to avoid the state
penalty because of her low income.
Vinfen, a 2,000-person company that runs programs for mentally ill
clients statewide, took a different approach that its officers said is
designed to help low-wage workers. New employees now have to work 30 hours
a week to qualify for insurance, up from 20.
"It's not a knee-jerk effort to reduce our costs," said Tim De Araujo,
vice president of human resources. "By denying them eligibility to our
plan, we gave them eligibility to the state plan. We felt this was the
right thing to do."
De Araujo said he would like to see the state offer employees a choice
of their employer plan or the state plan, whichever is more affordable.
Two-thirds of their employees earn less than $24,000 a year, which would
qualify them for state-subsidized coverage.
Separately, Vinfen renewed an offer of coverage, with a 70-75 percent
subsidy, to 650 existing employees who were eligible but not enrolled.
Only 72 signed up.
Some other firms have similarly tightened eligibility to control costs
or try to shift employees to state plans, said Christopher DeLorey, a
director of Telamon Insurance & Financial Network, and several other
brokers.
Policy makers and analysts are concerned that this pattern could boost
enrollment in the state-subsidized plan, which is already far above
predicted levels. The bulk of the newly insured so far are covered by
state-funded programs.
"Both the individual and the employer benefit" from the shift, said
Michael Widmer, head of the Massachusetts Taxpayers Foundation, a
business-funded financial watchdog. "But we don't have the public dollars
to fund this."
Some additional public money is coming from companies required to pay
fines of $295 per employee under the law because they don't offer
insurance.
Northeast Knitting Mills, a small sweater factory in Fall River,
dropped coverage in February because the fourth-generation family owners
could no longer afford it, said president Dan Reitzas. He will pay a
$13,000 fine, which is about 6 percent of his expenses, he said, but far
less than the $50,000 he was paying for insurance. He is helping employees
get a tax break on privately purchased insurance.
But other firms are avoiding fines by designating their employees as
independent contractors or using other questionable means, employees and
brokers said.
Paul Pietro, chairman of the Mid-State Insurance Agency, said he helped
one of his clients set up separate corporations for each of its
Massachusetts locations. Each then had fewer than 11 employees, so the
insurance law did not apply. "It's a loophole," said Pietro, who declined
to identify the client. Pietro said his other clients are paying the fine
or expanding insurance offerings.
Moore said he had heard of similar cases. "If it's a few employers, we
could publish a list of the folks using different schemes to avoid their
responsibility and let their customers know," he said.
Healthcare advocate John McDonough has another suggestion: Charge those
companies a large fee if many of their employees get state-subsidized
insurance.
Alice Dembner can be reached at Dembner@globe.com.