Costs Up, Options Down

ObamaCare's Higher Costs, Limited Options And Mandates Continue To Weigh Down Health Care Options And The Economy

TOP TAKEAWAYS

• Under ObamaCare, health care costs are expected to post the largest annual increases in three years, leaving millions to face double digit premium hikes or find new coverage.
• The Obama Administration estimates that 86 percent of Americans will be better off purchasing new plans, making switching plans annually a "new normal."
• As options decrease, UnitedHealth Group, the nation's largest insurer, is considering leaving ObamaCare's individual insurance marketplace, "raising new questions about the long-term sustainability of a key ObamaCare program."
• Soaring out of pocket costs and rising deductibles are forcing families to forgo needed medical care.
• Next year, ObamacCare's employer mandate will kick in, forcing small businesses to shed employees, slow hiring or face massive penalties.

HEALTH INSURANCE COSTS ARE ON PACE "TO POST THE BIGGEST ANNUAL INCREASE IN THREE YEARS"

MarketWatch: "Health Care Costs Appear To Be On The Rise Again." (Jeffry Bartash, "Health-Care Costs Appear To Be On The Rise Again," MarketWatch, 11/17/15)

• "Health Insurance Is Also On Track To Post The Biggest Annual Increase In Three Years. The Cost Of Insurance Has Climbed At A 3% Pace In The Past 12 Months." (Jeffry Bartash, "Health-Care Costs Appear To Be On The Rise Again," MarketWatch, 11/17/15)

Rising Health Care Expenses "Are A Drain On U.S. Households." "Whether the upward trend in costs persists remains to be seen, but rising health expenses clearly are a drain on U.S. households." (Jeffry Bartash, "Health-Care Costs Appear To Be On The Rise Again," MarketWatch, 11/17/15)

Gallup Poll Says 42 Percent Of Americans List Cost Of And Access To Healthcare As The Most Important Health Issues Facing The U.S. "Americans continue to name the cost of (22%) and access to (20%) healthcare as the most urgent health problems facing the U.S. Obesity and cancer are next on the list, cited by 15% and 14%, respectively. No other issue receives more than 2% of mentions from Americans." (Rebecca Riffkin, "Americans Again Cite Cost and Access as Top Health Issues," GALLUP, 11/18/15)

• ObamaCare Not Likely To Have Affected the Healthcare Situation For Most Americans Who Continue To Be Concerned About Cost And Access. "The Obama administration has made a major effort to address healthcare cost and access by passing the Affordable Care Act. But the law probably did not affect the healthcare situation for the large majority of Americans, most of whom get health insurance through an employer or Medicare." (Rebecca Riffkin, "Americans Again Cite Cost and Access as Top Health Issues," GALLUP, 11/18/15)

OBAMACARE CONSUMERS FACE DOUBLE-DIGIT PREMIUM INCREASES JUST FOR DOING NOTHING

Consumers That Purchased The Most Popular Low-Cost Plan On The ObamaCare Exchanges Will "Face Premium Increases Averaging 15 Percent Next Year." "Americans who bought the least expensive versions of the most popular tier of insurance sold through HealthCare.gov will face premium increases averaging 15 percent next year unless they switch to a different health plan, according to a new analysis." (Amy Goldstein, "Rate Hikes Widespread For Popular HealthCare.gov Insurance Unless People Switch Plans," The Washington Post, 11/18/15)

• "Premiums Are Escalating For 2016 In Virtually All Of These Plans." "The analysis shows that premiums are escalating for 2016 in virtually all of these plans. And in nearly three-fourths of the counties where consumers can buy coverage through the federal insurance exchange, the plan that was the lowest-price option for 2015 will no longer have the least expensive premium next year." (Amy Goldstein, "Rate Hikes Widespread For Popular HealthCare.gov Insurance Unless People Switch Plans," The Washington Post, 11/18/15)
• According To The Wall Street Journal's Findings, Some Counties Will See Increases In Premiums Of Up To 35 Percent in 2016 . "In Raleigh, N.C., for example, the monthly premium for the lowest-cost silver plan offered by Blue Cross Blue Shield is rising 35%, to $396 from $293 a month for a 40-year-old nonsmoker. In 13 of the 30 states with an increase, customers can switch to another insurer and pay a lower premium than they do now, as long as they are willing to accept changes in coverage-including a higher deductible in most of those states, the analysis showed. In the 17 other states with increases, customers don't have that option. Switching to a different insurer might mitigate the size of the increase, but plans will still cost more than in 2015. In a handful of those states, consumers would see a rise in their deductible. In the rest, they would see no change, or the deductible would fall. (Louise Radnofsky And Paul Overberg, "Health-Plan Rates Vary Widely, But Most Popular Have Jumped From 2015," The Wall Street Journal, 11/18/15)

Low-Cost Plans Were Chosen By Two-Thirds Of Federal Marketplace Enrollees. "The Kaiser analysis makes that point by focusing on the most commonly bought plans within the 'silver' level of coverage. Silver is the second-lowest tier, and roughly two-thirds of the people who bought insurance through the enrollment website for the federal insurance marketplace chose a plan at that level. Of those, nearly half chose the plan available in their area with the lowest premiums -- the plans that Kaiser studied in the three dozen states relying on HealthCare.gov." (Amy Goldstein, "Rate Hikes Widespread For Popular HealthCare.gov Insurance Unless People Switch Plans," The Washington Post, 11/18/15)

Complicating Matters For Unsuspecting ObamaCare Enrollees Is If They Are Auto-Enrolled In The Same Plan, They Will Be Subjected To Higher Premiums. "The pushes from Kaiser and HHS are intended to counteract the tendency of most people with health insurance to ignore the annual opportunity to change their coverage. In 2014, HHS announced first that HealthCare.gov would have a convenient feature allowing consumers to 'auto-enroll' without returning to the site to renew their insurance. But as last year's enrollment season neared, federal health officials began to encourage people to take an active role in choosing coverage because most could save money that way." (Amy Goldstein, "Rate Hikes Widespread For Popular HealthCare.gov Insurance Unless People Switch Plans," The Washington Post, 11/18/15)

• Millions Of Enrollees Will Be Hit With Higher Premiums. "Last Year, About Half Of The People Who Renewed Coverage In The Federal Exchange Returned To HealthCare.Gov To Comparison Shop. About One In Three Selected A Different Health Plan." (Amy Goldstein, "Rate Hikes Widespread For Popular HealthCare.gov Insurance Unless People Switch Plans," The Washington Post, 11/18/15)

Like Your Cheap ObamaCare Plan, You Can't Keep It: Many ObamaCare Consumers Will Be Forced To Change Policies In 2016, Or Face "Sticker Shock"

The Obama Administration Concedes That "Consumers Risk Insurance-Premium Sticker Shock Unless They Are Willing To Switch To A Different Plan." "The findings by the Kaiser Family Foundation, a nonpartisan health policy organization, reinforce a message that the Obama administration has been spreading since the Nov. 1 start of the third year's enrollment period under the Affordable Care Act: Consumers risk insurance-premium sticker shock unless they are willing to switch to a different plan." (Amy Goldstein, "Rate Hikes Widespread For Popular HealthCare.gov Insurance Unless People Switch Plans," The Washington Post, 11/18/15)

• Health And Human Services Secretary Sylvia Matthews Burwell Claims Enrollees Should Shop The Marketplace For A New Plan To Avoid These Hikes. " Late last month, Health and Human Services Secretary Sylvia Mathews Burwell released a similar analysis based on a different group of ACA plans. 'Our message to returning marketplace customers is simple: Shopping may save you money,' Burwell said." (Amy Goldstein, "Rate Hikes Widespread For Popular HealthCare.gov Insurance Unless People Switch Plans," The Washington Post, 11/18/15)
• Obama Administration: The Price Of Plans Will Increase And 86 Percent Of Those In The Federal Exchange Should Switch Their Policy For 2016. "The Obama administration is encouraging switching as a way to avoid steep increases in premiums - and to promote competition among insurers, as the law intends. Next year will be no different: The price of plans will rise in most states, and the administration says that 86 percent of people who currently have coverage through the federal exchange can find a better deal by switching." (Abby Goodnough, "Shopping For Health Insurance Is New Seasonal Stress For Many," The New York Times , 11/18/15)

Georgetown Professor Says Switching Plans Every Year May Be The "New Normal." "'This may be just one of those environments where there's a new normal,' said Sabrina Corlette, a professor at the Health Policy Institute of Georgetown University. For many consumers, the volatility in the markets has been a source of anxiety and disruption. To have any choice at all is a welcome development, many say. But switching plans is also becoming an unwelcome ritual, akin to filing taxes, that is time-consuming and can entail searching for new doctors and hospitals each year." (Abby Goodnough, "Shopping For Health Insurance Is New Seasonal Stress For Many," The New York Times , 11/18/15)

Oregon Woman Prepares For Third Policy Change in Three Years Through The Federal Exchange. "For 2014, the first year she got health coverage through the Affordable Care Act, Gail Galen chose a plan from a new nonprofit insurer, Oregon's Health CO-OP. But the price jumped for 2015, so Ms. Galen switched to a policy from a different company, LifeWise Health Plan. Now, with open enrollment for 2016 underway, she is preparing to leap to her third insurer in three years - and stocking up on whiskey, she says, only half in jest, as she braces for another round of shopping on the federal insurance marketplace. 'Every year I feel like I'm starting all over again, and I just dread it,' said Ms. Galen, 63, of Warrenton, Ore. 'My stress level just shoots up.'" (Abby Goodnough, "Shopping For Health Insurance Is New Seasonal Stress For Many," The New York Times , 11/18/15)

Another Man Who Will Be Switching Plans For The Third Time In Three Years Avoids Visiting The Doctor Since His Physician Changes Every Year Along With His Policy. "'I don't have a regular doctor anymore, so I avoid going,' said David Saphier, a self-employed technology consultant in Manhattan who will be switching to his third exchange plan for 2016. Some experts have raised concerns that frequently switching doctors could result in worse health care, though carefully controlled research on the issue is sparse." (Abby Goodnough, "Shopping For Health Insurance Is New Seasonal Stress For Many," The New York Times , 11/18/15)

Those Forced To Switch Plans Can Expect Big Changes In Out-Of-Pocket Costs And Coverage. "Of course, switching insurance plans may mean even bigger changes. Different plans may have different structures of deductibles and other out-of-pocket payments. They may also mean switching to new doctors or other caregivers." (Amanda Cox and Margot Sanger-Katz, "In Many Obamacare Markets, Renewal Is Not An Option," The New York Times' The Upshot, 11/18/15)

As Low Cost Options Narrow, The Nation's Largest Insurer Is Considering Leaving ObamaCare's Individual Insurance Market

UnitedHealth Group May Exit ObamaCare's Individual Exchanges, "Raising New Questions About The Long-Term Sustainability Of A Key Obamacare Program." "UnitedHealth Group Inc said it may exit the individual insurance exchanges created under U.S. President Barack Obama's healthcare law, raising new questions about the long-term sustainability of a key Obamacare program." (Caroline Humer, "UnitedHealth May Exit Obamacare Individual Exchanges," Reuters, 11/19/15)

The Company Said "Weak Enrollment And High Medical Costs For Exchange Members Were Taking Too Big A Toll On Its Performance." "The largest U.S. health insurer said weak enrollment and high medical costs for exchange members were taking too big a toll on its performance. It will evaluate during the first half of next year whether it will offer Obamacare plans in 2017." (Caroline Humer, "UnitedHealth May Exit Obamacare Individual Exchanges," Reuters, 11/19/15)

OBAMACARE WILL EAT INTO THE ELECTORAL FORTUNES OF DEMOCRATS AS OBAMACARE'S HIGH DEDUCTIBLES ARE TAKING ITS TOLL ON CONSUMERS ACROSS THE COUNTRY

Americans Can't Afford The High Cost Of Their Health Plan Deductibles

Rising Costs "Threaten To Undercut The Law's Popularity With The Customers It Relies On The Most: Relatively Healthy People." "Insurers have raised premiums steeply for the most popular plans at the same time they have boosted out-of-pocket costs such as deductibles, copays and coinsurance in many of their offerings. The companies attribute the moves in part to the high cost of some customers they are gaining under the law, which doesn't allow them to bar clients with existing health conditions. 'The result is that many people can't avoid paying more for insurance in 2016 simply by shopping around-and those who try risk landing in a plan with fewer doctors and skimpier coverage.' These dual realities threaten to undercut the law's popularity with the customers it relies on the most: relatively healthy people. Their participation is vital to offset the costs of sicker people who can buy coverage at equal prices for the first time under the law; if the healthier ones pull out, that would put additional upward pressure on premium prices." (Louise Radnofsky, Paul Overberg and Stephanie Armour, "Rising Rates Pose Challenge To Health Law," The Wall Street Journal, 11/18/15)

Many Families Are Foregoing Needed Medical Care Due To High Deductibles. "Nearly 30 percent of people insured through the federal marketplace who had deductibles higher than $1,500 went without needed medical care in 2014 because they could not afford it, according to Families USA, a health care consumer group based in Washington. That includes diagnostic tests, treatments, and follow-up care as well as prescription drugs." (Tracy Jan, "Critics Say High Deductibles Make Insurance 'Unaffordable,'" The Boston Globe , 11/16/15)

• Out-Of-Pocket Costs Are Forcing ObamaCare Consumers To Drop Coverage Altogether. "Cost concerns have lead tens of thousands of the newly insured to drop their Affordable Care Act plans and opt for free or discounted care at community health clinics. Consumer advocates worry that the numbers will increase as the trend toward high deductibles worsens." (Tracy Jan, "Critics Say High Deductibles Make Insurance 'Unaffordable,'" The Boston Globe , 11/16/15)

A Family That Once Volunteered For The Obama Campaign Are Dismayed By The Cost Of Their Health Plan, Saying "We Can't Afford The Affordable Care Act." "'This law was going to give people a chance,' said Cassaundra Anderson, 44, a freelance proof reader. But in April, when Roger Anderson fell while hiking and hurt his shoulder, he discovered, to his dismay, that simply being insured was not enough. The Andersons' mid-tier plan, which costs them $875 a month, requires them to meet a $7,000 deductible before insurance payments kick in. 'We can't afford the Affordable Care Act, quite honestly,' said Cassaundra Anderson, whose family canvassed for Obama in their neighborhood." (Tracy Jan, "Critics Say High Deductibles Make Insurance 'Unaffordable,'" The Boston Globe , 11/16/15)

A Woman In Ohio Says She Was Better Off Before ObamaCare, Saying She "Cannot Get Anything" With Her New Health Plan. "On a recent afternoon, Laura Torres, a 62-year-old home health aide who is in nursing school, visited a community health clinic tucked into a strip mall 20 minutes from downtown Columbus. This is where she sought care when she was uninsured, paying an affordable sliding scale rate based on her $22,000 yearly income. Now she visits Whitehall Family Health Center seeking financial - not medical - help. An insurance counselor there helped Torres apply for a government subsidy, lowering her $6,000 deductible to $800. But she says she was better off before having to buy insurance. 'I cannot get anything with this insurance. Nothing,' said Torres, who avoids seeking treatment for her thyroid condition and high blood pressure because of cost. 'I just pay my monthly payments, try to take care of myself, go to work, and hope something serious doesn't happen to me.'" (Tracy Jan, "Critics Say High Deductibles Make Insurance 'Unaffordable,'" The Boston Globe , 11/16/15)

An ObamaCare Supporter In Columbus, OH That Depends On The Law For Health Coverage Questions The Value Of Her Plan, Saying She Isn't Sure "It's Worth The Money." "Amete Kahsay, 53, works as a temporary warehouse packer in Columbus. The Affordable Care Act marketplace is her only option for health insurance. She and her husband, an airport shuttle driver, pay $275 a month for a 'bronze' plan with a $13,200 deductible. Shortly after they signed up for insurance last year, her husband rushed her to the emergency room when she experienced dizziness. The visit, which included a CT scan of her brain, cost $1,700. She paid the charge from her savings, then returned to her native Ethiopia, where care is cheaper, to consult a neurologist and seek follow-up care. 'I support Obamacare. Without it, I wouldn't have any type of insurance. But I'm not sure it's worth the money,' said Kahsay, a US citizen who is registered as an independent voter. 'Now, unless I get very, very sick, like only if it's life-threatening, I won't go to the doctor. I just lay down and take a rest.'" (Tracy Jan, "Critics Say High Deductibles Make Insurance 'Unaffordable,'" The Boston Globe , 11/16/15)

A Former Hardware Salesman From New Jersey Said His High Deductible "Makes It Impossible" To Visit The Doctor. "'The deductible, $3,000 a year, makes it impossible to actually go to the doctor,' said David R. Reines, 60, of Jefferson Township, N.J., a former hardware salesman with chronic knee pain. 'We have insurance, but can't afford to use it.'" (Robert Pear, "Many Say High Deductibles Make Their Health Law Insurance All But Useless," The New York Times , 11/14/15)

An Illinois Family Pays For Its Medical Expenses Out Of Pocket Due To Their High Deductible. "'Our deductible is so high, we practically pay for all of our medical expenses out of pocket,' said Wendy Kaplan, 50, of Evanston, Ill. 'So our policy is really there for emergencies only, and basic wellness appointments.' Her family of four pays premiums of $1,200 a month for coverage with an annual deductible of $12,700." (Robert Pear, "Many Say High Deductibles Make Their Health Law Insurance All But Useless," The New York Times , 11/14/15)

An ObamaCare Consumer From Albuquerque, NM Exclaimed Her Policy Is "A Catastrophic Policy , " As Her Deductible Is $6,000. "Josie Gibb of Albuquerque pays about $400 a month in premiums, after subsidies, for a silver-level insurance plan with a deductible of $6,000. 'The deductible,' she said, 'is so high that I have to pay for everything all year - visits with a gynecologist, a dermatologist, all blood work, all tests. It's really just a catastrophic policy.'" (Robert Pear, "Many Say High Deductibles Make Their Health Law Insurance All But Useless," The New York Times , 11/14/15)

Soaring Deductibles Are Expected To Be A Weak Spot For Democrats Running In 2016

Democrats Running For President Have Stopped Short Of Offering Full Support For Obamacare And Pledge Instead To Change The Law. "Now that the law's major provisions are in place, the outcry over cost has prompted Hillary Clinton, the Democratic front-runner, to call for changes to Obama's signature domestic achievement. Clinton defends the Affordable Care Act on the campaign trail but is pledging to lower out-of-pocket costs including deductibles and making affordable health care a 'basic human right.' Senator Bernie Sanders, a self-described socialist challenging Clinton for the Democratic nomination, says Obama's health law does not go far enough and advocates for a 'Medicare-for-all' single-payer system instead." (Tracy Jan, "Critics Say High Deductibles Make Insurance 'Unaffordable,'" The Boston Globe , 11/16/15)

In Ohio, ObamaCare Continues To Pose "A Significant Barrier To Democrats." "Although the law survived two Supreme Court challenges, it could still be on the line in the 2016 presidential election, posing a significant political barrier to Democrats in this critical battleground state, which includes both conservative rural sections of Appalachia and diverse cities." (Tracy Jan, "Critics Say High Deductibles Make Insurance 'Unaffordable,'" The Boston Globe , 11/16/15)

• Ohio Has A High Disapproval Rating Of ObamaCare As It Has Some Of The Highest Health Plan Deductibles In The Country. " The problem experienced by the Andersons is particularly acute in Ohio, which has the fourth-largest number of people enrolled in high-deductible insurance plans in the country, after Texas, Illinois, and Pennsylvania, according to America's Health Insurance Plans, the industry's trade association based in Washington. … The percentage of Ohioans who view the law unfavorably is higher than in the nation as a whole, especially among independents and Democrats, according to new data from the annual Ohio Health Issues Poll. Nearly half of Ohioans do not like the law, compared with the 42 percent national figure reported by the Kaiser Family Foundation in October." (Tracy Jan, "Critics Say High Deductibles Make Insurance 'Unaffordable,'" The Boston Globe , 11/16/15)

Harvard University's Robert Blendon: ObamaCare "Could Absolutely Hurt Democrats" In 2016 As Polls Show That The Law Has Done Little To Nothing Or Actually Hurt The Middle Class. "'This will be an issue at least one more time in the 2016 election. It could absolutely still hurt Democrats,' said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. 'Polls about the Affordable Care Act have a considerable amount of middle-income people who say either the program has done nothing for them or actually hurt them.'" (Tracy Jan, "Critics Say High Deductibles Make Insurance 'Unaffordable,'" The Boston Globe , 11/16/15)

OBAMACARE'S EMPLOYER MANDATE IS JEOPARDIZING SMALL BUSINESSES AND PUTTING JOB CREATION AT RISK

Businesses Can't Afford To Comply With The Employer Mandate

In January, Businesses Will Begin Getting Hit By ObamaCare's Employer Mandate. "Starting in January, the Affordable Care Act requires businesses with 50 or more full-time-equivalent employees to offer workers health insurance or face penalties that can exceed $2,000 per employee." (Melody Campbell, "Health Care Law Forces Businesses To Consider Growth's Cost," The New York Times , 11/18/15)

A Texas Salon Owner Is Halting Her Company's Growth Indefinitely Due To The Employer Mandate. "Ms. Hunter, who has 45 employees, is determined not to cross that threshold. Paying for health insurance would wipe out her company's profit and the five-figure salary she pays herself from it, she said. 'The margins are not big enough within our industry to support it,' she said. 'It's not that I don't want to - I love my employees, and I want to do everything I can for them - but the numbers just don't work. I'm a single mom, and I've worked really hard at what I have, wanting to build something,' she said. 'It's very frustrating that the government has put something in place that's restricting the growth plan I've been working toward for a decade.'" (Melody Campbell, "Health Care Law Forces Businesses To Consider Growth's Cost," The New York Times , 11/18/15)

Businesses Forced To Become Stagnant As They "Weigh Very Carefully The Price Of Growing Bigger." "For some business owners on the edge of the cutoff, the mandate is forcing them to weigh very carefully the price of growing bigger. 'There's kind of a deer-in-headlights moment for those who say, 'I have this new potential client, but if I bring them on, I have to hire five additional people,' said Philip P. Noftsinger, the payroll unit president at CBIZ, a financial services provider for businesses. 'They're really trying to assess how much the 50th employee is going to cost.'" (Melody Campbell, "Health Care Law Forces Businesses To Consider Growth's Cost," The New York Times , 11/18/15)

"The Average Annual Premium For Workers At Small Companies Currently Tops $6,100 For Individual Insurance And $16,600 For Family Coverage," And Often, The Employer Is Required To Cover The Majority Of The Cost. "Paying even a portion of the cost can be expensive. The average annual premium for workers at small companies currently tops $6,100 for individual insurance and $16,600 for family coverage. That premium is typically shared between the employer and employee. Businesses that fall under the health care law's mandate are required to offer their workers 'affordable' insurance, which the law defines as individual coverage that costs less than 9.5 percent of the employee's household income. (Because employers do not know how much money their workers' relatives make, their options for compliance include basing their calculation on only their own employees' wages.) For a full-time, minimum-wage employee making $14,500 a year, an employer offering an average-price individual plan would have to pay around $4,700 a year." (Melody Campbell, "Health Care Law Forces Businesses To Consider Growth's Cost," The New York Times , 11/18/15)

The Cost Of Confusing Reporting Requirements Weighing Heavily On Small Businesses

New Tax Forms For Small Businesses Are Proving Difficult To Complete "Added to that cost are the administrative requirements. Starting this year, all companies with 50 or more full-time workers - even those not yet required to offer health benefits - must file new tax forms with the Internal Revenue Service that provide details on employee head count and any health insurance offered. Gathering the data requires meticulous record-keeping." (Melody Campbell, "Health Care Law Forces Businesses To Consider Growth's Cost," The New York Times , 11/18/15)

Tax Attorney Says ObamaCare Forms Are The Most Complex He's Ever Seen. "'These are some of the most complex informational returns we've ever seen,' said Roger Prince, a tax lawyer with the consulting firm Berry Dunn in Portland, Me. Some of his clients, even small ones, have spent months reconfiguring their human resources and financial systems to track the information that the new forms demand." (Melody Campbell, "Health Care Law Forces Businesses To Consider Growth's Cost," The New York Times , 11/18/15)

"Simply Figuring Out How Many Qualifying Employees They Have Can Be A Challenge" For Many Small Businesses. "The health care law defines a full-time-equivalent employee as someone who works an average of 30 or more hours a week - and the hours worked by some part-time employees count toward the calculation. For businesses that use many seasonal, variable-hour or temporary workers, like those in the hospitality industry, simply figuring out how many qualifying employees they have can be a challenge." (Melody Campbell, "Health Care Law Forces Businesses To Consider Growth's Cost," The New York Times , 11/18/15)

For One Small Business Owner, "The Expense And Distraction Of All That Paperwork Is One Of The Biggest Frustrations," Making Him Hesitant To Hire New Employees And Cross The 50 Employee Threshold. "The expense and distraction of all that paperwork is one of the biggest frustrations for one business owner, Joseph P. Sergio. His industrial cleaning company, Polar Clean, which is based in South Bend, Ind., but dispatches teams nationally, has just under 50 core employees. One of its business lines is disaster restoration, and after a flood or hurricane, its temporary staff balloons. Mr. Sergio offers health insurance to his permanent staff, but the premiums have risen so quickly that he had to switch to a more restrictive plan, with a higher deductible. He is reluctant to go over the 50-employee line and incur all of the new rules that come with it. That makes bidding for new jobs an arduous and risky exercise." (Melody Campbell, "Health Care Law Forces Businesses To Consider Growth's Cost," The New York Times , 11/18/15)

• "Unknown Costs And Complicated Rules" Leave Small Business Owner Wondering If Expansion Is Beneficial. "'I've had to pull my controller and a couple of top people to sit and spend days going through this,' he said. 'If you ramp up, and it pushes you over 50, there's all these unknown costs and complicated rules. Are we really going to be able to benefit from going after that opportunity? It freezes you at a time when you need to be moving fast.'" (Melody Campbell, "Health Care Law Forces Businesses To Consider Growth's Cost," The New York Times , 11/18/15)

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