Web Exclusive | July 2012 | By Sonya Chudgar

What’s Next for Health Care?

Industry scrambles to understand health care after Supreme Court upholds law.

Lion's Choice employees enjoy a range of health benefits.
Lion's Choice employees enjoy a range of health benefits. image used with permission.

The dust has settled on the Supreme Court’s decision in the Patient Protection and Affordable Care Act (PPACA), and operators have had time to digest the upholding of President Obama’s health care reform. Many of them, though, are still trying to figure out what happens next and how the new health care model will affect their businesses.

While the National Restaurant Association (NRA) and a number of state restaurant associations oppose the law and are working toward a full repeal, some say a forward-looking approach is necessary.

“The reality is, a lot of things would have to line up pretty perfectly for the election results to have a major impact on whether this law continues into 2014 [when PPACA reforms are scheduled to go into effect],” says Sheldon Blumling, a partner at the law firm Fisher & Phillips. “There is so much to think about, you really need to start now to channel the passion into evaluating how best to integrate the new obligations into your business.

“If the law takes care of itself in some other way, great, but if not, at least you’re going to be prepared to either absorb the additional costs or plan around them properly.”

Many experts believe the industry will be affected by PPACA’s implementation in several ways. For example, quick serves may be forced to charge customers higher prices, cut back on employees or their hours, or shift to a model with fewer employee-customer touch points.

The employer mandate, also known as the pay-or-play principle, is likely to have the largest effect on the restaurant industry, Blumling says. The mandate requires employers with 50 or more full-time equivalent employees to provide minimum essentials coverage to all full-time workers and their dependents. If an employer chooses not to offer minimum coverage, it must instead pay a $2,000 penalty per employee per year.

The mandate will raise costs for employers who must either provide health care for the first time or spend more money to subsidize coverage, Blumling says.

Michelle Neblett, the NRA’s director of labor and workforce policy, says the employer mandate is especially disadvantageous to the restaurant industry because restaurants operate on very small margins, which experts say are generally 4–10 percent.

“Many employers and restaurant owners that I talk to say, ‘It’s the right thing to do to offer coverage and I want to do it, I want to continue doing it, but this cost is just unbelievable and it really eats all of my profits away,’” Neblett says. “It all comes down to cost.”

“Every employee that you can take and flip from full-time status to part-time status will eliminate a health care reform pay-or-play obligation.”

For a restaurant that does not yet offer health insurance, experts say they should consider two options: shrinking operations to a size that can be managed by fewer than 50 people or switching to more part-time employees, whom employers are not obligated to insure.

“Every employee that you can take and flip from full-time status to part-time status will eliminate a health care reform pay-or-play obligation,” Blumling explains. “That is one of, I think, the unintended consequences of health care reform. One of the policy goals was to get people covered.”

Enforcement of the employer mandate, Blumling says, will vary depending on the market and the type of talent a restaurant wants to attract.

While health care is not commonly offered across the quick-serve industry, operators who have done so have found it to be helpful.

Lion’s Choice, a Missouri-based roast beef franchise, already offers medical insurance to its employees. The company has about 270 employees, 60 of which are salaried. Jim Tobias, president of Lion’s Choice, says offering health insurance was critical to ensuring Lion’s Choice attracted top-level management.

“I think that’s one of the many things that sets us apart from our competitors,” Tobias says. “The fact that we have such a long tenure of managers and employees—the average manager has been with us over 17 years—makes everything easier. One thing, of course, that they look for is health insurance, so we try to offer that to them.”

The plan Lion’s Choice offers employees is a self-insured medical program that pays out benefits using a third-party administrator. Given that the number of full-time employees at Lion’s Choice is just above the 50 mark, Linda Stille, CFO of the brand, says the Supreme Court decision will not hit the company as hard as some of its competitors.

“It is possible—it is probable—that our expenses will go up, but to what extent and how that is going to affect us, we just wait and see,” Stille says.

Though changes from PPACA will not go into effect until 2014, Blumling says it is important for operators to begin planning now, especially since the number of employees an operator has on an average business day in 2013 will legally dictate whether the company surpasses the 50-employee mark for 2014.

“It takes a long time to figure out what’s going to work best for the company and to work it into your daily operations,” Blumling says. “And in that case, frankly, I don’t know that 18 months is a heck of a lot of time to start experimenting with maybe raising your prices to absorb more cost or using your part-time workers. These things can take time to figure out and make work operationally so by the time you get to 2014, the ship is running like you want it to.”

As the House passed a bill Wednesday, July 11, to repeal President Obama’s health care revamp in a 244-185 vote, representatives from the NRA add that though the Association supports a full repeal, it is also taking a forward-looking approach to understand the regulations and soften the impact as best it can.

“We’re doing a lot of education for our members,” Neblett says, pointing to the NRA’s health care webinars, speaking engagements, and information page on its website. “Our goal is to be a resource for our members and to educate our members about the law.”



The statement that claims restaurants will "flip" employees to part time from full time is a complete joke! Having worked in the industry for YEARS, there is no one aside from management who works full time on a regular basis. In fact, most restaurants that already offer benefits often keep your hours low (below 32) simply to avoid giving employees insurance.This statement and those like it influence those without industry knowledge (or those just a bit more gullible) into believing falsehoods and negative aspects of the PPACA.What I don't understand is how we live in a country that is so adamantly opposed to providing it's citizens healthcare and a living wage.

The government of this country was never established to fight battles between the business sector and its employees over wages. Nor was the government formed to dabble around in healthcare reform efforts. Freedom is free. Its the perks of it that get costly. I don't know why, at some point, everyone that lives in the good ole US of A decided that anything that they couldn't afford had to be paid for from the pockets of either those that they work for or those who have been diligent with their money throughout life and have amassed a savings (the wealthy). It isn't the place of the government to come in and tell us (business owners or wealthy folks) what we should be obligated to do with our earnings, which we worked very hard to get, just because someone else hasn't taken time to ensure their futures or work as hard as the next person. The federal government was formed primarily to offer defensive services to the citizens of this country during wartimes and to handle any international negotiations that need-be entered into or left. The rest of it has been added over the course of many years. Go look up the stats on how many new federal laws and regulations have been enacted by Congress in 2003. I believe the number is around 53,000. Everything we do is now regulated by the federal government, right down to how we spend the money that we don't owe them in taxes. You say it isn't fair to those who work minimum wage jobs to earn the minimum wage. I say no. You say it isn't fair that we don't provide benefits to minimum wage earners. Again - no. The entire reason we opened our doors for business was to make money. We do everything in our power to ensure this happens. Thats the simplicity of it. Life has never been, and will never be, fair to anybody living it. It's high time people pony up to the facts of life and get used to it. Fair isn't going to change. It'll just move on to the next issue after the current one is done.

This issue has continued to confound the best thinkers. However, one point, made by a friend in the medical industry, has been overlooked over and over. Who do you think is paying for those without insurance now? The same people that say that they cant afford it in 2014. Yes, the hospitals write off a great deal of unpaid bills now, but our rates are as high as they are now, in part, to cover those without insurance. And, that is why when one of my employees cut herself badly, the bill topped $2500 for stitches.And, I can assure you that I understand perfectly how small business works, AND I am a liberal. Being a conservative does not give you the corner on how business works! As an American, I would like to think that it is not about the "haves" being forced to share their stuff with the "have-nots" but about neighbors helping those in need.

Employee benefits compensation averaged $9.42 per labor hour worked(pulled from the US Bureau of Labor statistics). That puts a weekly cost per employee working 40hrs at $376.80, $1620.24 per fiscal period/month. This is a huge cost up front to small business. How this is supposed to not impact business growth and economic health I simply don't see it. The QSR brand I participate in is currently averaging $10,100 gross per week. With an average staff of 8 employees, 4 full time, this puts an additional $6480.96 burden on the SB owner and with an average ticket at $9.30 & monthly customer count at 4,400 per location we're looking at an average increase of cost per transaction of $1.47. That's just under 16% cost increase on average to afford healthcare for your 4 employees under this model. Referencing this article with an average food service QSR cost margin of 4-10% ... well healthcare just ate your profitability for lunch.

Employers with fewer than 50 employees are exempt from the employer mandate. An estimated 96% of all small businesses. Mine included. So no 1.47, cost margin in tact, profitability in tact. Employers with fewer than 50 employees, do qualify for the PPACA' SHOP exchange which offers small businesses a choice of competing plans from several providers.

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