Insurers apt to pass $63 health care fee to workers

WASHINGTON — Your medical plan is facing an unexpected expense, so you probably are, too. It’s a new $63-per-head fee to cushion the cost of covering people with preexisting conditions under President Obama’s health care overhaul.

The charge works out to tens of millions of dollars for the largest companies, employers say. Most of that is likely to be passed on to workers.

Chantel Sheaks, an employee benefits lawyer, calls it a ‘‘sleeper issue’’ with significant financial consequences, particularly for large employers.


‘‘Especially at a time when we are facing economic uncertainty, [companies will] be hit with a multimillion dollar assessment without getting anything back for it,’’ said Sheaks, a principal at Buck Consultants.

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Based on figures provided in the new regulation, employer and individual health plans covering an estimated 190 million Americans could owe the per-person fee.

The Obama administration says it is a three-year assessment, starting in 2014, that is designed to raise $25 billion. It starts at $63 and then declines.

Most of the money will be used to cushion health insurance companies from the initial hard-to-predict costs of covering uninsured people with medical problems. Under the law, insurers will be forbidden from turning away the sick as of Jan. 1, 2014.

Of the total pot, $5 billion will go directly to the Treasury, apparently to offset the cost of shoring up employer-sponsored coverage for early retirees.


The $25 billion fee is part of a bigger package of taxes and fees to finance Obama’s expansion of coverage to the uninsured. It all comes to about $700 billion over 10 years, and includes higher Medicare taxes effective this Jan. 1 on individuals making more than $200,000 per year or couples making more than $250,000.

But the insurance fee had been overlooked as employers focused on other costs in the law, including fines for medium and large companies that don’t provide coverage.

‘‘This kind of came out of the blue and was a surprisingly large amount,’’ said Gretchen Young, senior vice president at the ERISA Industry Committee, a group that represents large employers on benefits issues.

America’s Health Insurance Plans, the major trade group for health insurers, says the fund is an important program that will help stabilize the market and mitigate cost increases for consumers as the law takes effect.

But employers already offering coverage don’t see why they have to pony up for the stabilization fund, which mainly helps the individual-insurance market.


The fee will be assessed on all ‘‘major medical’’ insurance plans, including those provided by employers and those purchased individually by consumers. Large employers will owe the fee directly. That’s because major companies usually pay upfront for most of the health care costs of their employees. It may not be apparent to workers, but the insurance company they deal with is basically an agent administering the plan for their employer.

The fee will phase out in 2017 — unless Congress decides to extend it.