Implementing the Affordable Care Act: Boise restaurant jumps ahead

Bardenay offers a glimpse into 2014 and beyond by insuring some part-timers.

adutton@idahostatesman.comSeptember 19, 2013 

Cooks, servers and other employees gathered in the exposed-brick "boiler room" of Boise's Bardenay Restaurant and Distillery on a Wednesday morning in late August. For many of them, it was their first brush with receiving health insurance through work — or at all. This was a chance to ask questions of their boss, Bardenay owner Kevin Settles.

Settles, a member of the Idaho Health Insurance Exchange board, has a front-row seat to the Affordable Care Act's overhaul of health insurance. The law requires almost all Americans to have health insurance coverage by next year. The exchange will be a marketplace for uninsured Idahoans to buy insurance.

A year ago, Settles worried that a new federal mandate for midsize and larger employers to buy health insurance for full-time workers or pay a fine would hobble Bardenay. He estimated last year that it would cost $120,000 a year in penalties to not cover workers, while offering plans he thought then would cost him $440 a month would make it tough for Bardenay to expand outside of Idaho. (Bardenay has restaurants in Boise, Eagle and Coeur d'Alene.)

That mandate has since been delayed until 2015 by the Obama administration, after complaints that the calculations involved in complying with the rule are too complicated to handle by January.

But this summer, Settles made a decision: He would jump in a year early, offering plans to more than just salaried employees.

"It's something I've wanted to do, (but) no other cost to my business has accelerated at the rate health care has over the past number of years," he said. "I said, 'Well, let's roll the dice and see where it goes.'"

Since Sept. 1, Bardenay has offered a Blue Cross of Idaho plan to staff members who consistently work hours in the "high 30s" per week and who are expected to stay with the company.

Bardenay has about 200 employees, about 65 of them full-time. Because they tend to be young and healthy, the rates were low enough for Bardenay to afford, Settles said.

"We've picked out our rock stars who we think will successfully work an average of 38 to 40 hours a week, have demonstrated a history of doing that, are happy doing that," he said.

For them, Bardenay now pays 100 percent of the roughly $235 monthly premiums for a plan with a $2,000 annual deductible and $5,000 maximum out-of-pocket cost, $30 copays for general doctor's office visits, and Blue Cross paying 70 percent of claims once the deductible is reached.

The rest of the staff is likely to be eligible for subsidized health insurance plans on Your Health Idaho, the state insurance exchange that opens Oct. 1.

One benefit of beating the mandate's deadline, Settles figures, is that the company can accidentally "screw up" a technicality of employer-sponsored insurance coverage without the threat of thousands of dollars in penalties.

UNEXPECTED QUESTIONS

Some issues that Settles is encountering may arise late next year for other Idaho businesses that rely on transient and part-time workers. Some of those employers have cut staff hours to avoid having to offer insurance.

What if 20 percent of employees are seasonal, working only during summer or sporadically during the year? What if the year-round employees put in 40 hours in the summer, but only 25 hours in the winter? Would Bardenay have to offer them insurance? The answer, according to industry groups and federal guidance, is a resounding "maybe."

What if servers trade hours from one week to the next, sharing shifts that offer the best tips, in the spirit of teamwork - only to land in the under-30 hours group as a result? Do they suddenly not qualify for insurance?

What if employees want to work more hours because they want insurance?

None of these questions have black-and-white answers.

FIRST-TIME COVERAGE

For two employees of the Downtown Boise restaurant, this fall marks the first time they have been insured through work.

John Edsall, 49, a server who consistently works 40 hours a week, said he'd gone "a decade, at least" without health insurance.

"It's a huge peace of mind just knowing that ... if something huge comes along, it's not going to devastate me financially," he said.

He just could not afford to buy insurance for himself. He has made do so far. He visited a quick-care clinic in Boise where he could pay out of pocket, and when he lived on the East Coast without insurance, he participated in a clinical trial that saved him $45,000, he said.

James Wells, 29, a cook who works between 32 and 39 hours a week, can't remember ever having insurance as an adult.

"I've wanted to be more proactive in preventive maintenance," he said.

But going uninsured has meant trips to the emergency room for antibiotics "and (coming) out with a huge, huge, massive bill," he said.

Settles had predicted that within six months, most employees still will not have used their insurance plans.

Not true for Wells. It took him less than two weeks. The cook sprained his ankle dancing last week and went to the St. Luke's emergency room in Downtown Boise.

In the Bardenay dining room this week, wearing a brace on his ankle and a smile on his face, Wells wasn't sure how much he'll owe for the ER visit. But "the fact that 100 percent of the burden isn't on me alleviates some of the stress," he said.

Audrey Dutton: 377-6448, Twitter: @IDS_Audrey

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