I was going to write a nice post about being a doctor and a friend at the same time. I had it all thought out and had even found an interesting website about how to extract yourself from the relationship (either the doctor one, the friend one, or both) when it turns out your friend is a Lortab fiend. This was before it became clear that Papa John needed help:

A day after Barack Obama earned a second term in the White House, Papa John’s founder and CEO John Schnatter said the president’s signature health-care reform law would increase his business costs and possibly result in employees’ hours being cut.

Under the Affordable Care Act, full-time employees — those working 30 hours or more per week — would have to be provided with insurance at companies with more than 50 workers. Schnatter said it was likely that some franchise owners would reduce employees’ hours in order to avoid having to cover them.

“That’s probably what’s going to happen,” he said. “It’s common sense. That’s what I call lose-lose.”

Shoot, I thought to myself, he was doing the right thing but now is having to reconsider. He probably offered his employees health insurance and a 401K and now can’t afford it. Uh, turns out, no:

About a third of Papa John’s employees are covered by the company’s health insurance plan, although Schnatter said he has always wanted 100 percent of them on the plan. The rising costs of health insurance, he said, have been a deterrent.

So, while America was getting really inexpensive pizza delivered piping hot to its house, the “pizza guy” might be dying of consumption with no health coverage.  Papa, since you wanted to help, I’ve got good news!
Papa, the Affordable Care Act might allow you to achieve your desire:
1) I suspect a large number of your pizza delivery folk are under age 26 and not intending to make this their full time occupation. If they have parents with health insurance, Papa, you can shift the cost to your workers’ parents.
2) For your franchisees in states that opt for the Medicaid expansion, those employees making under 133% of poverty who are not covered will be Medicaid eligible. Good news, Papa, you can move the cost over to Uncle Sam.
3) For your franchisees with under 50 employees, the Health Insurance Exchanges will allow the purchase of subsidized insurance by the workers. In this case, Papa, you can be subsidized by your Uncle Sam.
4) For your franchisees that choose to cover their employees, the business is likely eligible for a credit of up to 50% of the employer’s contribution to provide health insurance for employees Once again, Papa, you can shift some of the cost to Uncle Sam.
5) With the elimination of the pre-existing condition and near universal coverage, care should be focused  less on picking insurance companies that are good at denying care and more on those that facilitate delivering good care. The Patient Centered Primary Care Collaborative includes several hundred large corporations who are betting that this will be the case. The good news is that the total cost of care has flattened over the past 18 months. The components of the Affordable Care Act seem to be working as they should. Papa, you are welcome to join the collaborative as well.
Having said that, Papa, you are correct that it may increase your “cost per pizza.” From the law, here is how you are personally liable for the funding:
1) Let’s see, your annual income is $2,500,000. Is your current health insurance policy worth over $8500 a year? If so, you will have to declare the amount as taxable income.  To pay for the extra taxes you may have to knock some folks back to part time.
2) You will no longer be able to pay for your Tylenol, Sudafed, and other over the counter meds from your flexible health spending account. Again, depending on how much Sudafed you purchase…
3) Then there’s the cosmetic surgery tax. If you are planning for that lift, maybe layoffs are in the offing.
4) In fact, insurance premiums did rise in 2011. In part, this is because the insurance companies, who agreed to a self-tax to pay for this, are passing some cost on to purchasers at this time. Sound familiar?
5) Lastly, the law was funded in large part by taking Disproportionate Share Money that was given to safety net hospitals to provide care for the poor and giving it to the patients in the form of increased Medicaid eligibility, subsidies and premiums TO LET THE PATIENT BETTER CHOOSE WHERE TO GO. Sort of market based response I’m sure you appreciate. If, Papa, your state (Florida) is opting out of the Medicaid expansion, your local taxes are liable to go way up to make up for the loss of these funds.

So, Papa, it could indeed be a lose-lose. If Florida opts out of the Medicaid expansion, you could be stuck with a higher tax bill for your personal health care and a higher tax bill to pay for hospitals to stay open and take care of all of the people who remain uninsured. Oh, well, your intentions were good.

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