Health Care Reform Resources for Employers

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Affordable Care Act Kept in Place with All Coverage and Reporting Obligations

The failure of the Republican-controlled Congress to repeal and replace the Affordable Care Act (ACA) in 2017 left in place the ACA's wide-ranging obligations for employers with 50 or more full-time employees or part-time equivalents to provide ACA-compliant health coverage to employees who work at least 30 hours per week, and to track and report all employee hours to the IRS, along with other administrative requirements.

Going forward, bipartisan support will be needed to pass specific, targeted reforms.

Until the ACA's employer coverage and reporting obligations are changed through legislative actions or regulatory adjustments, employers subject to the ACA must comply with all its coverage and administrative requirements.


Updates

A Split Congress May Pursue Health Care Fixes
The partisan divide makes it unlikely that major changes in the ACA will advance in the next Congress, but that doesn't mean bipartisan efforts to address health care challenges are off the table.

SHRM Supports Association Health Plan Rule, Opposes Lawsuit
The Society for Human Resource Management has filed a brief supporting a Department of Labor rule that makes it easier for small employers to band together to buy insurance through association health plans.

Final Rules Expand Exemption from Contraception Mandate
The U.S. Department of Health and Human Services issued two final rules Nov. 7 that exempt certain entities from the ACA's contraceptive mandate if their opposition is based on religious or moral grounds. 

Navigating the Changing Prescription Drug Market
Employers facing rising drug-coverage costs are advised to revisit their vendor relationships in 2019, as mergers between health insurers and pharmacy benefit managers alter the competitive landscape.

Due in 2019, Employers' Final PCORI Payment Is Rising
The final annual fee that self-insured health plan sponsors will pay to fund the Patient-Centered Outcomes Research Institute (PCORI)—due July 31, 2019—will go up by less than a dime from last year for each plan enrollee.

Get Ready for More ACA Penalties
The recent barrage of letters sent by the IRS proposing penalties under the ACA may be subsiding, but a new round is expected later this year. Employers need to take steps now to be prepared.

Regulations Aim to Let Employees Use HRAs to Buy Health Insurance
Federal agencies proposed letting employers fund a new kind of health reimbursement arrangement (HRA) that employees could use to buy individual-market insurance—a change that could transform the employer-provided health care landscape, some predict.

House Passes Bills Enhancing HSAs
Two bills passed by the House of Representatives would transform the use of health savings accounts (HSAs)—such as by nearly doubling the cap on annual contributions and allowing HSAs to pay for gym memberships—if the Senate goes along. 

Managing High-Cost Claimants Is Employers' Top Health Strategy
To keep health care expenses down and to improve workforce health, employers are helping workers and their dependents to manage their chronic conditions, stay healthy and avoid costly hospital stays.

ACA's Affordability Threshold Rises in 2019
Employers should not overlook the ACA's annual inflation-adjusted shift in cost-sharing limits for group health plan coverage, as they could face steep penalties for failing to provide affordable coverage under the ACA's shared-responsibility provisions.

2019 HSA Limits Rise, IRS Says
Next year, allowable HSA contributions for participants with self-only health coverage will rise by $50. For HSAs linked to family coverage, the 2019 contribution limit will rise by $100 above the family cap set for 2018.

Employers Hold Down Health Plan Costs for 2019
Employers' health care costs continue to slow but still outpace overall inflation, while employees' share of plan costs is holding steady, new reports indicate. Prescription drug cost increases have slowed as well except for specialty drugs.

For 2019, Employers Adjust Health Benefits as Costs Near $15,000 per Employee
With the cost of employer-sponsored health care benefits expected to approach $15,000 per employee next year, employers continue to make changes to their plans. New survey findings reveal the most common medical and drug benefit trends for 2019 and beyond.

Employers Assess Risk Tolerance with Wellness Program Incentives
Employers designing 2019 wellness programs must decide what approach to take on program incentives without Equal Employment Opportunity Commission guidance.

Final Rule on Association Health Plans Expands Options
A rule finalized by the Department of Labor will make it easier for small businesses to band together to buy health insurance without some of the regulatory requirements that individual states and the ACA impose on smaller employers.

Short-Term Health Plans Rule Could Affect COBRA Choices
A new final rule expands short-term health plans, which may appeal to departing employees seeking a lower-cost COBRA alternative, new employees not yet eligible for their employer's plan, and pre-65 retirees. But they should understand the coverage limits.

Elections Raise Specter of 'Medicare for All' vs. Employer Benefits
After the 2018 midterm congressional elections, will momentum grow for single-payer health care—such as by expanding Medicare so anyone can sign up ("Medicare for all") to replace private and employer-sponsored coverage, as many progressives advocate?

From the Archives

What's Next for Health Care Legislation?
Republicans are no longer expected to make big changes in the ACA, but bipartisan legislation streamlining ACA reporting and giving health savings accounts more flexibility are on the agenda. 

IRS Lowers 2018 Family HSA Contribution Limit by $50
The 2018 contribution limit for health savings accounts linked to family coverage will be $6,850—not $6,900, as the IRS had previously announced. Some employees who calculated their pretax payroll contributions at the beginning of the year will need to adjust their deferrals.

The Right Ingredients Brew Wellness Program Success
With the efficacy of workplace wellness programs being questioned, new research may help to explain why some efforts are successful and others aren't. That matters, because if employers can't show that their wellness programs are producing results, fewer will continue to offer them.

Does a New Study Underestimate Wellness Programs?
A major new study casts doubt on whether worksite wellness programs improve employees' health and lower health care costs. But does it tell the full story? 

Employees Are More Likely to Stay If They Like Their Health Plan
Employer-sponsored health coverage needs to be more flexible to innovate and meet workers' health care needs, experts say. 

High-Deductible Plans More Common, but So Are Choices
The share of big employers offering high-deductible health plans (HDHPs) has grown by more than 20 percent since 2016, new research shows. Employers are offering HDHPs alongside traditional plans to give employees more choices. Here's what employers and employees are paying. 

States Might Require Health Insurance
Some state lawmakers want to require residents to purchase health insurance to help mitigate the potential impact of the "repeal" of the ACA's individual mandate.

Will Medical Marijuana Have a Place in Employee Health Plans?
With 29 states and the District of Columbia now allowing the use of medical marijuana, employee health plans may have to consider adding coverage for the drug. In an environment in which opiate addiction continues to escalate, there may be more openness to reimbursing medical marijuana as an alternative, less addictive pain medication.

What the Individual Mandate Repeal Means for Employers
The Tax Cuts and Jobs Act effectively repeals the ACA's requirement that most Americans obtain ACA-compliant health coverage, effective in 2019. Here's how it will affect employer-sponsored health plans now, and what it portends for the future of the employer health care mandate and related reporting obligations.

IRS Begins to Send ACA Penalty Letters
The IRS has started to send out penalty notices to employers subject to the ACA that failed to provide ACA-compliant coverage to full-time employees. Employer that receive a penalty letter will have just 30 days to respond before the IRS demands payment.

Not Every Aspect of Form 1095-C Can Be Outsourced
Outsourcing the processing of Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, is common. But employers remain responsible for the accuracy of the form, which is cumbersome to complete, and should be knowledgeable about it when employees have questions.

Consider Employees' Reactions Before Reducing Birth Control Coverage
Most employer health plans are expected to continue providing no-cost contraception coverage for women, despite the Trump administration's announcement that it will allow employers to claim a religious or moral objection to the ACA's contraceptive coverage requirement. Employee relations repercussions and maternity costs are factors to consider.

Play or Pay: Rising Penalties' Role in Complying with the ACA
Every year the ACA is in effect, some employers must decide whether they will play according to the ACA's rules or pay ACA penalties. Even employers that are trying to comply may slip up and have to pay fees, which are adjusted up each year.

Crossing the Threshold—Small Business to ACA-Bound 'Applicable Large Employer'
If your small business has crossed the threshold to applicable large employer (ALE) status by reaching the threshold of 50 full-time equivalent employees, consider your vulnerability to the ACA's nondeductible employer penalties.

Out of Sight, Out of Mind? Don't Forget the Possibility of ACA Retaliation Claims
As the end of 2017 approaches, employers that failed to comply with the ACA's coverage obligations may soon be receiving employer mandate assessments. While we don't know the exact amount of employer dollars that will be at risk, the Congressional Budget Office estimates that between 2015 and 2024 it will be $139 billion.

Dealing with Rejected Form 1095-C Returns
Sometimes rejected returns are due to faulty transmission, missing (or multiple) attachments, an error reading the file or duplicate files. Remember, an initial rejection after an IRS computer review is not the same as a notice of a penalty assessment.

Relief Extended for 'Grandmothered' Small Group Health Plans
The Trump administration is allowing small business an extra year to renew certain older plans that don't comply with the ACA and that don't fall under the open-ended exemption for grandfathered plans.


SHRM Resources

For additional information on implementing the Affordable Care Act, SHRM members can contact the SHRM Knowledge Center.

SHRM Government Affairs

Health Care Public Policy and Advocacy Updates

IRS

Types of Employer Payments Under ACA and How They Are Calculated

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