Health Care Reform Resources for Employers

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Beginning in 2017, the Republican majority in Congress and the Trump administration made repeal and replacement of the Affordable Care Act (ACA) a top priority, and in March 2017 the House GOP leadership introduced the American Health Care Act (AHCA) as their designated bill to begin to "repeal and replace" the ACA. The House passed their legislation on May 4, 2017.

In July, Senate GOP leaders released the Senate's repeal and replacement bill, named the Better Care Reconciliation Act (BCRA), but defections by both GOP Senate conservatives and moderates blocked passage. On July 28, Senate Republicans' tried to pass a "skinny repeal" bill dubbed the Health Care Freedom Act—which would have eliminated penalties under the Affordable Care Act's (ACA's) individual mandate to enroll in ACA-compliant coverage and (through 2024) the employer mandate to provide coverage—went down to defeat by a vote of 49 to 51.

That failure left in place the ACA's wide-ranging obligations for employers with 50 or more full-time employees or 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, the GOP is likely to seek, with possible bipartisan support, 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.


Last-Ditch ACA Repeal Attempt Would Eliminate Employer Mandate
President Donald Trump has said he will sign a last-ditch effort to repeal and replace the Affordable Care Act. The Graham-Cassidy bill would repeal the employer mandate and give states more control over health care requirements, possibly making it more complicated for multistate employers to provide all their workers similar health care coverage.

Draft Forms Help Employers Prepare for 2017 ACA Information Reporting
The IRS has published draft forms and instructions to help employers prepare for reporting on health coverage they offered to their employees in 2017. The forms are to be distributed to employees and filed with the IRS early in 2018 by employers subject to the Affordable Care Act's reporting requirements.

Health Premiums Expected to Rise 5.5% in 2018, Driving Cost Management Steps
U.S. employers expect their health care costs to increase by 5.5 percent in 2018, up from a 4.6 percent increase in 2017. Cost-shifting to employees may have reached its limit, leaving employers looking for other ways to dampen future cost increases.

The ACA Remains but Targeted Reforms Will Be Sought
Advocates for easing the ACA's financial and administrative burdens on employers are hopeful that at least a few of the reforms on their wish list, as discussed in this article, will resurface in new legislation.

Even Absent a Mandate, Workplace Health Benefits Are Here to Stay
Without enforcement of the individual and employer mandates around health care, it's expected that few employees would opt out of paying for employer-sponsored coverage, and few employers would choose to stop providing group health coverage to their workers. But it's likely that some employers would pare back employee eligibility to enroll in their plans.

HSA Provisions in Failed GOP Bills Could Return in Future Legislation. Should They?
The health savings account (HSA) reforms in the now-abandoned Senate and House health care bills may yet be voted on by Congress, if HSA stand-alone legislation is introduced or as part of efforts to stabilize the public health care exchanges.

Draft Executive Order Would Expand High-Deductible Coverage for Chronic Conditions
The Trump administration is considering a draft executive order to allow high-deductible health plan enrollees to receive insurance payment for the treatment of chronic conditions—including prescription medications—before meeting plan deductibles.

How ACA Employer Provisions Differ from the Republican Health Care Bills
A chart detailing the differences between the employer provisions of the Affordable Care Act and the Republican health care bills.

Telemedicine Missteps: Consider HSA Eligibility and other Compliance Traps
When setting up a telemedicine benefit, beware mistakes that could imperil health savings account (HSA) eligibility or trigger group health plan status that's subject to the Affordable Care Act's coverage requirements.

Don't Overlook 2018 Change in 'Affordability' Safe Harbor Percentage
The IRS recently announced the maximum share of income that employees can be required to pay under the Affordable Care Act's affordability provision, as adjusted annually for inflation. Employers should consider this adjustment in determining how much of their plan premiums they can ask employees to pay next year.

Rising Health Benefit Costs Still Outpace Overall Inflation
The pace of the rising health plan costs for U.S. employers, having slowed last year, looks to be leveling off at about 7.5 percent for 2017. With plan design changes, most employers will see increases closer to 5 percent this year, insurers say.

IRS Sets 2018 HSA Contribution Limits
Next year, the amounts that employees can contribute to their health savings account (HSA) will Employers should consider these limits when planning for the 2018 benefit plan year and should review plan communications to ensure that the appropriate limits are reflected 

Employer Shared Responsibility: Have Penalties Been—or Will Penalties Ever Be—Assessed?
It's unclear whether, to date, any Affordable Care Act employer shared responsibility penalties and penalties for failure to timely (and correctly) file 2016 Form 1095-C information returns have been assessed by the IRS. That doesn't mean they won't be.

EEOC Settlement of Wellness Suit Leaves Unresolved Issues
A settlement reached by the U.S. Equal Employment Opportunity Commission (EEOC) and an employer over whether worker participation in a worksite health screening was "voluntary" is a warning signal not to go too far in pressing employees to participate in wellness-promoting initiatives. But conflicting federal rules and court decisions continue to muddy the compliance waters for employee wellness programs.

Expect a Push to Tax Health Benefits, Political Watchers Warn
As part of efforts to reform the tax code—or under a back-from-the-dead effort to repeal and replace the Affordable Care Act—employers could be taxed on group health benefits provided to workers, or employees could be taxed on benefits they've received.

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.

IRS to Accept Tax Returns Lacking Health Care Status; Employer Reporting Unchanged
Although the IRS has announced it will not reject taxpayers' 2016 returns that are missing health coverage information, employers still must distribute 1095 forms to employees and report employee health coverage to IRS, as deadlines loom.

New Law Lets Small Employers Use Stand-Alone HRAs
Enactment of the 21st Century Cures Act lets small businesses use health reimbursement arrangements (HRAs) to fund employees who buy individual plans on the open market. 

IRS Delays Employers' Deadline to Distribute ACA Reporting Form 1095 to Employees
The IRS is giving employers an additional 30 days to distribute the Affordable Care Act's tax year 2016 information-reporting forms to employees, extending the deadline from Jan. 31, 2017, to March 2. But the due dates for filing Forms 1094 and 1095 with the IRS remain unchanged: Feb. 28 for paper/mail submissions or March 31 for electronic filing.

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


Types of Employer Payments Under ACA and How They Are Calculated

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