Health Care Reform Resources for Employers


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

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 2017, 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. Senate Republicans' then tried to pass a "skinny repeal" bill dubbed the Health Care Freedom Act—which would have eliminated penalties under the ACA's individual mandate to enroll in ACA-compliant coverage and (through 2024) the employer mandate to provide coverage—but it, too, went down to defeat by a vote of 49 to 51.

A September 2017 effort to pass the Graham-Cassidy bill, a last-ditch attempt to repeal and replace the ACA that would have ended the individual and employer mandates and given the states greater authority over their health care systems, was not brought up for a Senate vote as Republicans lacked enough support to pass the measure.

These failures 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. Among these efforts, Sen. Lamar Alexander, R-Tenn., chairman of the Senate Health, Education, Labor and Pensions (HELP) committee, is working to forge health care compromise legislation with Democrats.

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.


ACA's Affordability Threshold Rises in 2019
Employers should not overlook the Affordable Care Act'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 Affordable Care Act 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 Affordable Care Act (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 (HSAs) 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 Affordable Care Act'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 Affordable Care Act's (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 Affordable Care Act (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 Affordable Care Act'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 Affordable Care Act (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


Types of Employer Payments Under ACA and How They Are Calculated


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