As someone who makes his living in the healthcare and health insurance industries (for nearly 30 years), I am often asked the question – how can we fix what is broken in our healthcare system, and assure that every citizen has access to care? More recently, I get the question – do you believe the Affordable Care Act (ACA) will be successful?
In attempting to answer these, and other healthcare reform related questions, I always start with the fundamental issue that our nation struggles to address; which is, do we desire a government run, universal, single payer system (see Canada, much of Europe, etc.), or a market based, largely private run, profit based system, such as the type we presently have?
The title of this entry says it all…”Madison Avenue meets the Affordable Care Act (ACA)”. It was announced today (7/25/2013) that the White House has authorized spending $684 million on a massive, national “publicity, marketing, and advertising” campaign to help promote and educate on the ACA. According to recent surveys, more than three quarters of the uninsured population (the veritable targets of the ACA) know little to nothing about the law. Their confusion is likely fueled by various government officials squabbling over various tenets of the law, to say nothing of the early July announcement delaying the so called employer mandate provision of the ACA. Research conducted by the Associated Press discovered that the massive Advertising and Promotion budget will not necessarily be evenly distributed.
Two recent blog posts informed of a one-year delay in implementing two parts of the Affordable Care Acts so called employer mandate – the reporting requirements and the associated pay-or-play penalties. Last week, the Treasury Department issued official guidance (in the form of Notice 2013-45) that clarifies the delay. Here are a few key points and implications extracted from the guidance:
Three specific ACA requirements (enforceable through IRS code) are affected by this delay:
1. Employers with self-funded plans, insurers, and other providers of health coverage will be required to submit a detailed report to the IRS concerning the health coverage it provided and the individuals to whom the coverage was provided.
Now that the dust has somewhat settled on last weeks exciting (and interestingly timed) announcement delaying the Affordable Care Acts so called “employer mandate”, let;s examine some of the fallout.
Technically speaking, the mandate itself was not delayed, but rather, the employer reporting aspect of the law. However, in effect, delayed reporting = delayed mandate. Once the seemingly universal exuberance over the announcement began to dissipate, the questions from policy wonks and stakeholders began to fly. The most significant question being – “how will the health insurance exchanges/marketplaces verify subsidy eligibility…
On June 26, 2013, the U.S. Supreme Court announced its decision regarding the constitutionality of the federal Defense of Marriage Act of 1996 (DOMA). The Court struck down Section 3 of DOMA, which limited marriage to opposite sex unions for purposes of federal law.
In a 5-4 decision, the court found this definition to be a violation of equal protection rights under the U.S. Constitution, holding that same-sex couples who are legally married under state law will be entitled to equal treatment under federal law with regard to income taxes and federal benefits. However, the Courts ruling does not establish a constitutional right to same-sex marriage.
The high courts decision will impact employers in states that…
Late this afternoon (7/2/2013), the Obama administration announced that it is DELAYING THE EMPLOYER MANDATE (also known as “employer shared responsibility” and “pay or play”) until 2015. In turn, the Treasury Department announced that – “it would delay its enforcement an entire year after hearing numerous concerns from employers about the challenges of its implementation”. Specifically, the assistant secretary for tax policy – Mark Mazur – said – “We have heard concerns about the complexity of the requirements and the need for more time to implement them effectively.
One of the Affordable Care Act’s (ACA) 18 new Taxes, Elimination of Deductions, and New Fees is something called the Patient -Centered Outcomes Research Institute fee (or PCORI for short). The fee is applicable to virtually any health insurance plan (both fully insured and self-funded), specifically the following:
– Fully insured medical plans (individual and group)
– Self funded group health plans (including some HRA and FSA plans)
– Retiree only medical plans
– COBRA health insurance coverage
– Limited or Mini-Medical plans
– Federal/State/Local governmental health plans offered by an employer
In my travels and presentations to various employer organizations around the country, I’m finding a great deal of misunderstanding concerning one of the more pressing aspects of the Affordable Care Act (or Obamacare) – the so called “employer shared responsibility” provision. Also referred to as the “employer mandate” and the “pay or play provision”, this aspect of the ACA poses two distinct types of penalty exposure to affected employers (generally those that employ at least 50 full time and full time equivalent employees). It’s extremely important to clarify that these penalties represent EXPOSURE, first and foremost; and only become actual payable penalties if specific action is taken by EMPLOYEE(s).
One of the most challenging aspects of Affordable Care Act (ACA) compliance is all the new forms, notices, and summaries required to be drafted, edited, approved, and ultimately distributed. The Department of Labor (DOL) recently issued guidance intended to assist employers in providing ACA related information to employees. This blog entry is intended to provide readers with a “heads up” on some new and revised notice/summary changes, and deadlines, resulting from the DOL’s guidance.
Employers were initially required by the ACA to provide notices to all current and newly hired employees regarding the existence of, and access to the new health insurance exchanges (now referred to…
The “trinity” of ACA enforcement (i.e., Departments of Labor, Treasury, and Health and Human Services) issued final regulations relative to wellness programs and rewards, on May 29, 2013. There were no surprises to what we already knew from the law itself. But reviewing the briefing reminded me that there are two (2) profoundly different types of wellness programs:
1. “Participatory”; and 2. “Health-Contingent”. Program rewards for the later are regulated/limited by the ACA, beginning in 2014, to no more than 30% (an increase from the present amount of 20%). However, there are NO LIMITS placed/regulated for the former type – Participatory – wellness programs. It is also important to note that the ACA allows a penalty of up to 50% for programs related to tobacco use.
