{"id":16575,"date":"2015-04-08T19:54:48","date_gmt":"2015-04-08T23:54:48","guid":{"rendered":"https:\/\/www.saratoga.com\/saratogabusinessjournal\/2015\/04\/business-report-employer-health-care-mandates.html"},"modified":"2015-04-08T19:54:48","modified_gmt":"2015-04-08T23:54:48","slug":"business-report-employer-health-care-mandates","status":"publish","type":"post","link":"https:\/\/www.saratoga.com\/saratogabusinessjournal\/2015\/04\/business-report-employer-health-care-mandates\/","title":{"rendered":"Business Report: Employer Health Care Mandates"},"content":{"rendered":"\n<div class=\"img-left\">\n<div><img loading=\"lazy\" decoding=\"async\" alt=\"bond column - amelia f. klein c.jpg\" src=\"https:\/\/www.saratoga.com\/saratogabusinessjournal\/wp-content\/uploads\/sites\/48\/2015\/04\/bond20column20-20amelia20f.20klein20c.jpg\" class=\"alignleft\" height=\"224\" width=\"150\">\n<\/div>\n<div class=\"img-caption\">Amelia F. Klein, a member in the Albany office of Bond, Schoeneck &amp; King PLLC.\n<\/div>\n<\/div>\n<p>BY AMELIA F. KLEIN<\/p>\n<p>It may not be true that the Patient Protection<br \/>\nand Affordable Care Act (ACA) was<br \/>\ncreated by Senate Majority Leader Harry<br \/>\nReid over a three-day weekend by cutting and<br \/>\npasting pieces from the various bills circulating<br \/>\nin Congress that had sufficient support.<\/p>\n<p>However, as someone who advises clients<br \/>\nevery day about how to comply with the ACA,<br \/>\nI believe this legend. The law is long &#8211; 906<br \/>\npages &#8211; and many of its provisions just don&#8217;t<br \/>\nhang together in a coherent way. As evidence<br \/>\nof this, the ACA was amended only one week<br \/>\nafter it was signed into law, by the Health Care<br \/>\nand Education Reconciliation Act of 2012.<\/p>\n<p>Still, it took 1\u00c2\u00bd years to discover the flaw that<br \/>\nforms the basis of the Supreme Court case in<br \/>\nKing v. Burwell:<\/p>\n<p>Internal Revenue Code section 36B, added<br \/>\nby the ACA, authorizes federal tax-credit<br \/>\nsubsidies for health insurance coverage that is<br \/>\npurchased through an &#8220;Exchange established<br \/>\nby the State.&#8221;<\/p>\n<p>Section 1321 of the ACA requires the federal<br \/>\ngovernment to operate an Exchange for any<br \/>\n&#8220;state [that] is not electing to operate an Exchange<br \/>\nor that&#8230; will not have the Exchange<br \/>\noperational by Jan. 1, 2014.&#8221;<\/p>\n<p>The problem? Only 16 states have established<br \/>\ntheir own Exchanges (now referred to<br \/>\nas &#8220;marketplaces&#8221;). The question in King v.<br \/>\nBurwell? &#8220;[W]hether the Internal Revenue<br \/>\nService (&#8220;IRS&#8221;) may &#8230; extend tax-credit<br \/>\nsubsidies to coverage purchased through<br \/>\nExchanges established by the federal government.&#8221;<\/p>\n<p>In other words, should the federal subsidies<br \/>\nbe available when coverage is purchased in<br \/>\none of the 34 states that where the health<br \/>\ninsurance marketplaces are run by the Federal<br \/>\ngovernment? The challengers to the law<br \/>\nsay &#8220;no&#8221;.<\/p>\n<p>The availability of subsidies for people who<br \/>\npurchase health coverage in a marketplace is<br \/>\na linchpin that holds many pieces of the ACA<br \/>\ntogether. For one thing, the assessment of the<br \/>\n&#8220;employer shared responsibility payments&#8221;<br \/>\nonly occurs when an employee goes to the<br \/>\nmarketplace, buys coverage, and is eligible<br \/>\nfor a federal subsidy.<\/p>\n<p>No subsidy means no IRS invoice for the assessment.<br \/>\nThese assessments support the bulk<br \/>\nof the costs of the ACA; according to the Brief<br \/>\nfor the Petitioner\/challenger (King), &#8220;billions<br \/>\nof dollars [are] spent each month.&#8221; What will<br \/>\nhappen to employer coverage if the linchpin<br \/>\nof federal subsidies is removed?<\/p>\n<p>In New York, nothing will change; at least<br \/>\nnot right away. New York, and its neighbors,<br \/>\nVermont, Massachusetts and Connecticut,<br \/>\nhave established State marketplaces, so subsidies<br \/>\nwill continue to be available to eligible<br \/>\nindividuals that purchase coverage there.<\/p>\n<p>Employers will be assessed penalties if<br \/>\neligible employees are not offered coverage,<br \/>\nor whose coverage is unaffordable by ACA<br \/>\nstandards or doesn&#8217;t provide a minimum<br \/>\nvalue, if those employees receive the federal<br \/>\nsubsidy. (Annual assessments equal $2,000 per<br \/>\nemployee, excluding the first 30 employees, for<br \/>\nfailure to offer coverage. For employers that<br \/>\noffer unaffordable or inadequate coverage,<br \/>\nthe assessment is $3,000 per employee that<br \/>\nbecomes eligible for a tax credit).<\/p>\n<p>In those states that have federally-run<br \/>\nhealth insurance marketplaces, the effect<br \/>\non health insurance costs will be immediate.<\/p>\n<p>Without the federal subsidy, coverage<br \/>\npurchased in the marketplaces will become<br \/>\nunaffordable. Healthy individuals will drop<br \/>\ncoverage, leaving insurers with only unhealthy<br \/>\nsubscribers.<\/p>\n<p>The costs to the insurers will go up, and premium<br \/>\ncosts will increase &#8211; causing the &#8220;death<br \/>\nspiral&#8221; described by Supreme Court Justice<br \/>\nSotomayor. The loss of the employer penalties<br \/>\nin those 36 states will have a devastating<br \/>\neffect on the revenues generated by the ACA<br \/>\n&#8211; revenues that have supported such things<br \/>\nas the Child Health Insurance Program and<br \/>\nMedicaid expansion (adopted by 29 states),<br \/>\ntax credits for small employers purchasing<br \/>\nhealth coverage, changes in Medicare provider<br \/>\nrates, the Medicare beneficiary drug rebate,<br \/>\nand the reinsurance plan for retiree coverage.<\/p>\n<p>Without the employer shared responsibility<br \/>\npenalties, employers may offer coverage to<br \/>\nfewer employees, or increase the premium cost<br \/>\nsharing to employees. However, the changes<br \/>\nto the structure of employer-sponsored health<br \/>\ncoverage will not change markedly. Employer<br \/>\nhealth plans will still have to:<\/p>\n<p>Provide young adult coverage to age 26;<br \/>\noffer preventive care without employee cost<br \/>\nsharing; cover pre-existing conditions; not<br \/>\nimpose annual or lifetime cost limits; limit<br \/>\ncoverage waiting periods to 90 days; provide<br \/>\nan expanded appeals process; and limit the<br \/>\nability to rescind coverage.<\/p>\n<p>The penalty for failing these requirements<br \/>\nis $100 per day per person affected. Is there<br \/>\nany desire, by Congress or employers, to repeal<br \/>\nthese popular provisions?<\/p>\n<p>The Obama administration said they have<br \/>\nno &#8220;plan B&#8221; if the Supreme Court rules in favor<br \/>\nof the challengers. During oral argument, Justice<br \/>\nScalia asked the government&#8217;s lawyer if<br \/>\nthe Court were to rule for the challengers, did<br \/>\nthe government actually expected Congress<br \/>\nto &#8220;just sit there while disaster ensues?&#8221; The<br \/>\nlawyer&#8217;s response: &#8220;This Congress?&#8221;<\/p>\n<p>The Supreme Court&#8217;s decision is expected<br \/>\nin late June.<\/p>\n<p>Klein is a Member in the Albany office of<br \/>\nBond, Schoeneck &amp; King, PLLC, where she<br \/>\nadvises employers in all types of benefit<br \/>\ncompliance issues.<\/p>\n<p>Photo Courtesy Bond, Schoeneck &amp; King PLLC<\/p>\n","protected":false},"excerpt":{"rendered":"<p> Amelia F. Klein, a member in the Albany office of Bond, Schoeneck &amp; King PLLC. BY AMELIA F. KLEIN It may not be true that the Patient Protection and Affordable Care Act (ACA) was created by Senate Majority Leader&#8230;<\/p>\n","protected":false},"author":121,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[58,82,87],"class_list":["post-16575","post","type-post","status-publish","format-standard","hentry","category-business-reports","tag-business-reports","tag-healthcare","tag-insurance"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\r\n<title>Business Report: Employer Health Care Mandates - Saratoga Business Journal<\/title>\r\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\r\n<link rel=\"canonical\" href=\"https:\/\/www.saratoga.com\/saratogabusinessjournal\/2015\/04\/business-report-employer-health-care-mandates\/\" \/>\r\n<meta property=\"og:locale\" content=\"en_US\" \/>\r\n<meta property=\"og:type\" content=\"article\" \/>\r\n<meta property=\"og:title\" content=\"Business Report: Employer Health Care Mandates - Saratoga Business Journal\" \/>\r\n<meta property=\"og:description\" content=\"Amelia F. 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