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Thursday, August 1, 2013

Delay in Implementation of Potential Employer Penalties Under ACA

Janemarie Mulvey
Specialist in Health Care Financing

Bernadette Fernandez
Specialist in Health Care Financing

Annie L. Mach
Analyst in Health Care Financing

The Patient Protection and Affordable Care Act (ACA, P.L. 111-148), as amended, attempts to increase access to health insurance coverage, expands federal private health insurance market requirements, and requires the creation of health insurance exchanges to provide certain individuals and small employers with access to insurance. To ensure that employers continue to provide some degree of coverage, ACA includes a “shared responsibility” provision. This provision does not explicitly mandate that an employer offer employees health insurance; instead, ACA imposes penalties on “large” employers if at least one of their full-time employees obtains a premium credit through the newly established exchange. A companion provision to the employer requirements is the ACA requirement for most individuals to maintain health insurance coverage (“individual mandate”) or pay a penalty, with exceptions. These provisions are effective in 2014 according to the ACA statute.

ACA requires the Internal Revenue Service (IRS) to coordinate various information reporting requirements. Specifically, this information will be used for determining whether

• employer coverage exists and, if it does, whether it is adequate and affordable for purposes of the employer shared responsibility payments; and

• individuals have an offer of minimum essential coverage for purposes of the individual mandate, as well as eligibility for premium credits in the newly established exchanges.

On July 2, 2013, the Obama Administration announced that it is going to delay, until 2015, enforcement and associated reporting requirements relating to potential employer penalties under ACA. On July 11, 2013, the IRS released Notice 2013-45, which provided more detailed information on this transitional relief. According to the IRS notice, this transition relief will provide additional time for input from employers and other reporting entities in an effort to simplify information reporting consistent with effective implementation of the law.

This delay may have implications for an individual’s health insurance coverage and eligibility for tax assistance provided through the exchanges. One potential impact of a delay in the enforcement of potential employer penalties may be a lower than projected number of “large” employers offering health insurance coverage. This may result in a larger than projected increase in the number of workers eligible for premium tax credits in the exchanges in 2014 and an increase in the number of uninsured. However, while measurement of the magnitude of this effect is beyond the scope of this paper, one recent study found that a delay may not have a significant effect on the employer-sponsored health insurance coverage. The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) have not yet completed an analysis of the impact that the Administration’s announcement and other recently issued final rules will have on spending and revenues under current law.

On July 11, 2013, The House of Representatives introduced H.R. 2667: Authority for Mandate Delay Act, which would delay for one year certain reporting requirements as well as penalties for certain large employers. CBO and JCT’s cost estimate of H.R. 2667 on July 16 reported that enacting H.R. 2667 would not affect direct spending or revenues because the bill essentially codifies the Administration’s recent announcement. Therefore, according to CBO, pay-as-you-go procedures do not apply.

Date of Report: July 16, 2013
Number of Pages: 14
Order Number: R43150
Price: $29.95

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