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Play or Pay under the ACA

PPACARising health insurance premiums have plagued employers for several years.  There is significant fear over future costs.  Upcoming requirements under the Affordable Care Act will place employers in a position of balancing those costs with potential federal penalties.

Beginning in 2014, large employers may be penalized if they do not offer full-time employees and their dependents minimum essential coverage or offer coverage that is deemed unaffordable. A “large employer” is defined as one that has 50 or more full-time equivalent employees during the preceding calendar year.  A full-time employee averages 30 or more weekly hours of work.  Hours worked by part-time employees are included in the calculation. These penalties amount to $2,000 per year per full-time employee (starting with employee number 31).

Coverage is “unaffordable” when:

  1. the employee’s share of the premium for self-coverage is more than 9.5 percent of the employee’s modified adjusted gross household income, and
  2. an employee receives a subsidy for coverage through a state exchange.

If coverage is not affordable, employers may be penalized $3,000 per year per employee who receives a federal individual insurance subsidy.

Affordable Care Act Penalties for Employers

PPACAThe United States Treasury Department has issued new regulations applying to large employers.  For those with more than 50 employees, the employer faces penalties for every employee who elects federally subsidized coverage, up to $3,000 annually but prorated per month.  Large employers will face decisions about how much employees will be contributing to their health insurance coverage.  The difference is that according to the Department, the 9.5% threshold under the Affordable Care Act applies to the individual’s coverage, not family coverage.  Under the ACA, an employee may opt for the federal subsidy if unable to get affordable insurance through the employer, and affordable is defined at this 9.5% threshold.  This ruling has the potential to save the federal government money if fewer people opt for coverage through insurance exchanges.  The effect on business, of course, would be the opposite.

Tennessee Declines Federal Partnership for Exchange

2008 CLE TN flagAccording to AP reports, Tennessee has rejected partnering with the federal government to create a health insurance exchange.

These exchanges are insurance markets created under the Affordable Care Act in which consumers can buy individual policies and obtain subsidies to assist with premiums.

Governor Bill Haslam has sent a letter to the Secretary of Health and Human Services citing his concerns about “aggressive federal timelines, a lack of true flexibility for states, and misguided federal policies.”

Because Tennessee rejected the creation of a state-based exchange at the end of 2012, Tennesseans will participate in an exchange run solely by the federal government.  The State estimates that 300,000 people may participate in the exchange, but some estimates set participation closer to 600,000.