Thursday, December 4, 2014

Affordable Care Act Challenges and Trends for 2015 & Beyond

By Cynthia Moore

Going into 2015, one of the biggest challenges facing employers continues to be the implementation of the Affordable Care Act (“ACA”). Applicable large employers need to make decisions regarding the measurement period that will be used for purposes of determining which employees are “full-time employees.” This determination is used for purposes of determining which employees must be offered coverage by the first day of the plan year beginning on or after January 1, 2015 in order to avoid the employer shared responsibility penalty. An applicable large employer also needs to determine which employees are full-time in order to comply with the employer reporting required by Section 6056 of the Internal Revenue Code of 1986, as amended (“Code”).

Reporting under Code Sections 6055 and 6056 is also a significant challenge, requiring each applicable large employer to collect detailed information about the group health plan coverage offered to and maintained by employees, their spouses and eligible dependents. Employers should be establishing processes to track this data in 2015 to comply with the initial reporting required in January 2016, either internally or through service providers.

Looking into my crystal ball, trends related to group health plans include:

  • Over time, as employees become familiar and comfortable with purchasing individual coverage on the Exchange, the take-up rate for COBRA continuation coverage will decline.
  • Smaller employers will consider self-funding in order to avoid certain fees assessed on health insurers and passed through to employers and certain other ACA mandates.
  • The move toward high deductible health plans will continue as employers seek to minimize the possibility that their group health plan will trigger the “Cadillac tax.”
  • Court decisions may continue to shape the implementation of the ACA. In particular, there are conflicting appellate decisions regarding whether an individual qualifies for premium subsidies if he or she purchases individual coverage on the federally-facilitated Exchange and the U.S. Supreme Court has granted cert to decide this critical issue.
  • Employers continue to wait for guidance from the IRS on the non-discrimination rules that will apply to insured health plans. These rules could significantly affect the manner in which health insurance has traditionally been offered to different groups of employees (such as full-time vs. part-time) and the amount of employee contribution that are charged to different groups of employees.
Only time will tell if my predictions come true, but I am confident in saying that the challenges will continue into 2015 as employers struggle to comply with the ever-changing ACA landscape.