Editorfs note: This post has been updated several times on July 2 and 3
as new information has emerged.
Late in the day on July 2, 2013, Mark Mazur, Assistant Secretary for Tax
Policy at the Department of the Treasury, announced in a memorandum ironically
entitled gContinuing to Implement the ACA in a Careful, Thoughtful
Manner [1]h that implementation of the Affordable Care Actfs
employer mandate would not be implemented on time, but rather delayed until
2015. Valerie Jarrett released a similar statement [2] from the White House.
The Administration has been under tremendous pressure from the business
community to delay implementation of ACA provisions affecting employers; it had
already delayed the implementation of statutory provisions prohibiting insured
employers from discriminating in favor of highly-compensated employees and
requiring large employers to automatically enroll new full-time employees in a
health insurance plan, subject to the employee opting out. The
Administration has now accommodated business one more time.
The reason given for the delay this time was difficulty in implementing ACA
provisions requiring insurers and self-insured health plans to report
information regarding individuals whom they cover and requiring large employers
to report coverage offered to their full-time employees. The
administration asserts that an additional year will give employers and insurers
the time they need to adapt to the reporting requirements and give the
Departments time to simplify the reporting requirement.
Without reporting, however, enforcing the employer mandate will be
impractical, so it is put off for a year. The Administration promises
guidance within the next week on how this will work and proposed rules this
summer to implement the reporting requirement.
As a practical matter, most employers subject to the mandate already offer
insurance. The mandate only covers employers with more than 50 full-time
or full-time-equivalent employees. Ninety-eight percent of employers with more than 200 employees
offer health insurance, as do 94 percent of employers with 50 to 199
employees [3]. The vast majority offer insurance that is
both affordable and adequate, as those terms are defined in the ACA. All
of the reasons employers now have for offering coverage to their employees —
significant tax subsidies, recruitment and retention of employees, and increased
productivity and decreased absenteeism when employees are healthy — will
continue to exist without the mandate penalty.
It can be expected, therefore, that most employees will continue to offer
coverage. It is to be hoped, moreover, that employers who have been
claiming that they have to reduce their employeefs hours of work to below 30 to
avoid the penalties will restore the lost hours, and small employers fearful of
growing over the 50 FTE threshold will focus on growing their businesses rather
than worrying about the ACA. Perhaps the extra year is what is needed to
reduce anxiety and build confidence in the business community in the workability
of the law.
The delay will also free employers from penalties for another year with
respect to employees with incomes between 100 and 133 percent of poverty who
receive premium tax credits because their employers fail to offer affordable
health insurance in states that refuse to expand Medicaid.
Employers are not penalized if their employees receive Medicaid, but are if
employees get premium tax credits because employee coverage is inadequate,
unaffordable, or unavailable. The delay gives recalcitrant states an extra
year to expand Medicaid before their employers of low income employees begin to
be penalized.
Some have raised the question whether the Administration has legal authority
to delay enforcement of the employer mandate. The effective date of the
mandate is January 1, 2014. I see no authority in the ACA for the
Administration to delay enforcement of the requirement. On the other hand,
this is not the first time an administration has failed to enforce or delayed
the enforcement of a law when it has faced practical difficulties enforcing the
law, or even when it simply disagreed with the the law. The Administrative
Procedures Act gives courts the authority to gcompel agency action unlawfully
withheld or unreasonably delayed.h A lawsuit to force the IRS to enforce
the mandate would have to be brought, however, by someone who could prove an
injury from lack of enforcement (other than the loss of revenue to the United
States Treasury), and it is hard to think of who could prove injury.
Employees, for example, would have a hard time proving that their employer would
have offered health insurance rather than simply paying the tax. In any
event, by the time the lawsuit wound its way through the courts, the mandate
would already be in place.
One has to hope, however, that the Administration has thought through the
ramifications of this delay for the other provisions of the ACA. The
statements say that implementation of the rest of the ACA, including the
availability of premium tax credits, is going forward on schedule. From
all appearances this is true. But tax credits are only available to
employed individuals who are either not offered health coverage by their
employers or are only offered employer coverage that costs more than 9.5 percent
of household income or that fails to offer gminimum valueh– covering 60 percent
of health care costs. Also, taxpayers are subject to the individual
mandate penalty if they fail to accept coverage from their employer that meets
the minimum value requirement and costs 8 percent or less of household
income.
If employers have no obligation to report coverage, how will the exchanges or
the IRS verify claims that coverage is unaffordable or inadequate?
Currently proposed rules allow the exchanges to rely on the attestation of the
applicant as to these claims if verification is not needed or cannot be
obtained. Will the lack of an employer mandate mean that many more
individuals will become eligible for premium tax credits, either because their
employers drop or do not expand coverage, or fail to respond to requests to
verify coverage? If employers fail to expand coverage to employeefs
children, as they would have had to under the mandate, more children may end up
on CHIP or Medicaid, or become eligible for premium tax credits.
But if more people receive premium tax credits, Medicaid, or CHIP, what does
this mean for the deficit (an issue that seems to have disappeared from the
radar screen as Republicans in the House try to repeal the ACA insurer fee at a
cost of $100 billion over 10 years without an offset)? Also, if more
people are freed from the individual mandate because they lack access to
affordable employer coverage, will fewer Americans purchase
insurance? The CBO has projected [4] most recently that the
employer penalty would yield $10 billion in 2015, presumably from employers who
fail to provide coverage in 2014. Can we afford to lose this revenue?
Perhaps the promised guidance will address some of these questions. Or
perhaps we will find out only in 2014.