CMSA Today - Issue 6, 2013 - (Page 22)
Case Management and the Law
Affordable Care Act:
Top 10 Issues to Watch
n early July, it wasn’t just the ﬁreworks raising eyebrows. The Obama administration
also caused a stir when it announced delayed enforcement of the Employer Shared
Responsibility requirements (aka the “Employer Mandate”) by a full year. This
surprising move may have pleased the employer community, since employers with
50 or more employees now have an extra year to prepare their Employer Mandate.
However, the delay also reﬂects the ﬂuid and unpredictable nature of the Patient
Protection and Aﬀordable Care Act (PPACA) implementation process, which can make
it diﬃcult for case managers to track its progress.
In an eﬀort to narrow the focus, here
is a list of the Top 10 PPACA issues for
case managers to monitor*:
The open enrollment period for the
Health Insurance Exchanges (HIX) begins
October 1, 2013. The Exchanges are
operated by the federal government,
individual states, or by a federal-state
partnership. There are 27 federally
facilitated Exchanges, 17 state-based
Exchanges, and seven states that will
operate Exchanges in partnership with
the federal government.
A number of key questions remain:
First, will all of the state-based and
federal Exchanges be ready by October
1? For example, the U.S. Department of
Health and Human Services (HHS) issued
a ﬁnal rule (www.ofr.gov/OFRUpload/
implementation of a signiﬁcant portion
of the Federal Small Business Health
Options Program (SHOP) Exchanges.
Further, the Exchanges are in various
*Note: this list is not exhaustive and top
issues are subject to change as the federal
government and states continue to
hammer out PPACA’s details.
stages of development, with many
speculating that some states will not be
ready by the open enrollment deadline.
Also, will people enroll in the
Exchanges? HHS Secretary Sebelius
hopes to enroll 7 million people in the
ﬁrst year and 24 million by 2023. As
a result, there is a need to reach out
to young and healthy Americans to
support insurance pools.
Finally, which insurance companies
will participate in the Exchanges?
The Obama administration released
data in May showing more than 120
insurers have applied to sell plans
through federally-run health insurance
Exchanges. The number of insurance
carriers participating at the state
level will vary depending on the state
Beginning January 1, 2014, all
individuals are required to have health
insurance, with a few exceptions. As
reported by the National Federation of
Independent Businesses, the Individual
Mandate penalties will kick in next year,
which consist of:
• Taxes begin in 2014 and rise in years
following. In each year, the tax consists of the higher of a dollar amount
Issue 6 • 2013 • DIGITAL
BY GARRY CARNEAL, JD, MA
or a percentage of household income.
For a given household, the tax applies
to each individual, up to a maximum
of three. Following is the schedule of
2014: The higher of $95 per person
(up to 3 people, or $285) OR 1.0%
of taxable income.
2015: The higher of $325 per person (up to 3 people, or $975) OR
2.0% of taxable income.
2016: The higher of $695 per person (up to 3 people, or $2,085) OR
2.5% of taxable income.
After 2016: The same as 2016, but
adjusted annually for cost-of-living
Some Americans might be exempt
from the Individual Mandate if they
meet certain criteria which include
religious observance, ﬁnancial hardship,
and nationality if they are American
Indians, among other exceptions.
Although the Employer Mandate
has been delayed to January 1, 2015,
it remains a cornerstone of PPACA
and is worth tracking as the federal
government revises employer reporting
requirements. Under the law, employers
with 50 or more employees are required
to oﬀer coverage with the option to opt
out, or face a $2,000 tax/penalty per
employee (in excess of 30 employees if
coverage is not oﬀered and if they have
at least one employee that receives a
premium credit through an Exchange.)
Employers with less than the equivalent
of 50 full-time employees are not
required to oﬀer coverage. It will be
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CMSA Today - Issue 6, 2013