PPACA Tax Overview BenefitMall Reference Guide - (Page 15)
PART D: Putting the Coverage Puzzle Together
5.12
How do all of the coverage options
authorized by PPACA fit together?
PPACA uses an array of tax incentives, tax
penalties, other funding mechanisms and regulatory
requirements to promote universal coverage.
Whether that goal will be met or not is beyond
the scope of this Reference Guide. However, it is
important to understand the landscape of all of
the coverage options so that brokers, employers
and others understand how the federal government
envisions that this will take place.
Law Professor Zelinsky provides a succinct overview
when he writes:
Under PPACA, all individuals subject to the
statute’s insurance requirement must, starting in
2014, have in force “minimum essential coverage.”
Such coverage can take one of five forms:
• First, health services from approved
government programs such as Medicaid,
Medicare, CHIP
, and federal veterans medical
care qualify as minimum essential coverage,
satisfying the individual insurance mandate.
• Second, participation in an “eligible employersponsored”
plan constitutes such coverage.
• Third, health coverage acquired in a state’s
“individual market” qualifies as “minimum
essential coverage” and thus discharges the
individual insurance mandate.
• Fourth, the individual mandate is satisfied
through health coverage “under a
grandfathered health plan,” which generally
means any “group health plan or health
insurance coverage” in effect on the day PPACA
was enacted March 23, 2010.
5.13
• Finally, the Secretary of Health and Human
Services, after consulting with the Secretary of
the Treasury, may recognize any other program
as constituting minimum essential coverage for
purposes of the individual mandate.27
What are the core themes that emerge
when reviewing PPACA’s health-related
tax provisions?
Law Professor Zelinsky identifies four themes that
emerge from studying the “the generally applicable,
health-related tax provisions of PPACA:”
• First, he notes that many of the provisions have
not been finalized. He writes, “It is unclear
whether these tax measures will take effect
as scheduled or will take effect in their current
forms.”
• Secondly, he points to the “enormous complexity”
of PPACA’s tax provisions. “Such complexity
will impose daunting enforcement challenges
upon the IRS and will create equally formidable
compliance burdens for firms and individuals,
most notably, for small businesses and taxpayers
of modest means.”
• Thirdly, he concludes that the pathway to
implementing PPACA’s coverage goals will be
“incremental” because PPACA builds upon and
reinforces the “existing systems of privatelyprovided
health insurance and of employersponsored
medical care.”
• Finally, he observes that the fourth theme to
emerge “from a survey of the tax provisions of
PPACA” is the lack of any “significant efforts to
control health care costs.” He fears that PPACA
will “accelerate U.S. health care spending.”
THE COVERAGE
TOGETHER
15
Table of Contents for the Digital Edition of PPACA Tax Overview BenefitMall Reference Guide
PPACA Tax Overview BenefitMall Reference Guide
Table of Contents
Individual Mandate & Tax Implications
Premium Subsidies
Employer Requirements & Tax Implications
PART A: Small Employer Tax Credits
PART B: Large Employer Tax Penalties
PART C: Employer W-2 Reporting Requirements
PART D: Employer Deductions for Retiree Drug Coverage
Additional PPACA Tax Provisions Impacting Employers & Employees
PART A: The Unearned Income Medicare Contribution Tax
PART B: Excise Tax on Comprehensive, High-Cost Health Insurance Plans
PART C: Assessing the Impact of PPACA on HSAs, MSAs, FSAs, & HRAs
Medicaid & Medicare Changes & the Impact on Employers
PART A: The Expanding Medicaid Program
PART B: Emphasis on Prevention & Related Services
PART C: Medicare Part D Updates
PART D: Putting the Coverage Puzzle Together
PPACA Tax Overview BenefitMall Reference Guide
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