Omni on Upcoming Changes to Employer Mandate in Affordable Care Act (Obamacare)

It’s mid-July, the dog days of Summer are upon us, the cold snowy winter and unseasonably cool spring are distant memories. At this time last year Omni was conducting seminars, webinars and training for almost everyone since the Affordable Care Act (“ACA”) was scheduled to launch its key feature, “the employer mandate” on January 1, 2014. Of course, we all know that went up in smoke and has been delayed until at least January 1, 2015.

This year we are taking a more wait and see approach since it seems like new regulations are released almost weekly and with the midterm elections due in November one can only wonder what new changes are in store between now and year- end. Of all the regulations written there are three which are noteworthy:

  1. The IRS issued Regulations that any large employer which incentivizes employees to receive subsidies from the exchange could be subject to a $100/ day ($36,500/ year) fine per employee.
    See: Employer Healthcare Arrangements
  2. The ACA allows an employer to impose a 90 day waiting period for new employees to be eligible for benefits. Regulations were issued which allow the first month of employment to be considered orientation and the 90 day period commencing immediately thereafter, in essence creating an allowable 120 day eligibility period for new employees.
    See: 90-day Waiting Period for Eligibility
  3. Regulations were issued which state that the employer mandate goes into effect on the renewal date on or after January 1, 2015 for employers with over 100 full time equivalent employees and on or after January 1, 2016 for employers with between 50- 99 full time equivalent employees. See: 2015 Employer Mandate

Should you require clarification on any of the above, want more information about ACA or just want to look at other health insurance options, please contact your Omni Account Executive.

The Whole Truth

A few weeks ago the Obama Administration announced that they were deferring the Employer Mandate component of the law. This created much buzz in the industry as to what would be the next shoe to drop.

A. Individual mandate?
B. Exchanges?
C. Subsidies?

Our answer is D. none of the above.

If you are a skeptic and believe that Obamacare is nothing more than a ploy to bring the country to a single-payer system, then why would they drop any of the above? Imagine if the Administration gets its wish and all the uninsured join an exchange. The Administration can then toot their horns and tell everyone how between Medicare, Medicaid and the Exchanges, Government has its hand in providing coverage to 75% of Americans. How difficult would it be to extend that to 100%?

While we’re on the issue of governmental control, isn’t it interesting that NYS announced two weeks ago the plans and rates on the exchange. Isn’t it interesting that two weeks later we don’t know what the networks will be?

Will high cost specialty hospitals like Memorial Sloan Kettering (Cancer) and Hospital for Special Surgery (Orthopedics) be included in the networks? Why is this information being kept from the public? I think we know the answer. The reason the State can advertise a 30% rate reduction for non group coverage is because the networks will be much narrower than what is currently available.

Thanks for taking the time to read our blog. We hope to hear from you and please let us know any topics you’d like us to address in the future.