Delay Won’t Keep People From Obtaining Health Coverage

July 3, 2013 at 3:25 pm

Here’s the bottom line about the Obama Administration’s announcement yesterday to delay health reform’s employer responsibility requirement and related reporting rules until 2015:  it will not keep people from getting health coverage, which is the key goal of health reform.

The vast majority of large employers — the only companies that are subject to the requirement to offer coverage and the related penalty if they don’t — already offer health coverage and are unlikely to stop.  (Most employers who don’t offer coverage now aren’t likely to change that decision either.)

What’s key is that the delay won’t affect a core component of health reform:  in 2014, workers who do not get coverage through their jobs will be able to get good coverage in the new marketplaces, with subsidies available to those with low and moderate incomes (incomes of up to 400 percent of the poverty line, or about $78,000 for a family of three).  In addition, workers whose companies offer coverage that is not affordable — because the employee’s share of the premium costs would exceed 9.5 percent of his or her income — or is not adequate to provide protection from injury or serious illness because it fails to meet standards that the Health and Human Services and Treasury departments have set for minimum coverage, also will qualify for subsidies to enable them to purchase coverage in the new marketplaces.  All of that will go forward.

Delaying the employer reporting rules (under which the first reports on whether firms offered coverage in 2014 wouldn’t have been due until 2015 anyway) won’t affect the information that employed individuals will need to provide to obtain subsidies to help them purchase coverage in the new marketplaces.  The application that workers will fill out when applying for subsidies will include a form that their employers must help them fill out so that the insurance marketplace can determine whether the employer coverage is affordable and adequate.  This involvement by employers will go forward on schedule.  (If the worker cannot get this information, either because the employer doesn’t provide it or for some other reason, the marketplace will make a decision based on the best available information.)

The goal of health reform is to provide coverage for all Americans — whether through Medicaid, private plans in the marketplace, or employer coverage.  Nothing in yesterday’s announcement puts a roadblock in these pathways.

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More About Judy Solomon

Judy Solomon

Solomon is Vice President for Health Policy at the Center on Budget and Policy Priorities, where she focuses on Medicaid and the Children’s Health Insurance Program and issues related to the implementation of health reform, particularly policies to make coverage available and affordable for low-income people.

Full bio | Blog Archive | Research archive at CBPP.org

4 Comments Add Yours ↓

Comments are listed in reverse chronological order.

  1. Jason McAvoy #
    1

    The article states that: “The application that workers will fill out when applying for subsidies will include a form that their employers must help them fill out so that the insurance marketplace can determine whether the employer coverage is affordable and adequate.” However, the testimony to the House Ways and Means Subcommittee on Health by Timothy Jost stated, “The application form includes an appendix for this information.21 The applicant can, but is not required to, ask the employer to provide information to fill out this form. The employer is not required to help, but it is hoped that employers will help their employees fill out these forms and make pre-populated forms available to employees.” So which is it, can employers refuse to to do this, or are they somehow legally compelled?

  2. Paul #
    2

    One error here –you say: “The application that workers will fill out when applying for subsidies will include a form that their employers must help them fill out so that the insurance marketplace can determine whether the employer coverage is affordable and adequate.”

    I suggest you take a look at the application, or the recent Rule — that section is entirely voluntary, and it isn’t even submitted even if the employer fills it out. And you are wrong that the recent changes won’t affect the info applicants need to provide — formerly they had to submit a lot of extra info if the Exchange had no data on their employer as per §155.315. Now they don’t (unless the Exchange already has data and their attestation diverges from that data).

    With all the misinformation going around, you really ought to be more careful about these kinds of blatant mistakes.

    • Judy Solomon #
      3

      In saying that the application includes a “ form that their employers must help them fill out,” we did not intend to imply that employers had to help; rather, our point was that workers will need their employers’ help to fill out the form, since workers will not have all of the required information. There is no requirement that employers actually provide the information. And, as the CMS Administrator pointed in her blog post (http://www.hhs.gov/healthcare/facts/blog/2013/07/myth-fact-marketplace.html), the employer verification requirement is essentially the same as initially proposed in April 2012 except for a temporary change in the verification requirements for state marketplaces during 2014.

  3. Memnon #
    4

    Yes, individuals may still be able to get health insurance coverage. As in many public policy debates the “devil” will be in the details. The Obama adminstration’s decision to allow the employer mandate to be delayed until 2014 will result in more of the uninsured individuals to meet their health care mandate by seeking government provided health insurance instead of requiring private sector firms to provide coverage.This will increase deficits at both state and federal levels. The current “Austerity American Style” agenda of the Republican majority of the House makes this reliance highly dubious in the short and medium term.

    If the AHCA had originally intended to have uninsured individuals relay soley on public sector health care insurance than the popular public option should not have been excluded from the legislation. The simple fact is the majority of U.S. working class citizens are employed by relatively small firms. If the U.S. is to continue having a private sector health care system then these employers participation is essential. Health care insurance must become as standard with all employers like OSADI payments.

    The delay of the employer mandate for the reasons of more time to “streamline” the requirements is disengenous. The only “streamlining” the Republicans want is repeal and it is difficult to rationalize that one more year will make the requirements easier to understand than the past three since the AHCA was passed in 2010.



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