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Get a quick view of the important past, present and future provisions in the Patient Protection and Affordable Care Act (PPACA) with links to more detailed information.
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The Patient Protection and Affordable Care Act (ACA) is the most sweeping health care legislation in the United States since the passage of national Medicare and Medicaid regulations in 1965. Enacted to increase the affordability of health insurance and reduce the number of uninsured individuals, ACA’s evolving impact on employers is profound and complicated. Like many new laws of its scope, ACA regulations are being implemented in stages. In 2015, large employers were mandated to comply with the law’s Shared Responsibility Payment rule (known colloquially as the “Pay or Play” mandate), which requires companies with more than 100 fulltime equivalent employees (FTEs) to provide health benefits to their workforce or pay possible penalties of $2080 or $3120 per FTE. In 2016, the Pay or Play mandate kicks in for employers with more than 50 FTEs. Another phased-in requirement in 2016 mandates employers to report their health coverage information to the Internal Revenue Service (IRS)—the benefits provided FTEs. The IRS is expected to use this information to enforce the Pay or Play provision. Down the line other ACA provisions come into effect. In 2020, the so-called “donut hole” in prescription drug coverage under Medicare Part D coverage will close. This much-lamented coverage gap occurs when a beneficiary’s covered prescription drugs exceeds approximately $3000 (depending on the year), until the paid amount reaches approximately $5000, at which point Medicaid absorbs most of the remainder of additional drug expenses. Also in 2020, an excise tax establishing an annual cap on employer-sponsored health coverage costs goes into effect. Employer-paid coverage exceeding $10,200 (in 2018) will be taxed at 40 percent. The intent of the rule (colloquially known as the “Cadillac tax”) is to dissuade employers from providing overly generous health benefits to executives.As with any law as complicated as the ACA, employers should review their obligations with an in-house attorney or outside legal counsel. Ultimate Software’s ACA Resource Center is another useful recourse assisting organizations to stay abreast of these evolving rules prior to their effective implementation.