More than three years into Obamacare the law is only becoming more confusing and burdensome for employers because of a flurry of regulations. As of March 2013, the three-year anniversary of the law, there were more than 20,000 pages of health care law regulations—enough to publish War and Peace 14 times or cover the length of 61 football fields. Even more regulations are in the pipeline. Many of the regulations arguably go beyond the language in the statute or the original intent of the lawmakers.
Here are a few of the more egregious examples of regulatory overreach impacting employers.
Employer Mandate
Statute: Starting in 2014, certain employers with 50 or more “full-time equivalent” employees that do not provide “affordable” health care coverage to all full-time employees (and their dependents) may be assessed a penalty if at least one full-time employee qualifies for a premium tax credit and uses it to purchase coverage in the health insurance exchange.
Regulation: Employers subject to the employer mandate are required to offer coverage to children under age 26 of all full-time employees, disregarding the fact that the language in the statute is meant merely as an acknowledgment that employers have the choice to extend coverage to the children of employees.
SHOP Exchange
Statute: Employers participating in a Small Business Health Options Program (SHOP) Exchange can offer their full-time employees at least one plan within a chosen coverage level or can offer all plans within a coverage level.
Regulation: A SHOP Exchange can require employers to allow their employees to select any plan within a coverage level.
Essential Health Benefits Package
Statute: All plans in the small group and individual markets must cover an essential health benefits package, which includes the items and services within the category of mental health and substance use disorder services.
Regulation: The regulation extends the mental health parity requirement to plans in the small group and individual markets, meaning that these plans must cover mental health benefits in a way that mirrors the coverage of medical benefits.
Summary of Benefits and Coverage
Statute: All plans must provide enrollees, applicants, and policyholders with a short (no more than four-pages) “plain language” summary of benefits and coverage details within 12 months after the standards are finalized.
Regulation: Plans must provide summaries within a near-impossible seven months (because the administration was late issuing its standards), and content must be provided in an exceedingly rigid and difficult template.
Rate Review
Statute: The federal government must establish a process to review unreasonable increases in premiums.
Regulation: If a health insurance issuer raises its rates on one product, even if within reason, it must submit a rate filing explanation for all its products—even for those products with no rate increases.
Workplace Wellness
Statute: Beginning in 2014, employers will be granted expanded ability to reward employees who meet health status goals by participating in wellness programs, as well as require employees who don’t meet these goals to pay more for their health coverage.
Proposed Regulation: All outcomes-based wellness programs must establish individualized goals and personalized rewards for meeting virtually any of these tailor-made benchmarks.
Plan Value and Health Savings Accounts
Statute: Employers must offer plans that cover at least 60% of the cost of covered services.
Regulation: Employer-provided Health Savings Account (HSA) funds that are used to pay for covered services are not entirely counted toward the 60% threshold.
Deductible Limits and Health Savings Accounts
Statute: Plans in the small group market cannot have deductibles that exceed $4,000 for family coverage and $2,000 for individual coverage.
Regulation: Employer contributions to an employee’s HSA can be used to pay down the deductible or pay for services before the deductible is met, an allowance that fails to recognize the full value of an employer’s HSA contributions.
Visit www.uschamber.com/health-reform to learn more.