The federal government has released final rules governing the Affordable Care Act’s Employer Responsibility Regulations (aka Pay or Play) provisions that will take effect in 2015 for many Alliance members. Once in effect, the ACA will impose penalties on employers that do not offer “affordable” and “minimum value” coverage to certain full-time workers, currently defined as an average of 30 hours or more per week.

The IRS had posted Frequently Asked Questions to help employers understand the new guidelines and the safe harbors that were created to help employers avoid penalties. Penalties are triggered only when one or more of a company’s full-time workers accesses tax credits to purchase coverage on the public exchange.

The final employer responsibility regulations include some changes to the proposed regulation that were released more than a year ago. Key changes include:

  • An exemption from penalties for employers in 2015 that have 50-99 workers as long as they certify that they have not reduced their workforce to fall under the 100 employee threshold. Employers of this size would be subject to penalties in 2016 if their regulations are not changed once again.
  • More wiggle room for employers that do not offer all employees coverage. Under the new rules, an employer with 100 or more workers will not be subject to the “4980H(a)” penalty ($2,000 X all FT employees minus 30) as long as they offer coverage to at least 70 percent of employees in 2015. This threshold increases to 95 percent in 2016. However, employers will still be subject to “4980H(b)” penalties equaling $3,000 per year for any full-time employee that is able to access exchange tax credits or cost sharing reductions.
  • A new definition for “seasonal employees” to apply to those positions for which customary annual employment is six months or less. For these individuals, the offer of coverage can wait until the end of a measurement period. This is not to be confused with the term “seasonal worker” used for the purposes of determining whether an employer is large enough to be subject to penalties.

John Barlament of Quarles and Brady will review these new regulations at our March 26 Alliance Learning Circle.

Congress Considers Changing the Definition of Full-Time

In a related note, a Congressional committee has approved one of several bills introduced this session to modify the Employer Responsibility provisions in the Affordable Care Act. The bill, which would define full-time as 40 hours for the purposes of the ACA, passed the House Ways and Means Committee on a party-line vote with Republicans on the committee supporting the measure and Democrats opposing it. Similar bills have gained bipartisan support but are stalled in the Senate.

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Melissa Duffy

Melissa Duffy

Guest Blogger, Health Policy Consultant

Melissa Duffy has spent the last three decades working to improve health care and health care policy for the “buy-side” of health care. She launched her career and found her passion for health improvement in her time as the lead health policy advisor in the Wisconsin Senate, where she helped shape meaningful legislation to improve accountability and expand health coverage options available to consumers and employers. Her mission on behalf of health care purchasers led her from the legislature to the startup of several nonprofit cooperatives designed to empower individuals and employers when it comes to quality, affordability, and fairness. Along the way, Melissa served as the Executive Director for one start-up, Chief Strategy Officer for another, and a consultant to other organizations trying to improve health care. Today, Melissa advises Common Ground Healthcare Cooperative and The Alliance on government affairs, healthcare policy, communications, and business strategy.

Read more blog posts by Melissa