Harry, thanks for the additional clarification. It is very helpful to understand better why this is happening. From the above, I would suspect this delay will lead to a modification or rewriting of some of the regulation.
Employers get a delay in providing insurance
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Right--well, maybe. This "outreach" (what we used to call "listening") might also have been done at an earlier point, which might have resulted in a better law. Politically, it may be difficult to find legislators of any stripe wanting to associate their name with anything linked to the ACA before the 2014 elections.
I'm wondering what the change means for next year in practical terms. Example: Joe works for a company that provides health care insurance for his family. Joe isn't satisfied with the coverage and service (high co-pays, long waits, etc). The health insurance exchanges in his state look like a better deal for him, and his earnings would qualify him for the federal subsidy. Can he buy the insurance through the exchanges and get the subsidy? According to the ACA, he can't get the subsidy if he has the ability to get insurance that meets the ACA requirements through his employer--but now he might have no way to know if this employer-provided insurance meets the ACA rules (since the company now doesn't have to provide this info until 2015). If Joe buys the insurance and it turns out that the employer coverage was ACA qualified, no subsidy? If he gets the subsidy anyway, shouldn't we be a bit sore that this failure by the government to do its job (i.e. administer a law they fought for) has resulted in a payment of thousands of taxpayer dollars to Joe and others that was entirely avoidable?
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Obviously I'm not a WH insider, but I firmly believe the "inside baseball" account was fluff. Lobbyists always have nice things to say about the WH in the press 
But hard truth is same issues had been raised & communicated to WH (& Congress) regularly even back before ACA was passed. Only difference now is that jobs are actually being affected (e.g. widespread cuts to 29hrs, FT hiring freezes) so WH did something. IF both sides had been working in good faith over past 3 yrs, IMHO this delay could have been avoided.
Unfortunate reality is now many employees will be faced with another year of uncertainty, lower coverage non-ACA qualified HI, or no HI at all. Many now fear WH may suddenly [-]gut[/-] delay other parts of ACA. How do ERs & near-ERs plan for that
But hard truth is same issues had been raised & communicated to WH (& Congress) regularly even back before ACA was passed. Only difference now is that jobs are actually being affected (e.g. widespread cuts to 29hrs, FT hiring freezes) so WH did something. IF both sides had been working in good faith over past 3 yrs, IMHO this delay could have been avoided.Unfortunate reality is now many employees will be faced with another year of uncertainty, lower coverage non-ACA qualified HI, or no HI at all. Many now fear WH may suddenly [-]gut[/-] delay other parts of ACA. How do ERs & near-ERs plan for that
CMS just published a new set of final rules (see here), one clarifies how the exchanges will verify healthcare for employed individuals. From Health reform GPS Health Reform GPS: Navigating the Implementation Process
So, it will be trust, crosscheck some, audit and sample others.
MooreBonds
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What will be the penalty if you're caught getting a subsidy that you don't qualify for? Just return of the subsidy? Will there be any additional penalty?
Seems similar current IRS income tax procedures.
Except, as MooreBonds points out, no specific info on penalties for 'cheaters'.
The rule clarification doesn't have any discussion on penalties. It does say (I think) the auditing will be done in the same timeframe as the application is submitted, so I imagine if there is a discrepancy it will be resolved.
Premium assistance is a function of income and MAGI, that is subject to verification and nothing has changed. An employee that has unaffordable coverage from an employer would already be eligible for coverage and assistance on the exchange. The risk for the exchange is someone who has affordable individual coverage but unaffordable (or no) family coverage; they were denied premium assistance by an IRS ruling earlier in the year. The uninsured children in this case would be referred to one of the CHIP programs, and spouses might qualify for Medicaid or other public coverage, so it's not evident that there is a real exposure here.
Premium assistance is a function of income and MAGI, that is subject to verification and nothing has changed. An employee that has unaffordable coverage from an employer would already be eligible for coverage and assistance on the exchange. The risk for the exchange is someone who has affordable individual coverage but unaffordable (or no) family coverage; they were denied premium assistance by an IRS ruling earlier in the year. The uninsured children in this case would be referred to one of the CHIP programs, and spouses might qualify for Medicaid or other public coverage, so it's not evident that there is a real exposure here.
pb4uski
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IIRC there is already a true-up provision that will provide for return of the subsidy.
Typically there is some sort of penalty for cheaters beyond just making the situation whole with interest, so it would seem likely there would be eventually. IMO it wouldn't make sense not to have some sort of penalty for cheating.
Why, are you thinking of cheating if there is no penalty?
Employees who will now not have coverage from their (large) employers until 2015 will be able to get the subsidies if they qualify. That will be a lot of extra taxpayer money paid out--i.e. money I'll be taxed to help a corporate balance sheet. There was a time when folks at least feigned concern about how much this would cost--now there's much more talk about just getting this thing going regardless of the number of zeros added to the deficit.
Htown Harry
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The SWR "race to the bottom" thread discussing Wade Pfau's latest paper sent me to the JFP's site and the table of contents of the latest issue.
There is a paper there that is relevant to this thread.
A New Way of Thinking about Employer-Sponsored Health Care Coverage Strategies
The author does an excellent job of summarizing the options that must be considered in an employer's economic analysis of providing HI coverage in the ACA environment.
There is a paper there that is relevant to this thread.
A New Way of Thinking about Employer-Sponsored Health Care Coverage Strategies
The author does an excellent job of summarizing the options that must be considered in an employer's economic analysis of providing HI coverage in the ACA environment.
Based on recent statements from officials, it appears there will be no attempts to verify what folks claim regarding their access to "affordable" insurance through their employer. From this piece:
As the article points out, this federal flow of "free" money will only work for states that didn't set up their own exchanges. States that did what the government wanted them to do (set up an exchange) will have to find another loophole.
Observation: When benefits or taxes are set up with absolutely no enforcement mechanism, what we really have is a system that subsidizes and encourages cheating. The only folks who are penalized are honest ones, and they soon rightly begin to feel more like "suckers" than good citizens. That's not good for society.
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As pointed out in the HHS announcement and also in the Sarah Kliff write-up, audits will be done on employment information supplied by exchange applicants to verify their claim regarding employer coverage.
The Kliff article he references can be found here Health insurance marketplaces will not be required to verify consumer claims - The Washington Post
Premium assistance will be provided based on estimated income, then verified after the fact by the IRS, as before. This is not new. What has changed is the exchange is not required to verify estimated income, it is now discretionary, with audits. This is how the IRS works today.
They didn't call this "the honor system". They (Kliff and Somashekhar) used those words for a different purpose and Roy re-purposed them. The last time I read such an effort to misportray something related to PPACA was also by Avik Roy, so this comes as no surprise. [-]He is a fountain of confusion, misrepresentation and misdirection.[/-] He doesn't like the PPACA and misses no opportunity to show that, even when he has to resort to flawed reasoning to do so. His point about this being used as a backdoor to get more benefits to the low income population in states that didn't expand Medicaid is entirely bereft of fact or reasoning.
The Kliff article he references can be found here Health insurance marketplaces will not be required to verify consumer claims - The Washington Post
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The whole thing is "new" (as in, "never yet tried"). And it looks like we won't get a chance to see how the envisioned system will really work until 2015.
Of course the main thing that has changed is that large employers don't have to provide health insurance that meets ACA standards for an additional year. That's a biggee.
No disagreement there.
rbmrtn
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Seems like this is getting misstated. The mandate wasn't delayed, it was the reporting requirements ( per the treasury release ). Maybe that is a defacto delay of the mandate.
Since 96% of employers in this category already provide insurance, it seems there would be a simpler reporting method to get to those few that don't.
Statement: Administration Delays Employer Health-Care Mandate - Washington Wire - WSJ
Since 96% of employers in this category already provide insurance, it seems there would be a simpler reporting method to get to those few that don't.
Statement: Administration Delays Employer Health-Care Mandate - Washington Wire - WSJ
The last two paragraphs of the Treasury announcement make it pretty clear: Employers don't have to provide insurance until 2015 (though it will be "encouraged") and there will be no penalty (the euphemistically named "shared responsibility payments") for failing to provide coverage.
If/how that access to "premium tax credits" will occur for those who are covered by employers is not fully explained. Such people shouldn't get any "premium tax credits" but since employers don't have to provide any reporting--it will be up to people to self report. And now we need to see an estimate of the increased federal outlays for premium subsidy payments that will occur because the administration is letting employers off the hook. That will probably be contained in the additional Treasury info that was promised.
I wonder if Congress will get a chance to vote on what the ACA has become.
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I agree. No foot-dragging or excuses. No "Oops, this is hard." Implement exactly what Congress passed on the timeline they specified so we can all see how this works.
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Congress did NOT vote on what ACA has become, inc thousands of pages of regulations written since its passage. We have witnessed changing effective dates stated in the law (e.g. SHOP & Employer mandate provisions), expansion of 2014 open enrollment period beyond initial determination, and now (for at least 1st yr) no verification of income for Exchange applicants. These issues may prove to have significant impact on at least 1st 1-2yrs of ACA's total cost to gov't (i.e. taxpayers).
Agree that ACA was passed & upheld by SCOTUS, and that a civil society SHOULD implement properly passed laws. But ACA is NOT being fully implemented, at least not according to the Law's text. To many, that IS a "do-over"- at least of certain key provisions of ACA. There is a fear that these repeated substantive delays may affect ACA's long-term political viability, particularly since (unlike SS or Medicare) it was passed without substantive bipartisan support.
pixelville
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State run healthcare exchanges and verification of subsidy
Looks like state run exchanges will not have to verify eligibility for healthcare subsidies for another year. Given that final subsidies are based on actuals anyway (as opposed to projected income), it really should not have an impact.
U.S. relaxes health law income, insurance status rule for exchanges - Yahoo! Finance
Looks like state run exchanges will not have to verify eligibility for healthcare subsidies for another year. Given that final subsidies are based on actuals anyway (as opposed to projected income), it really should not have an impact.
U.S. relaxes health law income, insurance status rule for exchanges - Yahoo! Finance
Z3Dreamer
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Huge impact. I go in and claim 140% FPL so I get virtually no co-pays and low deductible. At year end I find I am eligible for 390% plan. I have to pay increased premiums but I have still had low deductible and low co-pay. No crawl back provision that I am aware of.
Very minimal impact, overall.
All right, we now know the PPACA employer mandate isn't going to be implemented for another year, and we are all suitably outraged. Lets now get the thread back on topic, which is how this affects us and what things we need to do to prepare ourselves for the Oct availability.
This is already being discussed in another thread, so it's probably a good idea to merge the two.
Edit: threads merged. Now, back on topic, how does this affect us and what things should we do to prepare, if any?
Edit: threads merged. Now, back on topic, how does this affect us and what things should we do to prepare, if any?
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explanade
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So I'm covered by a large employer in CA.
If I retired within the next 12 months, I would just go apply for the CA exchange?
IOW, ACA as the trigger point for ER? Or maybe COBRA is a better option while we see how things shake out for the first year or two?
If I retired within the next 12 months, I would just go apply for the CA exchange?
IOW, ACA as the trigger point for ER? Or maybe COBRA is a better option while we see how things shake out for the first year or two?
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