Although The Affordable Care Act became law in March 2010, its major impacts on the public are still being rescheduled. While the individual mandate to obtain “adequate” healthcare coverage applies to adults and their family members starting in March 2014, employers’ obligation to offer that coverage has become a moveable feast.
Unfortunately “adequate” means whatever the government says it does. “Affordable” seems to mean priced to take so little of the family income that it does not trigger eligibility for a federal subsidy. The federal government controls the formula for triggering a subsidy.
In February 2014, the White House allowed firms with 50 to 100 employees to delay the offer of affordable healthcare coverage until 2016. Just as in the fall of 2013, the White House delayed until 2015 the obligation to offer health coverage within firms with more than 100 employees. Since most working Americans relied on employer health plans, quixotic delays in the employer obligation can mean employee families lack coverage, or pay dearly for coverage, or are in a quandary about the permanence of their coverage – and delayed coverage just applies to employees of firms in the 50-100 and 100+ employee strata.
Regardless of employment status, most Americans who are age 65 or more are eligible for Medicare health coverage and many low income Americans are eligible for Medicaid coverage. While the premiums, coverage and co-pays vary somewhat each year, the coverage relieves much worry and expense. But many Americans below age 65 await clarity on healthcare rules and prices.
There are 10.4 million unemployed people in the workforce. If they are unemployed for long, they gradually slip out of any employer health plan. Without employer coverage, the rules require them to enroll themselves and their family through a healthcare exchange. Then they must hunt for an affordable health plan, perhaps with a federal subsidy based on their current low income. If their circumstances are sufficiently dire, they can apply for Medicaid eligibility – a bittersweet circumstance.
Another 9.8 million people are self-employed but unincorporated. They also face the individual mandate without an employer to offer them coverage, much like an unemployed person. Those who fail to fulfill the mandate of obtaining health coverage will face fines.
There are 5.3 million self-employed, but incorporated people in the labor force. Their firm size dictates what obligation the firm has for offering coverage. Often those self-employed, incorporated people will be in the 1-49 employee stratum. In 2013, 28.45% of employees worked in firms with 1-49 employees. Instead of an obligation, a tax break is available to small firms that offer health coverage. The tax deduction declines as the size of the firm and average payroll increase.
In 2013, 7.94% of employees worked in firms with 50-100 employees. They will need to wait until 2016 to discover what their employer might offer. The 63.57% of employees working in firms with 100+ employees will find out what their employer plans in 2015.
The nation has been scrutinizing the Affordable Care Act for four fractious years, yet too few of the important details are known with surety. Will my employer offer coverage? Will I have to buy it myself? Will I be able to afford coverage? Should I just pay fines until I face a medical calamity?
This is no way to run healthcare.
Alan Daley is a retired businessman who writes for The American Consumer Institute Center for Citizen Research