The ACA and Legal Practices (#19) / Representing large employers

December 10, 2014

health-care-lawThis is installment #19 in a series of blog postings on the Affordable Care Act (ACA) and legal practices.

Attorneys face many complexities in representing large employers that are dealing with issues related to the ACA.

Most companies have been engaged in ongoing cost-benefit studies ever since passage of the ACA in 2010, to examine the choices that they face.

Throughout the past four years, there have been numerous uncertainties as to exactly what requirements are being placed on large employers (those with 50 or more employees).

The ACA carefully defined Qualified Health Plans (QHPs) with Essential Health Benefits (EHBs) to be sold on the Health Benefit Exchanges (to individuals and small businesses).

But there was less detail provided as to what types of plans were being required for large employers

In particular, could limited-benefit plans be used to keep costs down?

For the first few years, it seemed that “QHP-like” plans would be required for these employers.

Then, after extensive regulations appeared, it seemed that some types of reduced-benefit plans might be possible (as discussed in installments 15 through 17 of this series of postings).

More recently, the Department of Health and Human Services (HHS) has moved to shut the door on plans that do not cover usual physician and hospital services, so there is now a return to QHP-like coverage as the standard.

Some employers have offered comparable coverage for years, and thus can adjust with modest increases in costs.

For other employers, meeting the requirements will be financially stressful.

Due to employer pressure, the deadline for meeting these requirements was postponed from 2014 to 2015 for “larger” companies with 100 or more employees, and to 2016 for “midsized” companies with 50 to 99 employees.

Companies that do not provide adequate coverage (in terms of the scope of benefits and share of costs to be paid by employees) will be required to pay penalties—and may experience employee-relation issues.

Attorneys may be asked to assist large employers with understanding current regulations and options; dealing with insurance brokers; guiding benefit explanations, forms and record-keeping; helping design revised reporting systems, as required; and setting up procedures to deal with employee questions and problems.

It is also important for attorneys to be able to explain the “big picture” to large employers—what is going on with other types of organizations and in the courts—as program implementation proceeds.

Attorneys can provide the most effective assistance if they can combine overview explanations with detailed descriptions of the activities that most immediately affect their clients.

More information about implementation of the Affordable Care Act and associated legal practice issues may be found in recent books on the ACA and on the health care system, other postings to this blog, and on the ACA Blog, also written by the author of this series.