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The Delay in the ACA Employer Mandate: What It Means for Direct-Care Workers

July 25, 2013

As the October 1 deadline approaches for the opening of health insurance exchanges created under the Affordable Care Act (ACA), the Obama Administration has announced a delay in the requirement that employers with 50 or more employees either provide health insurance for employees working 30 or more hours per week or pay a penalty.

The delay, announced on July 2, gives employers until January 1, 2015 (instead of December 31, 2013), to comply with the mandate.  Although most businesses with 50 or more employees already offer health insurance, the delay for employers has raised some concerns about the impact on individuals without coverage. The law’s individual mandate, which requires everyone beginning January 2014 to buy insurance or pay a penalty, remains in effect.

For direct-care workers, who are more likely to lack employer-sponsored coverage than U.S. civilian workers overall, the delay in the employer mandate is not a major setback. This is because direct-care workers, who tend to have low family incomes, will more likely benefit from subsidized coverage in the newly created exchanges.

There is one challenge, however. The law requires that the exchange determine if an individual is offered qualified coverage by her employer, prior to offering subsidized insurance. With the delay in the employer mandate, it is not clear how this determination will be made or whether the delay will affect access to subsidized coverage for uninsured workers.

Direct-care workers — and other low-wage employees — should not have to wait to access affordable coverage simply because employers are being given a break on reporting. PHI and other advocates are continuing to press the administration to ensure that subsidized coverage is available beginning January 2014.

Another challenge for direct-care workers seeking affordable coverage is the fact that 27 states have decided not to pursue an expansion of their Medicaid programs. If all states expanded coverage, nearly 500,000 direct-care workers would be expected to be newly eligible for Medicaid nationwide; however, the decision by states such as Texas, with large numbers of uninsured direct-care workers, not to expand the program will leave tens of thousands of workers and their families without affordable coverage options.

We recommend that direct-care workers who are not offered affordable employer coverage explore two options in the coming months:

  • A health insurance marketplace, to assist consumers in shopping for coverage, will launch in each state on October 1. Uninsured direct-care workers should check out the insurance exchange in their state, as significant subsidies will be available for individuals with low incomes.
  • As of July 1, 23 states and the District of Columbia had announced plans to move ahead with Medicaid expansion, which is optional under the law. In these states, for workers with incomes below 138 percent of poverty (which is $15,856 for a household of one and $32,499 for a household of four), Medicaid coverage will be the best option. The Kaiser Family Foundation has a list of what each state is doing on its website.

To see if you’re eligible for subsidies, and what portion of the cost you will be expected to carry, try this calculator.

For more information on the postponement of the employer mandate and its impact of workers, read this FAQ from Kaiser Health News.

— by Carol Regan, PHI Government Affairs Director, and Gail MacInnes, PHI National Policy Analyst

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