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Individual Responsibility and Subsidies

On December 18, 2019, the Fifth Circuit Court of Appeals in TX issued a ruling that the individual mandate was unconstitutional. A number of states have implemented state-based replacements for the federal individual mandate. The ACA remains in effect and employers must still comply with the employer mandate and reporting requirements.

Articles

A Primer on ACA Protective Refund Claims, Eisner Amper, 8/3/2020

California Releases Details Regarding Employer Reporting for Its Individual Mandate, Accord, 8/3/2020

The Return to the Supreme Court, Groom Law, 6/3/2020

COVID-19: Considerations for commercial health insurance rates in 2021 and beyond, Milliman, 5/5/2020

Supreme Court to Hear Challenge To ACA, Health Affairs, 3/2/2020

Status of the State Individual Health Insurance Coverage Mandates, International Foundation, 2/13/2020

Texas, et. al., v. U.S. – The Fifth Circuit Rules, Groom Law Group, 1/10/2020

Viability of Affordable Care Act Is Still in Limbo, Morgan Lewis, 1/3/2020

Fifth Circuit Weighs in on State of Texas v. USA; Remands the All Important Severability Question to District Court for a Closer Examination, Accord Systems, 12/19/2019

New Jersey Individual Mandate Requires State Filings in March 2020 , Proskauer, 10/25/2019

ACA Round-Up: MLR Rebates, Insurer Competition, New Guidance On EDE, Health Affairs, 9/23/2019

ACA Litigation Round-Up: AHPs, Short-Term Plans, CSRs, And Risk Adjustment, Health Affairs, 8/5/2019

New Jersey issues further guidance on employer reporting in light of the state's individual, Ernst & Young, 7/22/2019

Rhode Island requires individual residents to carry health insurance, Ernst & Young LLP, 7/12/2019

California legislation to require individual residents to carry health insurance, Ernst & Young LLP, 6/25/2019

New Jersey 2019 Individual Mandate Will Require Extra Reporting Starting in February 2020, Accord Systems, LLC, 6/3/2019

House Passes Legislation To Strengthen the ACA, Health Affairs, 5/17/2019

Individual Insurance Market Performance in 2018, Kaiser Family Foundation, 5/7/2019

ACA Marketplace Open Enrollment Numbers Reveal the Impact of State-Level Policy and Operational Choices on Performance , The Commonwealth Fund, 4/16/2019

Appeal In Texas v. Azar Stayed Due To Government Shutdown, Health Affairs, 1/14/2019

ACA Update: Next Steps for Employers, International Foundation, 1/7/2019

ACA Litigation Round-Up: CSRs, Risk Adjustment, AHPs, And Short-Term Plans, Health Affairs, 1/3/2019

States Appeal ACA Ruling to Fifth Circuit, Health Leaders Media, 1/3/2019

The ACA's Cost-sharing Subsidies, HealthInsurance.org, 12/27/2018

ACA Ruled Unconstitutional – Now What for Employers?, Findley, 12/26/2018

Health Insurance Marketplace Calculator, Kaiser Family Foundation, 11/1/2018

Departments Propose Regulations Permitting HRAs for Individual Policies, ABD Insurance & Financial Services, 10/23/2018

ACA Regulations Watch: What to Expect This Fall, Health Affairs, 10/22/2018

The Short-Term, Limited-Duration Coverage Final Rule: The Background, The Content, And What Could Come Next, Health Affairs, 8/1/2018

Tracking Section 1332 State Innovation Waivers, Kaiser Family Foundation, 7/17/2018

Drivers of 2019 Health Insurance Premium Changes, American Academy of Actuaries, 6/1/2018

The impact of the $0 individual mandate penalty, Milliman, Inc., 6/1/2018

The Reshaping of the ACA, Marsh & McLennan Agency LLC, 5/31/2018

So, Your Employee Received an ACA Premium Tax Credit . . ., International Foundation, 12/20/2017

House, states, Trump administration reach settlement in ACA subsidies case , FierceHealthcare, 12/18/2017

ANALYSIS: ACA Marketplace Premiums Rise Substantially in 2018, But Many Will Pay Less for Coverage, Kaiser Family Foundation, 10/31/2017

The 2019 Proposed Payment Notice, Part 2: Consumer-Facing Provisions, Health Affairs, 10/28/2017

IRS Begins to Draw the Line in the Sand – Won’t Accept Individual Tax Returns without ACA Information, Accord Systems, 10/23/2017

HRAs, AHPs, and STLDIs: What the Executive Order Means for Benefit Plans, IFEBP, 10/20/2017 Blog explains President Trump's Executive Order dated October 12, 2017, and how it could affect employers and employees

The Revolution of Employer-Sponsored Health Insurance, Trucker Huss, 10/19/2017 Article explores possible effects of 10/12/17 Executive Order on HRAs and Employer Payment Plans (EPPs).

Treasury Inspector General Releases Assessment on IRS Implementation of Employer Shared Responsibility Provisions, Ernst & Young LLP, 6/15/2017

The Effects of Ending the Affordable care Act's Cost Sharing Reduction Payments, Kaiser Family Foundation, 4/25/2017

What's Working: Helping Members with Health Care Decisions, International Foundation, 7/1/2015 The administration of a multiemployer health and welfare fund describes how the fund took adavantage of ACA to gain subsidized coverage for union members who did not qualify for the fund's plans.

Sorting Out the Minimums and Essentials of ACA, International Foundation, 6/20/2014 Explains the meanings of and differences among these terms: minimum essential coverage, essential health benefits, minimum value

Fact Sheets

ACA Numbers & Limits 2014-2020, Kaufman & Canoles, 9/26/2019

FAQs

What are Individual Coverage HRAs and how do they affect employers? , International Foundation, 10/7/2019

Does the Tax Cuts and Jobs Act change any employer ACA responsibilities?, International Foundation, 1/4/2018

Under what circumstances can an individual receive a premium tax credit (PTC) on the public exchange, and why should employers care?, International Foundation, 12/14/2017

Are opt-out payments to employees included in the affordability calculation?, International Foundation, 9/1/2017

Do 1095 forms need to be completed for employees waiving medical coverage for the entire year, and if so, what codes are used?, International Foundation, 7/12/2016

Under the Affordable Care Act (ACA), can an employee waive coverage without the employer being penalized?, International Foundation, 2/16/2016

Government Resources

CMS Issues Final Rule on HHS Notice of Benefit and Payment Parameters for 2021, CMS, HHS, 5/14/2020

Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2020 Final Rule, IRS, HHS, 4/25/2019

CMS Issues Final Rule on HHS Notice of Benefit and Payment Parameters for 2020, CMS, 4/25/2019

The Premium Tax Credit - The Basics, IRS, 3/28/2019

Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2020 Proposed Rule, CMS, HHS, 1/24/2019

CMS Details Additional Process for Providing Relief for Consumers from Individual Mandate , Centers for Medicare and Medicaid Services, 9/12/2018

Guidance on Hardship Exemptions from the Individual Shared Responsibility Provision for Persons Experiencing Limited Issuer Options or Other Circumstances, CMS, 4/9/2018

Repealing the Individual Health Insurance Mandate: An Updated Estimate, Congressional Budget Office, 11/1/2017 November 2017 estimate of the financial impact of repealing the individual mandate

Affordable Care Act Tax Provisions for Individuals and Families, IRS, 2/15/2017

Premium Tax Credit Regulation VI, IRS, 12/19/2016 Final rule affects individuals who are eligible for employer-sponsored health coverage, opt-out credits

Premium Tax Credit NPRM VI, IRS, 7/8/2016 Proposed rule

ACA Exemption Fact Sheet , IRS, 3/18/2016 Fact sheet about the exemptions from the requirement to have health coverage if individuals could not afford coverage or met other conditions, how to claim an exemption during tax filing

Individual Shared Responsibility Provision, IRS, 7/20/2015 Everyone in your family must: report minimum essential coverage or report a coverage exemption or calculate/make a shared responsibility payment

Minimum Essential Coverage and Other Rules Regarding the Shared Responsibility Payment for Indivduals, IRS, 11/26/2014 Final rule on how wellness program incentives, HRA contributions and Section 125 cafeteria plan contributions are treated in determining whether an individual's employer-sponsored coverage is affordable

Shared Responsibility Payment for Not Maintaining Minimum Essential Coverage, IRS, 8/30/2013 Final rule

Individual Shared Responsibility for Health Insurance Coverage and Minimum Essential Coverage Final Rules , IRS, 8/27/2013 Fact sheet

Exchange Functions: Eligibility for Exemptions; Miscellaneous Minimum Essential Coverage Provisions, CMS, HHS, 7/1/2013 Final rule on types of coverage considered MEC, exemptions, penalties

Individual Shared Responsibility Provision Exemptions, Minimum Essential Coverage, HHS, 6/26/2013 Fact sheet