signed the Health Care and Education Reconciliation Act (H.R. 4872), which offers some adjustments to the PPAC. It also included provisions to revamp stu- dent financial aid.


Summary of Approach Te main focus behind the current ad-


ministration’s work on health care reform was to expand coverage, control health care costs and improve the health care delivery system. Te reforms in place are meant to make


health care more affordable, especially to some 32 million uninsured citizens. A critical component to achieving this is the individual mandate, which, with a few ex- ceptions, requires most U.S. citizens and legal residents to have health insurance. From there, the health care reform


law takes on the challenge of ensuring that these uninsured citizens and legal residents can obtain coverage through a series of reforms that include, but are not limited to, new employer requirements to offer coverage. Additionally, there are a host of other


reforms meant to expand coverage in- cluding, but, again, not limited to: the expansion of public programs (Med- icaid, CHIP); tax changes related to health insurance; the creation of the state-based health insurance exchanges; changes to private insurance; and other cost containments. Te point


stressed in many of the


resources reviewed is that, if an individ- ual/family already has health coverage through their employer, and the individ- ual/family likes the plan they have, they can keep it. If you are receiving cover- age through your employer, “Nothing in the health reform bill will require you to change your coverage,” noted the official White House Web site that details the re- forms’ impacts.


Mandates for Employers Employer requirements differ depend-


ing on the number of employees there are, whether your business already offers health insurance as a benefit, and whether at least one of your full-time employees receives a federal subsidy to purchase health insur- ance on his or her own. And with this there


are also new premium subsidies to employ- ers, which includes a tax credit for small businesses to offset insurance premiums. “In general, the law requires individu-


als to purchase health coverage and for some employers to provide it or face penalties. Te law sets out standards for minimum essential benefit plans avail- able through exchanges, and provides premium and cost sharing assistance to individuals with incomes below 400 per- cent of poverty. Te law also provides small business tax credits for certain small businesses. It raises taxes and cuts Medicare and other spending to finance the new entitlement to premium and cost sharing subsidies,” noted the U.S. Chamber of Commerce in its overview section of its April 2010 publication,


“Critical Employer Issues in the Patient Protection and Affordable Care Act.”


What Questions Should Businesses Consider? A recent Web series from the U.S.


Chamber of Commerce, “Aftermath: New Realities for Businesses in the Wake of the Health Care Law,” outlined a number of the considerations businesses will want to look at going forward. In summary, these considerations included:


Does the small business health in-


surance tax credit apply? If a business qualifies for it (those with 25 or fewer employees and an average workforce sal- ary of $50,000 or less) you will want to figure out whether and how to utilize it.


“Employers with between 25 and 50 em- ployees are not eligible for subsidies, and will not be fined for failing to offer health insurance; however, if they do offer a plan, the plan will need to meet essential ben- efit and actuarial standards, or employees will still be subject to the individual man- date penalty,” the article noted.


Is the plan a “qualified” plan? Does it


meet the new actuarial requirements en- acted in the PPAC (generally a 60 percent actuarial value), as well as cover all of the


“essential” benefits? (Te essential benefits will be promulgated by the Secretary of Health and Human Services prior to the mandates taking effect in 2014.)


What are the Plan Costs vs. Penalty


Costs? Tere are several dependant factors that go into what, if any, coverage a business is required to offer and then what, if any, penalties are levied for not having coverage. Businesses that offer coverage will most likely choose between a fully-insured plan (a traditional health insurance product, in which the insurer pays claims and takes on the risk), the self-insured route (employer forms an ERISA) or sending employees to the new exchange. Each scenario comes with certain cost savings but also penalty potentials — these need to be weighed.


How does the employees’ subsidy


eligibility factor in? In certain scenarios, it might be more financially advantageous for an employee to enter into the state based exchanges instead of receive coverage through the employer. Businesses need to know the possible subsidies that employees could receive if there is no plan offered.


What about other health related


benefits? Tere are also changes coming to long-term care options, prescription drugs for retirees and consumer-directed account options (for example, Health Savings Accounts [HSAs], Flexible Spend- ing Arrangements [FSAs], and the high deductible health plans [HDHPs]) that employers will want to review.


(Editor’s note: Te U.S. Chamber’s Web


series was published with the following dis- claimer: “Te following considerations is not legal advice but is intended to serve as an out- line to the new realities employers face in this landscape of compliance responsibilities.”)


Opposition Taking Shape Almost as soon as the health reform bills


became law, formal opposition kicked in. “In response to federal health reform


legislation, members of at least 39 state legislatures have proposed legislation to limit, alter or oppose selected state or federal actions, including single-payer provisions and mandates that would require purchase of insurance. In gen- eral the measures, covering both 2009 and 2010, seek to make or keep health insurance optional, and allow people to purchase any type of coverage they may


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