Focus on health reform: individual mandate, insurance exchanges

Foyer sur la réforme de santé : mandat individuel, échanges d'assurance

par Astrid Fiano, DOTmed News Writer | August 26, 2010
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Perhaps the most significant provisions of the Affordable Care Act are the creation of state-based exchanges and the employer and individual responsibility requirements. All of these provisions start in 2014. The most contested provision thus far is the individual mandate. This provision has been part of the basis of several lawsuits challenging the Affordable Care Act, and the subject of various bills introduced in state legislatures to prohibit mandatory coverage. In terms of obtaining health insurance and affordability of insurance, all these upcoming provisions reflect many of the original ideas behind health reform legislation. More on these changes to come are discussed below.

Individual and Employer Requirements in 2014

Beginning in 2014, most individuals (U.S. citizens and legal residents) will be required to obtain health insurance coverage or pay a tax penalty. In 2014, that penalty will be $95. The penalty increases to $325 in 2015 and $695 in 2016 (or up to 2.5 percent of income). If a person is unable to purchase coverage, exemptions will be available on the bases financial hardship, religious objections, and for Native Americans.

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Employers with 50 or more full-time employees who do not offer insurance coverage to their workers will be required to pay a penalty of $2,000 annually for each full-time employee (over the first 30 employees). Employers with more than 200 full-time employees, and that offer employees enrollment in one or more health benefits plans, will be required to automatically enroll new full-time employees in one of the plans offered. The employer would need to give adequate notice and the opportunity for the employee to opt out of automatic coverage.

The small business tax credit now in effect for qualifying business and nonprofit organizations will be increased in 2014. For small business, the credit will be up to 50 percent of the employer's contribution to health insurance for employees. For nonprofits, the credit is up to 35 percent.

Insurance Exchanges

In 2014, each state will be required to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans. The states must also establish a Small Business Health Options Program to assist qualified small business employers in the state in facilitating the enrollment of their employees in qualified health plans offered to the small group market. The exchanges will be administered through a government agency or a nonprofit organization. The states are allowed to merge the individual and small group markets.