Backers of a recently launched grass-roots drive to convince lawmakers to repeal a health reform law provision that will cap employees’ flexible spending account contributions at $2,500 a year starting in 2013 face an uphill battle to win congressional approval for repeal. The provision would raise an estimated $13 billion in federal revenues through 2013 and lawmakers would be reluctant to remove a provision that raises that much revenue, which will be used to help fund coverage for the uninsured, benefit observers say. ›› More

While last year's passage of health care reform legislation came after decades of discussion of reform proposals, the pace at which regulations are being released to implement the Patient Protection and Affordable Care Act has been anything but glacial. But guidance is still lacking on some critical issues, including rules on penalties when coverage is not offered. ›› More

From the time it was passed in March 2010, employers have been grappling with the Patient Protection and Affordable Care Act. In ways small and big, every employer with a health care plan will be impacted by the health care reform law. Some challenges are relatively minor, but other challenges are far more complex and present critical strategic questions. Just keeping up with and deciphering the myriad health care reform regulations being issued by the federal agencies can be overwhelming. And at perhaps the highest level, employers will have to evaluate whether it still will be in their own and their employees' best interests to continue to offer coverage after key provisions of the law take effect in 2014. ›› More

Starting in 2014, employers will be assessed a $2,000 fine for each full-time employee not offered coverage. But as experts have dug into the law, they have concluded that the penalty will be assessed for all full-time employees even if just one full-time employee is not offered coverage and is eligible for federal premium subsidies. Employer fears of being hit with such massive penalties have reached the Treasury Department, and the agency is responding to those concerns by developing regulations so the assessment would not apply in certain situations. ›› More

As many as 30% of employers may drop their health care plans after key provisions of the health care reform law kick in, consultant McKinsey & Co. found in a survey of more than 1,300 employers. That finding drew the ire of some congressional Democrats, who called on McKinsey to disclose more information about the employers—such as their size—it surveyed. McKinsey's findings differed from those of previous similar surveys. ›› More

Whether employers retain or drop their health care plans in 2014 will vary significantly by company size, a Mercer L.L.C. survey found. For big employers, potential savings from dropping coverage could be significantly eroded by the $2,000 per employee penalty they would be assessed, plus such added costs as loss of certain tax breaks and bumping up employees' salaries so they could purchase coverage on their own. On the other hand, very small employers are exempt from the $2,000 penalty and because they typically insure their plans, are more vulnerable to big rate hikes. ›› More

The Supreme Court will review the constitutionality of a key health care reform provision that requires individuals to enroll in a health care plan or pay a financial penalty. If the court strikes down the individual mandate, the financial viability of the broader law could be threatened. ›› More

It is a certainty that every employer will have to modify its health care plans to comply with the requirements laid down by the more than 2,000-page Patient Protection and Affordable Care Act. And those requirements are not static. Since the passage of the legislation, Congress has repealed two requirements. This resource, to be updated as needed, outlines the requirements employers face and the guidance provided by regulators to date to enable employers to meet those requirements. ›› More

Only a small percentage of employers, at least for now, intend to drop their health insurance plans after key provisions of the health care reform law go into effect in 2014. One reason that employers are reluctant to drop coverage is skepticism that insurance exchanges that are supposed to set by then will provide viable alternative coverage options for their employees. Some employers also are reluctant to drop coverage out of fear that they could lose their ability to attract employees, while other employers say that dropping coverage could be far more costly than anticipated. That's because lawmakers will likely substantially increase the current $2,000 per employee penalty on employers not offering coverage, if there is a surge in the number of employers that decide to terminate their health care plans. ›› More

Unlike many laws, the health care reform law does not have a single effective date—it has many. Some, like an extension of coverage to employees' adult children until age 26, already have gone into effect. Many others, such as one that requires employers to offer coverage or face financial penalties, don't take effect until 2014. One provision that could have the greatest financial impact on employers and lead to sweeping design changes doesn't take effect until 2018. This resource outlines key health care law requirements and their effective dates. ›› More

John Dean

Even the health care reform law's toughest critics likely would concede that the law will expand access—chiefly through federal premium subsidies and an expansion of Medicaid—to millions of uninsured, lower-income individuals. But will the law help to control health care costs? On that, there is considerable skepticism. Lafarge North America Inc.'s Philia Swam, who was named to the Business Insurance 2011 Benefit Management Honor Roll, says the law does nothing to encourage individuals to take steps to detect medical problems before they worsen. And that lack of emphasis on prevention, says Ms. Swam, means health care costs will continue to surge. ›› More

While state health insurance exchanges won't begin operations until 2014—and at first only for small employers—private exchanges already are popping up across the country. These private exchanges feature a defined contribution approach: If the premium for a plan selected by an employee exceeds what the employer has allocated, the employee pays the difference through pretax salary contributions. Proponents say the exchanges give employees more choices, while allowing employers to limit their liability. ›› More

The best strategy for employers to follow to inform employees of how the health care reform law will change their benefits is to avoid information overload and tell employees only what they have to know. If a plan, for example, has “grandfathered” status and thus the employer doesn't have to make certain changes, there is no need to communicate that, experts advise. Still, one relatively easy way to respond to employees' questions is to post a list of frequently asked questions and answers about the law. ›› More

The health care reform law could give a further boost to consumer-driven health insurance plans, which already are rapidly growing. A key reason for that boost is a health care reform law provision that will impose, starting in 2018, a 40% excise tax on the portion of plan costs that exceed $10,200 for single coverage and $27,500 for family coverage. With CDHPs costing far less than those amounts, the plans will become even more attractive to employers eager to avoid being hit with the new tax. ›› More

Many employers that face the loss of a federal tax break for providing prescription drug coverage to Medicare-eligible employees in 2013 already are restructuring the benefit. The tax break is part of the 2003 federal law that created the Medicare prescription drug program and was included to encourage employers to retain the prescription benefits offered to Medicare-eligible retirees. But employer strategies for dealing with the issue vary. ›› More

The foundation of the health care reform law is state-established exchanges where private insurers, starting in 2014, will offer coverage to individuals and to small employers. Starting in 2017, states can, if they so decide, open up exchanges to employers with more than 100 employees. But guidance issued by the Department of Health and Human Services is leaving it to the states to decide the conditions—such as how many employees they have—that will dictate which larger employers can buy coverage through the exchanges. And regulators have yet to provide guidance on whether employers with early retiree health care plans can obtain coverage through the exchanges. ›› More

Even though the health care law's ban on annual dollar limits on essential benefits does not go into effect until 2014, the restricted limits are far higher than those of so-called mini-med plans. Those plans, typically offered to new, low-wage employees in high-turnover industries, have annual limits that are a fraction what is permitted. But if plan sponsors can prove that meeting the annual limits will result in a significant premium boost, they can get a waiver from the annual limit rule. But employers have to move fast: Sept. 22, 2011, is the last day they can apply for a waiver, which if approved, will be good through the end of 2013. ›› More

The health care reform law left it to regulators to develop guidance on how employers are to comply with a provision requiring them to report annually health care plan cost information on employees' W-2 wage and income statements. Internal Revenue Service guidance—likely to be updated—answered numerous questions, but additional guidance is needed on employers' reporting duties under the health care reform law. ›› More

A provision in the health care reform law has enabled hundreds of thousands of employees' adult children to retain or win back group coverage while only modestly boosting employers' costs. That provision—one of the first Patient Protection and Affordable Care Act mandates to take effect and affecting nearly every employer—requires companies to extend coverage to employees' adult children until age 26. ›› More