Obamaco$t Coming Home to Roost

The Obama Administration is encouraging young adults to obtain coverage through health insurance marketplaces, which need healthy people to balance sicker ones in the risk pool. Why is this important? Keep reading.

Aetna projects over $300 million loss on ACA business and announced that it will stop selling in 11 of the 15 states where it currently offers individual insurance on the Affordable Care Act exchanges.  – Aetna released its second-quarter earnings report and also announced it will not go forward with previous plans to expand its offerings on state health insurance exchanges.  Aetna CEO Mark T. Bertolini said if the company cannot fix this aspect of its business then it will leave the exchanges.

Humana Plans to Scale Back ACA Business. – Humana is concerned about growing losses in its ACA business and “set aside about $208 million more in the second quarter to cover losses in” its ACA business. Humana said it plans to “scale back” its individual business for 2017, which means it will offer coverage in only 156 counties, compared to 1,351 in 2016, and it will sell healthcare plans through Affordable Care Act exchanges in 11 states, compared to 15 this year.

Obama Administration Sues to Prevent Mergers of Big Insurers – The Obama Administration is attempting to prevent the mergers of four large insurers. The Justice Department sued Anthem, Cigna, Aetna, and Humana to block their mergers, saying that they “would ‘drastically’ curb competition in the insurance industry,” and negatively impact options for consumers who purchase coverage through Affordable Care Act exchanges. (Finally, something on which Employee Benefit Advisors agrees with the Administration.) Aetna and Humana announced a plan to sell some of their assets with the aim of gaining regulatory approval for their proposed merger.


Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

ACA in the News

ACA Enrollment Down To About 11.1M – CMS figures show that enrollment under the ACA dropped from 1.6 million people down to 11.1 million. Nearly 85 percent of remaining enrollees, 9.4 million, were receiving tax credits averaging $291 per month to help them pay their premiums.

Battle over ACA Continues In Court and In Congress – Surprise! The Obama Administration and Congress are again at odds over the ACA. The Administration filed an appeal to US Judge Rosemary Collyer’s ruling that it used Treasury funds to subsidize ACA plans without approval from Congress. House Republicans unveiled a report which concluded that the Administration proceeded to use the funds despite knowing that congressional approval was necessary. The “scathing report” concluded the Administration “ignored its own advice and forged ahead with Obamacare payments to insurers without permission from Congress.” In 2012, the Treasury Department concluded Congress would have to approve funding for the ACA’s cost-sharing program, yet “the administration quietly withdrew its budget request for the program drafting a memo that said it didn’t need Congress’ blessing and running it by then-Attorney General Eric H. Holder Jr.”

President Obama Renews Call for Public Option – Healthcare reform has already proven to be a major player in the election debate, President Obama is advocating once again for a “public option.” This, along with proposals to cap the employer exclusion as well as single-payer initiatives in both Colorado and New York.


Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Repealing Obamacare (Part 2of 2) – The Employer Tax Exclusion

The National Association of Health Underwriters (of which Employee Benefit Advisors is a member) and other industry groups support the employer-based healthcare system and have been opponents to eliminating or capping the exclusion and supports a platform that would preserve existing tax incentives for insurance, including the exclusion.

Proposals that eliminate the exclusion would push individuals from group coverage into the individual market. While deductions or refundable tax credits would help consumers secure coverage in the individual market, NAHU believes that they would fall far short both financially and in terms of coverage of the current system that allows for tax-free contributions from employers.

An individualized health insurance market would be ripe for adverse selection leading to higher insurer losses participating in these markets. Insurers would offset these losses by reducing provider networks and increasing cost-sharing. Currently, employer-sponsored plans are much more likely to have a mix of health risks and, in this case, the volume of individuals allows the costs associated with higher risks to be spread over that mixed population of high and low risks. Eliminating the exclusion and pushing consumers to the individual market would reduce the means for spreading risk among healthy and unhealthy individuals. The healthiest would be more likely to opt-out of coverage, leaving the most unhealthy covered. Employers still offering health insurance could be faced with difficulty meeting participation requirements and ever-increasing rates in a potential death-spiral as only the sickest remain insured.

Financially, employees receiving employer contributions already receive generous “subsidies” for their health coverage. Group premium rates tend to be more favorable than individual markets given the ability to control for adverse selection, and employers and employees alike benefit by reducing the taxable income for contributions made to insurance premiums. When employees’ taxable income increases due to the new taxable status of employer contributions, the employer’s FICA match would also increase. For every new dollar of taxable income due to newly taxable employer contributions or employee contributions previously made on a pre-tax basis under Section 125, employers would be responsible for 7.65% in new costs until the employee reached the Social Security wage base.

Ultimately, eliminating the exclusion would in turn result in a massive tax increase on middle class Americans that would not come close to being offset by any deduction, particularly for lower-paid workers who don’t have a deduction for income tax. Rather, a deduction for this type of worker would likely cause them to forego coverage altogether since it would offer no immediate relief towards the cost of coverage.

Finally, moving from a group insurance marketplace to an individualized marketplace would cause considerable strain on the enrollment process. Group plans are highly efficient at seamlessly enrolling millions into coverage, and without these group plans agents and brokers would be faced with enrolling upwards of 170 million Americans individually into plans. The ACA has demonstrated the challenges of enrolling as few as 13 million consumers onto the federal and state marketplaces. Increasing this number by more than ten-fold would not be any less chaotic.

The bottom line is that the employer-based system has proven highly efficient at providing Americans with affordable coverage options for decades. Eliminating the tax exclusion would likely result in the demise of the employer-based system, a significant tax increase on middle-class families, significantly increased costs for coverage, and more restrictive plan offerings. Healthcare reform has proven its challenges; however it is important that any policy proposals not make difficult situations worse and eliminating or even capping the exclusion would be far worse for all Americans.

Repealing Obamacare (Part 1 of 2) – Individual Tax Credits

Republicans hope to repeal Obamacare. One plan getting attention is creating a health insurance federal income tax deduction of $7,500 per individual and $20,500 for family. Everyone will be free to use their tax credit to buy the health insurance of their choice, not just the plan their employer provides.

A derivative plan recommends a refundable health insurance tax credit that is based on age, rather than income since 40% of people don’t pay any federal income tax. Money left could be put into a health savings account. HSA eligibility would be extended beyond age 65 (an idea Employee Benefit Advisors really likes).

Policy proposals would eliminate or cap the employer tax exclusion for health insurance. This would decimate the employer-based system, where a majority of Americans, roughly 169 million, receive their insurance coverage.

The employer exclusion allows an employer’s contributions to an employee’s health insurance to be excluded from that employee’s compensation for income and payroll tax purposes. The result has been a highly efficient means of providing affordable coverage through group purchasing and its economies of scale by spreading risk and avoiding adverse selection.

Proponents contend that eliminating the exclusion would result in Americans having more control over their coverage, reduce job-lock, and result in greater transparency and reduced costs.

Everything You Need to Know About COBRA in Under 5 Minutes

Have your employees ever asked you for information about COBRA? Have you ever had to spend time trying to explain how it works? Wouldn’t it be nice to have a simple reference you could point them to?

Diversified Administration came up with this 5 minute video “Everything You Need to Know about COBRA in Under 5 Minutes”. This video answers some of the most frequently asked questions, such as:

  • What is COBRA?
  • Can I change plans with COBRA?
  • How long can my COBRA last?
  • How long does it take for my benefits to be reinstated?
  • Can I pick the date my COBRA starts?
  • When are my COBRA premiums due?
  • How long does my employer have to send out my COBRA Election Notice?

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

When does the affordable part of the affordable care act start?

Insurers Plan to Significantly Raise Premiums – Citing huge losses on ACA plans.

Continued Disapproval Of ACA – A new survey released by the Pew Research Center found that 54 percent of consumers still disapprove of it. Data show 31 percent of respondents believe the ACA “has had a mostly negative effect on them and their families.”

An End To Protections For People With Serious Illnesses, Pre-Existing Conditions. – The ACA’s protections for people with pre-existing conditions are raising costs and limiting options for everyone. Under the ACA, insurers cannot charge higher premiums for people with serious illnesses, or deny coverage because of pre-existing conditions. Suggestions are to end these protections, and create risk pools by states so that these consumers “can get affordable coverage. … You dramatically lower the price for everybody else. You make health insurance so much more affordable, so much more competitive and open up competition.”

Medicare Physician Reimbursement Proposal Could Reduce Number Of Practices. – A new proposal “designed to change how Medicare pays clinicians represent[s] the most sweeping overhaul the CMS has made in a long time to the business of running a physician practice.” The objective is to have most Medicare reimbursements “flow through payment models that reward doctors for the quality of care they deliver, not just how many patients they see.” These changes could “upend the way medicine is practiced today, accelerating the move toward hospital employment and making the small group practice a thing of the past.”

Audit Finds IRS Overpaid Some ACA Plan Enrollees By $8 Million. – An audit conducted by the Treasury Inspector General for Tax Administration found the “IRS mistakenly overpaid more than $8 million to customers and Obamacare users in California, and cheated tens of thousands of others out of nearly $2 million in 2015 because the government relied on incorrect information to figure their taxes.” Data show some “70,850 filers received $8.3 million in federal subsidies that they didn’t deserve, while roughly 69,400 taxpayers missed out on $1.9 million they should have got.” The article says the issue resulted “from erroneous forms the government sent to about 800,000 customers, which used the wrong benchmark to measure what their Obamacare payments should have been.”

More Employers Hiring Freelancers Due To Costs Associated With ACA. – Employers are getting rid of health benefits by shrinking their full-time workforce and hiring freelancers due to the increase in costs caused by the Affordable Care Act. Data show about “one-third of companies intend to work towards ‘eliminating’ healthcare benefits because of the ACA…and 60 percent of companies intend to hire more freelance employees than full-time employees.”


2017 ACA Required Contribution Percentages

The required contribution percentages for 2017 used to determine whether individuals are eligible for a premium tax credit and whether individuals are eligible for an affordability exemption from the individual mandate have increased.

Premium Tax Credit Eligibility will increase to 9.69% – Percentage is used to determine if an individual is eligible for a premium tax credit to purchase health coverage through the Health Insurance Marketplace (Exchange) if not able to get affordable coverage through an eligible employer plan.

Individual Mandate Affordability Exemption will increase to 8.16% – Exemption applies when the individual cannot afford coverage because the minimum amount they must pay for the premiums is more than 8.16% of the individual’s household income.

Pay or Play Affordability Safe Harbors – The employer shared responsibility (“pay or play”) regulations are expected to mirror the percentage in the affordability safe harbors.


Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Wellness: Prevention Pays

The Public Health Institute claims for every $1 spent on workplace wellness programs can save up to $6. Programs can reduce sick leave, medical costs and workers’ comp claims by 25%. A 1% reduction in health risks could save $83 – $103 annually in medical costs per person.

Even if the claims are exaggerated threefold a worksite wellness program is worth investigating. Small investments in health and wellness can generate big returns.


Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Obamacare, Obamaco$t – What you’re not hearing

Here are some headlines you’re nor hearing unless you’re paying really close attention to the ACA (Affordable Care Act), aka Obamacare.

12 failed co-ops which were created under the Affordable Care Act could cost taxpayers $1.2 billion – Four of the remaining co-ops created under the Affordable Care Act are experiencing weak enrollment, which is another indication that the startups remain on shaky ground. Data show these four co-ops have not yet signed up a minimum of 25,000 members, a crucial threshold which allows them to cover costs.

UnitedHealthcare to Drop Obamacare Exchanges in most states by 2017 – UHC expects to loose $650mm this year.

Despite ACA, Patients Still Subject To Surprise Medical Bills – Surprise medical bills happen most often in an ER visit when a hospital contracts with medical providers – including doctors, surgeons, anesthesiologists, lab technicians – that do not accept the same insurance plans the hospital does.

The maximum out-of-pocket costs will rise – Consumers can expect to pay more for healthcare costs. OOP expenses will rise to $7,150 for an individual / $14,300 for a family. Placing a significant financial burden on middle-income Americans who need a substantial amount of care.

State Medicaid Agencies Want Congress to Repeal ACA Insurance Tax – Medicaid agencies want lawmakers to permanently repeal the tax on health insurers. The article says “most private health insurance plans have had to pay the tax themselves,” but “states that contract with Medicaid managed-care plans have had to cover the premium tax to ensure that the health plans receive actuarially sound rates.” Some 38 states and Washington, DC contract with Medicaid managed-care plans. Continues To Be Vulnerable To Hackers – The GAO reports that security flaws ‘will likely continue to jeopardize the confidentiality, integrity and availability of

It’s been six years since the ACA was signed into law. How’s it going?


Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Up Up and Away – 2017 ACA Cost-Sharing Limits Released

HHS updated the annual limits based on the premium adjustment percentage for 2017. As a result, annual out-of-pocket expenses may not exceed $7,150 for self-only coverage or $14,300 for family coverage in 2017. – Why? It is an attempt to keep the premiums down. – I can hear the moans and groans of open enrollment already!


Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

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