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. Author manuscript; available in PMC: 2014 Jul 31.
Published in final edited form as: Health Aff (Millwood). 2013 Sep;32(9):1522–1530. doi: 10.1377/hlthaff.2013.0526

Exhibit 3.

Major Affordable Care Act Provisions Affecting Employer Health Insurance Offering

Provisions affecting employers directly: Impact on offering:
Employer penalties: Employers with 50 or more full-time workers face a penalty if any of their full-time workers qualifies for a premium tax credit. If the firm does not offer coverage at all the penalty is $2,000 for each full-time worker beyond the first 30. If the firm offers coverage that is not affordable, the penalty is the lesser of (1) $3,000 for each full-time worker who receives a credit or (2) $2,000 for each full-time worker in the firm beyond the first 30. Originally scheduled to take effect in 2014, HHS recently announced that this penalty will not be implemented until 2015. Increase offering for large firms
Small business exchanges: Establishes the Small Business Health Options Program (“SHOP exchange”) on which small employers, defined as those with fewer than 50 full-time workers, can get coverage. Between 2014 and 2016, states may choose to allow employers with 50 to 100 workers in the SHOP exchange; in 2017 and later, they may choose to allow employers of any size to offer coverage from the SHOP exchange. As of 2014 in some states and 2015 in others, a small employer may designate a menu of insurance options for employees. Increase offering for small firms
Small business tax credits: Employers with fewer than 25 employees and average annual wages below $50,000 are eligible for premium tax credits to offset the cost of coverage for up to 2 years. The maximum credit is currently 35 percent, rising to 50 percent in 2014. In 2014 and later, coverage must be purchased through a SHOP exchange. Increase offering for small, low-wage firms
Provisions affecting worker demand for employer-sponsored insurance:
Health insurance exchanges with community rating and guaranteed issue: Exchanges should, in theory, provide a viable alternative to employer-sponsored insurance since they capture the “economies of scale” and “risk pooling” advantages that employers have. In practice this depends on what the exchange risk pool looks like. Reduce offering for firms with many low- income workers
Premium tax credits: Premium tax credits are available to workers without access to affordable employer-sponsored coverage, where “affordable” means that the worker’s share of the premium for single coverage does not exceed 9.5 of the worker’s income. Reduce offering for firms with many low- income workers
Medicaid expansion: In some states, all individuals with incomes below 138% of the Federal poverty threshold will become eligible for Medicaid. Reduce offering for firms with many low- income workers
Individual mandate: Individuals who lack coverage for more than 3 months in a year face a penalty that is phased in between 2014 and 2016. The penalty is the greater of $285/1% of family income in 2014, $975/2% of family income in 2015, and $2,085/2.5% of family income in 2016 and later. Exemptions apply in the case of hardship, families with incomes below the tax filing threshold, Indians, and certain religious groups. Increase offering