NAHC Survey on ACA Employer Health Insurance Mandate

From Health Care Technology Report article

The National Association for Home Care & Hospice (NAHC) is urgently requesting input from every provider agency regarding the potential impact of the Patient Protection and Affordable Care Act (ACA) requirement that certain employers pay a penalty when they do not provide a qualified health plan to employees. 

The association has published a survey at and asked us to spread the word that widespread participation is essential in order to support efforts to bring our industry’s message to Congress in time for its Lame Duck session in December.

Quoting from an announcement by Bill Dombi, NAHC VP for Law

NAHC believes that many home care companies will be subject to penalties under the ACA as a result of not having a qualified health plan for their employees. The penalties will likely jeopardize the existence or financial stability of the companies and thereby create serious access to care problems.

At this point the level of impact is only speculative. The survey will help quantify the impact. It will also be used to support NAHC advocacy efforts that are designed to mitigate or eliminate the negative financial consequences of the employer mandate under the ACA. 

With the election now behind us, it is expected that Congress and the White House will recognize the need to “refine” the ACA to deal with its various unintended consequences. We see the loss of home care to our most vulnerable citizens as an unintended consequence.

Mr. Dombi concluded his message by requesting that all agency owners, administrators and management complete the survey as soon as possible. It will be kept open at through December 31, but information you provide early will be used during the lame-duck congressional session.

Summary of ACA Employer Mandate Standards
The ACA does not require employers to provide health insurance to employees and employers with fewer than 50 FTE employee equivalents from any ACA-related penalties. For those with 50 or more FTE employees, however, the rules are quite specific. These are the employers NAHC is anxious to hear from.

If such an employer does not provide insurance that meets the criteria of a qualified health plan health insurance and if just one of its employees qualifies for a subsidy for the purchase of non-group coverage offered through one of the new state or federal health insurance exchanges created by the ACA, that employer will be required to pay a penalty equivalent to $2000 per FTE (minus the first 30 workers).

Subsidies are available to individuals if their incomes fall between 138 and 400 percent of the Federal Poverty Level. In states that do not chose to implement a state health insurance exchange, individuals with incomes as low as 100 percent of the FPL will quality for subsidies. Dombi believes these income levels are likely to encompass most employees of home health providers.

An FTE is an individual who works 30 or more hours per week. Tax credits also may be available to certain employers of fewer than 25 FTEs (defined as number of total hours worked divided by 2080).

If the employer offers a qualified health plan to its employees, the employer will be penalized by the lesser of $3000 for each full-time employee that receives a subsidy or $2000 per full time employee that qualifies for a premium subsidy under the ACA (minus the first 30 workers).

Though an exact definition of a “qualified health plan” has not yet been settled, it is known that these plans will be required to offer coverage of ten categories of essential health benefits. However, indications are that a qualified health plan would be the equivalent to the average type of health insurance that is in place in each individual state’s small group plan or a plan offered to public employees.

Action Plan
NAHC intends to have congressional allies introduce legislation to address the employer mandate concerns of home care. The survey will help define the nature of the remedies that will be sought through legislative change. Any such changes will be difficult, but not impossible to achieve with the broad engagement of home care companies and other stakeholders in home care. Dombi said that NAHC considers this issue to be one of the highest priorities for the new Congress. 

HCTR will keep readers informed as NAHC’s efforts move forward through the upcoming Congressional session. Bill Dombi can be reached directly at