The Next (Big) Affordable Care Act Argument--and How it Impacts Employers and Employer-Sponsored Group Health Plans


[authors: Martha Zackin and Alden J. Bianchi]

In a July 7 article entitled Brawling Over HealthCare Moves to Rules on Exchanges, The New York Times reported on a brewing challenge to tax credit provisions of the Affordable Care Act that will affect both employers and individuals.  According to the Times,

“At issue is whether the subsidies will be available in exchanges set up and run by the federal government in states that fail or refuse to establish their own exchanges. ... The most likely challenger ... is an employer penalized because one or more of its employees receive subsidies through a federal exchange. Employers may be subject to financial penalties if they offer no coverage or inadequate coverage and at least one of their full-time employees receives subsidies.”

Section 1401 of the Affordable Care Act provides that eligible taxpayers may receive income tax credits for purchase of insurance “through an Exchange established by the State under [Act Section 1311]” (emphasis added). Section 1311 is the provision of the Act that enables the states to establish health insurance exchanges.  That provision does not refer to federally-facilitated exchanges.  Act section 1321 provides that if a state does not elect to create an exchange that meets federal requirements, the federal government will “establish and operate” an exchange.  This invites the question whether, in a state that fails to create an exchanges, there can be any tax credits for insurance bought on a federally run exchange?


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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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