ACA Employer Mandate Survey Closed: Preliminary Results
December 4, 2014 10:01 AM
On January 1, 2015, many home care companies will face significant increased costs for employee health insurance or large financial penalties under the ACA employer mandate. That is the overall indication from responses to NAHC’s 2014 ACA Employer Mandate Impact Survey. “These results mirror the 2013 results, thereby indicating that home care companies have not found reasonable solutions to address the requirements of the ACA employer mandate,” stated Bill Dombi, NAHC’s VP for Law who managed the survey development.
A high priority policy issue for NAHC since the ACA was enacted in 2010, the organization has been to create solutions for home care companies relative to the employer mandate. NAHC has advocated for the elimination of the mandate, exceptions for home care and hospice companies, changes to the definition of “full-time” employee, delays in the effective date of the requirements, tax subsidies for private pay clients, increased Medicaid rates, and more in hopes of finding one or more solutions. NAHC President Val J. Halamandaris successfully took the message to the White House in 2012 and 2013, leading to delays in the application of the mandate. However, beginning January 1, 2015, any employer of 100 or more full-time equivalent (FTE) employees will find the mandate taking effect.
To solidify NAHC’s advocacy on the employer mandate, nationwide surveys were conducted in 2013 and 2014 to demonstrate the real-life impact of this requirement. NAHC is now processing the survey responses and preliminary indications are that a high number of home care companies are at risk.
These preliminary results include:
46.22% of home care companies of all types expect to be subject to a financial penalty as they do not provide a qualified health insurance to all their full-time (30 hours per week) employees
22.16% of the home care businesses are considering closing entirely due to these costs
73.3% of affected companies are considering a shift to a part-time workforce to avoid the impact of the mandate
83.3% of survey respondents believe that the mandate will cause a reduction in access to home care
88.46% of survey respondents believe that he mandate could significantly reduce access to care for Medicaid beneficiaries
The mandates hit two home care sectors particularly hard: private pay personal care services and Medicaid home care. For companies that predominately provide private pay services (41% or more of total company revenue), 92.59% do not provide health insurance to all of their workers. Of those companies, 51% expect a significant financial penalty with estimated penalties as high as $558,000 annually.
Medicaid-primary home care companies (41% or more Medicaid home care revenues) show similar risks. 85.42% of such survey respondents do not offer health insurance to all employees. Of those companies, 64.1% expect to face a steep financial penalty as high as $4.5 million annually. So far, no state Medicaid program has stepped up to provide home care employees with health insurance or improve payment rates to cover such cost. To date, the federal Center for Medicaid Services has been unwilling to consider the concerns of Medicaid stakeholders including those voiced by NAHC and advocates for persons with disabilities as part of an ACA Medicaid Coalition, instead merely indicating that CMS would pay the appropriate federal financial portion (FFP) of any state Medicaid costs that increase as a result of the employer mandate.
NAHC is developing a White Paper to fully display the survey results and provide a detailed impact analysis. When completed, the White Paper will be used in the national advocacy on this issue and made available to the press and public.
NAHC extends its thanks to all who took the time to respond to the survey. Information gained from such surveys is extremely valuable in advocacy efforts on behalf of home care and hospice. The ACA employer mandate survey is the only source of crucial information on the impact of the employer mandate on home care companies, employees, and care to patients and clients in home care.