Employer-Related Health Care Reforms

POSITION

The Home Care Association of America (HCAOA) believes the employer mandate of the Affordable Care Act (ACA) jeopardizes the ability of private-pay, non-medical home care providers to maintain and expand needed services to seniors and individuals with disabilities.

HCAOA urges Congress and the Administration to work with the home care community to ensure we can provide health insurance for our employees or identify affordable alternatives that will prevent the loss of jobs.

In-Home Personal Care Providers Urge Action on Reforms to the Affordable Care Act

POSITION

The Home Care Association of America (HCAOA) believes the employer mandate of the Affordable Care Act (ACA) jeopardizes the ability of private-pay, non-medical home care providers to maintain and expand needed services to seniors and individuals with disabilities.

HCAOA urges Congress and the Administration to work with the home care community to ensure we can provide health insurance for our employees or identify affordable alternatives that will prevent the loss of jobs. To this end the HCAOA supports the following bills in Congress to repeal or modify key aspects of the employer mandate:

  • The American Job Protection Act (S.399/H.R.903) introduced by Senator Orrin Hatch (R-UT) in the Senate and Rep. Charles Boustany (R-LA) in the House, which would repeal the employer mandate provision included in the ACA

  • The Save American Workers Act (H.R.2575) introduced by Rep. Todd Young (R-IN) in the House, which amends the Internal Revenue Code of 1986 to repeal the 30-hour threshold for classification as a full-time employee for purposes of the employer mandate in and replace it with 40-hours. H.R.2575 was passed in the House on April 3, 2014.

  • The Forty Hours is Full Time Act (S.1188) introduced by Senator Susan Collins (R-ME) in the Senate, which would amend the Internal Revenue Code of 1986 to modify the definition of full-time employee from the current 30-hour threshold in the ACA to 40-hours.

  • The Small Business Fairness in Obamacare Act (H.R.3419) introduced by Rep. Jack Kingston (R-GA) in the House, which amend the Internal Revenue Code of 1986 to exempt certain small businesses from the employer health insurance mandate according to the definition of small business within the Small Business Act, and modify the definition of full-time employee from the current 30- hour threshold in the ACA to 40-hours.

  • The Small Business Tax Credits Accessibility Act (S. 2069) introduced by Senator Mark Begich (D-AK), which would amend the Internal Revenue Code of 1986 to expand the credit for employee health insurance expenses of small employers from the current 25-employee threshold to those with fewer than 50- employees.

  • The Small Business Stability Act (S.2168) introduced by Senator Heidi Heitkamp (D-ND), which would expand the option for voluntary coverage to employers under the ACA from the current 50 full-time employees threshold to 100 full-time employees.

Background

For 2015 and after, employers employing at least a certain number of employees (generally 50 full-time employees or a combination of full-time and part-time employees that is equivalent to 50 full-time employees) will be subject to the employer mandate provisions under section 4980H of the Internal Revenue Code (added to the Code by the Affordable Care Act). As defined by the statute, a full-time employee is an individual employed on average at least 30 hours of service per week. An employer that meets the 50 full-time employee threshold is referred to as an applicable large employer.

Under the employer mandate provisions, if these employers do not offer affordable health coverage that provides a minimum level of coverage to their full-time employees (and their dependents), the employer may be subject to a fine if at least one of its fulltime employees receives a premium tax credit for purchasing individual coverage on one of the new Affordable Insurance Exchanges.

These requirements place a significant burden on in-home personal care providers who employ significant numbers of part-time workers and who otherwise would not be considered a large employer. Failure to repeal or reform the employer mandate will force many in-home personal care providers to reduce hours for their workforce or eliminate jobs entirely so as not to quality as a “large employer” under the ACA.

The employer mandate hits in-home personal care providers hard, particularly those caring for seniors and individuals with disabilities who are Medicaid beneficiaries. Medicaid’s rates for personal care services do not take into account these new significant health care costs. A 21-state sample of Medicaid personal care reimbursement rates showed an average hourly rate of $15.94 with a low rate of $10.04.

If you would like more information on this matter or have questions please contact Patrick Cooney at Patrick@federalgrp.com or by calling (202) 347-0034 x101.

The Home Care Association of America (HCAOA) is the nation's first association for providers of private-pay home care. HCAOA was founded on the principle that quality private duty home care has one model of care and that model is to employ, train, monitor and supervise caregivers, create a plan of care for the client and work toward a safe and secure environment for the person at home.