Where Are We with the Affordable Care Act?

The Affordable Care Act (ACA) continues to be something U.S. employers have to contend with. Even with the elimination of the individual mandate beginning with the 2019 tax year, employers are still required by law to offer their workers a qualifying health insurance plan. Those workers can refuse said plan, but any such refusals do not mitigate the employer's responsibility to offer qualifying health insurance.

Employer mandates are familiar to most employers by now. But what is the state of the ACA above and beyond that? Where are we now, and what does the future hold for former President Barack Obama's signature legislative initiative?


Steady Enrollment since 2017

The first thing to talk about is health insurance enrollment under the ACA. As reported by U.S. News & World Report, numbers from the CDC show that enrollment has held steady since 2017. Just over 9% of the U.S. population was not covered by insurance in 2018, amounting to just under 30 million people. The numbers are unchanged from 2017.

CDC data also reveals that 69% of adults up to age 64 were covered by private health insurance in 2018. Some 20% were covered by government-backed insurance plans while 13% were uninsured.


The Cost of Health Insurance

One of the key concerns of the ACA before its implementation was potential premium hikes. We have seen significant price increases over the last couple of years; the trend doesn't look to subside anytime soon. A Congressional Budget Office report from 2018 estimated that insurance premiums would continue to rise into the next decade.

Furthermore, the report suggested that price increases could have a negative effect on employer-sponsored plans. Premiums could climb high enough to either depress wages or force employers to turn their workers over to publicly funded plans.


Quality of Coverage

In terms of policy quality, it would appear as though more workers are being transitioned to plans offering less coverage. U.S. News & World Report sites Commonwealth Fund data that shows some 87 million people underinsured in 2018. Being underinsured is defined as having health insurance inadequate to meet one's needs, forcing a person to either struggle to pay out-of-pocket expenses or forgo medical insurance altogether.


Help with Compliance and Premiums

The current state of the ACA is best described by saying it is intact but not necessarily providing the kind of coverage it was originally intended to provide. From our perspective though, it's all about helping our clients maintain ACA compliance throughout the year. We know the ACA inside and out. We have to. It's part of our responsibility to those companies that elect to use us as their payroll and benefits administration provider.

Our ACA compliance services include timely and accurate reporting, tracking, data management, and decision support. We consider ourselves a partner rather than just a service provider. In that regard, we partner with our clients to ensure compliance every step of the way.

Above and beyond compliance issues are additional issues related to health insurance premiums. There's nothing we can do to expand Medicaid coverage or get more people enrolled. But we do work with a group of trusted advisors who help us create custom solutions for employers of all sizes.

There is no guarantee that we can bring down the cost of health insurance premiums for your business. But there's no way to know until we look at your needs and then turn to our advisors for assistance. If we can make the ACA more palatable through more cost-effective solutions, we are happy to do so.



  1. U.S. News & World Report – https://www.usnews.com/news/health-news/articles/2019-02-27/cdc-insuranc...
  2. CBO – https://www.cbo.gov/system/files?file=2018-06/53826-healthinsurancecover...
  3. U.S. News & World Report – https://www.usnews.com/news/healthiest-communities/articles/2019-02-07/l...