Two years after the U.S. enacted healthcare reform, thegovernment continues to issue new regulations piecemeal. Complyingwith the Patient Protection and Affordable Care Act has beenespecially arduous for self-insured companies that provide theirown coverage to employees rather than paying a premium to aninsurance provider.

Self-insured companies got more work last month when theDepartments of Health and Human Services, Labor and Treasury issueda final rule on summaries of benefits and coverage that allcompanies must provide to new enrollees and special enrollees onthe first day of the plan year beginning after Sept. 23.

The summaries were a hotly contested topic for self-insuredcompanies, which argued that the new write-ups would duplicateinformation they are already required to provide under ERISA andcould confuse employees. The government listened to such concerns,but rejected a proposal from business groups to exempt self-insuredcompanies from the requirement to provide such summaries.

Though self-insured companies will have to scramble in the nextsix months to get the forms ready, “generally, the final rule isdefinitely a big improvement over the proposed rule,” says DebbieHarrison, senior manager of public policy at the National BusinessGroup on Health.

Even after the final rule, companies continue to protest,claiming they don't have enough time to comply with the mandates,which stipulate a four-page format for each plan, along withcalculations of costs for complicated health conditions andprocedures, such as maternity and diabetes care.

This week, the American Benefits Council wrote a letter to thefederal departments requesting an additional year to comply andguidance ensuring that in the meantime, companies could provide thesummaries the way they were already doing it.

Summaries of benefits and coverage are not the only to-do itemskeeping companies busy. In January, the Internal Revenue Serviceprovided additional guidance on the new requirement that companiesreport the value of healthcare coverage on the W-2s issued toemployees, beginning in January 2013. The guidance clarified someconcerns about how to calculate the cost of healthcare forreporting purposes, and the IRS said it would continue to reviewcomments as it considers future guidance. Until then, companiesmust work with what they have to figure costs for the benefitsprovided this year for next January's W-2s.

Even as self-insured companies comply with the new regulations,they are looking ahead to the changes that will occur in 2014, whenthe state exchanges come online. At that point, depending onwhether they are in a high-wage or low-wage industries, companiescan begin to decide whether it's worth it to continue to providehealth coverage or better to let employees move to an exchange andpay the penalty of $2,000 per employee.

So far, 14 states and the District of Columbia have enacted astate insurance exchange by legislation or an executive order,while the rest are lagging behind to a greater or lesser degree,according to the Urban Institute, a nonpartisan economic and socialpolicy research concern.

Many states are waiting to see how the Supreme Court rules onthe individual mandate and how the 2012 election goes, eventhough states are supposed to show significant progress on theirexchanges by January 2013. “There's a certain amount ofdice-rolling on the part of the legislators,” says Lee Doble,managing director of employee benefits services at Frank Crystal& Co.

Jay Fahrer, director of government relations at theSelf-Insurance Institute of America, agrees. “Wait and see is theway to characterize healthcare reform right now,” he says. Asidefrom watching politics this year, “2014 is the year that everyoneis waiting for,” says Fahrer, pictured at right.

Paul Dennett, senior vice president of healthcare reform at theAmerican Benefits Council, says that the weightiest issues are tocome. “Employers will need to ask: Should they change their role asa plan sponsor, continue to provide health coverage, narrow it?”Dennett says. “There are a number of broader strategic questionsthat employers will face in the future, but that are not beforethem right now.”