The budget agreement that Congress passed late last year included a holiday gift for employers: a two-year delay in the effective date of the Affordable Care Act’s excise tax on high-value health benefits. The postponement, from 2018 to 2020, has increased expectations that the so-called Cadillac tax will eventually be repealed.
“The congressional activity provides significant momentum to our efforts to have the tax repealed,” said Annette Guarisco Fildes, president and CEO of the ERISA Industry Committee, which represents large companies on benefits and compensation issues. “In our view, it’s a recognition that the tax is ill-conceived.”
Since the Affordable Care Act became law in 2010, the prospect of a 40 percent excise tax on company-provided health plans whose value exceeds certain thresholds—set at $10,200 for individual plans and $27,500 for family plans for 2018—has encouraged many employers to make changes to their healthcare benefits to try to ensure they won’t exceed those thresholds.
Meanwhile, groups representing employers have been working to repeal the tax. Last year, four separate measures mandating a repeal were proposed in Congress, two in the House and two in the Senate. The move to eliminate the tax is backed by unions as well as employer groups. Brian Marcotte, president of the National Business Group on Health, which represents large companies on health policy issues, said the delay in the implementation of the Cadillac tax makes it more likely that it will be repealed. But given the Obama administration’s opposition to a repeal, he doesn’t expect to see anything this year.
“I don’t think it will happen in 2016,” said Marcotte, pictured at left. “I think we probably have to look to the 2017, 2018 window.”
In the meantime, he said, the postponement is likely to result in a pause in companies’ shift to offering high-deductible health plans as employees’ only option.
Over the past five years, more and more companies have been adopting high-deductible health plans, he said, with a big jump occurring from 2014 to 2015. That year also saw a 50 percent increase in the portion of big companies offering the high-deductible plan as the only option, a situation that is known as “full replacement.”
“Then we saw it level off for 2016,” Marcotte said. “But we saw in the survey results that 27 percent of companies said they were considering full replacement for 2017.
“The companies that are waiting to see what’s happening with excise tax put it on hold,” he said. But he predicted that if the excise tax were to take effect, “you would see another round of companies moving to full replacement.”
Two Reactions to the Affordable Care Act Excise Tax
“The biggest question is: Is it a two-year delay, or this is a process to full repeal?” said Joe Kra, a partner and actuary in the New York office of human resources consultancy Mercer who runs the local healthcare practice. “As I talk with my clients, there are many that have the reaction of, ‘We just had a two-year delay; I doubt we’re ever going to see this tax.’”
Kra said he has seen companies take two approaches to the Cadillac tax. Some decided to make changes to their healthcare benefits gradually so that when the tax was implemented in 2018, they wouldn’t have to pay it, he said. “Another school of thought is, ‘Let’s wait and see. If the tax goes into effect, I’ll rip the Band-Aid off and do what I have to do to avoid paying the penalty.’
“Since we’ve seen the delay, there are many more organizations that are reluctant to make changes that they wouldn’t otherwise make just in reaction to the tax,” Kra said.
Repealing the tax would eliminate the $80 billion of revenue the Congressional Budget Office (CBO) has estimated that the Cadillac tax will bring in over 10 years to offset some of the costs of healthcare reform. But proponents of a repeal argue that the revenue is highly unlikely to materialize.
For starters, companies uniformly say they’ll do whatever it takes to avoid paying the excise tax. The CBO’s estimate also anticipates that companies which make health coverage less attractive to employees will compensate by raising their wages, thus boosting the federal government’s revenue from income taxes. But again, proponents of a repeal say wage increases are unlikely.
“The thinking that if we could help companies lower their costs by not having such rich benefits, then they will shift that revenue to higher wages is flawed,” Marcotte said. “There’s not a one-for-one relationship between healthcare and wages, and unless you’re actually reducing your healthcare costs—not just reducing the rate of the upward trend—only then would it even be considered in the mix as to how it would affect wages.”
Meanwhile,one of companies’ criticisms of the Cadillac tax is that the thresholds don’t take into account the effects that geographic location and the age and gender of plan participants have on the cost of health insurance.
“The way it’s structured today, the thresholds are pretty arbitrary,” Marcotte said. “If I’m in the Northeast and I have an older population, even though I may have a moderate plan design, I may trigger the tax, versus a company with a younger population in the Southeast with a very rich benefit design may not trigger the tax.”
“The problem is that the tax is based upon factors that are really outside of an employer’s control, such as where an employee lives or their age or gender,” said the ERISA Industry Committee’s Guarisco Fildes, pictured at right.
She noted that in addition to postponing the tax’s implementation for two years, the budget bill directed the comptroller general to undertake a study and provide a report to Congress on “the suitability of the use of age and gender in calculating the tax.”
The budget measure also said companies’ Cadillac tax payments would be tax-deductible, in a change from the original healthcare reform legislation. Guarisco Fildes called that “an important recognition that the tax would be an additional cost of providing healthcare and would appropriately be tax-deductible rather than being treated as a penalty of some sort.
“But we think by and large employers will continue to look forward and make design changes to ensure they will not be subject to the tax,” she added.