The Affordable Care Act’s (ACA’s) Employer Shared Responsibility Provisions (ESRP)

Summary

The employer shared responsibility provisions (ESRP), which often are referred to as the employer mandate, generally incentivize large employers to offer adequate and affordable health insurance coverage to their full-time employees and full-time employees’ dependents. If an applicable large employer fails to offer health insurance or offers substandard coverage to its employees, the employer may be subject to a penalty (i.e., assessment payment).

All common-law employers, including government entities (such as federal, state, local, or Indian tribal government entities), are responsible for annually determining whether they are considered an applicable large employer (ALE), which is generally an employer that has at least 50 full-time employees (including full-time equivalent employees, which are a representation of non-full-time employees as full-time employees).

If an employer qualifies as an ALE in a given year, then it will be subject to the ESRP in the subsequent year, meaning it will have to offer adequate, affordable health insurance coverage to generally all of its full-time employees (and their dependents) or it will risk being subject to one of two penalties. Regardless of penalty type, a penalty will be triggered only if at least one full-time employee receives financial assistance through an exchange. These types of financial assistance generally are not available to employees who were offered affordable and adequate coverage by their employer. If an employer does not qualify as an ALE, then it will not be subject to the ESRP and will not face a penalty for failing to offer health insurance coverage to its full-time employees.

Which potential ESRP penalty an ALE may be subject to is contingent upon whether an ALE offered appropriate health insurance to enough of its full-time employees (and their dependents). If an ALE offered appropriate health insurance to 95% or more of its full-time employees (and their dependents) and at least one employee received a premium tax credit or cost-sharing subsidy through a health insurance exchange, then the employer may be subject a penalty that is the lesser of (1) an amount based on the number of people who received financial assistance through an exchange or (2) an amount based on the number of the firm’s full-time employees. If an ALE did not offer appropriate health insurance coverage to its full-time employees (or offered appropriate coverage to less than 95% of its full-time employees and their dependents) and at least one employee received a premium tax credit or cost-sharing subsidy through a health insurance exchange, then the employer may be subject to a penalty based on the number of the firm’s full-time employees.