published Thursday, January 23rd, 2014

No Medicaid expansion means millions more in taxes for Tennessee businesses

Local and national coverage

Extra employer taxes

Employers will pay "premium tax credits" for low-income employees who purchase insurance on the federal exchange. The shared responsibility rule is projected to cost employers more in states that rejected the Medicaid expansion and whose employees are more apt to sign up for subsidized care otherwise covered by Medicaid.

• Georgia employers are projected to have to pay $70 million to $106 million more a year

• Tennessee employers are estimated to have to pay $48 million to $72 million more a year

• Alabama employers are projected to pay an extra $31 million to $46 million more a year

Source: Jackson-Hewitt Tax Service

Employers in Tennessee, Georgia and Alabama will likely pay more than $150 million in new taxes annually because the states are not expanding their Medicaid program, according to a new study.

The new study released Wednesday by Jackson Hewitt estimates that not expanding Medicaid under the Affordable Care Act could cost employers nearly $1.5 billion each year in the 25 states that have not yet expanded Medicaid for adults.

The tax penalty is somewhat hidden in the language of the Affordable Care Act, said the study's lead author Brian Haile, Jackson Hewitt's senior vice president of health policy.

The Affordable Care Act was written under the assumption that all states would expand Medicaid, meaning that the state-backed health care program could cover people who earn up to 138 percent of the federal poverty level, instead of topping out at 100 percent of the federal poverty level. The federal poverty level is $11,490 per year for an individual.

With Medicaid expansion in mind, the law includes a "shared responsibility" tax which penalizes employers if one of their employees qualifies for a subsidy, called a Premium Tax Credit, to purchase insurance on the federal exchange.

The shared responsibility rule was written, in part, to prevent employers from abruptly dropping health care coverage for low-income employees. Employers will not be penalized if employees sign up for Medicaid.

But in 2012, the Supreme Court ruled that states did not have to expand Medicaid. In states that didn't expand Medicaid, employees earning between 100 percent and 138 percent of the federal poverty level will not qualify for Medicaid, but some will qualify for tax credits on the exchange. Employers will be fined between $2,000 and $3,000 per qualified person who signs up for insurance on the exchange.

The Jackson Hewitt study estimates, 35,000 workers in Georgia, 24,000 employees in Tennessee, and 15,000 workers in Alabama will qualify for premium tax credits. The actual amount that employers will be penalized will depend on the number of people that ultimately decide to take advantage of that option.

"Just because there has not been strong enrollment interest thus far doesn't mean squat," said Haile, adding that low-income consumers tend to buy insurance when they get their tax refund. "There's going to be solid enrollment," Haile said, but adds that there might not be accurate enrollment data until May or June.

"Jackson Hewitt has no position as to whether it's a good idea or a bad idea to expand Medicaid," Haile said, "I'm just pointing out that there will be a tax consequence to this decision."

The Jackson Hewitt report says, "Any projections of the 'net' costs of Medicaid expansions should also reflect the very real costs of the shared responsibility tax penalties to employers in states that do not expand Medicaid."

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