The responsibilities for implementing the Affordable Care Act are spread across several federal departments and the offices within them. This is the latest in a series of briefs developed by HealthReformGPS describing the implementing agencies and their roles.

Background

The U.S. Department of Labor (DOL) has played an important role in regulating the health insurance system since passage of the Employee Retirement Income Security Act of 1974 (ERISA). That law created the office initially known as the Pension and Welfare Benefits Administration, whose name was changed in 2003 to the Employee Benefits Security Administration (EBSA) when it was upgraded to a subcabinet position headed by an Assistant Secretary. EBSA has responsibility for regulating employer-sponsored insurance plans, both for companies that are self-insured (meaning that a company assumes the risk for its employees’ health and pays insurance claims out of the company treasury) and those that are fully insured (in which an employer purchases an insurance policy on the open market on behalf of its employees, thus shifting the risk to the insurer). The plans EBSA regulates currently provide insurance to 49 percent of all Americans.

Though the Affordable Care Act (ACA) left the basic framework of ERISA unchanged, it introduced many new requirements on employer-sponsored insurance (ESI) to strengthen the rights of beneficiaries. DOL is the lead agency responsible for implementing these new requirements.

DOL’s Role in Immediate Reforms

EBSA has been a partner with the Department of Health and Human Services and the Internal Revenue Service in issuing many of the regulations that will give consumers additional insurance protections before the law is fully implemented in 2014. These include:

• allowing parents to keep dependent children on their health insurance policies through age 26;
• prohibiting pre-existing condition exclusions for children, lifetime and annual limits, and rescissions;
• requiring coverage of preventive services without cost sharing; and
• establishing minimum standards for internal appeals of benefit determinations and external review of denied claims.

DOL is also one of the agencies responsible for developing rules determining which health insurance plans qualify for “grandfathered” status, which would exempt them from certain provisions of the ACA.

DOL’s Role in the New Insurance Marketplace

EBSA will also have major responsibilities for implementing the changes to employer-sponsored insurance that will take effect beginning in 2014. As described in the Implementation Brief titled “Health Reform and ERISA,” the ACA does not require employers to offer insurance. However, after the new state insurance exchanges come online in 2014, the law does impose requirements on employers who choose not to offer insurance, while providing other ways for uninsured workers to obtain coverage. Employers with 50 or more employees that do not offer coverage will be required to pay an assessment for each full-time employee that is indexed to inflation. Large employers are also not required to contribute to the cost of employee health plans, but they will pay an assessment if their employees enroll in a subsidized policy through the exchange. Employers subject to assessments must also meet new reporting requirements about details of their health insurance arrangements. Employers with at least 200 full-time employees that do offer coverage will be required to automatically enroll new full-time employees.

The changes DOL will have to implement concerning self-insured plans include new reporting requirements and many of the same patient protections applied to fully insured plans.

Studies and Workforce Development

In addition to its role in regulating employer-sponsored insurance, DOL has responsibilities for other facets of health reform. The legislation instructs the agency to conduct multiple studies in conjunction with the Department of Health and Human Services, including one on the large group market, another on plan offerings, and one on employee wellness.

Additionally, DOL is partly responsible for implementing sections of the law devoted to development of the health care workforce. It is represented on the National Health Care Workforce Commission, which is tasked with coordinating the workforce efforts throughout the federal government, and has already begun disbursing some health care career grants created by the ACA