For many small businesses, it’s simply not economically or administratively feasible to offer group health insurance to employees, which can create a competitive disadvantage for business owners trying to attract top talent that needs health coverage. The good news of the launch of state health insurance exchanges under the Affordable Care Act was that, for the first time, individuals had guaranteed access to health insurance regardless of employment status, eliminating the need or requirement for employers to provide coverage. The bad news, however, was that to avoid disrupting the existing employer group health insurance marketplace, the Affordable Care Act imposed penalties on businesses if they tried to simply give employees tax-preferenced reimbursements to buy their own coverage on the exchanges.
However, the 21st Century Cures Act, signed by President Obama shortly before leaving office, created a new Qualified Small Employer Health Reimbursement Arrangement (QSEHRA), which allows small businesses with fewer than 50 full time equivalent employees to offer an HRA for employees to purchase their own health insurance on a tax-preferenced basis – tax-deductible to the employer and tax-free to the employee – without running afoul of the ACA coverage mandates. Although employees cannot “double dip” and obtain premium assistance tax credits and employer HRA dollars, it is now possible for employers to give a specified tax-preferenced dollar amount reimbursement to employees – up to $5,050 for individuals and $10,250 for couples and families in 2018 – for their medical expenses, including health insurance premiums for coverage purchase on an exchange.
The primary appeal of the QSEHRA for most small business owners is that it’s a way to provide employee “health benefits”, without taking on the full burden – and cost uncertainties – of offering group health insurance. Instead, employers can control their costs by explicitly setting a monthly dollar amount that becomes available to employees for reimbursement, avoiding payroll taxes on any dollars actually spent, and keeping any unused QSEHRA dollars that aren’t actually claimed by employees as a reimbursement (since technically an HRA is a health reimbursement arrangement, not an actual account).
Notably, the QSEHRA benefits are not available for most small business owners themselves, though with the above-the-line deduction for health insurance premiums for small business owners, the QSEHRA would often be a moot point anyway. Nonetheless, for small business owners looking to do “something” to support employee health benefits, and have better control over their business and costs than offering group health insurance directly (or joining a PEO), a QSEHRA may be a very appealing tax-preferenced alternative!