The enactment of the Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care and Education Reconciliation Act of 2010 (HCERA), collectively referred to as the Affordable Care Act (ACA), begins an extended period during which far-reaching changes to the American healthcare system will take effect. While these reforms leave much of the current employer-based system intact, the reforms will impact every employer in the country. While there is still no federal law that requires employers to provide employees with healthcare insurance, in 2014, employers with more than 50 employees that do not offer coverage will be subject to financial penalties. In addition, U.S. citizens and legal residents with few exceptions will be required to have qualifying health coverage beginning in 2014.

The drive to control the cost of health benefits continues to cause employers to implement a variety of cost-cutting and cost-shifting strategies ranging from self-insurance and managed care to defined-contribution, or consumer-directed, health plans.

For information on other requirements relating to healthcare benefits, Please see the national Health Care Insurance, national Health Information Privacy, national Health Insurance: Play or Pay?, and national Health Insurance Continuation/COBRA. sections.