Whenever the final book on the Patient Protection and AffordableCare Act is written, the year 2016 may not garner the most lengthyof chapters in terms of implementation. Most of Obamacare's policyand rules changes have been enacted (or in some rare cases,tweaked.) Heck, it might not garner much more than a footnote. Butbenefits professionals across the nation know better—2016 is ashaping up to be a pivotal year in the PPACA story.

Start with the numbers. Now that the nation is a few years intoPPACA, there's no consensus on whether the law is making healthinsurance more affordable or insuring more people. Reports onhealth insurance rates have been widely reported, but those figuresare based on parts of the law that are already in effect andcarriers that have submitted rates to state insurance commissionersfor 2016.

In summary: Some premiums are up. Some are way up. Some aredown. And some are staying the same. Every so often, the Departmentof Health and Human Services announces another huge number ofpeople who've signed up for health insurance under Obamacare. Just as fast, opponentsbegin picking apart the statistic.

But while the numbers are all over the place, the law and thepolitics in 2016 are known quantities. A few small parts of the lawwill be implemented, barring delays, including the last phase ofthe employer mandate and an increase in the penalty for not signingup for coverage. While the reporting requirements will occupy lotsof time for brokers and agents, many are taking 2016 to talk toclients about parts of the law that are years down the road, mainlythe Cadillac tax. And as a backdrop, it's a presidential electionyear, which means candidates are either trashing or laudingPPACA—it depends on the crowd. And the poll numbers.

“We don't really sell health insurance anymore,” says DeniseVanPutten, an account executive at Lighthouse Group of GrandRapids, Michigan. “We're consultants, strategists andpartners.”

The politics

Ever since Obamacare's passage, Republicans in Congress havetaken every opportunity to try to replace or repeal the law.Recently departed House Speaker John Boehner announced the effortto repeal PPACA almost as soon as the ink from President Obama'spen dried after signing the bill into law. Since then, severalattempts at replacement were made, but they were fought off byPPACA's supporters.

While Obamacare faced scrutiny in 2012, the 2016 election cycleis a different political landscape. For starters, Obamacare faces astiff challenge from the right—and the left—on the campaign trail.With a herd of Republicans running for the party's nomination,PPACA has been dissected by everyone who's in the race. So far,though, only Jeb Bush has offered a credible plan to replaceObamacare. But as Tea Party, conservative and moderate contendersjockey for position in the Republican fold, more alternatives couldcome.

The controversial Cadillac tax is also under scrutiny on bothsides of the aisle, with Democratic presidential frontrunnersHillary Clinton and Bernie Sanders coming out against the PPACAprovision.

But, one of the most counter-intuitive political challenges toPPACA comes from the left, where Vermont Sen. Bernie Sanders saysObamacare doesn't go far enough. The insurgent candidate would liketo take health care reform several steps further and replace PPACAwith a nationwide single-payer system.

The rules

However, parts of PPACA aren't up for political discussion in2016. President Obama signed the PACE Act into law in earlyOctober, which effectively changes how PPACA defines a smallemployer. As PPACA was originally written, the definition of asmall employer would have expanded to employers with 100 employeesor fewer. The PACE Act keeps the definition at 50 or less. It wasone of the few times Obama has agreed to tweak his signaturedomestic policy.

“To have them added into the small group market was going tocause a big increase in premiums,” says Marcy Buckner, vicepresident of government relations for the National Association ofHealthcare Underwriters. “We were part of a coalition with groupslike ourselves and carriers. Oftentimes, the carriers and agentsaren't on the same page, but we worked well on this. It was a greatsuccess.”

Under the PACE Act, though, individual states are still able todetermine what constitutes a small- or large-group employer. Somestates, such as New York, are holding the line at 100 employees.Compounding the confusion over the the law's requirements is thefact that some employers have already shifted their offerings tocomply with PPACA's original language.

“I commend the government for passing the PACE Act—it really dideliminate a lot of issues the mid-market groups would have faced,”VanPutten says. “But some groups renewed early, so they would havecomplied with the law. And just recently, the insurance companiescreated all new systems, so some of the groups that renewed earlyare having to shuffle back and forth. It's a lot more work foremployers, the broker-agents and the carrier-partners.”

Also in 2016, the minimum penalty for not buying healthinsurance will increase to whichever is higher: $695 or 2.5 percentof an employee's income over $10,000.

Benefits professionals are also bracing for the onslaught ofcompliance regulations that will be required in 2016.

“I think very few employers understand what's coming by the endof February,” says David Contorno, owner of Lake Norman Benefits inMooresville, North Carolina. “It's going to hit employers' radar,and they're going to turn to their brokers and ask how to getprepared for this, and a lot of brokers are going to be unpreparedfor the conversation.”

A self-described technology geek, Contorno has been collectingall the data electronically for a few years now. But many benefitsprofessionals are going to be overwhelmed by the amount ofinformation the government is requiring through the IRS.

“I read something the other day on the IRS website about howlong they are estimating it would take an employer to file theforms and I laughed out loud,” Van Putten says. “If our groupschoose to go to an outside vendor, the cost for an 80 person groupcould be $6,000–8,000 to implement and administer the forms, not tomention the amount of additional work it takes the employers tofile the form.”

Another symptom of the reporting in 2016 is a phenomenon knownas the “family glitch.” Back when it became mandatory to buy healthinsurance, PPACA required husbands and wives whohad access to a plan that meets the minimum requirements and wasdeemed affordable to purchase the health insurance through thespouse.

Many people, however, purchased a plan through an exchange andtook a subsidy. In 2016, the nation could be seeing the firstpeople who will have to pay back the subsidy—whether it was aninadvertent or nefarious act on their part.

“The spouses of employees went to the exchanges and were able toget a subsidy because the government didn't have the information,”Contorno says. “Now, some people have been getting subsidies fortwo years, but the government is getting the information to be ableto say to the spouse, 'You were not supposed to be able to get asubsidy.'”

Looking ahead

Many brokers and agents are talking to their clients about theCadillac tax, which levies an annual 40 percent excise tax on planswith premiums of $10,200 or more for individuals or $27,500 forfamilies.

Included in the tabulation are any dollars contributed toflexible spending accounts, health reimbursement accounts andhealth savings accounts. (Dental, vision, accident, disability, orlong-term care insurance coverage won't count, though.)

So far, the tax has the power to affect employers that offermore robust health insurance options for their employees. Thatincludes unions who have bargained for better health plans.

“The latest numbers say it will impact 40 percent to 50 percentof the overall benefits plans out there—that's a big number,” saysDoug Field, CEO and founder of the Institute for Healthcare Consumerismin Alpharetta, Georgia.

The tax will start being collected in 2018, but Field and othersare lining up support to jettison the tax.

“Most of us in this business believe there's lots of bipartisansupport for the repeal of the Cadillac tax,” Field says. “But wealso think it's realistic that we may be able to get contributionsto HSAs removed from counting toward that tax threshold. If we dothat, the majority of companies will be OK. None of us in thebusiness like the Cadillac tax—the most successful HSAs are fueledby employers making contributions. If you remove that, you'retaking the air out of the tires.”

Field also pointed out that the Cadillac tax's threshold willonly adjust for inflation, so plans that come in under thethreshold may quickly surpass the threshold as costs grow fasterthan the inflation rate.

And as Field and other industry insiders point out, the tax willessentially be passed on to the consumer in the form of higherpremiums.

Also new in 2016, brokers and agents will be able to contact acall center staffed with individuals who can help sort throughspecific PPACA issues. Also, Buckner says, brokers and agents willbe able to participate in bi-weekly stakeholder calls that will runthroughout 2016. And, healthcare.gov has made it easier to findlocal brokers and agents who can help consumers with questions.

No one has a crystal ball, but industry veterans can see somelikely outcomes from 2016's Obamacare implementation—and the restof the law, too.

“I think we're going to see the continuation of a shift to moreand more groups that are moderately healthy go into a self-fundedscenario,” Contorno says. “And what I predict is going to happen in2016 is the fully insured pools with carriers are going to get lesshealthy as more healthy pools go to self-insured. I foresee upwardpressure on fully insured rates.”