Since the delay of the Affordable Care Act’s (ACA) “CadillacTax” provision, which was passed on December 18, 2015, some may bewondering how the ACA will be funded until 2020.I do not believe we have been given the answer.

The Cadillac Tax was to be imposed as a means of funding the ACAby penalizing employers for offering high-cost employer sponsoredhealth insurance plans to employees. One must take intoconsideration that with continued double-digit healthcare premiumincreases, the so-called “high cost” plans are not so far-fetchedfor many more employer sponsored plans in the future. TheCadillac tax was also to double as anincentive for plan sponsors to look at less expensive planalternatives by the time the tax would be imposed, which is now2020.

The tax, were it not delayed, would have assessed a penalty of40 percent for plans costing an employee more than $10,200annually, and family plans costing an employee $27,500 annually. Ihave little doubt that the craftsman of the ACA actuarially assumedthere would be more employers subject to penalties in future years,despite most efforts to curb premiums.

But because the tax has been delayed, questions about how theACA will be funded until 2020 have arisen. While still some plansponsors speculate about whether the ACA will ultimately berepealed, others are still preparing for 2020 by attempting toprovide affordable plan options for their employees. This is andwill become increasingly more difficult due to spiraling healthcare costs and corresponding premiums. I have heard it asked manytimes: “How much more can I impose on my employees?” Add to thatconcern the even greater Rx inflation due to new and very expensivedrugs coming to market for Hepatitis C, rheumatoid arthritis andcholesterol.

Though there have been no definitive plans announced tosupplement the funding that would have resulted from the CadillacTax, other taxes and fees have been responsible for the partialfunding of health care reform, some paid by individuals, otherspaid by employers, including numerous taxes on medical devicemanufacturers, indoor tanning services, charitable hospitals thatfail to comply with Obamacare requirements, brand name drugs andhealth insurers. Other fundraising for the ACA comes through theelimination of tax deductions for certain drug coverage and tax increases forthose with a certain income threshold.

Since the ACA’s emergence, we have read about failed stateexchanges, bankrupt cooperatives, and the significant losses themajor insurance carriers have incurred participating in the federalexchanges. We have also seen the failure of the government to paythe subsidies to insurance carriers in the timely fashion promisedand expected. With the various delays and elimination of ACAfunding clauses, we all must wonder where the money to pay for ACAwill ultimately come from. Does everyone have a mirror?

According to an article by Reuters with information from theCongressional Budget Office, U.S. taxpayers will ultimately beresponsible for $660 billion this year alone as a subsidy to thosereceiving health insurance under the age of 65. Those figures areexpected to rise to $1.1 trillion over the next decade.

The burden will not only fall on the backs of the consumer, buton employers that want to help lift the burden of the high cost ofhealth care. And, providing major medical insurance might not beenough in today’s environment. Ultimately, it will come down toemployers educating themselves on the most effective strategies andseeking the guidance from benefits brokers to come up withcreative, alternative solutions that will make it easier foremployees to live healthy lives.

As the lifespan of the ACA remains undetermined, employers needto educate and prepare as best as possible. Uncertainty, especiallywith the election around the corner, will be a key theme the restof this year, particularly in the health care realm.

So, the question remains: Will the ACA keep fighting the goodfight going forward, or will it crumble under pressure?