Thursday, June 20, 2013

ERISA Sec 510 & PPACA's Whistleblower Provisions May Have Already Made It Illegal To Reduce An Employees Hours to Avoid Penalties in 2014

This a portion of a detailed and  well written article on a significant, unresolved legal issue in Reform.  In short, it may be illegal for an employer to reduce an employee's hours now in an effort to ensure they don't get benefits in 2014 under PPACA.   I've provided the link and most pertinent portions below. This will be scary for many businesses.  

The key will be to always make sure a business has a legitimate purpose, other than Reform, to reduce an employee's hours below 30.  

...ACA’s Whistleblower Provision.  ACA’s whistleblower provision states that no employer shall discharge or discriminate against “any employee with respect to his or her compensation, terms, conditions, or other privileges of employment” because, among other things, the employee “has received” a credit or subsidy provided by ACA.[5]  The U.S. Department of Labor recently issued regulations and guidance on the statute’s whisteblower provisions.  This guidance specifically states that an employee’s hours or pay may not be reduced for having received a subsidy to purchase insurance via a public health insurance exchange.[6]  The guidance leaves open whether courts will view ACA’s whistleblower provisions as applicable to the reduction of an employee’s hours so that the employee would not have coverage and also not be full-time.  In that case, the employee might go to a health insurance exchange to purchase coverage and obtain a premium subsidy.  As explained above, had the employee been full-time, the employee’s action might have resulted in a tax penalty to the employer.  The ACA whistleblower issue is whether this type of employer activity would be prohibited by being viewed as reducing hours of work in anticipation of the employee receiving a subsidy to purchase insurance via an exchange and in an effort to avoid a penalty with respect to the employee.  This open issue is at the heart of workforce realignment strategy. ... 
[C]omplainants must show only that a protected activity was a “contributing factor” leading to the adverse employment action.  Upon making this prima facie case, the burden shifts to the employer to demonstrate by clear and convincing evidence that the same employment action would have resulted absent the protected activity.  A “contributing factor” is “any factor which, alone or in connection with other factors, tends to affect in any way the outcome of the decision.”[10]  OSHA’s [the whistleblower enforcement agency] interim final rule notes the nature of the “contributing factor” test: 
In proving that protected activity was a contributing factor in the adverse action, a complainant need not necessarily prove that the respondent’s articulated reason was a pretext in order to prevail, because a complainant alternatively can prevail by showing that the respondent’s reason, while true, is only one of the reasons for its conduct, and that another reason was the complainant’s protected activity.[11] 
As for remedies, ACA authorizes “all relief necessary to make the employee whole, including injunctive and compensatory damages,” such as reinstatement, back pay with interest, and “special damages,” including but not limited to:  litigation costs, attorneys’ fees, and expert fees.[12] 
It remains unclear whether ACA’s whisteblower protections will apply to workforce realignment decisions.  As discussed above, ACA’s “pay or play” penalties are only assessed on the number of full time employees, thus realignments to reduce hours, especially for low wage workers eligible for subsidies and credits, could be viewed as unlawful interference with the terms of employment.  From the employees’ perspective, such workforce changes directly impact access to medical care for all similarly-situated individuals, and would stem solely from to an employer’s desire to avoid ACA’s penalties – penalties that are triggered when one or more full-time employees receive a subsidy through a public health insurance exchange.  From the employer’s perspective, realignment is a business decision to avoid taxes, and such changes could help workers qualify for subsidies and credits, thereby providing more affordable access to care.  Given the burden shifting approach for ACA’s whistleblower protections, and the enhanced remedies provided by ACA, including back pay with interest and special damages, plaintiffs may well pursue claims that workforce realignments interfere with protected rights to coverage.  Because ACA’s protections mirror Title VII, it is possible that courts will apply the forward-looking Title VII protections announced in Burlington N. & Santa Fe Ry. Co. v. White, 548 U.S.C. 53, 57 (2006), to expand ACA’s protections from tangible adverse employment actions to any action that “could well dissuade a reasonable worker” from obtaining coverage. 
ERISA Section 510.  Section 510 of ERISA makes it unlawful to interfere with employee benefits and protects the right to both present and future benefit entitlements.  First, the provision protects plan participants from adverse employment action, such as termination, discipline, or discrimination, for exercising the right to benefits available under the terms of the governing plan.  Second, employers may not use adverse employment action to interfere “with the attainment of any right to which such participant may become entitled under the plan.”[13]  Third, participants are protected from retaliation when they give information, have testified, or are about to testify “in any inquiry or proceeding relating to [ERISA].”[14]  Because any employment decision may impact the right to present or future benefits, courts require plaintiffs to show specific intent to interfere with benefits to prevail under Section 510.[15]  Plaintiffs enforce these anti-retaliation and anti-discrimination protections under ERISA’s remedial provisions, Section 502(a)(3).  Remedies are thus generally limited to “appropriate equitable relief,” which can include reinstatement, restitution, and back pay.[16]  There are substantial disputes, however, regarding the scope of any monetary remedies, including backpay, for Section 510 violations.[17]  Thus, plaintiffs may try to argue their claims also arise under ACA’s whistleblower protections to qualify for the enhanced remedies available to such claims. 
Because ERISA applies to health plans established or maintained by employers, the statute’s anti-discrimination and anti-retaliation provision may apply to workforce realignment decisions when such action interferes with employee access to employer-provided health coverage.  
Proskauer’s Perspective.  Employers seeking to avoid ACA’s coverage mandates by realigning their workforces may risk suit under the statute’s whistleblower protections and ERISA § 510.  Because such suits may straddle both ACA and ERISA, parts of these cases could proceed before a jury.  In the event that such cases arise, plaintiffs may try to first establish that the employer was acting with specific intent to avoid the newly codified health care coverage responsibilities.  If “specific intent” is demonstrated under ERISA § 510, then violation of the ACA’s “contributing factor” standard may be a foregone conclusion.  There are, however, substantial defenses against such claims, including that such changes are the natural result of legitimate business decisions and completely insulated from attack....