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Employers in Tennessee will have to pay tens of millions in new taxes annually because the state is not expanding its Medicaid program, according to a new study.

The new study released Wednesday by Jackson Hewitt estimates that Tennessee's failure to expand Medicaid could cost employers in the state between $48 million and $72 million in 2015.

The tax penalty is somewhat hidden in the language of the Affordable Care Act, said the study's lead author Brian Haile, Jackson Hewitt's senior vice president of health policy.

The Affordable Care Act was written under the assumption that all states would expand Medicaid, meaning that the state-backed health care program could cover people who earn up to 138 percent of the federal poverty level, instead of topping out at 100 percent of the federal poverty level. The federal poverty level is $11,490 per year for an individual.

With Medicaid expansion in mind, the law includes a "shared responsibility" tax which penalizes employers if one of their employees qualifies for a subsidy, called a Premium Tax Credit, to purchase insurance on the federal exchange.

The shared responsibility rule was written, in part, to prevent employers from abruptly dropping health care coverage for low-income employees. Employers will not be penalized if employees sign up for Medicaid.

But in 2012, the Supreme Court ruled that states did not have to expand Medicaid. In states that didn't, such as Tennessee, employees earning between 100 percent and 138 percent of the federal poverty level will not qualify for Medicaid, but some will qualify for tax credits on the exchange. Employers will be fined between $2,000 and $3,000 per qualified person who signs up for insurance on the exchange.

In Tennessee, the Jackson Hewitt study estimates, 24,000 people will qualify for premium tax credits. The actual amount that employers will be penalized will depend on the number of people that ultimately decide to take advantage of that option.

"Just because there has not been strong enrollment interest thus far doesn't mean squat," said Haile, adding that low-income consumers tend to buy insurance when they get their tax refund. "There's going to be solid enrollment," Haile said, but adds that there might not be accurate enrollment data until May or June.

"Jackson Hewitt has no position as to whether it's a good idea or a bad idea to expand Medicaid," Haile said, "I'm just pointing out that there will be a tax consequence to this decision."

The Jackson Hewitt report says, "Any projections of the 'net' costs of Medicaid expansions should also reflect the very real costs of the shared responsibility tax penalties to employers in states that do not expand Medicaid."

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