After more than 50 votes in Congress and two attempts before the U.S. Supreme Court to mothball the ACA and public exchange marketplace, some Republicans are now seeing the budget reconciliation process as yet another avenue for achieving this long-time goal. 

Other members of the GOP prefer to reserve this budget tactic for tax reform or other policy objective, according to a recent report by the National Law Review. The publication also suggested that Paul Ryan (R-WI), who chairs the House Committee on Ways and Means, plans to meet a budget resolution deadline of July 24 for committees with jurisdiction over health care issues to come up with a repeal plan.

Annette Guarisco Fildes, president and CEO of the ERISA Industry Committee, can understand why the ACA repeal movement continues to have fresh legs.

Also see: State-based marketplaces lag behind federal exchange

“Our large employer members are also very concerned about the law and the unreasonable burdens that it places on them, especially those that had already been providing valuable and generous health benefits to millions of workers and their families,” she says. “So, it’s understandable that there would be many attempts to repeal something that they find so offensive.”

Fildes believes there’s some flexibility to use budget reconciliation for ACA repeal, but defers to experts on Capitol Hill as to what can and cannot be done through this process. ERIC has been working closely with both Congress and the Obama administration to craft a more reasonable set of rules for employers with respect to reporting encourage, as well as a repeal of the 40% excise tax on so-called Cadillac-style plans, the employer mandate and overly burdensome reporting requirements.

“They add no value,” Fildes says. “Not one additional person gets better health care as a result of the administrative burdens that are imposed through the reporting requirements or the employer mandate.”

Now that the Supreme Court has approved federal subsidies for Healthcare.gov enrollees, her sense is that it helps “clear the decks for a more focused discussion about what’s wrong with the Affordable Care Act, and how it diverts important resources from providing actual health care to employees to unreasonable, unnecessary administrative burdens and compliance costs.”

Related concerns involve how the excise tax could treat health savings accounts and the medical inflation adjustment, as well as any negative impact on wellness programs or on-site clinics. “There needs to be fundamental changes to how the tax is calculated and the administrative cost to calculate that tax so that we can make sure that it really only gets at the excessively generous plans that were originally targeted by the legislation,” Fildes explains

 

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