The Affordable Care Act is messy legislation and because of the stalemate in Washington, much of the progress on the ACA has been made through IRS and HHS regulation. In a bit of a surprise, late in March, Congress passed the Protecting Access to Medicare Act of 2014, which the president signed into law April 1. It primarily addresses Medicare reimbursement policy but also amends the ACA to eliminate the health insurance deductible cap.

This law is important because insurers need deductibles higher than the $2,000 cap to meet the 60% or even 70% actuarial value requirement for the lower-level bronze and silver plans. Since the ACA’s passage, the only other notable changes to this poorly drafted law were the elimination of CLASS and the 1099 requirement, two technical corrections that were attached to equally important legislation. The passage of the Protecting Access to Medicare Act signals that both sides of the aisle are starting to inch together.

And a lot more is needed. The 30-hour work week requirement for full-time employment is too low. The House has passed a bill to amend this to 40 hours. However, this will not go through anytime soon; if it passes the Senate, there is a threatened presidential veto.

Once we get through the midterm election this year, look for important changes to start to move. One proposal that is beginning to gain ground is the elimination or curtailment of the employer deduction for health care. This was originally a Democratic proposal but is now being discussed by Republicans as an option. It makes much more sense to everyone than the Cadillac Tax, which would likely hit the core of Democratic constituencies.

It is also becoming clear that Republicans probably don’t want repeal of the ACA — because if they get it, they would also get responsibility for the alternative. But even as Washington shows signs of a budding accord, implementation of the ACA will certainly not be a sprint. It may be the longest marathon ever. Keep a lot of energy bars stored up … you will need them.

Hasday is chief operating officer of Frenkel Benefits, LLC, one of the largest privately held independent employee benefits brokers in the United States. Reach him at chasday@frenkel.com or (212) 488-0200, and read more from Hasday at frenkelyspeaking.com.  

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