With ongoing calls from the White House for Senate Republicans to renew their repeal and replace efforts, and with modest suggestions of a more bipartisan approach, Congress is likely to revisit changes to the Affordable Care Act in the fall. Since the July 28 defeat, other Republican Senators have begun working on new bills they hope to introduce when the Senate returns.
So what should advisers and employers be ready for?
For one, changes to health savings account requirements allowing funds to be used to pay health insurance premiums and establishing state block grants in lieu of funding to expand Medicaid eligibility are among the reforms that have more uniform support from Republican representatives.
If the subject of comprehensive tax reform moves ahead of healthcare on the Congressional docket, discussion of the elimination of ACA taxes — including the repeal or delay of the so-called "Cadillac tax" — may resurface.
Also, the spotlight may also start to shine on actions undertaken by the Trump administration. The Centers for Medicare and Medicaid Services has already advanced certain measures relating to the individual market. For example:
- Announcing a new program that will permit states to obtain waivers from certain ACA market-reform requirements in exchange for establishing high-risk reinsurance pools and other innovative programs addressing affordability of coverage; and
- Adopting a final rule that shortens the ACA exchange open-enrollment period to Nov. 1 through Dec. 15, 2017 — to more closely align it with Medicare — and takes other enrollment measures aimed to strengthen the individual health insurance market.
However, more pressing issues — such as the continued funding of cost-sharing reductions for low-income individuals — may signal the level of support that can be expected from the Trump administration toward maintaining key elements of the ACA.
To date, ACA rules on employers sponsoring group and individual healthcare coverage appear to have received little attention from regulators, and most of the requirements remain in place. The only exception is an interim final rule that was leaked in May addressing exemptions from the mandated contraceptive coverage under the ACA's preventive benefits provision.
This means, among other things, that the Summary of Benefits and Coverage Rule template, updated effective April 1, 2017, must be addressed by employer plans and, as of now, employer reporting obligations will continue in January 2018.
Under this administration, changes are imminent for the ACA and a range of other laws and regulations affecting healthcare and health benefits.
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