Health Reform Change May Have Slowed Down, but It Has Not Stopped

Health Reform Change May Have Slowed Down, but It Has Not Stopped

Last week, President Trump and the Republican-controlled Congress halted their immediate efforts to change the Affordable Care Act (ACA).  While we now know that sweeping health policy changes like the elimination of the employer mandate will not occur in the near future, we are hearing that other important health policy actions are still underway.  As legislative and regulatory changes evolve, Kistler Tiffany Benefits keep you informed about what may lie ahead for group health insurance plans and other employee benefit offerings.

Even though the political events of last week were dramatic, Congressional leaders and the Trump Administration have not actually abandoned health care reform.  Presently, Congress is considering several smaller bills that would impact employer health plans, including one addressing wellness program changes and another clarifying how stop-loss coverage for self-funded plans may be regulated.  These bills have bipartisan support and two of them–one that allows for small businesses to create association-based health plans and another intended to make it easier for health plans and doctors to negotiate prices–have already passed the House of Representatives with wide margins and are being considered in the Senate.

The Trump Administration and Congressional leaders have also signaled that their next big legislative priority could be comprehensive tax reform, and of course that process could create big changes for employers and group benefit plans.  On the plus side, many of the tax burdens created by the ACA could be repealed, like the national tax on all fully-insured health plan premiums and the looming excise tax on high cost health plans that will impact employer plans of all sizes.  Comprehensive tax reform, however, could revitalize the call to either eliminate or cap the income tax exclusion on employer-provided health benefits, including the payroll tax benefits of offering group coverage.  Kistler Tiffany Benefits is fully committed to protecting the tax-preferred status of employer-sponsored health insurance coverage, and we urge all of our clients to weigh in with your elected representatives on this issue.

While changing the ACA whole-scale is very controversial, there are many ideas to improve key provisions that both Republicans and Democrats agree on.  So in addition to action on tax reform, Kistler Tiffany Benefits expects to see even more bills introduced in the months ahead to change and/or repair some of the more troublesome parts of the ACA. Plus there is significant interest on both sides of the aisle to advance legislation to reduce the cost of medical care and prescription drugs, increase price transparency, and improve the value and quality of care. Addressing health reform change through smaller pieces of legislation may take longer, but this method may ultimately be more successful because different legislators can work together on improving the parts of health reform that are the most important to them and their constituents.

President Trump also has a great deal of administrative authority, and the executive order he signed on his first day in office that promised regulatory change and relief for both individuals and employers when it comes to the ACA is still a key part of his policy agenda.   This relief is likely to come through tweaks and clarifications to ACA implementation guidance, as well as changes to regulations, including possibly rescinding some existing requirements.  All of these changes could have major impacts on how employee benefit plans operate.  Some areas the Trump Administration is already working on administrative change include individual and small group health insurance market stabilization efforts and a review of the fiduciary rule, which as currently written could impact employer-based retirement options and health savings accounts.  More regulatory changes being pondered could address employer-sponsored wellness programs, essential health benefit and preventative care requirements, large employer health coverage information reporting, Form 5500 filing procedures, nondiscrimination rules, and more.

Finally, this is a great time for employers to identify what kind of health policy changes would work best for them and their employees.  As Congress and the Trump Administration regroup on health care, it will be important for everyone who works in the employee benefit space to communicate ideas about truly lowering costs and helping to reduce the administrative and tax burdens on group benefit plans, like the elimination of the looming Cadillac Tax.

Through our leadership roles in several professional associations, Kistler Tiffany Benefits will work in Washington, D.C. and the state capitols to make sure policymakers understand the realities people and companies face when it comes to their employee benefit choices.  We are optimistic that our advocacy efforts will result in positive change, but what we know for sure is that Kistler Tiffany Benefits will always be here to support our employer partners and we remain committed to providing you with exceptional service and information in the months ahead.

By Jessica Waltman, Special Contributor

Jessica Waltman is a health reform strategist, with more than 20 years of experience in health insurance markets and health policy. She is the former Senior Vice President, Government Affairs, for the National Association of Health Underwriters.