Health Reform Update: What Can We Expect Now?

Health Reform Update: What Can We Expect Now?

The latest Congressional efforts to repeal and replace parts of the Patient Protection and Affordable Care Act (ACA) failed again last week when the Senate voted 51-49 to reject a measure dubbed the “skinny repeal” bill.  The breakdown of the latest reform attempt not only shows the deep divide among our lawmakers, but it also leaves many Americans wondering what will happen next.

While President Trump and some other politicians are still encouraging the Senate to try again to pass a repeal bill quickly, in reality, for now, lawmakers may be out of time.  Congressional leaders advanced their repeal bill using budget reconciliation rules so that they would have the advantage of just needing a simple majority for approval in the Senate. But using budget rules for the bill also means that it expires at the close of the federal government’s fiscal year on September 30, 2017.  Given the upcoming August Congressional recess, as well as other priorities that must be completed by the end of September, like raising the debt ceiling, passing other federal spending measures and perhaps tax reform, it looks like the clock has run out on this particular effort to repeal and replace parts of the ACA.

So if Congress is not acting on health reform now, will anything ever change?  Consumers wondering what to expect next should keep these five points in mind:

  1. Current health insurance requirements and programs remain in place unchanged. These include the individual mandate to obtain minimum essential health insurance coverage, the obligation of large employers to offer such coverage or pay a fine, the related employer reporting and compliance requirements, the health insurance exchanges and individual market subsidies for eligible low-income people, and the federal Medicaid program. Businesses still need to follow all of the rules pertaining to offering coverage as before and their health plan options for the year ahead will likely stay on course.
  2. The Trump Administration can impact employer and individual health plans in some ways through regulatory changes. New regulatory guidance is coming this fall on mental health parity compliance. The documents for next year’s employer reporting process must also be released soon, including the forms and instructions for Forms 1094/1095 B and C.  Another area where the Trump Administration could act quickly would be to make modifications to essential health benefit and preventive care requirements and they have hinted they may make changes to individual mandate enforcement.
  3. Congress still has an immediate opportunity to address what many believe is the most pressing ACA problem—the lack of individual health insurance coverage options available through the health reform exchanges in many states. Spending for the federal Children’s Health Insurance Program (CHIP) needs to be reauthorized by September 30, and when Congress handles that, they are likely to include provisions to help the struggling individual insurance market.  It’s possible that they will include ACA repair provisions that would impact employer plans too.
  4. Congress and the Trump Administration could affect health plans and medical coverage costs if they address comprehensive tax reform next month. Some issues that could be on the table include the looming ACA “Cadillac tax” on high-cost plans, the medical device tax, the national health insurance premium tax on fully-insured group and individual health plans, and health savings account improvements.
  5. It’s still possible that Congress could work in a bipartisan manner to create longer-term health coverage improvements for consumers. While a comprehensive bipartisan effort to change the ACA is improbable, more targeted measures to make parts of the law easier on individuals and employers remain a possibility. A group of about 40 bipartisan lawmakers who call themselves the Problem Solvers Caucus have been meeting regularly to talk about ways to stabilize markets. Also, Congress might tackle issues that impact medical care costs, like prescription drug prices and medical liability reform.

Kistler Tiffany Benefits will continue to keep a close watch on any actions the Congress or the Trump Administration might take that would impact our clients’ health plans.  We will keep you informed about major developments as they occur.

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.