My recent visit to Capitol Hill was good… enlightening. There is always something powerful as I walk through the corridors of the Cannon House Office Building (built in 1908). The wide marble hallways, the rotunda and an American flag proudly stationed at the door to each Congressman’s office all a great reminder of the many men and women who have come before us to be a voice and make a difference for others.
This year is especially impactful for me. We have another year of significant change ahead and an opportunity to make a difference. As vice chair of the National Association of Health Underwriter’s (NAHU) Legislative Council, it is my year to be master of ceremonies and help plan the national fly-in bringing over 1,000 agents, brokers, benefits specialists and consultants to Washington DC.
This is our time to meet and educate ourselves and our lawmakers on the impact of the benefit laws, current and future, on our clients. It is a chance to bring real stories and knowledge to help shape the changing laws.
Health care reform and the Affordable Care Act (ACA) continue to be the “talk of the town.” Even outside the offices, walking through the tunnels connecting the three House buildings and wading through the sea of humanity in the Longworth House Building cafeteria, I overhear many conversations about the ACA. For, against, repeal, replace, modify, the words are a maze like the actual law itself.
In various sessions with our nation’s representatives passions are high. Many Republicans cautiously approach reform wanting to ensure that the new program is an improvement and that there is bipartisan support. Other Republicans are proponents of quick actions to alleviate the burden placed on individuals by the ACA. Democrats are working to preserve the ACA and its pieces that benefit the population most.
Although there are many viewpoints, there is one thing for certain, things are moving forward. In response to the agenda of the new Administration, both the House and Senate are pushing forward to create an alternative to the ACA. House leadership met with newly confirmed Health and Human Services (HHS) Secretary, Tom Price to begin laying out a solution. Although some groups of Republicans want the law repealed before they work on a replacement, the President, HHS Secretary and other Republicans want repeal and replace to be simultaneous.
The outline of health care policy resulting from the House/HHS meeting shows six key initiatives to their action:
- To move health care decisions to patients, families and physicians
- Provide coverage protections regardless of age, income, medical conditions, or circumstance
- Gives patients tools to make coverage affordable and portable
- Allows all individuals access to quality coverage
- Removes barriers that restrict choice
- Modernizes and strengthens Medicaid
Subsequent to the release of the House priorities, Republicans have been working on legislation to move things forward. On February 24, a “leak” of the discussion draft of the bill gave us some insight into what the new law will look like. It keeps certain provisions of the ACA— removes some— and modifies others. Additional changes were released last week and more changes were released earlier this week on Monday, March 6. No matter which version you look at there are some items that consistently appear. Most of the changes will likely take effect in 2018, 2019 and 2020. Here are some draft highlights of the potential changes and provisions:
- Removal of:
- Most of ACA’s taxes and penalties imposed on individuals and health plans. Individual’s tax penalties like the chronic care tax (tax threshold for deducting medical expenses) and the additional Medicare tax are to be removed. Likewise, these bills call for the removal of taxes on health care providers, such as the tax on medical device manufacturers, health plans, and pharmaceutical companies. These taxes have unfortunately be passed through to the consumer causing an increasing the prices for medical goods and services and, subsequently, health insurance
- The individual and employer mandates
- Premium tax subsidies - to be replaced by a refundable tax credit for each qualifying family member without access to employer-sponsored or other group health coverage
- Modifications to:
- Health savings accounts (HSAs) to remove limitations and make them more favorable to individuals
- Open enrollments and special enrollments adding verification requirements to ensure that only eligible individuals enroll in coverage
- Employer reporting leaving open a potential for shorter reporting, as the need may arise
- New provisions to:
- Provide incentives for people to keep continuous coverage thereby providing greater stability in the marketplace
- Return governance of health insurance plans, including the establishment of essential health benefits and rating rules, to the States
- Cap the employer exclusion (employee’s pre-tax benefit) at a percentage of the actuarial value of the plan. [This provision does not appear in the newest version but was in the prior two drafts.]
The final bill will come out soon and then go to Committees for mark-up. Additionally, the Congressional Budget Office will score the bill determining any additional cost by lost revenue or additional spending. Things are continuing to move forward.
The most important thing for employers and individuals to understand, and I heard it clearly during all my conversations on the Hill, is that no one wants to take away insurance coverage from individuals.
They want to create a stronger program that gives individuals access to quality care and coverage while helping to reduce the overall cost of health care. A tall order and a recipe that no one, to date, has ever gotten right.
One thing I know is that when all the sensational headlines fade, we’ll be here helping you to understand and apply the best solutions possible. We will continue to sift through the facts, make sense of all new developments, and ensure we have the inside track to better serve you. As all those who’ve come before us, we will continue to strive to make a difference by bringing your voices, concerns and best interests forward.