Senate Republicans now plan to focus on repealing the ACA without a replacement plan, based on a budget reconciliation bill from 2015. This proposal would provide a two-year delay of the repeal to provide a stable transition period.
Health Reform Bulletin 128 | House Passes the American Health Care ActCBIZ, Inc.
On May 4, 2017, the House passed the American Health Care Act of 2017 (“AHCA”, H. R. 1628). Since the initial bill was officially introduced on March 20, 2017 (see The GOP Proposal to Repeal and Replace the Affordable Care Act, HRB 127, 3/10/17), there have been several amendments made to the law’s text. The bill will now progress to the Senate for consideration; its fate in the Senate is unclear at this point. Every indication is that the bill with undergo significant scrutiny and probably substantial change. Following is a brief overview of certain provisions of the bill passed by the House.
For attorneys who must litigate the Affordable Care Act, familiarization of its rules can be daunting and unforgiving. Personal instinct and legal experience in fields outside of health law can often be of little value, as contemporary health care law often appears to contradict business law. Drawing from a variety of legal concepts, this seminar will explain what happens when the worlds of health care and litigation collide. The lessons to be learned are to proceed with caution, and remember to honor and obey the newly laid hierarchy at the heart of this epic (and very long) reform law.
Health Reform Bulletin 128 | House Passes the American Health Care ActCBIZ, Inc.
On May 4, 2017, the House passed the American Health Care Act of 2017 (“AHCA”, H. R. 1628). Since the initial bill was officially introduced on March 20, 2017 (see The GOP Proposal to Repeal and Replace the Affordable Care Act, HRB 127, 3/10/17), there have been several amendments made to the law’s text. The bill will now progress to the Senate for consideration; its fate in the Senate is unclear at this point. Every indication is that the bill with undergo significant scrutiny and probably substantial change. Following is a brief overview of certain provisions of the bill passed by the House.
For attorneys who must litigate the Affordable Care Act, familiarization of its rules can be daunting and unforgiving. Personal instinct and legal experience in fields outside of health law can often be of little value, as contemporary health care law often appears to contradict business law. Drawing from a variety of legal concepts, this seminar will explain what happens when the worlds of health care and litigation collide. The lessons to be learned are to proceed with caution, and remember to honor and obey the newly laid hierarchy at the heart of this epic (and very long) reform law.
The Health Care and Education Affordability Reconciliation Act of 2010 was recently passed by the House and will be signed into law 03/30/2010. NAHU (National Association for Health Underwriters) published a comprehensive timeline of the changes coming over the next few years. Please contact me with any questions.
Health Reform Bulletin 122 | 2017 Inflationary Adjustments and moreCBIZ, Inc.
1) 2017 Inflationary Adjustments; 2) Final Rules: Excepted Benefits, Lifetime and Annual Limits, and Short-Term, Limited-Duration Insurance; and 3) Whistleblower and Retaliation Protections
Intertwined Guidelines: Untangling Your Enrollment Notice Requirementbenefitexpress
DOL, PPACA, ERISA, COBRA, and HIPAA all have guidelines for enrollment notices - learn best practices for including the notice in your benefits strategy.
Health Insurance in Fort Worth May Be Expendable As Senate Bill Fails to Passjthorn4
The report states total cost of these expansions is roughly $600 billion, which has prompted several who are against the bill to suggest pausing the legislation until possibly 2022. This would directly impact those with health insurance in Fort Worth.http://insurance4dallas.com/fort-worth-health-insurancehttp://insurance4dallas.com/health-insurance-fort-worthhttp://insurance4dallas.com/fort-worth-health-insurance-agenthttp://insurance4dallas.com/group-health-insurance-fort-worthhttps://insurance4dallas.com/affordable-health-insurance-fort-worth-tx/
ACA (mis)Management: What Everyone Has Learned & the Game Plan for 2017benefitexpress
After our first ACA reporting season, it’s time to regroup and review what we’ve learned for 2016. The IRS is eliminating extensions and good faith efforts, raising penalties, and strictly limiting transitional relief.
With higher stakes, ERISA attorney Larry Grudzien reviews the changes to ACA reporting for 2016 and common ACA management issues.
Constructing HRA: Blueprints for Solid Administrationbenefitexpress
Learn the ins and outs of offering a private benefits marketplace for your employees, HRA administration, and various agencies regulating what's included.
Helping Job Hunters Navigate Their Health Insurance Optionsdpomer99
These PowerPoint slides are from a workshop I conducted at The Career Place in Woburn, Massachusetts on October 13, 2009: www.careerplacejobs.com/aboutUs.htm
Enrolling homeless people in HUD programs and other public benefits is a major hurdle in ending homelessness – and even more so if those being enrolled are immigrants. This workshop will focus on the eligibility requirements and disqualifications for several federal programs. Speakers will also touch on the difference between federal and local limitations on access to public housing.
The latest HRB has been released and details various ACA reminders, PCORI Fees HHS Rules and much more. Check out the slideshare document and be sure to contact us at www.cbiz.com should you have any questions.
This update is part of a Brown & Brown series summarizing the guidance issued in connection with the Patient Protection and Affordable Care Act. For this edition, we examine the recent resurgence and passage of the American Health Care Act (AHCA).
Health Reform Bulletin 130 | Senate Releases Health Care Reform ProposalCBIZ, Inc.
he Senate has now made public its health care reform bill, named the “Better Care Reconciliation Act of 2017”. In many ways, it tracks the House bill passed on May 4, 2017 (see the CBIZ Health Reform Bulletin 128 – House Passes the American Health Care Act, 5/5/2017).
Health Reform Bulletin 133 | Executive Order Directing Modifications to the A...CBIZ, Inc.
An Executive Order, signed on October 12, 2017, promotes modifications of certain aspects of the Affordable Care Act (ACA) (also see press statement). In a nutshell, this Executive Order directs the ACA’s governing agencies (Health and Human Services/Labor/Treasury) to address three
elements: formation of association health plans, expansion of short-term, limited-duration insurance, and expanding the rules to allow individual premium to be reimbursed through health reimbursement arrangements (HRAs). Briefly, this Executive Order directs the governing agencies to
The Health Care and Education Affordability Reconciliation Act of 2010 was recently passed by the House and will be signed into law 03/30/2010. NAHU (National Association for Health Underwriters) published a comprehensive timeline of the changes coming over the next few years. Please contact me with any questions.
Health Reform Bulletin 122 | 2017 Inflationary Adjustments and moreCBIZ, Inc.
1) 2017 Inflationary Adjustments; 2) Final Rules: Excepted Benefits, Lifetime and Annual Limits, and Short-Term, Limited-Duration Insurance; and 3) Whistleblower and Retaliation Protections
Intertwined Guidelines: Untangling Your Enrollment Notice Requirementbenefitexpress
DOL, PPACA, ERISA, COBRA, and HIPAA all have guidelines for enrollment notices - learn best practices for including the notice in your benefits strategy.
Health Insurance in Fort Worth May Be Expendable As Senate Bill Fails to Passjthorn4
The report states total cost of these expansions is roughly $600 billion, which has prompted several who are against the bill to suggest pausing the legislation until possibly 2022. This would directly impact those with health insurance in Fort Worth.http://insurance4dallas.com/fort-worth-health-insurancehttp://insurance4dallas.com/health-insurance-fort-worthhttp://insurance4dallas.com/fort-worth-health-insurance-agenthttp://insurance4dallas.com/group-health-insurance-fort-worthhttps://insurance4dallas.com/affordable-health-insurance-fort-worth-tx/
ACA (mis)Management: What Everyone Has Learned & the Game Plan for 2017benefitexpress
After our first ACA reporting season, it’s time to regroup and review what we’ve learned for 2016. The IRS is eliminating extensions and good faith efforts, raising penalties, and strictly limiting transitional relief.
With higher stakes, ERISA attorney Larry Grudzien reviews the changes to ACA reporting for 2016 and common ACA management issues.
Constructing HRA: Blueprints for Solid Administrationbenefitexpress
Learn the ins and outs of offering a private benefits marketplace for your employees, HRA administration, and various agencies regulating what's included.
Helping Job Hunters Navigate Their Health Insurance Optionsdpomer99
These PowerPoint slides are from a workshop I conducted at The Career Place in Woburn, Massachusetts on October 13, 2009: www.careerplacejobs.com/aboutUs.htm
Enrolling homeless people in HUD programs and other public benefits is a major hurdle in ending homelessness – and even more so if those being enrolled are immigrants. This workshop will focus on the eligibility requirements and disqualifications for several federal programs. Speakers will also touch on the difference between federal and local limitations on access to public housing.
The latest HRB has been released and details various ACA reminders, PCORI Fees HHS Rules and much more. Check out the slideshare document and be sure to contact us at www.cbiz.com should you have any questions.
This update is part of a Brown & Brown series summarizing the guidance issued in connection with the Patient Protection and Affordable Care Act. For this edition, we examine the recent resurgence and passage of the American Health Care Act (AHCA).
Health Reform Bulletin 130 | Senate Releases Health Care Reform ProposalCBIZ, Inc.
he Senate has now made public its health care reform bill, named the “Better Care Reconciliation Act of 2017”. In many ways, it tracks the House bill passed on May 4, 2017 (see the CBIZ Health Reform Bulletin 128 – House Passes the American Health Care Act, 5/5/2017).
Health Reform Bulletin 133 | Executive Order Directing Modifications to the A...CBIZ, Inc.
An Executive Order, signed on October 12, 2017, promotes modifications of certain aspects of the Affordable Care Act (ACA) (also see press statement). In a nutshell, this Executive Order directs the ACA’s governing agencies (Health and Human Services/Labor/Treasury) to address three
elements: formation of association health plans, expansion of short-term, limited-duration insurance, and expanding the rules to allow individual premium to be reimbursed through health reimbursement arrangements (HRAs). Briefly, this Executive Order directs the governing agencies to
SUD and Health Care Reform: Key Changes Being Considered by Congress and the ...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Jackie Selby - Substance Use Disorders Crash Course Webinar Series - June 13, 2017.
Discussion Points:
* How would the American Health Care Act impact SUD services?
* What is the U.S. Department of Health and Human Services doing differently regarding SUD services?
* How does the executive budget proposal impact SUDs?
* Are parity requirements for SUD services going to change?
Take a coffee break every Tuesday in June at 2 p.m. ET to join us for a 15-minute webinar covering substance use disorder (SUD) issues!
http://www.ebglaw.com/events/sud-and-health-care-reform-what-are-the-key-changes-being-considered-by-congress-and-the-trump-administration-substance-use-disorders-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
1) Discuss what seems to be the current posture of the Trump Administration and Republican Party leadership relative to expected health care policy changes.
2) Identify key distinctions between the Affordable Care Act (ACA aka ObamaCare) and the American Health Care Act (AHCA aka TrumpCare).
3) Recognize key strategies for future success regardless of changes to US healthcare policy and law.
Outlook for 2017 and Beyond - Five Exposures to Watch in Health CareEpstein Becker Green
Mark Lutes, Chair of the Board of Directors of Epstein Becker Green and a Member of the firm’s Health Care and Life Sciences practice, delivered the attached keynote presentation, "Outlook for 2017 and Beyond - Five Exposures to Watch," at the Healthcare Financial Forum on March 15, 2017.
The Trump Administration’s policies, and decisions made by Congress, will transform how providers deliver care and receive payment for healthcare services. While President Trump’s February 28 speech to Congress offered few details of a White House vision on health care reform, clues as to a potential future are offered in bills under consideration in the House. In this interactive presentation, we will help finance executives predict the top exposures for their organizations in 2017 by reviewing elements of the shift in the payment paradigm, the Washington policy context and its impact on the threats and opportunities facing their organizations, and the outlook for further legislative and regulatory change.
Key exposures that will be covered include:
Executives Orders & Scrutiny of Regulation
Tax Reform Impacting Commercial Health Care Coverage
Medicare Trends
Exchange Population Coverage Changes
Medicaid Expansion Population Financing Changes
http://www.ebglaw.com/events/healthcare-financial-forum-outlook-for-2017-and-beyond-five-exposures-to-watch/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
May 2017 Summary of the American Health Care Act T.docxalfredacavx97
May 2017
Summary of the American Health Care Act
This summary describes key provisions of H.R. 1628, the American Health Care Act, as approved by the House
of Representatives on May 4, 2017, as a plan to repeal and replace the Affordable Care Act (ACA) through the
Fiscal Year 2017 budget reconciliation process.
American Health Care Act
H.R. 1628
Date plan
announced
March 6, 2017; passed by the House of Representatives on May 4, 2017
Overall
approach
Repeal ACA mandates (2016), standards for health plan actuarial values (2020),
and, premium and cost sharing subsidies (2020).
Modify ACA premium tax credits for 2018-2019 to increase amount for younger
adults and reduce for older adults; allow tax credits to apply to coverage sold outside
of exchanges and to catastrophic policies. In 2020, replace ACA income-based tax
credits with flat tax credits adjusted for age. Eligibility for new tax credits phases out
at income levels between $75,000 and $115,000
Retain private market rules, including requirement to guarantee issue coverage,
prohibition on pre-existing condition exclusions, requirement to extend dependent
coverage to age 26. Modify age rating limit to permit variation of 5:1, unless states
adopt different ratios, effective 2018. Retain essential health benefits requirement,
with state option to waive. Retain prohibition on health status rating with state
option to waive for individual market applicants who have not maintained continuous
coverage.
Retain health insurance marketplaces, annual Open Enrollment periods (OE), and
special enrollment periods (SEPs).
Impose late enrollment penalty for people who don’t stay continuously covered.
Establish Patient and State Stability Fund with federal funding of $115 billion over
9 years available to all states, and additional funding of $8 billion over 5 years for
states that elect community rating waivers. States may use funds to provide financial
help to high-risk individuals, promote access to preventive services, provide cost
sharing subsidies, and for other purposes. In 2020, $15 billion of funds shall be used
only for services related to maternity coverage and newborn care, and mental health
and substance use disorders. [For 2018-2026, a further $15 billion is allocated
through the fund for Federal Invisible Risk Sharing Program (reinsurance). This
program is established as part of the fund, though administered by CMS to make
payments directly to health insurers.] In states that don’t successfully apply for
grants, funds will be used for reinsurance program.
Repeal funding for Prevention and Public Health Fund at the end of Fiscal Year
2018 and rescind any unobligated funds remaining at the end of FY 2018. Provide
supplemental funding for community health centers of $422 million for FY 2017
Encourage use of Health Savings Accounts by increasing annual tax free
co.
Learn how you can successfully navigate the Affordable Care Act, "Obama Care".
This easy to read outline will benefit your family and business.
Call (816-224-9466) for more information today.
Crystal Connection (1/2019): Trending News in Employee Benefits, January 2019Susan Glenn
The Crystal Connection monthly magazine provides the most up-to-date developments in federal and state regulations that affect employer-sponsored benefits programs, as well as trends in benefits. This is a must read for employers who want to stay compliant and in the know!
Health Reform Bulletin 125 | Updated Employer Shared Responsibility Guidance,...CBIZ, Inc.
The latest HRB has been released. Get updates on the following: 1) Updated Employer Shared Responsibility Guidance; 2) ACA Implementation Guidance; 3) Gender Identity Discrimination: Preliminary Injunction Issued; 4) Final Rules - Premium Tax Credit; and 5) 2018 Benefit and Payment Parameters.
Compliance Bulletin - Washington Enacts Employee-paid Long-term Care ProgramKelley M. Bendele
Governor Jay Inslee signed a bill into law on May 13, 2019, that establishes a state-operated public insurance program to pay for long-term care services.
ACA Compliance Bulletin - Final Notice of Benefit and Payment Parameters for ...Kelley M. Bendele
In response to the White House announcing that it would no longer reimburse insurers for cost-sharing reductions made available to low-income individuals through the Exchanges, many issuers increased premiums in 2018 and 2019 only on silver level qualified health plans.
DOL audits can be triggered by negligence or mistakes on your part, or because your plan falls within one of the areas in which the DOL is focusing its investigative efforts.
Compliance Bulletin - Federal Court Strikes Down Association Health Plan RulesKelley M. Bendele
On March 28, 2019, a federal court stated that the final rule on association health plans was an "end-run" around the ACA and that the DOL exceeded its authority under ERISA.
ACA Compliance Bulletin - IRS Issues Letter 5699 to Noncompliant EmployersKelley M. Bendele
An ALE that fails to comply with the Section 6056 reporting requirements may be subject to penalties equal to $260 per violation for failure to file correct information returns by required deadlines.
ACA Compliance Bulletin - Final Rule Expands Short-Term, Limited-Duration Ins...Kelley M. Bendele
Although short-term, limited-duration insurance is not an excepted benefit, it is specifically exempt from the definition of "individual health insurance coverage" and, therefore, is not subject to the ACA's market reform requirements.
ACA Compliance Bulletin - Affordability Percentages Will Increase for 2019Kelley M. Bendele
The updated affordability percentages, which are effective for taxable years and plan years beginning January 1, 2019, are significant increases from 2018.
Employers should ensure that their health FSA will not allow employees to make pre-tax contributions in excess of $2,650 for 2018, and they should communicate the new limit to their employees as part of the open enrollment process.
U.S. Justice Department Reverses Title VII Transgender PolicyKelley M. Bendele
The Department of Justice (DOJ) now takes the position that Title VII does not protect transgendered and other individuals from gender identity discrimination in the workplace.
On January 20, 2017, President Trump signed an executive order intended "to minimize the unwarranted economic and regulatory burdens" of the ACA until the law could be repealed and eventually replaced. However, the executive order does not include specific guidance regarding any particular ACA requirement or provision, and does not change any existing regulations.
If the employer mandate is repealed, many ALEs will likely want to modify their plan designs to go back to pre-ACA eligibility rules. Employers may also consider increasing the amount that employees are required to contribute for group health plan coverage.
For 2018, Rev. Proc. 17-36 decreases the affordability contribution percentage to 9.56 percent. This means that employer-sponsored coverage will be considered affordable under the employer shared responsibility rules if the employee's required contribution for self-only coverage does not exceed 9.56 percent of the employee's household income for the tax year.
This infographic visually depicts five major consequences of adopting single-payer healthcare: eliminating upwards of 11 million U.S. jobs, forcing patients to wait for care, rationing prescription drugs, restricting research and development, and increasing taxes.
Because the cost-sharing limits for HDHPs will change for 2018, employers that sponsor these plans may need to make plan design changes for plan years beginning in 2018.
Unless a specific tax exemption applies, wellness incentives are generally subject to the same federal tax rules as any other employee rewards or prizes.
HHS Extends Transition Policy for Non-ACA Compliant Health PlansKelley M. Bendele
Due to President Donald Trump's executive order directing federal agencies to provide relief from the burdens of the ACA, HHS is now promoting the availability of these waivers.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
1. Provided By:
eESI
SENATE EFFORTS TO REPLACE
THE ACA ON HOLD
OVERVIEW
Republicans in the U.S. Senate announced on July 18, 2017, that
they are postponing a vote on the Better Care Reconciliation Act
(BCRA) due to a lack of votes. The BCRA is the latest bill
proposed to repeal and replace the Affordable Care Act (ACA).
The initial draft of the BCRA was released on June 22, 2017,
followed by an amended version released on July 13, 2017.
Senate Republicans now plan to focus on repealing the ACA
without a replacement plan, based on a budget reconciliation
bill from 2015. This proposal would provide a two-year delay of
the repeal to provide a stable transition period. However, it
would not repeal the ACA in its entirety, due to restrictions with
the budget reconciliation process. It is unclear whether this
approach has the required votes to pass the Senate at this time.
IMPACT ON EMPLOYERS
The Senate has not voted on any ACA repeal or replacement
proposal at this time. It is unclear whether the Senate plans to
abandon the BCRA completely. Any ACA repeal and replacement
bill that passes the Senate would need to go back to the House
for approval before being signed into law by President Donald
Trump.
HIGHLIGHTS
• The Senate postponed a vote on the
BCRA due to a lack of votes.
• Instead, Senate Republicans plan
to introduce legislation repealing
the ACA without implementing a
replacement plan.
• The Senate Republicans’ new
proposal would not repeal the ACA
in its entirety, and would include a
two-year delay of the repeal.
IMPORTANT DATES
June 22, 2017
Senate Republicans issued the BCRA.
July 13, 2017
Senate Republicans released an
amended version of the BCRA.
July 18, 2017
Senate Republicans put off a vote on
the BCRA in favor of a new approach.
2. 2This ACA Compliance Bulletin is not intended to be exhaustive nor should any discussion or opinions be construed as legal
advice. Readers should contact legal counsel for legal advice.
Legislative Process
Republicans in both the Senate and the U.S. House of Representatives are using the budget reconciliation
process in their efforts to repeal and replace the ACA. This means that the proposed bills can only address ACA
provisions that directly relate to budgetary issues—specifically, federal spending and taxation. As a result,
these proposals cannot fully repeal the ACA. Budget reconciliation legislation can be passed by both houses
with a simple majority vote. However, a full repeal of the ACA must be introduced as a separate bill that would
require 60 votes in the Senate to pass.
On May 4, 2017, the House voted 217-213 to pass the American Health Care Act (AHCA), which is their
proposal to repeal and replace the ACA. As a result, the AHCA moved on to the Senate for consideration. In
response, the Senate drafted the BCRA as their own ACA repeal and replacement bill, followed by an amended
version of the BCRA on July 13, 2017.
The Senate’s new proposal is mirrored after ACA repeal legislation included in a budget reconciliation bill that
passed both the House and Senate in 2015, but was vetoed by then-President Barack Obama. The new bill
would delay the repeal for two years, but would not completely repeal the ACA due to restrictions with the
budget reconciliation process. At this time, it is unclear whether the Senate plans to abandon the BCRA
completely. The Senate may choose to introduce this proposed legislation in the future, with or without
additional amendments.
Amendments to the BCRA
The biggest change included in the amended version of the BCRA would have allowed individuals to purchase
“catastrophic plans” beginning in 2019. Catastrophic plans do not comply with all of the ACA’s requirements
and typically do not cover many of the benefits included in other types of health plans. These plans generally
have lower premiums and higher deductibles, and are intended only to protect against “catastrophic” medical
costs (for example, costs related to an accident or serious medical condition). Under the ACA, only individuals
under the age of 30 and those who could not afford other coverage could purchase catastrophic coverage.
The amended version of the BCRA also would have:
Prohibited premium tax credits for consumers who receive HRA contributions from their employers for
individual health insurance coverage;
Provided additional funding for insurers to cover high-cost individuals;
Provided additional funding for substance use disorder treatment and recovery support services, as
well as for research related to the opioid abuse crisis; and
Removed the BCRA’s repeal of the ACA’s Medicare net investment tax and additional Medicare tax.
In addition, the amended BCRA would have made a number of amendments to certain Medicaid provisions.
3. 3This ACA Compliance Bulletin is not intended to be exhaustive nor should any discussion or opinions be construed as legal
advice. Readers should contact legal counsel for legal advice.
ACA Provisions Not Impacted
Like the AHCA, the BCRA would not affect the majority of the ACA. For example, the following key ACA
provisions would remain in place:
Cost-sharing limits on essential health benefits (EHBs) for non-grandfathered plans (currently $7,150
for self-only coverage and $14,300 for family coverage)
Prohibition on lifetime and annual limits for EHBs
Requirements to cover pre-existing conditions
Coverage for adult children up to age 26
Guaranteed availability and renewability of coverage
Nondiscrimination rules (on the basis of race, nationality, disability, age or sex)
Prohibition on health status underwriting
Similarly, the requirement to offer the EHB package for individual and small group plans also remains in place.
In addition, age rating restrictions would also continue to apply, with the age ratio limit being revised to 5:1
(instead of 3:1), and states would be allowed to set their own limits.
Repealing the Employer and Individual Mandates
The ACA imposes both an employer and individual mandate. Like the AHCA, the BCRA would reduce the
penalties imposed under these provisions to zero, effectively repealing both mandates (although they would
technically still exist). These changes would apply retroactively for months beginning after Dec. 31, 2015. The
AHCA would have allowed issuers to add a 30 percent late-enrollment surcharge to the premium for
applicants that had a lapse in coverage, in an effort to limit adverse selection and encourage individuals to
maintain health coverage. However, the BCRA removed this late-enrollment surcharge, so that issuers may
not charge higher premiums for individuals who do not maintain continuous coverage.
Note that neither the AHCA nor the BCRA would repeal the ACA’s reporting requirements related to the
employer and individual mandates (Section 6055 and Section 6056 reporting).
Replacing Health Insurance Subsidies with Tax Credits
The ACA currently offers federal subsidies in the form of premium tax credits and cost-sharing reductions to
certain low-income individuals who purchase coverage through the Exchanges. Like the AHCA, the BCRA
would repeal the cost-sharing reductions, effective in 2020. The BCRA would, however, technically leave the
premium tax credit provision in place, with heavy amendments taking effect in 2020. These amendments
would essentially replace the ACA’s premium tax credits with a portable, monthly tax credit to all individuals,
which can be used to purchase individual health insurance coverage.
4. 4This ACA Compliance Bulletin is not intended to be exhaustive nor should any discussion or opinions be construed as legal
advice. Readers should contact legal counsel for legal advice.
The BCRA would:
Restrict individual eligibility for premium tax credits to those with incomes not exceeding 350 percent
of the federal poverty level (reduced from the current eligibility limit of 400 percent);
Eliminate the cap on repaying Exchange subsidy overpayments; and
Amend the “applicable percentage” schedule for determining the amount of premium tax credits an
individual is eligible for, so that younger individuals would be eligible for higher tax credits.
The BCRA (like the AHCA) would also repeal the ACA’s small business tax credit, beginning in 2020. In addition,
between 2018 and 2020, the small business tax credit generally would not be available with respect to a
qualified health plan that provides coverage relating to elective abortions.
State Waivers
The AHCA included an option for states to obtain limited waivers from certain ACA standards, in an effort to
lower premiums and expand the number of insured. Specifically, states could apply for waivers from the EHB
requirement and community rating rules (except strict limitations applied with respect to rating based on
gender, age and health status). The BCRA eliminated this state waiver option.
However, the BCRA would provide states additional flexibility to use waivers that currently exist under Section
1332 of the ACA. The ACA’s Section 1332 State Innovation Waivers are intended to allow states to pursue
innovative strategies for providing their residents with access to high-quality, affordable health insurance
while retaining the basic protections of the ACA. Currently, four states have submitted applications for Section
1332 Waivers (Alaska, Hawaii, Vermont and Iowa; California submitted an application, but later withdrew it).
The BCRA would expand the ACA provisions that could be waived under Section 1332, and lower the standards
that states must meet in order to be eligible for a Section 1332 Waiver. In addition, the BCRA would also allow
the Department of Health and Human Services (HHS) to fast-track waiver applications from states
experiencing an urgent or emergency situation with respect to health insurance coverage within the state.
State Stability Fund
The AHCA would have established a Patient and State Stability Fund for 2018 through 2023 to provide funding
to states that have applied for, and been granted, a state waiver from the ACA’s community rating rules.
Because the state waivers would not be available under the Senate proposal, the BCRA decreases the amount
available through this fund, to be used to help address coverage and access disruption.
In addition, the BCRA would establish a second long-term state innovation fund that would dedicate $62
billion over eight years to encourage states to assist high-cost and low-income individuals to purchase health
insurance by making it more affordable. In 2018, the BCRA would also provide $2 billion in state grants for
substance abuse disorder treatment or recovery support services for individuals with mental health or
substance use disorders to address the opioid crisis.
5. 5This ACA Compliance Bulletin is not intended to be exhaustive nor should any discussion or opinions be construed as legal
advice. Readers should contact legal counsel for legal advice.
Enhancements to Health Savings Accounts (HSAs)
HSAs are tax-advantaged savings accounts that are tied to a high deductible health plan (HDHP), which can be
used to pay for certain medical expenses. To incentivize use of HSAs, the BCRA (like the AHCA) would:
Increase the maximum HSA contribution limit: The HSA contribution limit for 2017 is $3,400 for self-
only coverage and $6,750 for family coverage. Beginning in 2018, the BCRA would allow HSA
contributions up to the maximum out-of-pocket limits allowed by law (at least $6,550 for self-only
coverage and $13,100 for family coverage).
Allow both spouses to make catch-up contributions to the same HSA: The BCRA would allow both
spouses of a married couple to make catch-up contributions to one HSA, beginning in 2018, if both
spouses are eligible for catch-up contributions and either has family coverage.
Address expenses incurred prior to establishment of an HSA: Under the BCRA, starting in 2018, if an
HSA is established within 60 days after an individual’s HDHP coverage begins, the HSA funds would be
able to be used to pay for expenses incurred starting on the date the HDHP coverage began.
Relief from ACA Tax Changes
Like the AHCA, the BCRA would provide relief from many of the ACA’s tax provisions. The affected tax
provisions include the following:
Cadillac tax: The ACA imposes a 40 percent excise tax on high cost employer-sponsored health
coverage, effective in 2020. Like the AHCA, the BCRA would delay the effective date of the Cadillac tax
to 2026.
Restrictions on using HSAs for over-the-counter (OTC) medications: The ACA prohibits taxpayers from
using certain tax-advantaged HSAs to help pay for OTC medications. Like the AHCA, the BCRA would
allow these accounts to be used for OTC purchases, beginning in 2017.
Increased tax on withdrawals from HSAs: Distributions from an HSA (or Archer medical savings
account) that are not used for qualified medical expenses are includible in income and are generally
subject to an additional tax. The ACA increased the tax rate on these distributions to 20 percent. Like
the AHCA, the BCRA would lower the rate to pre-ACA percentages, beginning with distributions in
2017.
Health flexible spending account (FSA) limit: The ACA limits the amount an individual may contribute
to a health FSA to $2,500 (as adjusted each year). Like the AHCA, the BCRA would repeal the limitation
on health FSA contributions for taxable years beginning in 2018.
Additional Medicare tax: The ACA increased the Medicare tax rate for high-income individuals,
requiring an additional 0.9 percent of wages, compensation and self-employment income over certain
6. 6This ACA Compliance Bulletin is not intended to be exhaustive nor should any discussion or opinions be construed as legal
advice. Readers should contact legal counsel for legal advice.
thresholds to be withheld. Although the original version of the BCRA, like the AHCA, would have
repealed this additional Medicare tax beginning in 2023, the amended BCRA removed this repeal.
Deduction limitation for Medicare Part D subsidy: The ACA eliminated the ability for employers
receiving the retiree drug subsidy to take a tax deduction on the value of this subsidy. Like the AHCA,
the BCRA would repeal this ACA change and reinstate the business-expense deduction for retiree
prescription drug costs without reduction by the amount of any federal subsidy, effective in 2017.
Beginning in 2018, both the AHCA and the BCRA would also repeal the medical devices excise tax, the health
insurance providers fee and the fee on certain brand pharmaceutical manufacturers. The 10 percent sales tax
on indoor tanning services would be repealed effective Oct. 1, 2017, to reflect the quarterly nature of this
collected tax. Finally, the BCRA would also reduce the medical expense deduction income threshold to 7.5
percent, beginning in 2017.
Modernize Medicaid
Most of the differences between the AHCA and the BCRA relate to the Medicaid program. Like the AHCA, the
BCRA would repeal the ACA’s Medicaid expansion, and make certain other changes aimed at modernizing and
strengthening the Medicaid program. For example, the BCRA would provide enhanced federal payments to
states that already expanded their Medicaid programs, and then transition Medicaid’s financing to a “per
capita allotment” model starting in 2021, where per-enrollee limits would be imposed on federal payments to
states. Unlike the AHCA, though, the BCRA would also guarantee coverage for children with medically complex
disabilities and ease restrictions on coverage of treatment for mental diseases in psychiatric hospitals.