As we reflect back on the first five years under the ACA, there is one consistent theme — change. Change in the form of changes employers have made to their health benefit programs and change and delays in the implementation of the law. Could there be more ahead? There are certainly some possibilities.
The Supreme Court is expected to deliver another ACA-related decision in the King vs. Burwell case in June. While we are all speculating on what the decision will be, the Republicans are preparing a response in the event the Justices decide to disallow subsidies to members of the federally facilitated public exchanges. Some of the changes being proposed include things like:
- Capping tax credits from the current 400% federal poverty limit to 300% FPL and limiting tax exclusions on employer-provided health insurance to $12,000 for individual coverage and $30,000 for family coverage (Hatch and Burr).
- Keeping Healthcare.gov subsidies intact through August 2017, and repeal the individual mandate (Johnson).
- Restoring federal funding to the States, which can choose individual tax credits deposited in patients’ HSAs or per capita block grants (Cassidy).
All of these are just “proposals” at this point in time, but they definitely give us a glimpse into some of the types of changes lawmakers are considering.
The IRS received comments from employer groups on the first installment of Excise Tax guidance last Friday. Mercer, along with other groups representing employers, submitted comments. We reported earlier in the week on the type of changes Mercer proposed — exclude noncore medical benefits (such as workplace wellness programs and on-site medical clinics) from the calculation of coverage costs, provide employers with enough flexibility to calculate coverage costs consistent with reasonable actuarial principles, and postpone implementation of the excise tax or at least provide a “good faith” compliance period. Other groups proposed similar changes with common themes of requests for simplicity and flexibility. The IRS has said it will provide a second round of guidance for comment before issuing draft regulations on the excise tax.
Lots of activity in Washington, DC, as we wait for the Supreme Court decision and to see what regulators and lawmakers will do next. One thing is for sure: Things will change!