As the Supreme Court deliberates over whether to invalidate Affordable Care Act (ACA) insurance subsidies provided to individuals through federally-run exchanges, Republican lawmakers’ efforts to ready contingency plans are gaining momentum.
Last week Reps. Paul Ryan, R-WI, John Kline, R-MN, and Fred Upton, R-MI, the chairmen of the House committees that oversee health policy, proposed what they called an “off ramp” from the ACA that would let states opt out of the law’s key requirements. In the Senate, Sens. Orrin Hatch, R-UT, Lamar Alexander, R-TN, and John Barrasso, R-WY, offered their own plan to provide help to those who would lose their subsidies and new flexibility for states to redesign their health care marketplaces.
Freshman senator Ben Sasse, R-NE, plans to introduce legislation this week that would continue providing subsidized coverage for 18 months to those who lose their coverage in a framework similar to COBRA.
Other, more targeted proposals are also being offered. New legislation from Republican lawmakers would clarify that employers can take advantage of the ACA’s higher permissible incentives for qualifying wellness programs without violating the Americans with Disabilities Act. Companion Senate and House bills come in the wake of employer frustration over the lack of related guidance from the Equal Employment Opportunity Commission and its recent lawsuits against wellness plans.
In addition, Reps. Lynn Jenkins, R-KS, and Ron Kind, R-WI, are reviving a bill that would amend the ACA to restore over-the-counter drugs as eligible expenses for health savings accounts (HSAs).
These broader ACA-replacement plans will be rendered moot for now if the Supreme Court upholds the law, but key aspects of these and less sweeping proposals will continue to be actively considered by Congress regardless of the Court’s decision.