As the 114th Congress convenes this week, Republicans plan to use their House and Senate majorities to attempt targeted changes to the ACA, recognizing that full repeal isn’t possible with President Obama in the White House. First up on the agenda could be legislation to change the law’s employer shared-responsibility definition of a full-time employee from 30 hours of work per week to 40 hours. Other legislation could aim to strike down the employer shared-responsibility mandate; the individual purchase mandate; an annual tax on health insurers; a Medicare cost-cutting board that has yet to be appointed; and a provision in the law designed to temporarily limit insurers’ financial losses.
Meanwhile, a Supreme Court challenge to the law’s subsidies that help some residents in states with federally-run insurance exchanges buy coverage could alter GOP strategy. If justices side with challengers arguing that the law allows subsidies only for state-based exchange coverage, Republicans may have to decide whether to step in with legislation or allow individuals to lose the financial help. None of the more comprehensive GOP health care reform proposals has advanced, though internal conversations about potential next steps are ongoing.
On the regulatory front, federal agencies have proposed new rules governing ACA-required Summaries of Benefits and Coverage (SBCs) and outlining two types of limited wraparound coverage as excepted benefits. The SBC proposal includes an updated SBC template, glossary, instructions and coverage examples, as well as some relief for certain account-based plans. For the first time, SBCs would have to include statements disclosing whether the coverage meets the ACA's standards for minimum essential coverage and minimum value but no premium information would be required. If finalized, the changes would apply to most plans starting with their first open enrollment period that begins on or after September 1, 2015.
Proposed excepted benefit rules include two pilot programs that employers could offer as wraparound benefits for individual health insurance policies. The programs would be exempt from ACA market reforms and those covered could receive public exchange subsidies. One program would apply to coverage wrapping around ACA’s multistate exchange plans; the other to part-timers and retirees with individual market coverage. The programs would have to be offered by December 31, 2017, and close by the later of three years or the end of a collective bargaining agreement.