Opt-out Arrangements; Congress to Break; Clinton on Health

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Opt-out Arrangements; Congress to Break; Clinton on Health
Calendar12 July 2016

Key provisions of IRS proposed rules released last week cover many issues related to ACA premium tax credits including the affordability impact of opt-out payments to employees who decline employer coverage. The affordability of employer-provided coverage affects whether employees and their family members can receive premium tax credits or cost-sharing subsidies from public exchanges, which in turn can trigger employer shared-responsibility assessments. The proposed rules on opt-out arrangements would, if finalized, apply to plan years beginning on or after Jan. 1, 2017.

Congress enters its final week before recessing for the summer with further action on health care legislation – including a House-passed mental health parity bill – likely to slip to September. The mental health bill directs regulators to come up with an "action plan" for coordinating enforcement and to issue more guidance on parity topics for employers and issuers, such as nonquantitative treatment limits that satisfy Mental Health Parity and Addiction Equity Act regulations. Other provisions would clarify that parity standards apply to any eating disorder benefits, including residential treatment, covered by a plan. Despite overwhelming House approval, similar legislation remains ensnared in the gun control issue in the Senate, but the measure could break free and become law this year.

Hillary Clinton is pledging to follow through on progressive health care policies in a new campaign document as Democratic delegates meet on the party's platform and she woos Bernie Sanders' supporters. The Clinton proposal affirms positions she has taken during the primaries, including extending Medicare as an option to Americans 55 years and older and taking steps to lower out-of-pocket costs.

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