Avoiding what would have been major market disruptions and a political firestorm if the Supreme Court had invalidated subsidies in federally-run exchanges in last week’s King decision, Congress is poised to try to move a series of smaller bipartisan ACA changes. It’s unclear, however, how many of the measures – such as repealing or revising the 40% tax on high-cost health plans, the employer mandate, and the weekly 30-hour definition of a full-time worker – might make it over the finish line in this Congress. Senate Democratic support could falter once controversial revenue offsets are identified and President Obama issues veto threats. These proposals must also compete with a crowded non-ACA health agenda and other legislative priorities including appropriations bills and a debt limit hike.
On the regulatory front, new rules for health plans’ summary of benefits and coverage (SBC) clarify and modify employers’ obligations for this mandate. The revisions incorporate certain safe harbors and transitional guidance issued in recent years. Most plans must follow the revised rules starting with this fall’s open enrollment for the 2016 plan year. Proposed revisions to SBC templates and other model materials, however, will undergo further testing before new versions apply for fall 2016 open enrollment. Employers should prepare to comply with the revised rules this fall and to revamp SBCs next year.