What’s New

Senate Republicans Release Updated Discussion Draft of ACA Repeal Bill

On Thursday, June 22, 2017, Senate Majority Leader Mitch McConnell of Kentucky released a 142-page healthcare “Discussion Draft” of
legislation, called the Better Care Reconciliation Act of 2017 (BCRA), which is the Senate version of the Affordable Care Act (ACA) “repeal and replace” legislation American Health Care Act (AHCA) passed by the U.S. House of Representatives last month. An updated “Discussion
Draft” of the BCRA was released on June 26, 2017 with the intention of calling for a vote on the bill before the Fourth of July recess. However, Senator McConnell had to delay that vote after it became clear that it would not get the 51 votes required under the Budget Reconciliation rules to pass. A further updated Discussion Draft of the BCRA was released on July 13, 2017. A summary of the updated July 13 draft of the BCRA by the U.S. Senate Committee on the Budget is available here and a section-by-section summary of the July 13 version is available here and here.

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PCORI Fees Due by July 31, 2017

Employers that sponsor self-insured group health plans, including health reimbursement arrangements (HRAs) should keep in mind the upcoming July 21, 2017 deadline for paying fees that fund the Patient-Centered Outcomes Research Institute (PCORI). The amount of PCORI fees due by employer sponsors and insurers is based upon the number of covered lives under each “applicable self-insured health plan” and “specified health insurance policy” (as defined by regulations) and the plan or policy year end date.

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House Republicans Pass ACHA

A revised version of the American Health Care Act (AHCA) passed the House of Representatives on May 4, 2017. The vote was very close, with 217 in favor and 213 opposed. Every House Democrat and 20 House Republicans opposed the measure.

This is not the original version of the AHCA, which was pulled before a March vote because of Republican concerns that there were not enough votes to pass.  A number of changes were subsequently made to the original bill.  However, the AHCA still has to pass the Senate before arriving at the President’s desk to be signed into law.

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House Republicans Withdraw the ACHA Before a Planned Vote

On Friday, March 24, 2017, the US House of Representatives pulled from the floor the American Health Care Act (AHCA), the proposed legislation to repeal and replace the Affordable Care Act (ACA).  The withdrawal was rumored to signal the end of ACA repeal efforts; however, it has been reported that House Republican leaders and the Trump administration have renewed negotiations to repeal the ACA.  At this time, there are no details about what may be in any renewed repeal legislation or the timing of its release.

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Transforming the ACA

The House Ways & Means Committee and House Energy & Commerce Committee issued draft language as directed by the January budget resolution to repeal & replace the Affordable Care Act.  The proposed legislation is called the American Health Care Act.  If approved by the committees, it will move to the House Budget Committee, and then the House Rules Committee before it can be voted on in the House.  The bill would next progress to the Senate for a vote and finally to the President for his signature.  Republican leadership has repeatedly stated they intend to have the bill on the President’s desk by Easter, April 16.

The language of the American Health Care Act is not final and will likely change as it moves through the legislative process. Following is a summary of the Act’s major provisions organized by the stakeholders impacted.

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Executive Order Issued on the ACA

President Trump issued an Executive order intended to minimize the economic and regulatory burdens of the ACA. The order has no immediate effect on employers, many of whom are in the process of complying with the reporting requirements.

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Post Election Debrief: What’s Next for the ACA?

The votes have been counted and Donald Trump is the president-elect and Republicans control Congress. Among
the many questions around the proverbial watercooler is what now for “Obamacare”? While it is impossible for anyone
to predict the future, we undertake to make a short, best guess about the future of the Affordable Care Act (“ACA”).

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HHS Issues Final Rule on ACA Nondiscrimination Provisions (Section 1557)

In May, the Department of Health and Human Services (HHS) published a final rule implementing Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of, among other grounds, sex (including gender identity) in certain health programs and activities. Specifically, entities covered under the rule cannot deny, cancel, limit or refuse to issue health coverage; deny or limit a claim; or impose additional cost sharing on a protected individual.

The rule will require many group health plans and employers to cover health care services provided to transgender individuals and is expected to have broad implications for the provision of transgender- and gender transition-related medical treatment. The extent to which the rule may apply to a particular plan or employer involves some analysis. However, it is clear that HHS intends to encourage coverage of health care services for transgender individuals in the broadest manner possible.

The rule is effective for plan years beginning on or after January 1, 2017. Some aspects of the rule that require notices and accommodations for individuals with disabilities or limited English language skills are effective 90 days after the July 18, 2016 effective date of the final rule.

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Marketplace Subsidy Notices: What Employers Need to Know

In late June, the U.S. Department of Health and Human Services (HHS) reportedly mailed out several hundred thousand notices to employers, dated June 21, 2016, informing them that one or more of their employees have been certified as eligible for a premium subsidy through a federal Health Insurance Marketplace. Employers in states with state-run Marketplaces may have received
similar notices since 2015; however, HHS has just begun sending notices from the federal Marketplaces this June. A list of states and whether their Marketplace is state-based or federally-facilitated can be found here.

The notice informs the employer that the individual indicated that he or she worked for the employer and either: (i) didn’t have an offer of health care coverage from the employer; (ii) did have an offer of health care coverage, but it wasn’t affordable or did not provide minimum value; or (iii) was in a waiting period and unable to enroll in health care coverage. This alert describes the appeal process and provides recommendations for employers who have received a notice and are considering whether to appeal.

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