Today, the House Republican leadership and the White House decided to put off a vote in the House of Representatives on Speaker Ryan's American Health Care Act (a.k.a. reconciliation bill or AHCA). While the bill mostly focuses on the individual market and reforming Medicaid, the AHCA also has several provisions impacting large self-insured employers which would:
- Reduce the employer and individual mandates to zero;
- Delay the Cadillac Tax from 2020 to 2026;
- Repeal all other ACA taxes in 2017 except the 0.9% Medicare payroll tax on high-income earners, which is repealed in 2022;
- Repeal the ACA limits on HSAs, FSAs, HRAs, and MSAs, and increase the maximum contribution for HSA’s; and
- Allow States to determine which essential health benefits must be covered.
Regarding the other major provisions of the AHCA, it would replace the ACA exchange premium tax credit and cost-sharing subsidy in 2020 with an advanceable refundable tax credit; significantly reform the Medicaid program to give states more flexibility, reduce costs, and create a work requirement; and create a $115 billion "Patient and State Stability Fund" to lower costs and, improve coverage of maternity and newborn care, mental health, and substance use disorders. However, the AHCA does not change key provisions of the Affordable Care Act important to large employers such as:
- The burdensome reporting requirements;
- Wellness program requirements; and
- Increased transparency.
Legislation as complex and impactful as revisions to the Affordable Care Act typically does not move in a straight line. At a minimum, there is a likely to be a cooling-off period during which the various constituencies within the Republican Party and the White House assess the situation and determine next steps. It is difficult to believe that conservative members of Congress who ran in 2012, 2014 and 2016 on ACA repeal and replace can run again in 2018 having left the ACA intact. At the same time, what struck us about the House debate today were Republican members of Congress talking about the "education" that has gone on since the first of the year about what the ACA actually is and provides.
