- January 2017
Since the enactment of the Affordable Care Act (“ACA”) in 2010, Congressional Republicans have waged an unrelenting battle to repeal/de-fund/delay/alter President Obama’s signature first-term legislative achievement popularly known as Obamacare. During the 114th Congress just passed, that effort achieved limited success as several NAW-supported incremental reforms of substantial import to wholesaler-distributors and the employer community generally became law. Of particular note:
ACA-mandated expansion of the small group market was repealed. (Protecting Affordable Coverage for Employees (“PACE”) Act.)
The ACA’s auto-enrollment mandate applicable to employers of 200+ employees was repealed. (Bipartisan Budget Act of 2015.)
The annual fee on health insurance providers (the “health insurance tax” or “HIT”) was suspended for one year. (FY ’16 Omnibus Appropriations and Tax Extenders Bill.)
Implementation of the 40% excise tax on high-cost employer-sponsored health coverage (the “Cadillac Tax”) was delayed for two years. (FY ’16 Omnibus Appropriations and Tax Extenders Bill.)
- Legislation was enacted as part of the 21st Century Cures Act permitting small employers not covered by the ACA’s employer mandate (i.e., fewer than 50 employees) to contribute on a pre-tax basis to health reimbursement accounts (HRA) to help employees pay individual health premiums and out-of-pocket medical costs.
The sweeping Republican victory in the 2016 national elections ensures that the effort to “repeal and replace” Obamacare will be front-and-center in the new 115th Congress’ earliest days. While all substantive, procedural and timing details of the coming repeal and replace effort are unknown as Staff Reports goes to print, the process of Obamacare repeal will begin in the 115th Congress’ first week with Senate consideration of a budget resolution aimed at the ACA. The Budget Resolution will include “reconciliation instructions” that will allow the subsequent repeal of significant parts of the ACA under “expedited procedures” that provide for passage with limited debate and a simple majority vote in both houses – in other words, not subject to filibuster in the Senate.
The content of the Republicans’ ACA replacement plan remains unclear. House Republicans provided insight into their agenda last summer with the release of a campaign-oriented document titled “A Better Way: Our Vision for a Confident America,” and which includes a health policy component that inaugurates a discussion between House Republicans and stakeholders in search of common ground on market-driven, patient-centered ways to achieve important access, cost-containment, and quality goals. NAW has pledged to be a “willing, enthusiastic partner in this process.”
Among the issues of principal concern to NAW as the Obamacare repeal and replace process unfolds are:
Protect the current tax treatment of employer-provided health benefits;
Full repeal of the Cadillac Tax;
Full repeal of the HIT; and
- Repeal of the employer mandate.