GOP still likely a long way away from achieving seven year campaign pledge

On May 4, 2017, Republicans completed the first step in the long journey to repeal and replace portions of the ACA with the passage of the American Health Care Act (AHCA) – temporarily salvaging their mission to overhaul the nation’s health system. Previously stalled due to objections, the bill mustered just enough votes in the House (217-213)* after the addition of amendments that would allow states to waive the ACA’s essential health benefits package and insurance requirements for individuals with pre-existing conditions.

There are a number of provisions contained within the final version of the bill that may be of importance to TASC Providers/Clients. Here’s a brief description…

Age 26: Retains the requirement that family policies cover grown children.

Cadillac Tax: Currently set to become effective in 2020, the effective date of the excise tax on high cost health plans will be pushed back until 2026.

Employer/Individual Mandates: Ends tax penalties on individuals who don’t purchase health insurance and on large employers who don’t offer coverage to their workers; allows insurers to apply a 30% surcharge to customers who’ve been uninsured for more than 60 days.

FSA Cap: The cap on employee contributions to a health FSA imposed under the ACA is eliminated for tax years after December 31, 2016.

HSA Catch-Up Contributions: The AHCA will permit both spouses to make additional catch-up contributions to a single HSA; effective for tax years after December 31, 2017.

HSA Contribution Limit: Under the AHCA, the maximum contribution to an HSA will be equal to the sum of the annual deductible and the out-of-pocket expense maximum for single or family coverage; effective for tax years after December 31, 2017.

HSA Distribution Tax:  The ACA increased the excise tax on distributions not used for qualified medical expenses from 10% to 20%. Under the AHCA, that additional tax will revert back to 10% for distributions made after December 31, 2016.

HSA Establishment:  Under current law/regulations, only medical expenses incurred after the establishment of an HSA are considered eligible for reimbursement. In an effort to addresses the administrative problems connected with this requirement, the AHCA provides that as long as the HSA is established within 60 days of the date of health coverage, any medical expenses will be considered eligible regardless of whether they were incurred prior to the establishment of the HSA. This provision will be effective with respect to coverage after December 31, 2017.

Over-the Counter Medicines:  The ACA provided that the only prescribed drugs/medicines or insulin would be considered qualified medical expenses eligible for reimbursement from a FSA, HRA or HSA.  This provision would be eliminated for amounts paid or expenses incurred after December 31, 2016.

The nonpartisan Congressional Budget Office (CBO) was unable to complete an updated analysis detailing the effects of the latest changes in time for last week’s vote…meaning GOP lawmakers acted on the bill without updated figures on how many people would lose coverage or how much it would cost.

The measure is expected to undergo a major overhaul in the Senate, as that body’s politics are expected to prove far dicier than those in the House (i.e. much smaller and quite diverse Republican majority). Plus, the upper chamber operates on procedural rules that may block numerous parts of the AHCA. Senate Majority Leader Mitch McConnell has established a working group of 13 Senators to develop the Senate’s bill.  The content and timing of the Senate’s version is not clear yet.

It’s important to remember that this legislation is still pending, and has not been signed into law. At this time, the ACA (including all associated regulations and penalties) is still the law of the land; compliance is still required. TASC will continue to update you as this legislation moves through the political process to ensure our Providers/Clients compliance with the law.

* The bill was passed under budget reconciliation authority, so many provisions of the ACA could not be addressed or completely repealed by this bill.