SubscribeOn October 11, 2022, the US Department of Treasury (Treasury) and the Internal Revenue Service (IRS) issued final regulations to modify how affordability under the Affordable Care Act (ACA) is determined for an offer of coverage to a family member by an employer-sponsored group health plan, effective for the tax year beginning after December 31, 2022. By changing the affordability analysis to look at the total cost to cover family members—rather than the cost to only the employee—the new rule expands eligibility to receive premium tax credits (PTCs) in the ACA marketplace to an employee’s spouse and dependents.
Affordable Care Act (ACA)
Texas Judge Rules Against ACA Preventive Care Provisions
On September 7, 2022, a US district court judge for the Northern District of Texas issued a ruling that preventive care provisions in the Affordable Care Act (ACA) requiring private insurance plans to cover drugs that prevent HIV infection at no cost to patients violate religious rights.
The ACA requires that private insurers cover certain preventive health services, including STD screenings and HIV pre-exposure prophylaxis (PrEP) prevention drugs. In his ruling, the judge found that that the rights of the employers that brought suit have been violated under the Religious Freedom Restoration Act by the requirement that they sponsor health insurance that covers sexual health services such as PrEP drugs that help prevent the spread of HIV.
It is not yet clear whether enforcement will occur immediately and whether coverage requirements will be blocked for just those who brought suit, for everyone in Texas or nationwide. The US Department of Health and Human (HHS) is expected to appeal the ruling.
Court Cases Challenge English-Only COBRA Election Procedures
Two pending federal cases could reveal situations in which employers with a significant multi-lingual workforce should provide translated versions of their COBRA election materials.
Senate Rejects Proposals to Repeal and Replace Affordable Care Act
Senate Republicans failed to pass legislation to repeal and replace the Affordable Care at the end of July. After voting to proceed with debate on the American Health Care Act, which was passed by the House in May, the Senate introduced and voted against several replacement amendments and bills, including a new version of the Better Care Reconciliation Act, with amendments by Senators Ted Cruz (R-TX) and Rob Portman (R-OH), and the Obamacare Repeal Reconciliation Act.
PCORI Fee Due by July 31, 2017
The Patient-Centered Outcomes Research Institute (PCORI) fee was established under the Affordable Care Act (ACA) to advance comparative clinical effectiveness research. The PCORI fee is assessed on issuers of health insurance policies and sponsors of self-insured health plans. The fees are calculated using the average number of lives covered under the policy or plan, and the applicable dollar amount for that policy or plan year. Although there is recent discussion in the press about the repeal and replacement of the ACA, the PCORI fee has not currently been repealed. The fee is indexed for future years, and is scheduled to end in 2019.
Senate Republicans Unveil ACA Repeal Bill
Last week, Senate Republicans unveiled draft legislation to move toward repealing portions of the Affordable Care Act (ACA). The draft health care bill, known as the Better Care Reconciliation Act, was hatched behind closed doors without public committee hearings or debate, in response to concerns raised by the House’s American Health Care Act (AHCA), which passed by the slimmest of margins on May 4, 2017. The bill faces an uphill battle as several Republican senators have already come out in opposition to the draft bill, conservatives have criticized the bill not going far enough to repeal the ACA and moderates are uneasy about the impact severe cutbacks to the Medicaid system will have on their constituents. Senator Mitch McConnell has vowed to bring the draft bill to a vote this week before Congress recesses for the Fourth of July holiday.
Legally Mandated Benefit Plan Changes Still Require Bargaining
A unanimous panel of the NLRB, including Chairman Philip A. Miscimarra, held that ACA mandates do not relieve an employer of its duty to bargain with a union representing its employees regarding certain health insurance benefit plan changes.
House Narrowly Passes American Health Care Act
On Thursday, May 4, 2017, the US House of Representatives passed the American Health Care Act by the slimmest of margins with no Democrats voting in favor of the bill. Amendments to the original bill attracted more support from both moderate and conservative Republicans by the introduction of two amendments: one that gives more leeway to the states to request waivers from the more onerous provisions of the ACA that cannot be changed through the budget reconciliation process, and a second one that adds $8 billion of funding to the bill to help improve the “high-risk pools” that could be set up by states to provide coverage to individuals with pre-existing conditions who cannot find affordable insurance in the open market.
View From McDermott: Employee Benefit Plan Considerations for Health Systems in 2017
Amy Gordon, Jeffrey Holdvogt, Susan Nash and Mary Samsa wrote this bylined article on health system employee benefit opportunities and challenges in 2017. The authors urged health systems to review internal controls for 403(b) plan compliance and new design opportunities for 457(f) plans, to review their short- and long-term health plan operation in light of any Affordable Care Act replacement.
Manager Amendments to the American Health Care Act
On Monday March 20, 2017, technical and policy amendments to the American Health Care Act of 2017 (AHCA) were introduced to address concerns by more conservative Republicans. The House just announced they are delaying the vote on the AHCA likely due to the uncertainty that it would pass.
