Part 1 of this blog described two strategies congressional Republicans might pursue next year to roll back the Affordable Care Act: (1) advancing a philosophy by voting to scrap the law in its entirety; and (2) as a practical matter offering specific amendments to chip away at the law’s key features. 

What ACA amendments might Congress consider in 2015?   

Human Resources Legislation

INTELLIGENCE FOR HCM PROFESSIONALS

Stay Informed About Changing Compliance Regulations & Workforce Trends
Read the HR Legislation Blog to stay on top of complex HR & Payroll policy issues

Changing the Affordable Care Act: 2015 Legislative Outlook—Part 2

Mon Nov 24, 2014

Changing the Affordable Care Act: 2015 Legislative Outlook—Part 2

Part 1 of this blog post described two strategies congressional Republicans might pursue next year to roll back the Affordable Care Act: (1) advancing a philosophy by voting to scrap the law in its entirety; and (2) as a practical matter offering specific amendments to chip away at the law’s key features.

What ACA amendments might Congress consider in 2015?

  • Highest on the priority list will be legislation to repeal the medical devices sales tax, something a coalition of Democrats and Republicans already supports.  Estimated to raise some $30 billion over ten years, the tax was included in the 2010 law to help finance subsidies for people who enroll in exchange-based health coverage.

    Many members of Congress have concluded that the tax discourages medical innovation, e.g., in breakthrough heart pacemakers —key to improving health and reining in costs.

  • Another legislative target could be the employer “play or pay” mandate, specifically two numerical thresholds—the 30-hour per week definition of “full-time employee” and the 50-employee definition of “applicable large employer.” While arguments can be made for the original metrics their unintended consequences could prompt a legislative fix.

    The 30-hour threshold is thought to encourage employers to limit work hours of some employees to avoid triggering the employer mandate, thus suppressing full-time job opportunities. And the 50-employee target may cause small firms to let jobs go unfilled so they don’t cross the line into the play or pay regulatory labyrinth.

    Congress and the President, perhaps on a bipartisan basis, might agree to change the full-time employee definition to 40 hours per week and the “large” employer threshold to 100 or more full-time employees.

  • A far more controversial challenge to Obamacare and the Administration might be an amendment to repeal the individual mandate to enroll in health coverage or pay a fine—a requirement the Supreme Court upheld in 2012. Republicans and some Democrats believe as a matter of principle that Washington should not force citizens to buy health insurance under penalty of law.

    President Obama in his post-Election Day press conference made clear that he will oppose repeal of the individual mandate. Nevertheless, Republicans will move to repeal it and the legislation could win 60 votes in the Senate—setting up a veto confrontation with the White House.

  • Another item on the legislative list could be repeal of the Independent Payment Advisory Board (IPAB), to which the 2010 law granted broad powers to enforce limits on Medicare spending with limited congressional oversight. IPAB is not likely to survive the first round of ACA amendments.

  • Other ACA amendments are expected, including possibly a proposal to “grandfather” existing health plans affected by the President’s pledge that “if you like your existing health plan you can keep your existing health plan.”

Republicans may also target the employer play or pay mandate in an effort to water down what they consider overly prescriptive regulations. While details are not yet known it seems unlikely that a repeal of the employer mandate would succeed, particularly given the $100+ billion in Treasury revenue employer penalties are estimated to generate.

As much as employers could wish for a year of stability in ACA compliance, Election Day gave Republicans large majorities in House and Senate for the 114th Congress that convenes in January. The Affordable Care Act will be among the new leadership’s highest priorities for change. Whether the healthcare reform law will be dismantled, scaled back, chipped away at or merely tweaked isn’t clear. But there’s no doubt it will be changed.