Legislative and Compliance Update: Future of the ... · Health Status: May not charge more for Pre-Existing Conditions: Continuous Coverage Penalty. Essential Health Benefits: •
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– Lower Medicaid spending per enrollee for new adults– Declining costs for new enrollees since expansion– Marketplace premiums 7% lower in expansion states compared to
non-expansion states (greater risk pool)• Reduction in uninsured hospital visits and uncompensated care
whereas non-expansion had no reduction• Documented significant job growth• Adults with disabilities significantly more likely to be employed
– Over half expansion enrollees reported Medicaid enrollment made working easier
What is Reconciliation and What are the Limitations?
• Pros:– Only requires 51 votes in the Senate (50 if VP serves as tie-
breaker)• Cons:
– Can only address budget/revenue items– Must be at least budget-neutral in ten year window– Must be tied to fiscal-year budget reconciliation instructions
• Republicans win both Houses of Congress & Presidency• Promise “repeal and replace” of ACA will be waiting for President
on inauguration dayNovember 2016
• Republicans make first attempt to repeal ACA through American Healthcare Act (AHCA)
• Bill pulled from floor minutes before vote• Paul Ryan declares ACA “is the law of the land for the foreseeable
future”
March 2017
• MacArthur Amendment introduced and repeal effort gains steam• Republicans in House vote 217-213 to pass bill• White House hosts Rose Garden Ceremony to celebrateMay 2017
ACA Republican ProposalsTaxes on High Earners:• Additional 0.9% Medicare HI tax for high wage
earners • 3.8% tax on certain passive income• Wages paid in excess of $500,000 to officer,
director or employee of insurer not deductible
Taxes on High Earners:• Early proposals eliminated taxes• Later proposals retained taxes
Medicaid :
States may expand coverage for Medicaid to those above 133% of FPL, and receive Federal reimbursement
• Gradual phase-out of ACA expansion• Shift traditional Medicaid funding to per capita or
block grants (i.e., federal contribution is set subject to CPI-M inflation until 2025 when CPI inflation), meaning states carry the primary risk of increasing costs
• AARP v. EEOC– AARP argued there should be no incentives for wellness – programs. – Court found incentives are permissible but found no basis for – EEOC settling on 30% limit. – Remanded for further rulemaking – Existing rules remain in effect, pending new regulations.