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Senate releases its proposal to repeal and replace ACA

22 Jun 2017 12:13 PM | Anonymous

As you may recall, the American Health Care Act was passed in dramatic fashion in the House last month.  To become a bill, the Senate would have to agree to the same version (and if not, there will be a House/Senate committee that reconciles the bills).  Today, Senate Republicans released their response to AHCA, entitled "Better Care Reconciliation Act of 2017." 

Significantly, the bill does not propose to tax employee premiums on health insurance as the original leaked version of AHCA had done.  So, for now at least, pre-tax deductions for health insurance are safe.

The bill, similar to AHCA, did not eliminate the employer and individual mandates, but eliminated the penalties.  The Cadillac tax is also delayed until 2025. Limits to HSA and FSAs placed by ACA are repealed.  However, instead of premium subsidies being available on the exchange based only on age, as AHCA had proposed, the Senate bill ties these subsides to both to age, but also to income.

Just like AHCA, the Senate's version does not  eliminate reporting requirements (1095s), nor touches things like pre-existing condition exclusion prohibition, coverage for adult children, preventative care mandate, or annual/lifetime limit prohibition.

AHCA was criticized by some for rolling back the Medicaid expansion too quickly, so the Senate version of the bill seeks to do the same thing, but to phase out the expansion until 2024. 

AHCA also contained a last-minute amendment that would allow states to waive essential health benefits and create their own standards.  The Senate version does not allow for these waivers, though it does loosen the ability to seek waivers more generally and gives states more flexibility regarding ACA requirements.

Despite a bill being released, and pressure to pass something before the July 4th recess (which begins next Friday), the Senate needs 51 votes to pass the measure.  Presently there are 52 Republicans in the Senate, though if 2 vote against the bill - creating a 50/50 split - Vice President Pence gets the deciding vote.  So Republicans need to work to get nearly all Republicans and, are unlikely to bring the bill for a vote until they feel comfortable they have the votes. 

In short, this bill doesn't have any immediate effect and because it differs from the House, there will have to be some reconciliation - if it passes the Senate.  So for most, simply stay tuned.  But also consider talking to your Senators and letting them know how this bill will impact you, your employees, and your company.

Senator Tammy Baldwin: https://www.baldwin.senate.gov/feedback

Senator Ron Johnson: https://www.ronjohnson.senate.gov/public/index.cfm/email-the-senator

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