About an hour ago, the House of Representatives passed H.R. 1628, the American Health Care Act, by a narrow 217 (Republican) v. 213 (Democratic) votes.
The AHCA is the bill that repeals and/or reforms multiple provisions of the Affordable Care Act (“ACA”), including all of the following:
- “PAY OR PLAY” MANDATE: Repealed as of 1/1/2016.
- ACA REPORTING: partial repeal of Employer reporting requirements for ALEs (IRC 6056 as of 1/1/16), but retains reporting on offer of MEC coverage (IRC 6055).
- INDIVIDUAL MANDATE PENALTY: Repealed and replaced with a 30% surcharge on premiums when individuals experience a break in coverage greater than 63 days within a 12-month period.
- INSURANCE MARKETPLACES/EXCHANGES: Modifies rating methodologies from a 3:1 to a 5:1 ratio; modifies the provision of subsidies to individuals in exchanges as of 1/1/2019.
- MEDICAID EXPANSION: Repeals expansion as of 2020 and grants states discretion ability to establish eligibility criteria for Medicaid eligibility.
- MARKET REFORM CHANGES: Provides state discretion to define essential health benefits as of 1/1/2020 and allows for the creation of high-risk pools for individuals with chronic conditions , prohibits pre-existing condition exclusions.
- REPEALS MYRIAD OF ACA TAXES: PCORI, Health Insurance Tax, Exchange surcharge in small group coverage, medical device manufacturer tax, annual limits on health FSAs, Medicare taxes for high-income earners, etc.
- CADILLAC TAX PLAN: Delayed until 2026.
We are continuing to review the details of H.R.1628 and the impact to our clients. If you have any questions, contact us at 209-847-3065.