Last week, in a 217-213 vote, the GOP won a narrow victory in their fight to repeal and replace the Affordable Care Act with the American Health Care Act (ACHA). A major success for Republicans even though all voting Democrats and a group of moderate Republicans voted “no”. The bill is now headed to the Senate, where it is expected to face major changes before heading back to the House for another vote.

More about the GOP bill

Among other things, the GOP health bill (ACHA) would:

• Repeal all of the ACA’s tax provisions except a 0.9 percent Medicare surtax on high-income earners that will remain until 2022.
• Eliminate the fines the Affordable Care Act imposed on those who don't buy coverage but allow issuers to add a 30% late-enrollment surcharge for certain lapses in coverage.
• Repeal the ACA’s Medicaid expansion and make changes to the existing program. As one example, the AHCA would provide enhanced federal payments to states that already expanded their Medicaid programs and transition Medicaid’s financing to a “per capita allotment” in 2020.
• Give states option to impose work requirements on Medicaid recipients who are nondisabled, nonelderly or non-pregnant adults.
• Replace the ACA’s subsidies with a portable, monthly tax credit for all individuals that could be used to purchase individual health insurance coverage.
• Block federal payments to Planned Parenthood for a year.
• Increase the maximum HSA contribution limit and other enhancements.
• The employer shared responsibility mandate (the requirement that applicable large employers offer health coverage to their full-time employees or pay a penalty) would be effectively eliminated — retroactive to the start of 2016.

Which ACA provisions are expected to survive the overhaul?

The American Health Care Act is limited to addressing ACA provisions that directly relate to budgetary issues (mostly federal spending and taxation). So, yes, if passed, a number of provisions will survive the overhaul, including:

• Coverage for adult children up to age 26
• Guaranteed availability and renewability of coverage
• Nondiscrimination rules (on the basis of race, nationality, disability, age or sex)
• Prohibition on health status underwriting
• Cost sharing limits on essential health benefits (EHBs) for non-grandfathered plans
• Prohibition on lifetime and annual limits for EHBs
• Requirements to cover pre-existing conditions

The healthcare overhaul still has a ways to go before becoming law. Stay tuned for updates as this unfolds in Washington. Unless it is passed by the Senate and signed by President Trump, the ACA will remain intact.

What should employers do in the meantime?

For the time being, the ACA remains the law, and employers must continue to comply with it. Human resource directors must continue to track employees' hours and coverage offers carefully, keeping in mind that this will be essential even if the ACHA is passed.

Our Healthcare Services Team can help you understand the implications of this bill—contact us.