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ACA Repeal Bill Nixed: What Is Next for Healthcare Reform, Employers?

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The Republicans' best attempt to repeal the Affordable Care Act (ACA) to date has been axed. Where does that leave employers and what can they expect next?

For starters, it leaves employers with the ACA and everything that comes with it: the employer mandate, the reporting requirements; everything. In other words, any organizations that relaxed their ACA compliance efforts — believing the Republican's American Health Care Act would repeal and replace the ACA — could be exposing themselves to non-compliance penalties.

The more complicated question is: What happens next?

A piecemeal approach?

With this appearing to be the GOP's best shot at repealing and replacing the ACA (or at least parts of it) in one stroke, and the party failing to push its legislation through Congress, President Trump and House Speaker Paul Ryan (R-WI) appear resigned to the fact that the ACA will remain in place indefinitely.

"We're going to be living with Obamacare for the foreseeable future," Ryan said after announcing the GOP bill would not be voted on in the House.

Trump has even indicated that after this loss for the GOP, he wants the party to focus on other issues, like tax reform.

But that does not mean health reform will be on the back burner. It now appears that Republicans' best course of action to implement reform changes would be to attempt to "fix" parts of the ACA that are deemed not working. And it could do that by including small healthcare provisions in other pieces of legislation, like future tax reform bills.

President Trump and his fellow Republicans could also seek to offer concessions to Democrats in future legislation as a means to get members of the Left to agree to include certain provisions of the American Health Care Act in future bills.

For example, Republicans are still expected to push hard for a rollback of the ACA's expansion of Medicaid and members of the GOP could seek to include rollback provisions in future tax reform legislation in exchange for proposing a tax reform plan Democrats would find more palatable.

How did we get here?

So why did the American Health Care Act fail, despite Republicans controlling the House, Senate and White House? The answer starts with the fact that the GOP did not have the 60 seats in the Senate to avoid a filibuster by the Democrats. In other words, despite being the majority party, it did not have enough votes to pass a broad ACA repeal bill outright.

As a result, Senate Republicans had to use a process known as reconciliation to attempt to reshape the ACA. Reconciliation is a process that allows for the passage of budget bills with 51 votes instead of 60, meaning Republicans could vote on budgetary pieces of the health law without giving the Democrats a chance to filibuster.

The problem for Republicans was reconciliation severely limited the extent to which they could reshape the law — and it is a big reason the why American Health Care Act looked, at least to some, like "Obamacare Lite." Ultimately, what caused President Trump and Speaker Ryan to pull the bill before the House had a chance to vote on it was that so many House Republicans voiced displeasure with the bill and said they would not vote for it.

Specifically, here are some of what conservatives did not like about the American Health Care Act:

  • it largely left a lot of the ACA's "entitlements" intact — like government aid for purchasing insurance
  • it did not do enough to curtail the ACA's expansion of Medicaid
  • too many of the ACA's insurance coverage mandates would remain in place
  • the Congressional Budget Office estimated that the bill would result in some 24 million Americans losing insurance within the next decade, and
  • it did not do enough to drive down the cost of insurance coverage in general.

Posted In: Congressional Activity; Affordable Care Act (ACA); Executive Branch

Want to know more? Read the full article by Christian Schappel at HR Morning

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