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Health plans - policy

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[Opinion] Growth of Underinsurance Now Rampant in Employer-Sponsored Plans
"[P]rotection provided by employer-sponsored plans is rapidly deteriorating, including in the highly touted large group plans. A relatively high percentage of individuals with these plans are finding that they are underinsured. They are experiencing financial barriers to health care and are suffering financial hardship when they must access that care." (Physicians for a National Health Program [PNHP])
New Health Care Bill Would Offer Stability, Respite on Premiums
"The legislation from Republican Sen. Lamar Alexander of Tennessee and Democratic Sen. Patty Murray of Washington ... would send a reassuring message to insurers selling individual health policies ... Consumers who get subsidized coverage ... would benefit, since the bill is expected to deter more insurers from exiting the market. That would maintain access to coverage. But it seems unlikely that the legislation will provide relief from premium increases for 2018, already set in many cases. It does include a rebate mechanism for consumers." (Associated Press, via
[Opinion] Options to Expand Health Insurance Enrollment in the Individual Market
"Options to enhance, increase, or extend tax credits could increase total enrollment in the individual market by 1.0 million to 3.4 million and the insured population by 800,000 to 2.6 million. Adding reinsurance could increase enrollment by 1.2 million to 5.4 million and total coverage by 900,000 to 3.4 million. Costs for these options range from $2.5 billion to $18.8 billion, with those policies producing the biggest coverage gains generally requiring the biggest public investments." (The Commonwealth Fund)
Employee Benefits Cases in the Supreme Court Since ERISA's Enactment
32 pages. "[In] the Court's last 42 terms [since ERISA's 1975 effective date] ... the Court has issued merits opinions in 125 argued cases and one unargued case directly involving employee benefit arrangements including IRAs, and two additional argued cases substantially implicating these arrangements ... for an astonishing total of 128 decisions.... [T]he Court has been concerned with who can bring claims involving employee benefits, what kind of claims can they bring, what kind of remedies can they seek ... and whether State laws implicating employee benefits will be enforced, as frequently as it has considered substantive issues affecting employee benefits." (Eversheds Sutherland)
[Opinion] NASE Applauds Senate Introduction of 'Copper Plan' Health Insurance Legislation
"We applaud this bipartisan group of Senators who understand that greater flexibility in the health insurance marketplace creates access to more affordable care and greater participation. As many small business owners and entrepreneurs continue to face costly health care premiums impeding their ability to secure affordable coverage, the Copper-level plan would help bring relief and guarantee hundreds of thousands more Americans have access to care[.]" (National Association for the Self-Employed [NASE])
Bipartisan Health Proposal Is Too Late for 2018, But a Salve for 2019
"The new bipartisan health proposal ... would send health insurers a message they have sought all year: that it's safe to stay in the marketplaces.... Though the proposal would guarantee payments to health insurers that President Trump canceled last week, and restore funding for Obamacare advertising that [HHS] slashed, those changes would probably come too late to lower insurance prices or increase sign-ups significantly." (The New York Times; subscription may be required)
Back in the Spotlight: The ACA Again Takes Center Stage
"Besides appropriating funds for the CSR program for a two-year period, the new bill would: [1] create a new 'copper' level plan for the Marketplace Exchange, essentially extending the availability of less expensive catastrophic coverage -- which is now available only to adults under age 30 -- to all adults; [2] provide states with greater flexibility to innovate, both in the design of their Medicaid plans and in the ACA health insurance coverage requirements for insurers within a state, streamlining the waiver approval process; and [3] implement rules for states to enter into interstate health insurance compacts for the sale of insurance across state lines." (Ballard Spahr LLP)
State Attorneys General Ask Court for Injunction Reversing CSR Payment Halt
"The motion asks the court to make a decision by 4:00 PM October 19, as the next cost-sharing reduction payment is due on October 20. The plaintiffs ask for a nationwide injunction as the issue it addresses is nationwide in scope.... The states argue that Congress has in fact appropriated funds to cover the cost sharing reduction reimbursement payments.... Congress appropriated in the ACA funds for the premium tax credits and, the states argue, this appropriation covers the CSR payments as well." (Timothy Jost, in Health Affairs)
The Alexander-Murray Market Stabilization Package: What's In It, and Where Is It Going?
"The key component to the deal is stable funding for the cost-sharing reduction (CSR) subsidies ... [Also included] is a loosening of criteria for the section 1332 waiver process under the ACA ... [It] changes the requirement that state proposals be 'as affordable as' ACA coverage would be; it requires only that they have 'comparable affordability.'.... The pending agreement also [1] includes up to $106 million to restore consumer outreach efforts that the Trump Administration had rescinded.... [2] would allow anyone to buy a Copper plan, regardless of age or income level.... [3] authorizes funding for state reinsurance programs ... [4] would compel CMS to generate regulations implementing the section 1333 interstate compact component of the ACA, which so far have not been issued." (Health Affairs)
Trump's ACA Moves Put Focus on Courts
"The administration announced last week that it would immediately stop making monthly cost-sharing reduction (CSR) payments to reimburse insurers for subsidies to low-income individuals who buy ACA exchange coverage.... A number of states quickly responded to the announcement with a lawsuit seeking an injunction to ensure that the payments continue ... The decision also puts new pressure on Congress to appropriate funding for the subsidies." (Mercer)
[Guidance Overview] The Individual Mandate for Health Insurance Coverage: In Brief (PDF)
"This report provides an overview of the individual mandate, its associated penalty, and the exemptions from the mandate. It discusses the ACA reporting requirements designed, in part, to assist individuals in providing evidence of having met the mandate. The report includes some national -- and state -- level data on the application of the mandate's penalty in tax year (TY) 2014 and TY2015." [Report R44438, Oct. 11, 2017] (Congressional Research Service [CRS])
The Effects of Iowa's Proposed Stopgap Measure on Health Insurance Costs and Coverage
"The Iowa Stopgap Measure is likely to lower premiums, decrease the number of uninsured, and decrease average health care spending for most groups on the [ACA-compliant] health insurance market. The Iowa Stopgap Measure is also likely to increase the federal deficit, but the federal cost per enrollee on the ACA-compliant individual market would be lower than under current law.... [E]nrollees with incomes over 200 percent of the federal poverty level on the ACA-compliant market could be at risk of foregoing necessary care, as they lose access to the higher actuarial value gold and platinum plans." (RAND Corporation)
A New Plan to Rescue the ACA: Medicare-at-55
"Under this proposal, Medicare-at-55 would be universal for people in the 55-64 age group and they would leave their current private insurance. It would require an increase in the Medicare payroll tax contribution ... Medicare-at-55 is quite different from proposals suggested by Democrats in 2009 and 2017, which allowed people aged 55-64 to voluntarily buy into Medicare as an alternative to private insurance.... While the 55-64 age group has higher health care costs than younger people, they have lower costs than current Medicare beneficiaries[.]" (Health Affairs)
[Guidance Overview] White House Takes Steps to Modify Healthcare Rules and Stop CSR Funding (PDF)
"While the Executive Order hints at the possible paths the DOL might utilize to expand access to [association health plans (AHPs)], there is a host of unanswered questions ... [including] [1] will the AHP be treated as a 'multiple employer welfare arrangement' (MEWA) ... [2] will sole proprietors be allowed to participate in the AHP ... [3] could individual non-employees be permitted to participate in AHPs; and [4] will DOL utilize its existing authority ... to except certain self-funded plans from state regulation if the AHP is determined to constitute a MEWA.... The Executive Order appears likely to result in the Departments pulling back on their existing guidance related to the use of non-integrated HRAs. Depending on how the HRA is treated under any new guidance, the Departments will need to address a series of related questions[.]" (Groom Law Group)
[Guidance Overview] President Orders Agencies to Consider Rulemaking Targeted at Changed Health Care Landscape
"[A]lthough questions have been raised as to whether a plan sponsored by a group or association acting on behalf of its employer-members constitutes a single employer for purposes of the MEWA definition, the DOL has historically concluded that such plans are not sponsored by a single employer unless part of a control group. The Secretary of Labor is now being asked to revisit that guidance, particularly with a focus on geography and industry." (Michael Best)
[Opinion] Sorry Everybody, But Trump Hasn't Instigated the Obamacare Apocalypse
"The Trump executive order claims to legalize association health plans, but in reality is much more limited. The order allows small businesses -- but not voluntary associations -- to pool together to buy insurance in bulk.... [T]he likely policy impact of this part of the executive order is minimal to zero.... Short-term, limited duration health insurance plans, or STLDIs, used to be an afterthought in the health insurance market.... Trump's executive order simply reverts back to the pre-2016 rules." (Avik Roy, in Forbes)
How Might Trump Health-Care Order Affect Group Plans?
"An obvious step that would help accomplish the president's goals with respect to HRAs would be allowing employers to fund the accounts for the purpose of providing workers with tax-free cash to buy their own health insurance policies. But would employers welcome that change?" (CFO)
A Fateful Thursday for the ACA: Likely Effects and Legal Reactions
"[A]bout ten states instructed their insurers to assume that the CSRs would be paid in setting their 2018 rates.... [In] five states, insurers are loading the cost of the CSR repeal onto all metal levels.... [A]bout half the states have instructed their insurers to load all the increased cost onto the premiums of silver plans.... [A] few states, apparently including the states where CMS directly enforced the ACA, have given no instructions to insurers, allowing each to pursue its own strategy.... Insurers will not be able to simply stop reducing cost sharing. The cost-sharing reductions are clearly required by federal law.... [T]he attorneys general of 18 states and the District of Columbia ... filed on October 13 a separate action in the Northern District of California ... asking the court to enjoin and declare illegal the CSR funding cutoff." (Timothy Jost, in Health Affairs)
[Opinion] Halting ACA Subsidies Hurts Employer Plans, Too
"Employers rely on a healthy and viable individual health insurance marketplace, since an unstable market could result in further cost-shifting from health care providers to large employer plans. Additionally, erosion of the ACA exchanges would make individual market coverage a less viable option for part time workers, early retirees, and those who would otherwise elect to secure coverage through the individual market rather than sign up for, or remain on, COBRA." (American Benefits Council)
[Opinion] Premiums in Obamacare Exchanges Now Up 10% to 20% More After Administration Ends Unlawful Insurance Bailouts/subsidies
"In California, for example, Exchange plans were to increase by 12.5% in 2018, without these additional payments to reduce the cost of Silver plans (the most common Exchange plan, where about 60% of enrollees end up) will go up 25% instead." (Benefit Revolution)
President Trump Nominates Preston Rutledge to be an Assistant Secretary of Labor, Employee Benefits Security Administration
"Mr. Rutledge currently serves as senior tax and benefits counsel on the Majority Tax Staff of the U.S. Senate Finance Committee where his responsibilities include employee benefits, retirement issues, tax-exempt organizations, health tax issues, and the tax provisions of the [ACA]." (The White House)
Administration's Ending of Cost-Sharing Reduction Payments Likely to Roil Individual Markets
"The effect of terminating the payments has been well analyzed, including a report from the Congressional Budget Office. It will drive up premiums as insurers attempt to cover the cost of the reductions. As premiums go up, so will premium tax credits. Indeed, the government will probably pay more in premium tax credits than it saves in cost-sharing reduction payments. Individuals who earn too much to receive tax credits will be particularly hard hit by the premium increases. Some of these could decide to pursue new forms of coverage that might be made available under the measures announced in President Trump's October 12 executive order." (Timothy Jost, in Health Affairs)
[Guidance Overview] Trump Administration Takes Action to Abide by the Law and Constitution, Discontinue CSR Payments
"After a thorough legal review by HHS, Treasury, OMB, and an opinion from the Attorney General, we believe that the last Administration overstepped the legal boundaries drawn by our Constitution. Congress has not appropriated money for CSRs, and we will discontinue these payments immediately." (U.S. Department of Health and Human Services [HHS])
[Opinion] Short-Term Health Plans: Still Bad for Consumers and the Individual Market
"Cost-sharing designs in short-term coverage leave members facing major, unpredictable financial risk.... When considering the deductible, the best-selling plans have out-of-pocket maximums ranging from $7,000 to $20,000 for just three months of coverage. In comparison, the ACA limits out-of-pocket maximums to $7,150 for the entire year." (The Commonwealth Fund)
[Opinion] Actuaries Caution on Potential Risks and Effects of Health Care Executive Order on Consumers, Insurance Markets
"If healthier, lower-cost groups establish [association health plans (AHPs)] that operate under less restrictive regulatory requirements, it could leave higher-cost and less healthy groups in the traditional insurance market, driving up premiums. These adverse consequences could affect the individual market as well if groups are defined to include self-employed individuals. Similarly, short-term plans not subject to ACA requirements could attract lower-cost individuals, driving up premiums for ACA-compliant coverage." (American Academy of Actuaries)
[Guidance Overview] Trump Executive Order Expands Opportunities for Healthier People to Exit ACA
"The fact sheet accompanying the order acknowledges that regulations will proceed through notice and comment rulemaking. This will likely take months. Indeed, rulemaking will likely be proceeded by studies by the affected departments, and any proposed and final rules will likely have to be reviewed by the Office of Management and Budget. Therefore, changes are unlikely to affect plans beginning on January 1 of 2018, although some changes may take effect mid-year." (Timothy Jost, in Health Affairs)
[Official Guidance] Text of Executive Order: 'Promoting Healthcare Choice and Competition Across the United States'
"Within 60 days of the date of this order, the Secretary of Labor shall consider proposing regulations or revising guidance, consistent with law, to expand access to health coverage by allowing more employers to form [association health plans (AHPs)]. [T]he Secretary should consider expanding the conditions that satisfy the commonality-of-interest requirements under current [DOL] advisory opinions interpreting the definition of an 'employer' under section 3(5) of [ERISA] ... The Secretary of Labor should also consider ways to promote AHP formation on the basis of common geography or industry....

"Within 60 days of the date of this order, the Secretaries of the Treasury, Labor, and [HHS] shall consider proposing regulations or revising guidance, consistent with law, to expand the availability of [short-term, limited duration insurance (STLDI)]....

"Within 120 days of the date of this order, the Secretaries of the Treasury, Labor, and [HHS] shall consider proposing regulations or revising guidance, to the extent permitted by law and supported by sound policy, to increase the usability of HRAs, to expand employers' ability to offer HRAs to their employees, and to allow HRAs to be used in conjunction with nongroup coverage....

"The Secretaries shall consider and evaluate public comments on any regulations proposed under ... this order." (The White House)

[Official Guidance] President Takes Action to Improve Access, Increase Choices, and Lower Costs for Healthcare
"The order directs the Secretary of Labor to consider expanding access to Association Health Plans (AHPs), which could potentially allow American employers to form groups across State lines.... The order directs the Departments of the Treasury, Labor, and [HHS] to consider expanding coverage through low cost short-term limited duration insurance (STLDI).... The order directs the Departments of the Treasury, Labor, and [HHS] to consider changes to Health Reimbursement Arrangements (HRAs) so employers can make better use of them for their employees." (The White House)
President Trump's Executive Order Advances GOP Go-To Ideas to Broaden Insurance Choices, Curb Costs
"The Trump administration Thursday advanced a wide-ranging executive order aimed at expanding lower-cost insurance options, allowing employers to give workers money to buy their own coverage and slowing consolidation in the insurance and hospital industries.... President Donald Trump's action, which will not take effect in time to affect the upcoming open enrollment for coverage in 2018, signals a shift in the administration's strategy, which relied on Congress to repeal the [ACA]. Trump is now using the force of his executive rule-making authority to implement long-favored GOP policy alternatives." (Kaiser Health News)
Association Health Plans: Can the Administration Expand Access Without Congress?
"While the Secretary of Labor's powers are not without limit, [ERISA section 514(b)(6)(B)] does appear to be sufficiently robust to enable a class of self-funded association health plans that would be generally immune from state law. Applying current law rules to determine whether a MEWA is ERISA-covered would constrain membership in the class based on the bona fide association and control requirements ... These requirements are also the product of [DOL] guidance, so the [DOL] presumably could enlarge the class of self-funded MEWAs by adopting a more liberal reading of these requirements. This would, however, require the Department to upend decades of guidance[.]" (Mintz Levin)
Report: White House to Nominate EBSA Assistant Secretary
"A published report says the Trump administration is prepared to nominate a new Assistant Secretary for the [DOL]'s Employee Benefits Security Administration (EBSA). Politico Pro says that the much-anticipated nod will go to Preston Rutledge, currently Senior Tax and Benefits Counsel for the Senate Finance Committee under Chairman Orrin Hatch (R-UT) -- a position he has held since 2011." (National Association of Plan Advisors [NAPA])
[Opinion] Can Association Health Plans Accomplish the ACA Repeal Congressional Efforts Could Not?
"[If] the federal government reverses its longstanding approach to AHPs and finds that insurance sold through an association of small employers or individuals is, in effect, a large-group health plan, the AHP would have to comply with far fewer standards.... While each small business and individual would purchase a separate insurance policy, the association sponsoring the health plan would be regulated under the same standards as a large employer." (The Commonwealth Fund)
White House Narrows ACA Contraception Mandate
"HHS officials have stated that, based on the groups that have already filed lawsuits over the provisions, the change will still leave '99.9 percent of women' with access to free birth control through their insurance. Meanwhile women's rights and civil liberties groups are portraying the new rules as a massive discriminatory blow. Regardless, employers that utilize this broadened exemption can expect to be targeted by civil rights and medical rights groups, and should anticipate potential litigation." (Fisher Phillips)
Trump to Sign Order Easing Health Plan Rules
"The order is aimed at expanding insurance options for Americans who buy coverage on their own or work for a small employer ... Mr. Trump will order [HHS, DOL] and Treasury, to take steps to make it easier for people to band together and buy insurance through 'association health plans' ... The president also will order the agencies to start winding back an Obama-era rule curbing ... 'short-term medical insurance' ... [T]he executive order would order agencies to expand health reimbursement accounts[.]" (The Wall Street Journal; subscription may be required)
Overlooked by ACA: Many People Paying Full Price for Insurance 'Getting Slammed'
"[As] of 2017 there were 17.6 million people in the individual market, 5.4 million of whom bought policies outside the health exchanges, where premium help is not available. Combine that with the percentage of people who bought insurance on the exchanges but earned too much ... to get premium subsidies, and the estimate is 7.5 million, or 43 percent of the total individual market purchasers ... And who are these people? 'They're early retirees,' said [Robert Laszewski]. 'They're people working part time who have substantial outside income. They're people who are self-employed of any age, people who are small employers.' " (Kaiser Health News)
House Proposal for Federal Employee Health Program Could Decimate Workers' Benefits
"A proposal to change how the government calculates its contributions to premiums in the federal government's insurance program could make health care all but unaffordable for workers and retirees, employee groups said. The report on the House budget resolution, approved Thursday by a 219-206 vote, includes a provision that advocates changing how the Office of Personnel Management formulates the government's maximum contribution to insurance premiums through the Federal Employees Health Benefits Program." (Government Executive)
[Official Guidance] Text of CMS Bulletin Addressing Enforcement of ACA Section 1303, Coverage of Certain Abortion Services by Qualified Health Plans (PDF)
"Issuers must be able to demonstrate compliance with the following: [1] Issuers may not seek premium tax credit payments for coverage of non-Hyde abortion services. [2] Issuers may not seek reimbursement for CSRs for non-Hyde abortion services. [3] Issuers must provide an annual notice in the summary of benefits and coverage that describes whether non-Hyde abortion services are covered by the QHP. [4] Issuers must charge and collect no less than $1 per enrollee per month for coverage of non-Hyde abortion services, and deposit such amounts collected into a separate allocation account that is used exclusively to cover non-Hyde abortions.... [I]ssuers should provide enrollees with notice stating that a portion of the total premium amount owed is a separate payment for non-Hyde abortion services ... Where we are charged with directly enforcing these statutory requirements in the FFEs, we intend to do so fully, beginning with the 2018 plan year and later years, and call upon States that operate their own Exchanges to do so as well." [Unnumbered document, Oct. 6, 2017] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Trump Administration Set to Roll Back Birth Control Mandate
"Employers claiming an exemption from the contraceptive coverage mandate 'do not need to file notices or certifications' with the government, although they would need to inform employees of changes in coverage. The exemption will be available to for-profit companies, whether they are owned by one family or thousands of shareholders. The Trump administration said the new rules would take effect immediately because 'it would be impracticable and contrary to the public interest to engage in full notice and comment rule-making.' Still, it said, it will accept comments from the public." (The New York Times; subscription may be required)
[Official Guidance] Text of Agency Interim Final Rule and Comment Request: Moral Exemptions and Accommodations for Coverage of Certain Preventive Services Under the ACA
100 pages. "These interim final rules expand exemptions to protect moral convictions for certain entities and individuals whose health plans are subject to a mandate of contraceptive overage through guidance issued pursuant to the [ACA]. These rules do not alter the discretion of the Health Resources and Services Administration, a component of [HHS], to maintain the guidelines requiring contraceptive coverage where no regulatorily recognized objection exists. These rules also provide certain morally objecting entities access to the voluntary 'accommodation' process regarding such coverage....These interim final rules are effective on October 6, 2017.... Written comments on these interim final rules are invited and must be received by December 5, 2017." (U.S. Department of the Treasury, Internal Revenue Service [IRS]; Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; and U.S. Department of Health and Human Services [HHS])
[Official Guidance] Text of Agency Interim Final Rule and Comment Request: Religious Exemptions and Accommodations for Coverage of Certain Preventive Services Under the ACA
163 pages. "These interim final rules expand exemptions to protect religious beliefs for certain entities and individuals whose health plans are subject to a mandate of contraceptive coverage through guidance issued pursuant to the [ACA].... These rules also leave the 'accommodation' process in place as an optional process for certain exempt entities that wish to use it voluntarily.... These interim final rules and temporary regulations are effective on October 6, 2017.... Written comments on these interim final rules are invited and must be received by December 5, 2017." (U.S. Department of the Treasury, Internal Revenue Service [IRS]; Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; and U.S. Department of Health and Human Services [HHS])
Association Health Plans: A Favorite GOP Approach to Coverage Poised for Comeback
"Under association health plans, small businesses can join associations -- based on certain types of professional, trade or interest groups -- that offer insurance to members. Republicans for decades have favored such arrangements, seeing them as a way for small groups to get more clout with insurers.... GOP lawmakers this year tried, but failed, to pass legislation that would create new federally certified associations that could be sold across state lines with reduced state oversight. Even so, these plans have always been controversial." (Kaiser Health News)
ERISA Advisory Council to Meet November 7-8
"[An] open meeting of the Advisory Council on Employee Welfare and Pension Benefit Plans (also known as the ERISA Advisory Council) will be held on November 7-8, 2017.... The purpose of the open meeting on November 7 and the morning of November 8 is for the Advisory Council members to finalize the recommendations they will present to the Secretary. At the November 8 afternoon session, the Council members will receive an update from leadership of [EBSA] and present their recommendations." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
[Opinion] Reducing the Externalities Caused by Limited Benefit Plans
"These plans practice an extreme form of cherry picking that governs both entry and exit. While they may be affordable to the people who buy them, this is largely because they are free-riding on the ACA-compliant market.... The business practices of limited benefit plans create negative externalities in the ACA-compliant market, which make that market smaller and more expensive than it would otherwise be. It seems reasonable to consider some strategies for minimizing these spillover effects. One approach to externalities is regulation." (Health Affairs)
[Opinion] The Health Reform That Hasn't Been Tried: Lowering the Cost of Care
"Republicans have now failed twice to repeal and replace ObamaCare. But their whole focus has been wrong. The debate centered, like ObamaCare, on the number of people with health insurance. A more direct path to broadening access would be to reduce the cost of care. This means creating market conditions long proven to bring down prices while improving quality--empowering consumers to seek value, increasing the supply of care, and stimulating competition." (The Wall Street Journal; subscription required)
[Opinion] Is an Employee's Health Really the Employer's Business?
"In the corporate world, employees have come to expect their employers to sponsor health insurance coverage.... While employer-sponsored health insurance is a valuable talent attraction and retention tool, is the health of employees really the business of companies? ... In efforts to improve employee well-being, ... employers can go wrong when perceived as being too paternalistic, such as when advocating their employees to do certain things." (Talent Economy)
[Opinion] ECFC Letter to House Speaker Paul Ryan on Employee Benefits Provisions in the Unified Framework for Tax Reform (PDF)
"ECFC believes that any cap of the employer exclusion is bad for employees and will result in employers curtailing the maintenance of consumer-directed health accounts, particularly those accounts funded through employee salary deductions through a cafeteria plan.... [T]he enhanced Child Tax Credit could work in concert with the dependent care assistance FSAs to provide assistance in financing child care expenses for all working Americans.... While delay of the effective date of the Cadillac Tax is helpful in the short run, delay will only slow the trend of employers eliminating or curtailing employee contributions to FSA and HSA; only complete repeal of the Cadillac Tax or the exemption of employee contributions from the calculation of the tax will stop this trend." (Employers Council on Flexible Compensation [ECFC])
Tax Reform Might Not Spare Employee Benefits
"The Republican framework for tax reform that the White House unveiled last week does not propose specific changes to how employer-sponsored benefit plans are taxed, but that doesn't mean Congress won't choose to do so when it crafts legislation.... While eliminating current deductions to offset lower tax rates could prove tempting to Congress, there also may be opportunities to improve the tax treatment of some employee benefits[.]" (Society for Human Resource Management [SHRM])
Ninth Circuit Faults Retiree Plan's Disclosure of Lifetime Maximum
"The ACA's detailed amendments to the Public Health Service Act (PHSA) included a prohibition on group health plans or their insurers setting lifetime limits on benefits for any participant or beneficiary.... [A] blanket provision [stated] that the amended PHSA provisions would apply to ERISA group health plans 'as if included in this subpart.' This part of ERISA (Part 7) includes an exception for certain plans with fewer than two active employees. However, King argued that the ACA superseded this provision, especially since it eliminated a similar PHSA provision for certain retiree-only plans. The court ruled that the ACA ban did not apply to retiree plans ... Any inconsistency that was created between PHSA and ERISA is not so drastic that plans cannot comply with both, [the judge wrote]." [King v. Blue Cross and Blue Shield of Ill., No. 15-55880 (9th Cir. Sept. 8, 2017)] (HR Daily Advisor)
[Guidance Overview] CRS Report: Resources for Frequently Asked Questions about the Affordable Care Act (PDF)
35 pages. "This report provides resources to help congressional staff respond to constituents' frequently asked questions about the law. The report lists selected resources regarding consumers, employers, and other stakeholders, with a focus on federal sources. It also lists CRS reports that summarize the ACA's provisions." [Report R43215, updated Sept. 28, 2017] (Congressional Research Service [CRS])
Selection in Health Insurance Markets and Its Policy Remedies
"[The authors] review the theory and evidence concerning selection in competitive health insurance markets and discuss the common policy tools used to address the problems it creates." (National Bureau of Economic Research [NBER])
A Majority of Companies Now Like the ACA
"Only about one-third of 300 health benefits professionals surveyed by Mercer in mid-September said they favor a full repeal and replacement ... 95% of participants said they favored simplifying the required shared-responsibility reporting. Additionally, concern over the 40% excise tax on high-cost health plans, currently slated to take effect in 2020, remains rampant." (CFO)
[Opinion] Failure to Approve Oklahoma Waiver Undermines Trust Between HHS and States
"By failing to follow through on repeated assurances to Oklahoma that its 1332 reinsurance waiver would be approved on an expedited timeline, the federal government dealt a devastating blow to Oklahoma consumers and magnified suspicions that [HHS] is more interested in undermining the [ACA] than partnering with the states to stabilize the individual market for the nearly 20 million Americans who depend on that market for their health security." (Health Affairs)
Potential Impacts of Uncertainty Regarding ACA Cost-Sharing Reduction Payments (PDF)
"The continuation of CSR payments has come into question, and insurers warn that they may leave the market or raise premiums without a commitment to sustained funding. To understand the concern about funding CSR payments, it is important to understand the context in which CSRs are provided, beginning with insurance premiums." (Congressional Research Service [CRS])
[Opinion] Stabilizing and Strengthening ACA Nongroup Markets (PDF)
"[T]argeted policies could fix the ACA's problems without sacrificing its gains in coverage, affordability, and access to care. These policies would stabilize the nongroup insurance markets, encourage insurer participation, improve affordability, and rein in premium growth. [The authors] divide these policies into two categories: those that should be implemented immediately to stabilize the markets and those that would strengthen the ACA for the long term." (Urban Institute)
CMS Did Not Provide Effective Oversight to Ensure That State Marketplaces Always Properly Determined Individuals' Eligibility for Qualified Health Plans and Insurance Affordability Programs
"Although CMS provided oversight and technical assistance, it did not ensure for the 2014 through 2016 coverage years that all State marketplaces [1] had the system functionality to verify individuals' eligibility for QHPs and insurance affordability programs and resolve inconsistencies in eligibility data according to Federal requirements and [2] had or used the system functionality to perform the process for determining ineligibility for individuals who had not filed a tax return to reconcile the premium tax credit. Further, CMS did not ensure that all of the marketplaces completed required independent audits." (Office of Inspector General [OIG], U.S. Department of Health and Human Services [HHS])
The Health Reform That Employers Would Like to See
"Just 35% of all respondents say they favor repeal and replace, with 51% opposed and 14% expressing no opinion. Respondents from smaller organizations (fewer than 500 employees) were more likely to favor repeal and replace (59%).... 95% said they would favor simplified ACA employer shared responsibility reporting rules ... More than 9 out of 10 respondents (92%) favor permitting higher contributions to health spending accounts, and nearly as many (87%) would like to allow contributions up to the level of the out-of-pocket maximum." (Mercer)
Obamacare Repeal Isn't Dead as Long as Republicans Control Congress
"The last few bills Republicans have tried, and failed, to pass were wildly unpopular, rejected by health care groups and scored poorly by the Congressional Budget Office. Still, the party believes that it must make good on its seven-year promise to repeal the law. Republican voters say it's a priority, and donors do too." (Vox)
Trump Plans to Issue Executive Order Allowing Interstate Sale of Health Insurance
"In remarks to reporters on Wednesday, Trump said he is preparing to issue an executive order that would allow people to cross state lines in order to 'buy their own healthcare.' ... The idea, [Sen. Rand Paul (R-KY)] said, would be to modify [ERISA] by expanding the definition of who can form 'associations.' Corporations that operate in multiple states are already allowed to purchase insurance across state lines under ERISA, and Trump could authorize individuals to do the same." (FierceHealthcare)
Supreme Court May Have First ERISA-Free Term in Six Years
"The last time the Supreme Court went a full year without hearing an ERISA case was the 2011-2012 term. Although another ERISA-free term may be in the cards, a handful of pending petitions raise questions that could pique the justices' interest." (Bloomberg BNA)
[Opinion] Actuaries Continue to Urge Stabilization Measures for the Individual Health Insurance Market
"The Academy's Health Practice Council urges policymakers and regulators to focus on the following actions that would help stabilize the health insurance market: [1] Permanently fund cost-sharing reduction (CSR) reimbursements; [2] Enforce the individual mandate; [3] Support enrollment outreach and education; [4] Provide external stability funding; and [5] Avoid legislative and regulatory actions that increase market uncertainties." (American Academy of Actuaries)

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