Congress to Repeal the “Cadillac Tax”

President Donald Trump announced that he will not continue federal subsidies, known as cost-sharing reduction (CSR) payments, to insurance companies that reduce health care costs for low-income enrollees. Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) announced that they have reached a bipartisan agreement to stabilize the Affordable Care Act (ACA) markets.

The bill, known as the Bipartisan Health Care Stabilization Act, would provide CSR payments for two years and would allow states to obtain Section 1332 waivers through a streamlined approval process. These waivers would not exempt states from:

  • covering the minimum ACA requirements
  • guaranteed renewability of coverage
  • elimination of pre-existing condition restrictions
  • coverage of dependent children to age 26
  • the prohibition on annual and lifetime limits

The Bipartisan Health Care Stabilization Act appears to have the necessary 60 votes in the Senate for passage, but it is unclear whether it will be considered by the full Senate absent support from Trump.

As Congress continues negotiations on the CSR payments, this week the U.S. District Court for the Northern District of California heard arguments for a temporary restraining order that would have forced the Trump administration to keep making the payments while a lawsuit works its way through the courts. On October 25, the court ruled against the emergency order, denying the motion for an injunction. To date, more than 10 million Americans are enrolled in the ACA exchanges, and nearly 6 million people receive the CSR subsidies.

Lastly, Speaker Paul Ryan (R-WI) announced earlier this week that House efforts to repeal and replace the ACA are over for the year.

The ACA continues to be in effect

On Tuesday, September 26, 2017, the Senate acknowledged that the attempt to reform the Affordable Care Act did not have the votes necessary to pass the Senate. This most recent bill was the last attempt, backed by Senate Republican leadership, to pass a partisan measure to partially repeal and replace the Affordable Care Act. Under budget reconciliation, the bill could have passed the Senate with a simple majority vote, which was not the case.

Now that the clock has officially run out for the fiscal year 2017 budget, ACA repeal and replace efforts do not appear to have a path forward in the near future. Republican leadership have indicated that they will move on to other priorities at this time, particularly tax reform. There is still recognition that there is work to be done on the ACA. How they proceed remains up in the air at this time.

The ACA and all its provisions still continue to be the law of the land. This is inclusive of Employer Shared Responsibility provisions.

Compliance will continue to monitor for any developments in Congress.

ACA Update

On June 22, 2017, a draft was released by the Senate Republicans to repeal and replace the Affordable Care Act. The Senate is drafting a new health care bill called the Better Care Reconciliation Act that substitutes the House bill, but still contains similar regulations. The Senate’s bill will have to face another vote before it lands on President Trump’s desk.

The Better Care Reconciliation Act includes changes to Medicaid, subsidy amounts, waiver process for states and the individual mandate. Until the bill is passed, all reporting requirements are still in effect. Employers should still continue to offer minimal essential coverage to their full-time employees who are working on an average of 30 hours per week.

ACA Updates

  • On May 4th, 2017 the House of Representatives approved the bill to repeal and replace major parts of the Affordable Care Act. The bill still needs to be approved by the Senate, which would need to happen through the budget reconciliation process. It is not certain yet whether the Senate would be permitted to pass the American Health Care Act (AHCA) in its current form.
  • Several key provisions were added to or modified such as Pre-existing Conditions, Health Status Underwriting, Essential Health Benefit Requirement for Insured Plans and Age Weighted Underwriting. Employers should become familiar with the AHCA provisions that most directly impact group health plans.
  • Currently, the ACA’s employer information reporting requirements are still in effect until further notice.

 

ACA Updates

  • All 1094 and 1095 forms should have been filed to the IRS at this time. The deadline to file electronically was March 31st 2017.
  • On March 6, 2017, House Republicans announced a bill to partially repeal and replace the Affordable Care Act (ACA). Nothing has yet been passed by Congress or signed into law by President Trump, and it’s uncertain whether the bill will ultimately be passed. The bill drafts are in their initial form and will likely go through significant debate and revision. There is still disagreement among members of Congress as to the details of the bill.

 

Update on President Trump’s ACA plan

President Donald Trump signed an executive order to “Minimize the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal” which is a very broad directive to move to make the regulation easier and less costly on states, individuals, and what is being interpreted as employers. The order calls for change and provides some guidance as to what needs to be changed but does not in fact change anything. The intent is to soften pieces of the ACA until repeal and replacement can be accomplished. In order for a repeal to take place, it will take a coordinated effort with Congress.

Article: Premiums to Skyrocket for Some Obamacare Customers

The price of certain health care plans sold through President Barack Obama’s health care law will be rising by double digits next year, a development that Republicans say shows Obamacare isn’t working.

The Department of Health and Human Services announced Monday that benchmark premiums for plans sold on the federal exchange, Healthcare.gov, are rising by an average of 25 percent next year – more than three times the 7.5 percent rate increase seen last year.

Responding to the hikes, Republican National Committee Chairman Reince Priebus called the law a “full-fledged train wreck which has worsened our health care system” and urged voters to “hold Democrats in Congress who passed this destructive law accountable” by electing Republicans in various races.

Click here to read the full article.

2016 ACA Reporting Deadlines

ACA Information Reporting Forms 2015 Tax Year Deadlines (forms filed in 2016) 2016 Tax Year Deadlines (forms filed in 2017)
Forms 1095-B and 1095-C due to employees (to be postmarked if mailed, or sent by e-mail if applicable conditions met). March 31, 2016 Jan. 31, 2017
Forms 1094-B, 1095-B, 1094-C and 1095-C due to IRS if filing on paper. May 31, 2016 Feb. 28, 2017
Forms 1094-B, 1095-B, 1094-C and 1095-C due to IRS if filing electronically.* June 30, 2016 March 31, 2017
*Any employer filing 250 or more information returns during the calendar year must file these returns electronically. For employers with fewer than 250 returns, electronic filing is voluntary.

All clients on our ACA Reporting Service have forms that are filed electronically.  If you have not started coding with your ACA representative, you need to start doing so now.  There is not much time left to submit your information.

The extended reporting deadlines are not the only relief that’s ending. Due to the phasing-in of the ACA’s shared responsibility mandate—also known as “play or pay”—only organizations with 100 or more full-time or equivalent employees were subject to the shared responsibility mandate in 2015, and they only needed to insure 70 percent of their full-time workers.

Starting in 2016, however, all organizations with 50 or more full-time employees or equivalents must insure 95 percent of their full-time employees to avoid liability under the ACA’s shared responsibility provisions, and the resulting penalties.

ACA Marketplace Notices

Health Insurance Marketplace notices have started to go out. The federally facilitated Health Insurance Marketplaces are informing employers that individuals in their companies have submitted applications for coverage through the Health Insurance Marketplace. The state run Marketplaces have been sending these notices out for some time. The notices state the following: an employee has been determined to be eligible for premium tax credits or cost-sharing reductions to help pay for Marketplace coverage and has enrolled in Marketplace coverage; the employer is receiving the notice because the employer may have to pay an employer shared responsibility payment to the IRS; and the employer has the right to appeal the determination.

The notices will provide information reported by the employee. For example, whether the employee was offered coverage, whether that coverage was affordable and provided minimum value, and / or whether the employee was in a waiting period and couldn’t enroll in coverage. The notice will provide detail about the employee and their eligibility for premium tax credit or cost-sharing reductions to help the employee pay for the coverage.

An employer may file an appeal to the Marketplace if the employer believes a mistake was made when determining the employee’s eligibility for assistance paying for coverage. An employer with 50 or more full-time and full-time equivalent employees is considered an Applicable Large Employer subject to the ACA’s employer shared responsibility penalties. There was transition relief for the 2015 plan year for ALEs who are between 50-99 FTE employees. In order to appeal, the employer must submit the Employer Appeal Request Form available at https://www.healthcare.gov/downloads/marketplace-employer-appeal-form.pdf or by sending a letter that includes the information requested on the form. The appeal must be submitted within 90 days of the date of the Marketplace notice. The appeal should include a copy of the Marketplace notice being appealed, the completed appeal request form (or letter) and any supporting documentation upon which the employer is relying.

The Marketplace determination of an employee’s eligibility for assistance will not determine whether the employer must pay an employer shared responsibility penalty. Only the IRS can determine if an employer owes the penalty under Code Section 4980H. The Marketplaces will report to the IRS who they feel owe an employer shared responsibility payment. The IRS has not yet started sending out penalty notices.

Please remember that the ACA does include a non-retaliation provision. ACA Section 1558 prohibits employers from discriminating or retaliating against an employee because they received assistance with paying for health insurance premiums through the Marketplace.

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