In recent weeks, the Trump Administration has been considering allowing health insurance to be purchased across state lines and expanding access to “Association Health Plans” (AHPs) that could take economic advantage of...more
At this writing, the prospects for success of the latest Republican effort to replace the Affordable Care Act appear bleak — but the Graham-Cassidy bill on which the GOP has pinned its last-ditch hopes highlights a major...more
9/25/2017
/ 1332 Waiver ,
Actuaries ,
Affordable Care Act ,
Block Grants ,
Cost-Sharing ,
EHB ,
Federal v State Law Application ,
Health Insurance ,
Healthcare Reform ,
Insurance Risk Pool ,
Medicaid ,
Medicare ,
Premiums ,
Public Health Insurance Marketplace ,
Repeal
With its “employer mandate”—i.e., the requirement that applicable large employers make an offer of group health coverage to substantially all full-time employees or face the prospect of a penalty—the Affordable Care Act (ACA)...more
6/15/2017
/ Affordable Care Act ,
Captive Insurance Company ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Employer Mandates ,
Health Insurance ,
IRS ,
Large Employer ,
Medical Stop-Loss Rules ,
MEWAs ,
Self-Funded Health Plans
Senate Majority Leader Mitch McConnell recently gave a candid assessment of the chances of getting an Affordable Care Act (ACA) replacement bill through the Senate, saying “I don’t know how we get to 50 (votes) at the...more
6/8/2017
/ Affordable Care Act ,
American Health Care Act (AHCA) ,
Congressional Budget Office ,
Employer Mandates ,
Essential Health Benefits ,
Health Insurance ,
High Risk Pools ,
Individual Mandate ,
Legislative Agendas ,
Medicaid ,
Medicaid Expansion ,
Medicare ,
Proposed Legislation ,
Tax Credits ,
Trump Administration
The stunning failure of the U.S. House of Representatives to pass the American Health Care Act (AHCA) (which we previously reported on here) has political and policy implications that we cannot forecast. Nor it is it clear to...more
3/28/2017
/ Affordable Care Act ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Health Insurance ,
Large Employer ,
Legislative Agendas ,
Medicaid ,
Medicaid Expansion ,
Preemption ,
Proposed Legislation ,
Repeal ,
State Health Plans ,
Trump Administration
On March 6, 2017, after years of promising, GOP lawmakers in the House of Representatives introduced the “American Health Care Act” (AHCA), the first concrete legislative proposal detailing the initial provisions designed to...more
3/22/2017
/ Affordable Care Act ,
Cadillac Tax ,
Congressional Budget Act of 1974 ,
Dependent Coverage ,
Employer Mandates ,
Flexible Spending Accounts ,
Health Insurance ,
Health Savings Accounts ,
Individual Mandate ,
Medicaid Expansion ,
Medical Device Tax ,
Medicare Part D ,
Minimum Essential Coverage ,
Over-the-Counter Sales ,
Premium Subsidies ,
Prescription Drugs ,
Proposed Legislation ,
Repeal ,
Small Business ,
Tax Credits
A recent report from the nation’s top actuaries takes a sobering look at the challenges policy makers face in creating a viable individual (i.e., non-group) health insurance market—a critical component of any plan to replace...more
On January 25, the Seventh Circuit Court of Appeals issued it much-anticipated decision in EEOC v. Flambeau, Inc. This case involved the regulation of employer-sponsored wellness plans and programs. Since 2006, the rules...more
This week continues our survey of key Republican proposals to “repeal and replace” the Affordable Care Act (ACA). In the past two weeks, we have reviewed the Trump/Pence transition plan, entitled “Healthcare Reform to Make...more
The recent Republican election victories appear to ensure that the Affordable Care Act’s (ACA) days are numbered. But with nearly a fifth of the U.S. economy, and the health care coverage for some tens of millions of U.S....more
12/29/2016
/ Affordable Care Act ,
Employee Retirement Income Security Act (ERISA) ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Health Savings Accounts ,
Healthcare ,
Healthcare Reform ,
HSA ,
Medical Stop-Loss Rules ,
Medicare ,
MEWAs ,
Wellness Programs
The Trump campaign promised to “repeal and replace” the Affordable Care Act. On the campaign trail, candidate Trump was particularly critical of the ACA’s individual mandate, the subsidization of premium charges to older...more
The Affordable Care Act made fundamental and important changes to the way the United States finances health care. The law did not represent a radical departure from prior law or policy, however. The ACA instead worked within,...more
The Affordable Care Act was—at least until the election of Donald J. Trump as President—the single most important piece of Federal social legislation in the United States in more than a generation. The law’s fate is now...more
Employer-sponsored group health plans and health insurance issuers (or carriers) are subject to information reporting requirements under the Affordable Care Act (ACA), including the obligation to report taxpayer...more
We reported in a recent post on proposed regulations dealing with, among other things, the treatment of hospital indemnity or other fixed indemnity insurance products in the group market. This post takes a closer look at the...more
8/27/2016
/ Affordable Care Act ,
Department of Health and Human Services (HHS) ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Health and Welfare Plans ,
Health Insurance ,
Hospitals ,
Indemnity ,
Minimum Essential Coverage ,
NAIC ,
Supplemental Insurance
On June 10, the Departments of Treasury, Labor, and Health and Human Services (The “Departments”) issued a set of proposed regulations dealing with expatriate health plans, excepted benefits, lifetime and annual limits, and...more
For the last half of 2015, we spent a good deal of time explaining the Affordable Care Act reporting requirements that applied to carriers and large employers. This post examines the how of ACA reporting. In particular, it...more
In Q&A format, recently issued Notice 2015-87 addresses a number of pressing issues that have arisen under the Affordable Care Act (ACA), including that law’s employer shared responsibility rules, information reporting...more
Issued at the end of last year, Notice 2015-87 provided detailed guidance on a host of topics. The notice has been referred to colloquially in some quarters as the “pot luck” notice. Among other things, the notice, in Q&A 4,...more
This post concludes our half-year series of posts focusing on the Affordable Care Act’s reporting requirements. These requirements are challenging in the extreme. Carriers and employers, and their vendors, service providers...more
Under the Affordable Care Act’s reporting requirements that have been the subject of this series, statements to responsible individuals (a/k/a “employees”)—i.e., Forms 1095-B and 1095-C—must be furnished on or before January...more
The Treasury Department and the IRS this week issued Notice 2015-87 that addresses, among other things, the effect of Health Reimbursement Account (HRA) contributions, cafeteria plan flex credits and opt-out payments on...more
It took a while, but most employers and their advisors have finally gotten the hang of the Affordable Care Act’s employer shared responsibility rules. That is, they understand generally that:
1. “Applicable Large...more
Affordability—i.e., whether health coverage is “affordable”—occupies an important place in the Affordable Care Act’s (ACA) regulatory scheme. Under that law’s individual mandate, no penalties are imposed for failure to...more
Last week we examined the reporting challenges associated with employee terminations, changes in status, and breaks in service under the monthly measurement method. As we explained, “[t]he final regulations under Code § 4980H...more