Monday, January 11, 2016

Why the Latest ACA Repeal Attempt Actually Means Something

On Friday, President Obama vetoed the bill that would repeal significant parts of the ACA and defund Planned Parenthood for a year. On its face this just seems like another pointless repeal attempt by the GOP, (as they have tallied over 50 attempts at this point). However, this one needs to have an asterisk beside it.

The reason this one is different is because it actually made it to President Obama's desk to get vetoed.  Why that means something is because most prognosticators believe that Republicans will keep the House and the Senate in the 2016 election so only the White House is really up for grabs.  While Republicans probably won’t have a veto-proof majority in 2017 (just like they don’t now), this proves they don’t need one to get at least a version of repeal to the president’s desk.  So if the president in 2017 is Trump, Rubio, Cruz, Bush (insert name here), then they have proven they will be able to get a bill to repeal significant portions of the law through budget reconciliation to their desk.

If you aren’t familiar with budget reconciliation or the politics of the situation the below article does a good job explaining it. In summary, it only requires majority approval in the Senate, and it allows the majority to avoid a filibuster to get it through. Interestingly enough, budget reconciliation was actually the same way the Democrats were able to get the ACA through when it was originally signed into law back in 2010.
When Paul Ryan was asked why there was no alternative to the ACA provided with this bill, his answer was "Just wait".  He now has his committee chairmen working on an alternative option.  This was just a dress rehearsal, and it was successful for the GOP. They are hoping for a final performance in early 2017 that would be a huge blow to the ACA as we know it today.  

Monday, December 28, 2015

IRS Delays 6055 & 6056 Reporting Deadlines

On Monday the IRS released notice 2016-4 announcing that it is giving employers additional time to file forms associated with sections 6055 and 6056 of the Affordable Care Act.
The deadline for employers to electronically file the forms for 2015 which provide coverage information to the IRS was extended to June 30 from March 31, while non-electronic form reporting was delayed to May 31, 2016 from Feb. 29.
In addition, the deadline for furnishing employees with 1095-C coverage forms for 2015 was extended to March 31 from Feb. 1.
The IRS said in the notice that employers needed “additional time to adapt and implement systems to gather, analyze and report this information.”
This delay will be welcomed by employers and their filing partners across the country.
To read the notice in its entirety click here.

Monday, December 21, 2015

Key ACA Delays Included in Budget Deal

On Friday the U.S. Senate passed a $1.1 trillion omnibus spending bill and a $650 million tax break package that includes three key delays/moratoriums of taxes and fees associated with the Affordable Care Act.

The most noteworthy of the delays was  two year delay of the 40% excise tax on high-cost plans, commonly known as the Cadillac Tax. The Cadillac Tax, which would be imposed on the portion of group health plan premiums that exceed $10,200 for single coverage and $27,500 for family coverage was set to go into effect in 2018.  This delay postpones the much maligned tax to 2020. The bill also made any amounts paid as a result of the tax, tax deductible.

While the delay is a win for employers, the threat of the tax still looms large and many industry experts don't expect the delay to result in a significant change of course for companies planning to make benefit design changes and tweaks to stay below the tax.

According to the bipartisan nonprofit Committee for a Responsible Federal Budget, delaying the Cadillac tax until 2020 will cost the government $16 billion.

Another welcomed piece of the tax break package was a 2 year moratorium on the medical device excise tax. This tax is a 2.3 percent excise tax that manufacturers and importers must pay on sales of certain medical devices beginning Jan. 1, 2013.  Opponents of the tax argued that it was a hindrance to innovation and research and had a particular negative impact on smaller start up companies that typically have very thin margins in early years of operation.

The delay is estimated to subtract $3.4 billion from the federal budget between 2016 and 2017.

The final delay/moratorium was on the health insurer fee.  The health insurer fee is a tax on health insurance that insurance companies pay on their fully insured blocks of business. The amount of the tax was $8 billion in 2014 and increased by 41 percent for 2015. The tax is scheduled to total more than $145 billion over the next ten years. 

It's estimated that this tax had between  a 3% and 4% impact on fully insured policies over the last two years. Insurance companies will now not have to pay this fee for 2017.

Monday, October 5, 2015

Senate Passes ACA Small Group Market Rule Repeal

On Oct. 1, 2015, the U.S. Senate passed legislation repealing the Affordable Care Act (ACA) requirement that the small group market in every state be expanded to include businesses with 51-100 employees.  
The Protecting Affordable Coverage for Employees (PACE) Act was passed by the U.S. House of Representatives earlier in the week. It has been reported that President Obama will sign the Act into law, although some sources previously indicated that he might veto it.

Small Group Market Expansion

Most states have historically defined “small employers” as those with 50 or fewer employees for purposes of defining their small group health insurance market.
Effective for 2016 plan years, the ACA expanded the definition of a “small employer” to include those that employed an average of between one and 100 employees.

The PACE Act eliminates the ACA’s new definition and gives states the option of expanding their small group markets to include businesses with up to 100 employees.
Impact on Employers

The expansion of the small group market was expected to have a significant effect on mid-size businesses. These businesses would have been required to buy coverage for employees in the small group market, which is more heavily regulated than the large group market.
This change was expected to increase premiums costs for employers and employees and reduce flexibility in plan design due to added small group market requirements.

Some states have already amended their state laws to adopt the expanded small group market definition. These states will have to take action to undo those changes.
Most states are taking already taking advantage of a transition rule provided by the Dept. of Health and Human Services (HHS). HHS has said it will not enforce small group market regulations for mid-size businesses if their policies are renewed by Oct. 1, 2016.

This means that many employers have already been able to delay moving from the large group to the small group market. The PACE Act will make this relief permanent.


Final 2015 forms for 6055 & 6056 reporting

The IRS has issued final 2015 forms for 1094-B, 1095-B, 1094-C and 1095-C for the 6055 & 6056 reporting due in the first quarter of 2016.

Form 1094-B,Transmittal of Health Coverage Information Return:

Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Return:

Form 1095-B, Health Coverage:

Form 1095-C, Employer Provided Health Insurance Offer and Coverage: 

Thursday, June 25, 2015

Supreme Court Verdict: Subsidies Through Federal Exchanges Will Stand

On Thursday morning the Supreme Court ruled in a 6-3 decision that subsidies provided to individuals through a Federal exchange would stand. This is a win for the Obama administration who felt that the case never should have made it to this point. Earlier this month after the G7 Summit in Krun, Germany the President stated the following:

"And so this should be an easy case. Frankly, it probably shouldn’t even have been taken up. And since we’re going to get a ruling pretty quick, I think it’s important for us to go ahead and assume that the Supreme Court is going to do what most legal scholars who’ve looked at this would expect them to do."

This morning the president got his wish, with only the most conservative members of the court  - Justices Scalia, Thomas and Alito - dissenting from the majority ruling.  Chief Justice Roberts penned the majority opinion which can be accessed by clicking here.

In the opinion the Chief Justice acknowledges that the wording is ambiguous, however states:

"the statutory scheme compels us to reject petitioners' interpretation because it would destabilize the individual insurance market in any state with a federal exchange, and likely create the very 'death spirals' that Congress designed the act to avoid,"

In his dissenting opinion Justice Scalia made his position quite clear:

"Under all the usual rules of interpretation... the government should lose this case," Scalia writes. "But normal rules of interpretation seem always to yield to the overriding principle of the present court: The Affordable Care Act must be saved."

So now, after the years of drama and waiting there will be no change to the structure and administration of the ACA subsidies.  This is good news to the nearly 6.4 million Americans that are currently receiving subsidies in the 34 exchanges being administered by the Federal government. The Kaiser Family Foundation estimates that there were $1,737,476,989  of monthly subsidy dollars at risk.

From an employer perspective it will continue to be business as usual. PCORI fees and Transitional Reinsurance fees will be due later this year and the new reporting requirements under sections 6055 & 6056 of the law have companies scrambling to find a solution to comply in the first quarter of 2016.

With the ruling now in the rear view mirror, the republican congress will likely now attempt to challenge specific aspects of the law, such as the medical device excise tax, 30-hour threshold for full-time employees and the Cadillac tax to name a few.

Greg Stancil is the Director of Healthcare Reform for Scott Insurance

Thursday, June 18, 2015

IRS releases draft of 2015 forms for 6055-6056 reporting

Fortunately for employers and vendors who have already started gathering data for the 2015 reporting there are very few changes to the forms.

The main forms that will be utilized by employers are the 1094-C and 1095-C forms. The 1094-C is unchanged and the 1095-C just has one additional voluntary field.  

A link to the forms is provided below:

Form 1094-B,Transmittal of Health Coverage Information Return: 

Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Return:

Form 1095-A, Health Insurance Marketplace Statement:

Form 1095-B, Health Coverage:

 Form 1095-C, Employer Provided Health Insurance Offer and Coverage: