The latest version of the Senate Republican healthcare bill contains some significant changes, but provisions impacting employer-sponsored plans remained largely untouched.
The plan, unveiled on Thursday, retains a number of important changes for employers that were included in an earlier draft of the legislation made public last month. GOP lawmakers have been working for months on an effort to undo large swaths of the Affordable Care Act.
“Generally, the changes that were applied didn’t significantly change the dynamics of the Senate bill as it relates to large employers,” says Michael Thompson, president and chief executive of the National Alliance of Healthcare Purchaser Coalitions, a nonprofit network of business health coalitions.
Employer groups have been supportive of several major provisions highlighted in the earlier version of the Better Care Reconciliation Act that remain in the new proposal. Those include measures to remove the penalties associated with the employer mandate and a delay to the Cadillac tax for high-cost plans.
The latest Senate bill also retains important changes to health savings accounts that, for example, allow employees to allocate more funds into the accounts and that permit the money to be used on over-the-counter medications. It also reduces the penalty associated with redrawing funds from the account for non-qualified medical spending.
Providing more flexibility around the use of HSAs — tax-advantaged accounts that accompany high-deductible health plans — benefits employers and employees alike, says Chatrane Birbal, senior adviser for government relations at the Society for Human Resource Management.
“As healthcare costs arise, more employers are embracing high-deductible plans and this is a good way for employees to plan ahead for their medical expenses,” she says.
There is one small fix related to health savings accounts that made it into the revised draft, explains James Gelfand, senior vice president of health policy for the ERISA Industry Committee.
The updated language now permits out-of-pocket medical expenses for adult children up to 26-years-old who remain on a parent’s health plan to be paid for out of the primary account holder’s HSA. There were previously limitations on use of those funds for those over 18 who remained on a parent’s plan, based on Internal Revenue Service guidelines.
“One of the little tweaks they’ve put in to improve the bill is changing the IRS code to say, actually, yes, an adult dependent still counts and can use an HSA to help save on their healthcare costs,” he says.
Experts note, however, that a key change in the new bill related to HSAs — the ability to use the pre-tax money to pay insurance premiums — does not appear to apply to employer-based plans.
There are several other provisions in the revised legislation that are likely to be debated by the Senate in coming weeks, but that do not directly impact employers.
One controversial measure, developed by Republican Sens. Ted Cruz of Texas and Mike Lee of Utah, would allow insurers to offer lower priced, non-ACA-qualified plans in the individual market in addition to plans that meet Obamacare requirements. The latest bill also would provide more funding for the opioid epidemic.
Sen. Lindsey Graham, R-S.C. and Sen. Bill Cassidy, R-La., meanwhile, announced this week that they are developing an alternative proposal to the one unveiled by Republican leaders. Initial details for the alternative proposal were released on Thursday. The legislation is centered on a strategy to send more federal funding directly to the states through block grants.
“Instead of having a one-size-fits-all solution from Washington, we should return dollars back to the states to address each individual state’s healthcare needs,” Graham said in a statement on Thursday.
Those representing employer-based plans said they have reservations about the Graham and Cassidy proposal.
Gelfand notes that the alternative plan is expected to keep in place many of the taxes stemming from the ACA, such as the Cadillac tax and a tax on branded prescription drugs, and is unlikely to contain some of the BCRA revisions around the use of HSAs.
“It basically provides none of the relief that the BCRA would provide,” he says.
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