What’s next for ACA repeal and replace?

As Republicans move forward with efforts to repeal and replace the Affordable Care Act, employers are forced to wait on those eventual changes.

“Repealing and replacing the ACA is challenging — the politics, the legislative process for reconciliation and our healthcare system are all complex,” Cheryl Risley Hughes, principal in Mercer’s Washington Resource Group, said Friday during a Mercer webcast discussing the new Trump administration and implications for employers.

In the meantime, employers are wondering how a replacement plan will affect their employees and the bottom line.

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U.S. President-elect Donald Trump, center, greets attendees during an election night party at the Hilton Midtown hotel in New York, U.S., on Wednesday, Nov. 9, 2016. Trump was elected the 45th president of the United States in a repudiation of the political establishment that jolted financial markets and likely will reorder the nation's priorities and fundamentally alter America's relationship with the world. Photographer: Andrew Harrer/Bloomberg

One bill proposed as an ACA replacement, the Patient Freedom Act of 2017, gives states greater control over their insurance options.

The bill, introduced by Sens. Bill Cassidy (R-La.), Susan Collins (R-Maine), Shelley Moore Capito (R-W. Va.) and Johnny Isakson (R-Ga.), offers states one of three options: keep ACA provisions but with less funding, establish a new state market-based alternative, using deposits into Roth HSAs, or reject most of Title I of the ACA, except provisions on annual and lifetime limits and coverage for children to age 26.

The success of this bill relies on establishing a Roth HSA, into which the federal government or states will deposit funds that could be used for purchasing health insurance and cover cost sharing.

See also: Employers urged to continue ACA compliance as no repeal plan emerges

Many of the possible replace-and-repeal bills include expanded availability and uses of account-based plans, continuation of certain ACA consumer protections, health coverage tax credits, a cap on employee tax exclusion for employer-provided coverage, interstate insurance sales, medical liability reform and support for employer wellness programs, according to Mercer.

The Patient Freedom Act of 2017 does not appear to repeal the Cadillac tax, according to Mercer.

Although President Donald Trump is pushing for the repeal and the replacement of the ACA to occur simultaneously, one Mercer executive says it is unlikely.

“Repeal and replace won’t necessarily happen in one fell swoop,” said Geoff Manville, principal in Mercer’s Washington Resource Group. “It will probably be done through a series of more narrowly targeted bills.”

See also: Proposed Form 5500 revisions would have big employer implications

Manville also notes that the president has held off on repealing the ACA’s taxes, which could provide bolstered funding to the repeal and replacement bill.

Beyond the ACA, Trump’s executive orders offer no guidance on the widely unpopular excess tax, nor do they expatriate health coverage, Form 5500 reforms, determining minimum value or affordability issues.

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