Recent ACA Developments

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Court Strikes Down Association Health Plan Rule

DOL Rule Called ‘End-Run’ Around Affordable Care Act

A federal judge has ruled that two parts of the Department of Labor (DOL) rule expanding employers’ ability to join in association health plans (AHPs) violate ERISA. AHPs are group health plans sponsored by a group of employers. In June 2018, the DOL issued a rule allowing AHPs to offer coverage to some or all employers in a state, city, county, or multistate metro area, or to businesses in a common trade, industry, line of business, or profession in any area, including nationwide.

The March 28 federal court opinion stated that the rule was an “end-run” around the Affordable Care Act, and that the DOL exceeded its authority when it defined “employer” in the rule to include associations of disparate employers. The court also struck down a part of the DOL rule that expanded memberships in AHPs to working owners without employees.

The court directed the DOL to reconsider how the remaining provisions of the June 2018 rule are affected by the opinion. Further legal and regulatory developments are expected.

Small Businesses May Be Able to Keep Existing Non-ACA Compliant Health Coverage Through 2020

Policies Renewed Under Extended Non-Enforcement Policy Must Comply by January 1, 2021

A previously extended non-enforcement policy which allows health insurance issuers, at their option, to continue group coverage that would otherwise be terminated or cancelled has been further extended to policy years beginning on or before October 1, 2020, provided that all policies come into compliance by January 1, 2021. Health insurance issuers that renew coverage under the extended non-enforcement policy are required to provide standard notices to affected small businesses for each policy year.

Coverage subject to the non-enforcement policy will not be considered to be out of compliance with key Affordable Care Act provisions, including:

  • The requirement to cover a core package of items and services known as essential health benefits;
  • The requirement that any variations in premiums be limited with regard to a particular plan or coverage to age, tobacco use, family size, and geography;
  • The requirements regarding guaranteed availability and renewability of coverage; and
  • The requirements relating to coverage for individuals participating in approved clinical trials.

Click here to review the extended non-enforcement policy.

White House working on secret healthcare plan with three conservative think tanks

The White House is quietly working on a healthcare policy proposal to replace the Affordable Care Act, according to multiple sources with knowledge of the matter.

While it is not clear how far along the process is, work on a proposal has been going on for months. The effort appears to belie criticism that Trump’s decision to restart the debate on healthcare, an issue Democrats used to their advantage in the 2018 midterms, was an error committed without forethought.

“The White House, mainly through the National Economic Council, has been engaged on thinking about health care reform for a while now, and they have been engaged with a group of center-right health policy groups to talk about various proposals and ideas,” a conservative health policy analyst told the WashingtonExaminer.

The analyst said the administration has been “having conversations” on healthcare policy and has reached out to numerous think tanks, including the Heritage Foundation, the Mercatus Center, and the Hoover Institute.

“They’ve had conversations for the last several months and as recently as a few weeks ago,” the analyst said. “Before the president said what he said, they’d been consistently focused on working on a healthcare plan.”

Trump said Tuesday that Republicans would soon become the “party of healthcare.“ The remark was surprising to many, in light of Republicans’ failure to repeal Obamacare the drubbing the GOP took in the midterms. Many Republican lawmakers insist that they won’t act on legislation until Trump comes up with a plan.

Then on Thursday, while speaking to reporters on the South Lawn of the White House, Trump said his administration was “working on a plan now” — though he said there was “no great rush” to roll out a proposal and added that he was waiting for the courts to repeal the ACA.

The president brought up healthcare again on Friday, claiming he would have a “much better” plan than Obamacare. “The health care’s going very well,” he told reporters in Florida.

The White House did not provide a comment, pointing instead to Trump’s statements on Thursday.

Policy leaders at several conservative think tanks confirmed to the Examiner that a healthcare plan is indeed the works. They said a proposal would take concepts from the Graham-Cassidy bill, by Sen. Lindsey Graham, R-S.C. and Sen. Bill Cassidy, R-La., and the Health Care Choices proposal, which was signed by many conservative policy leaders, including the Heritage Foundation and former Sen. Rick Santorum, R-Penn. One analyst said a White House proposal would most likely be brought up in the Senate first.

Heritage Foundation Director of Domestic Policy Studies Marie Fishpaw noted that the president has already included concepts from the Health Care Choices proposal in his 2020 budget.

The proposal, according to Fishpaw, “would lower premiums by up to a third, lowering costs while also protecting people with pre-existing conditions.” It would replace federal payments to insurance companies with grants for each state, giving individual states more leeway to determine how to use the money.

View the full Washington Examiner article here.