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On June 22, the Senate released its initial discussion draft health care bill titled "Better Care Reconciliation Act" (BCRA), which was revised on July 13. This Senate bill is a substitute amendment to the House- passed H.R. 1628, the American Health Care Act that was created under the budget reconciliation process and therefore, amends only the tax provisions of the ACA. This draft bill will change during negotiations before the Senate is expected to vote on the measure.
The employer provisions included in the Senate bill are similar to H.R. 1628, which passed the House on May 4.
As of July 13, 2017 the following are key issues of interest to the HR profession and the workplace, which are included in the draft Better Care Reconciliation Act:
This bill does not change the requirement that insurance carriers offer coverage to individuals with pre-existing conditions. In addition, other existing ACA insurance standards like providing coverage for adult children up to age 26, guaranteed renewability, no discrimination based on gender and community rating requirements, except as permitted by waiver, would remain the law. The legislation does not eliminate the employer reporting requirements under the ACA.
Outlook: The fate of the bill remains uncertain. Senate Majority Leader Mitch McConnell (R-Ky.) delayed a vote planned for the week of July 17 following the disclosure of Senator McCain's medical procedure, which leaves the GOP short of support to advance the bill. In addition, Republican senators Susan Collins (Maine), Rand Paul (Kentucky), Mike Lee (Utah) and Jerry Moran (Kansas) have announced their opposition to the new version of the bill.
In response, Senate Majority Leader McConnell suggested a new proposal to hold a procedural vote the week of July 24 on the House-passed health care bill, the American Health Care Act. If that procedural vote is adopted, an amendment will be introduced to revive a 2015 Reconciliation bill, which proposed to repeal the ACA tax provisions. The 2015 Reconciliation bill was passed by Congress but ultimately was vetoed by then President Obama. Senators Susan Collins, Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska) have announced that they'll oppose such a measure. Senate leadership must retain the support of the remaining 50 Republicans to pass the bill, with Vice President Mike Pence breaking the tie.
The non-partisan Congressional Budget Office released it's analysis on July 19 that if Congress passed a bill without a replacement plan 59 million Americans would be uninsured by 2026, the average health care premium would increase by 50 percent in 2026 and the federal deficit would decrease by $473 billion over ten years. On July 20, the CBO released it's analysis of the draft Senate discussion bill, the Better Care Reconciliation Act. The CBO estimates that 50 million Americans would be uninsured by 2026, average premiums in the nongroup market will increase before 2020 and then lower thereafter. CBO estimates that the federal deficit would decrease by $420 billion over ten years.
From a SHRM perspective, employers & employees continue to believe that offering health benefits is important way to recruit, retain and value talent. Employers have offered health care benefits since WWII and the number of individuals insured by employer-sponsored coverage continues to grow. According to Kaiser's Employment Health Benefits 2010 Annual Survey, 157 million individuals were covered by employer-sponsored coverage. Today, over 177 million Americans and their families have health insurance through their employer.
SHRM Position: SHRM believes that offering health benefits is an important way to recruit, retain and value talent. SHRM supports some of the provisions included in the bill such as the reduction of the employer mandate penalty, the inclusion of a six-year delay of the excise tax on health care plans and the repeal of the restrictions on the use and limitations on contributions to HSAs and FSAs.
The Society believes that congressional reforms should strengthen and improve the employer-based health care system. Health care reform proposals should: ensure that tax policy contributes to lower costs and greater access; preserve the federal Employee Retirement Income Security Act to allow for common benefit plans across state lines; encourage increased use of prevention and wellness programs; improve quality and transparency; and streamline medical liability laws to reduce health care costs.
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