8 questions you should be asking about health care reform

On May 4, Republicans gained enough support to pass the American Health Care Act (AHCA) through the House by a 217 to 213 vote. While this lays out a solid footprint for what’s to come, there’s still a lot of uncertainty surrounding health care reform.

Employers, like everyone, have plenty of questions about how it will all shape up, and if the AHCA can make it through the Senate. Still, some questions are more important than others—even if we don’t quite have the answers yet. Here are eight of the biggest questions about health care reform right now.

1. What AHCA amendment helped Republicans reach a compromise?

After the AHCA fared poorly under the Congressional Budget Office (CBO)’s score in mid-March, Republicans released a set of amendments to garner additional support. The AHCA never quite made it to a House vote with these provisions, and it seemed as if the bill was dead.

In the eleventh hour, Republicans proposed two additional amendments. The MacArthur Amendment would allow states to opt out of key ACA provisions, including parity for underwriting rules, and enable them to charge higher premiums to those with pre-existing coverage and a lapse in coverage. The other, known as the Upton Amendment, would add an additional $8 billion to fund high-risk pools in states that choose to opt out of these provisions.

2. What does the rest of Republicans’ three-pronged approach to health care reform look like?

The AHCA was never meant to stand alone—additional actions have always been planned to support Republicans’ health care reform plan. The only problem with the original bill was that the substance of parts two and three were too hazy to bolster confidence in part one—and so it fell through before making it to the House floor.

So far, we know prong two would come in the form of executive orders and regulatory reform that can be tackled through the Department of Health and Human Services. Prong three would be more substantial legislative reform coming from Congress—which means it needs an elusive 60-vote majority in the Senate.

Both prongs have made some steps forward: the second through Trump’s expansion of individual mandate exemptions, and the third through the passing of the Small Business Health Fairness Act in the House. But there are still a lot of blanks to be filled as the first prong makes its way to the Senate.

3. Will health savings accounts (HSAs) see new life?

This is a reform that Republicans are hoping to tackle with prong three. HSAs are pre-tax savings accounts that can be used for a variety of health care expenses. Currently, they can hold $3,400 for an individual or $6,750 for a family, and can only be used by those with high-deductible plans. Republicans want to expand the capabilities of HSAs, enabling them to hold more money and dropping the deductible requirement.

These changes have pros and cons, based on how much money you have to put aside in the first place, but expect to hear more about them.

4. Will health insurance be sold over state lines?

This is another well-intentioned, prong-three concept that we can expect to pop up again—even if it may have less impact than expected. In some states, it’s already legal to purchase insurance from out-of-state insurers. The bigger question here may be whether insurers will take the offer if it’s given to them. Even if regulations across all 50 states lined up and allowed the free exchange of insurance plans over state lines, insurers may not bite because setting up networks away from home is a daunting task.

5. Will the Trump administration sabotage the ACA?

The ACA needs a lot of federal assistance to run properly. The healthcare.gov website needs maintenance, penalties need collection, and portions of the law need enforcement. With the Trump administration in charge, it’s possible that maintenance and upkeep will be ignored—causing the ACA to break down, and triggering a slew of problems.

The Trump administration doesn’t want to spend its money and resources enforcing a law it hates, but if it chooses to simply let the law “implode” due to lack of attention, Republicans could face massive consequences down the line. It’s a risky political gamble to simply let the system fall apart, but it’s too early to tell if they’ll do it anyway.

6. What bill changes are expected to be made in the Senate?

The House passed the AHCA without waiting for it to receive a new CBO score, which may indicate the bill will create higher premiums for individuals with pre-existing conditions and the elderly. Once the new CBO score is determined, it’s possible that changes may be made to pre-existing conditions, underwriting parity, and Medicaid funding. As the bill makes its way to the Senate, many conservative Republicans worry that the parts of the bill they strongly support will be altered—especially pieces allowing states to charge more for those with pre-existing conditions.

7. How long will ACA reform take?

As businesses and insurers hold their breath to see what happens next, one of the biggest questions is exactly how long they have to keep holding it. The ACA took about nine months to become law after its introduction, and that was without all the discord the Republican Party faces within its ranks. At very best, expect at least another six months to pass before a new health care bill removes any piece of the ACA. At worst, it could be several years—or never.

8. Will health care reporting happen in 2018?

While there is no guarantee either way, the simplest answer is yes. If reform isn’t passed by the end of the year, the next reporting season will have started before any change has taken effect. Even if legislation does pass, it’s likely another form of reporting will be required. Keep your data in check and make sure you have the tools you need to escape the fines and penalties associated with avoiding ACA compliance.

These questions are just the tip of the iceberg in the long and complicated process of health care reform. What other questions do you have as the administration continues to shape its new policy? Let us know!

Tags: aca, Repeal and replace, American Health Care Act, MacArthur Amendment