Current state of health care reform and employer next steps

This week brought a bevy of updates to the Republican Party’s health care reform battle, culminating Monday night in the possible death of the Better Care Reconciliation Act/American Health Care Act and Republicans’ hopes to repeal and replace the Affordable Care Act. However, tonight the bill might be saved in an emergency Republican meeting. Not unexpectedly, this dizzying cascade of continued changes has left employers wondering what to do now.

 First, they need to understand the three most likely paths forward for health care reform: repeal and replace, total repeal, or bipartisan collaboration.

Repeal and replace

The plan to repeal and replace the bill was announced dead by media on Monday night when four Senators publically stated they would vote against the BCRA. But that might not have been the end.

The opposing Senators will meet tonight to work out their differences. This could lead to a procedural motion to take up the bill and start the health care debate on the Senate floor. It could also stall out.

Total repeal

Many Republicans ran (and some were elected) on the promise of a total repeal of the ACA.

If a total repeal were to take place, Republicans have indicated they’d give themselves one to three years to construct a brand new law to replace the ACA. During this time, the ACA would remain in effect. 

However, three Republican Senators immediately said they would vote “no” on this proposition of total repeal, effectively killing its viability. 

Bipartisan fix to ACA

A bipartisan effort to fix the ACA seems to be the most likely option left, but how this would actually play out is unclear since bipartisanship is all but gone in relation to health care reform. Furthermore, too many questions exist: Would both parties even come to the table? And, if so, what’s on it—full repeal or ACA amendments?

As time marches on, these questions will be answered, but it will take a long time before any bipartisan effort is realized. Republicans took six whole months to reach this point, and this was supposed to be the “easy” part. They control the House, Senate, and White House.

What do employers do now?

The answer is simple. Employers comply with the current law!

The ACA continues to be the law of the land, and employers must track their employees throughout this year and offer coverage when appropriate under the federal guidelines to remain in compliance.

At SyncStream, we’ve heard many employers say the same thing throughout the year:  “Republicans are going to get rid of the ACA, so I don’t have to worry about ACA compliance this year.”

This is not true.

I can’t stress the importance of compliance enough. The events of the past few days make it clearer than ever before that the risk of non-compliance with the current law far outweighs the probability that repeal and replace will be successful. The employer mandate and reporting responsibilities have not been eliminated.

The graphic below is an estimation of how general sentiment regarding ACA compliance has shifted over the last six months. The chart is based solely on our observations in conversations with our customers and other employers throughout the year.  

employed mindset related to aca compliance

*Graph indicates a general representation of trends.

As long as the possibility of a successful repeal and replace appeared more likely than the probability of ACA non-compliance, many employers didn’t worry much about ACA compliance. No employers expected the current repeal and replace efforts to die in January.

Regardless of the outcome of tonight’s meeting or any future debate, employers need to choose the most prudent course of action from a risk management perspective and continue ongoing ACA compliance efforts. This has been our advice all year, pending an official repeal or amendment of the ACA, but it has never been more resoundingly true than it is today.