Major U.S. Congressional Actions in 2018 – Healthcare

SUPPORT for Patients and Communities Act

  • Includes reforms to Medicare and Medicaid to combat the opioid crisis.
  • Advances mental health treatment and addiction recovery initiatives.
  • Increases efforts and resources to combat illicit synthetic drugs from crossing the border.
  • Encourages the development of other non-opioid drugs.

Status: Signed into law on 10/24/18

Delayed Affordable Care Act (ACA) Cadillac and Medical Device taxes

  • Placed a two-year delay on the ACA’s 40% excise tax on high-value healthcare plans, until 2022.
  • Delayed an ACA excise tax on medical devices from going into effect until 2020 and retroactively removed the tax for the 2017 tax year.

Status: Signed into law on 1/22/18

Individual Mandate Repeal

  • Congress reduced the individual mandate penalty to $0 to begin in 2019.
  • The penalty changed as part of tax reform legislation passed in December 2017.

Status: Signed into law on 12/20/17

Sources: Congress.gov; Bruce Jaspen, “Big Employers Win Delay for Obamacare’s Cadillac Tax Once Again,” Forbes, January 23, 2018

Trump Administration 2018 Recap: Healthcare

Short-Term Limited Duration Insurance Plans

  • Allows individuals to buy health plans that do not meet ACA standards such as not charging more for pre-existing conditions and covering many different basic health services.
  • The plans last less than a year but can be renewed for up to three years.

Expanded Association Health Plans

  • Small businesses can join together to purchase health insurance plans that do not have to meet ACA standards.
  • Allows small businesses and self-employed workers to join together by geography or industry to obtain healthcare coverage as if they were under a single large employer.

Risk Adjustment Payments

  • The original risk adjustment program established under the ACA encouraged insurers to accept all customers without charging more for patients in need of substantial medical services.
  • The final rules for 2019, announced in December 2018, reissues the same risk adjustment payment program for the 2018 benefit year.

“President Trump is bringing more affordable insurance options back to the market, including through allowing the renewal of short-term plans.”

— HHS Secretary Alex Azar

Sources: “About Association Health Plans,” US Department of Labor, 2018; HHS.gov  

Potential 2019 Healthcare Agenda Items for Congress

Introducing Universal Healthcare

  • Many Democrats campaigned on different versions of “Medicare-for-all” during the 2018 midterms.
  • There is support for different forms of “Medicare-for-all” from many Democrats.
  • Sen. Bernie Sanders (I-VT) and Rep. Pramila Jayapal (D-WA) have proposed ”Medicare-for-all” bills.
  • Several others including Sen. Tim Kaine (D-VA) have proposed Medicare or Medicaid buy-in options.

Repealing the Medical Device Tax

  • Congress may reintroduce legislation that would repeal the 2.3% excise tax on medical devices sold by medical manufacturers.
  • The original bill, the Protect Medical Innovation Act of 2018, was introduced to the House on January 3, 2017, and passed the house on July 24, 2018.
  • The bill did not see any movement in the Senate.
  • The tax is currently set to take effect in 2020.

“This caucus is committed to not only making sure that every American across the country has quality, affordable healthcare but also holding the president accountable for making meaningful improvements to our healthcare system instead of continuing to promote policies that take healthcare away from people.”

— Rep. Pramila Jaypal (D-WA-07)

Sources: Congress.gov; Felicia Sonmez, “House votes to repeal medical device tax,” The Washington Post, July 24, 2018

Potential 2019 Healthcare Agenda Items for the Trump Administration

Expand Health Reimbursement Arrangements (HRAs)

  • HRAs allow employers to reimburse employees for out-of-pocket medical expenses.
  • The Trump administration has proposed a rule that will allow the use of HRAs for the purchase of individual health insurance coverage.
  • This would affect companies that have less than 50 employees that currently do not have to offer health insurance benefits to their employees.

Approve Medicaid and Medicare Waivers

  • Section 1115 waivers and Section 1332 waivers allow states to implement innovative ways to provide access to quality healthcare through Medicaid and Medicare respectively.
  • The Trump administration will likely continue to accept Section 1115 waivers that implement work requirements as a condition of eligibility for Medicaid.

“By loosening the reins on HRAs and allowing these savings tools to deliver greater benefit to more people, the administration is injecting choice into a market that urgently needs it. This proposal offers relief for workers who may have previously faced a choice between an unaffordable on-exchange plan or no coverage at all, and it accomplishes this while upholding a commitment to workers with pre-existing conditions.”

— Rep. Peter DeFazio (D-OR)

Sources: Congress.gov; Felicia Sonmez, “House votes to repeal medical device tax,” The Washington Post, July 24, 2018

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