ACA & Health Care Reform: Where Do We Go From Here?

August 16, 2017 Tom Jegou

Today was a key date for insurance carriers participating in the marketplace. They were to submit any final adjustments to their proposed 2018 premium rate requests. Uncertainty over the Republicans’ promise to dismantle the Affordable Care Act (ACA) and President Trump’s vague threats to curtail cost-sharing subsidies has prompted many insurers to seek substantial premium increases. This uncertainty is also causing many insurance companies to pull out of the marketplace altogether, which could lead to a marketplace collapse.

And it is this uncertainty that has given insurers a bit of a reprieve. Today’s deadline has been extended nearly three weeks. Insurers now have until Sept. 5 to calculate their 2018 rate requests.

Nevertheless, insurers are likely holding their collective breath until Aug. 21, when they are scheduled to receive the next round of cost-sharing payments. Insurers rely on these subsidies, a carryover from Obamacare, to lower the deductibles and copays of lower-income policyholders.

Trump could pull the plug on these payments without legislative approval. Doing so, however, would be very risky as it could destabilize the health exchanges even more.

So how did we arrive at this juncture, and where are we likely headed? And how will this affect compliance for healthcare organizations such as long-term care and skilled nursing facilities?

2016: Election rhetoric

Let’s go back to the presidential campaign. “Repeal and replace” Obamacare was one of Trump’s key campaign promises.

Jan. 20, 2017: Executive order

Fast forward to Jan. 20, when Trump signed his first executive order, specifically targeting Obamacare by asking the Internal Revenue Service (IRS) to be lenient in enforcing ACA penalties for individuals and insurance companies. Of note is that it did not mention employers.

May 4: Acronym soup

The House passed the American Health Care Act of 2017 (AHCA). This bill required approval by the Senate and the president to become a law. The Senate modified the House bill, renaming it the Better Care Reconciliation Act (BCRA). BCRA removed Individual and employer mandates but did not cut Medicaid expansion as proposed in earlier bills.

July 14: Governors take a stand

At their annual summer meeting, the nation’s governors came out strongly against the BCRA. Opposition came not just from Democratic governors but from Republicans as well.

July 28: ‘Skinny repeal’

In a dramatic 49-51 vote, the Senate rejected the scaled-down Republican plan to repeal parts of the ACA. The failed to pass by three votes: John McCain (AZ), Susan Collins (ME), and Lisa Murkowski (AK). President Trump responded with a series of tweets, threatening to let ACA implode, the first of which read:

August: Congress on vacation

While Trump had requested that the Senate cancel its August recess to continue to work on the legislation, the most he got was a delay, which was all for naught. As of today, Congress still has yet to pass a bill making any significant change to ACA. The following scenarios are extremely unlikely:

  • That there will be a second Senate vote on the same bill
  • That the three dissenting Republicans will change their votes
  • That the bill will receive any support from Democrats

September: Bipartisan discussions

So what’s next? Next month, the Senate health committee is scheduled to begin bipartisan hearings on about how to fix the ACA — that is, how to stabilize the individual health insurance market.

Our predictions

Here’s our take on the situation. Based on what has transpired, we do see changes coming down the pike, but nothing so transformational as we may have been led to believe.


For healthcare organizations, as of now it’s business as usual.

  1. Payroll-Based Journal (PBJ) is here to stay. No proposed legislation threatens PBJ. In fact, the Centers for Medicare & Medicaid Service (CMS) is pushing forward, actually expanding the impact of PBJ. As of Monday, SNFs that miss two PBJ deadlines will have their 5 Star Rating suppressed on the CMS Nursing Home Compare site. (For additional insights, read my post on PBJ audits.)
  2. 1095-C reporting will be required for the remainder of 2017. Healthcare facilities would be wise to ignore the smokescreen of impending legislative changes. Because the data collected through reporting is necessary for processing credits to individuals, it is very unlikely that any legislation will remove the reporting requirement for this year.
  3. ACA mandates are still in effect. To date, no legislation has successfully repealed the core mandates of the ACA. President Trump’s executive order for leniency, which did not mention employers, was vague and open to interpretation by the IRS.

Still up for grabs

While both the AHCA and BRCA would have ended Medicare expansion, this provision was removed from the “skinny repeal” in an attempt to gain support. This will be a point of debate in future ACA modifications.


About the Author

Tom Jegou

As Compliance Expert at SmartLinx, Tom Jegou oversees SmartLinx innovations in our payroll and compliance systems. Tom is focused on transforming client needs into leading-edge products. Tom leads cross-functional teams from a product's conception through to its launch. Tom led the design of the 1095-C and Payroll-Based Journal reporting features in the WorkLinx<sup style="font-size: 60%;">TM</sup> suite. Since 1996, Tom has worked with every aspect of Human Capital Management Systems. He has defined, supported, implemented and managed Payroll, Time and Labor and HR systems. Tom is a Certified Payroll Professional through American Payroll Association.

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