“Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal.”

“Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal.”

January 27, 2017 Health Insurance & Employee Benefits, The Beacon Blog 0 Comments

On January 20th, a few hours after President Trump was sworn into office, there was breaking news about the president’s executive order, “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal.”

According to the text of the order, it charges the departments and agencies associated with the enforcement of the Affordable Care Act (ACA) to ease the burden of the ACA as we transition to repeal and replace.

The Executive Order does not repeal any specific piece of the ACA legislation and it doesn’t mention any specific legislation or regulation the President wishes to be eased, repealed, rescinded or amended. Rather, the order serves to re-enforce Congress’s power. Change to the ACA legislation would of course require newly approved legislation and regulation guidelines. The focus with crafting a new piece of legislation appears to be centered upon marketplace stability.

Do not make the mistake of viewing the Executive Order as permission to discard complying with the requirements of the ACA legislation, which will likely remain in effect for at least several months before new legislation is voted upon. All statutes and regulations enacted by the ACA continue to be in place at this time and both companies and individuals are required to remain in compliance with the law.

The following outlines actions required for continued ACA compliance, as well as additional items that may be of significance for certain employers and group health plans

  • Additional Medicare Tax for High Earners. Remember to withhold Additional Medicare Tax (0.9%) on wages or compensation paid to an employee in excess of $200,000 in a calendar year.
  • Coverage of Preventive Services. Continue to monitor guidelines for preventive services, which are regularly updated to reflect new scientific and medical advances. As new services are approved, non-grandfathered group health plans will be required to cover them with no cost sharing for plan years beginning one year later.
  • Medical Loss Ratio (MLR) Rebates. Distribute rebates received from insurance companies to eligible plan enrollees as appropriate. Rebates are due to employer policyholders by September 30th. These rules do not apply to employers who operate self-insured plans.
  • PCORI Fees. Employers sponsoring certain self-insured health plans (including HRAs not treated as excepted benefits) are responsible for fees to fund the Patient Centered Outcomes Research Institute (PCORI). IRS Form 720 must be filed annually to report and pay the fees no later than July 31st of the year following the last day of the plan year     to which the fee applies.
  • Form W2 Reporting of Employer Provided Health Coverage. Continue to report the cost of health coverage provided to each employee annually on Form W2, which must be furnished to employees by January 31st each year, unless transition relief applies. (This requirement does not apply to employers required to file fewer than 250 Forms for the preceding calendar year.)
  • The Transitional Reinsurance Program collects contributions from employers sponsoring certain self-insured plans that provide major medical coverage. Employers with self-insured plans may utilize a third party administrator or administrative-services-only Contractor for transfer of the contributions. (Note: For the 2016 benefit year, a self-insured plan that does not use a third party administrator to perform its claims processing, claims adjudication, and enrollment functions generally does not have to pay these fees.)

About the Author

Anthony Cellucci

With over twenty years of experience consulting businesses in the area of Employee Benefits and Insurance, Anthony delivers expert advice and benefits solutions to his clients. He is a co-founder of The Beacon Group of Companies, a broad based financial services firm located in King of Prussia that provides companies with the highest level of industry expertise and ongoing client service.