It’s hard to keep up with all the health care legislation news lately. That’s why we’re providing regular summaries of the latest news, reflecting the current state of health care in the United States or how it may be changing in the not-too-distant future. Here’s a recap of some of this week’s stories:
Legislation Aimed at Expanding HSAs Introduced in the Senate and House
The Health Savings Act of 2017 was introduced this week by Senator Orrin Hatch (R-UT), Chairman of the Senate Finance Committee, and Senator Marco Rubio (R-FL) and companion legislation was introduced in the House by Rep. Eric Paulsen (R-MN). The goal of the legislation is to increase the adoption and usage of health savings accounts (HSAs).
Similar to prior versions, the legislation calls for expanding eligibility rules, increasing the maximum contribution limit, expanding expenses eligible for reimbursement from an HSA, and providing for greater flexibility with the interactions of flexible spending accounts (FSAs) and health reimbursement arrangements (HRAs) with HSAs. The bill would also allow for reimbursement of over-the-counter drugs from an FSA, HSA, or HRA.
The introduction of this legislation further signals the intent of Republican leadership to include HSA expansion as an important component of health care reform. Chairman Hatch serves as the leader of the Senate Finance Committee and Rep. Paulsen is a member of the Health Subcommittee of the Ways and Means Committee.
Their positions on these committees will likely ensure HSA expansion is a top priority, as both committees have jurisdiction over health care legislation. Several of the HSA reforms outlined in this bill are echoed in the health care reform briefing issued by Republican members this week (discussed below).
Republicans are on a Health Care “Rescue Mission” and HSAs are a Key Pillar of Reform
On Thursday, Republicans issued a briefing on health care reform, committing to “repair the damage done by Obamacare by repealing the law and replacing it with a better system” with action to commence after the President’s Day recess.
According to the briefing, House Republicans and the Administration “are working hand-in-hand” to repeal the Affordable Care Act (ACA) and replace it with a patient-focused health care system delivering more choice and access to affordable health care.
HSA expansion is a central element of the Republican agenda to make health care more consumer centric. The briefing emphasizes that by empowering individuals to make their own health care spending and savings decisions, the utilization of HSAs increases the quality and affordability of health care.
The briefing outlines policies reforms to expand the use of HSAs, which largely track the reforms outlined in the Health Savings Act of 2017, including:
- Increasing the maximum HSA contribution limit to equal the maximum out-of-pocket amounts allowed under law. For 2017, the maximum amount that can be contributed to an HSA is $3,400 for individual coverage and $6,750 for family coverage. However the 2017 maximum out-of-pocket amounts allowed under law are $6,500 for individual coverage and $13,100 for family coverage.
- Allowing both spouses to make catch-up contributions to the same HSA, if both spouses are eligible for catch-up contributions and either spouse has family coverage. Under present law, a spouse’s catch-up contribution amount is not eligible for division between the spouses; the catch-up contribution must be made to the HSA belonging to that spouse.
- Providing an administrative fix for expenses incurred prior to the establishment date of an HSA. This fix wouldtie the establishment date of the HSA to the date an individual’s coverage under an HSA qualifying plan begins, if the HSA is created within 60-days of the start date of the coverage. The HSA establishment date is key because in order to reap the HSA tax benefits, the medical expense must be incurred after the HSA’s establishment date.
The briefing is titled “Obamacare Repeal and Replace: Policy Brief and Resources” and was released by Republicans Members of the House Committee on Energy and Commerce, House Committee on Education and the Workforce, House Committee on Ways and Means, Senate Committee on Finance, and Senate Committee on Health, Education, Labor and Pensions.
HHS Regulations Proposed to Stabilize Individual and Small Group Health Insurance Markets
The Department of Health and Human Services (HHS) issued proposed regulations intended to stabilize the individual and small group health insurance markets. These regulations would make changes to the guaranteed-availability rules, exchange annual open enrollment and special enrollment periods, and certain other exchange standards.
Specifically, the proposed regulation would require people signing-up on an exchange outside of the annual enrollment period to provide documentation of their eligibility for special enrollment. It would also shorten the annual enrollment period for obtaining exchange coverage for the 2018 plan year.
Even though President Trump has called for a repeal and replacement of the ACA, the proposed regulations are viewed as necessary to protect consumers ““enrolled in the individual and small group health insurance markets while future reforms are being debated.”
These changes are perceived as being favorable to insurers and are intended to help prevent insurers from bailing out of the marketplace or hiking premiums. However, the proposed regulations coincides with Humana’s decision to exit the exchanges at the end of 2017, creating additional uncertainty for the 2018 marketplace.
HSAs Likely be Central to State Medicaid Reform
President Trump’s pick to lead the Center for Medicaid and Medicare Services (CMS) had a relatively smooth confirmation hearing on Thursday, although Democrats on the Senate Finance Committee expressed frustration at her lack of specifics about how she would reform Medicaid and Medicare.
Verma is known for her Medicaid work in Indiana under former Gov. Mitch Daniels on the state’s original 1115 Medicaid waiver. In addition, she worked closely with Vice President Mike Pence when he served as governor on the state’s ACA Medicaid expansion, known as Healthy Indiana Plan 2.0.
Verma supports the use of HSAs as a coverage mechanism for the Medicaid population. HSAs were a centerpiece of the ACA Medicaid expansion that Verma designed for Indiana under Vice President Pence. Under Indiana’s ACA Medicaid expansion, certain beneficiaries are required to make small monthly contributions to HSAs to receive coverage.
According to a 2016 Health Affairs blog post, Verma believes that these mechanisms require individuals to have “skin in the game,” which encourages beneficiaries to make “cost and value conscious healthcare decisions.”
Andrew Puzdner Out and Alexander Acosta in as Labor Secretary Nominee
The nomination of Andrew Puzder to become President Trump’s Labor secretary collapsed amid growing Republican opposition to his confirmation. After multiple delays, Puzder’s confirmation hearing was scheduled for February 16.
However, his withdrawal came a day before the scheduled hearing as Republicans became increasingly concerned about Puzder’s past employment of an undocumented housekeeper.
President Donald Trump on Thursday announced his intent to nominate Alexander Acosta, a former Justice Department official and current dean of Florida International University College of Law, for labor secretary. “He’s had a tremendous career,” Trump said from the White House. “I think he’ll be a tremendous secretary of Labor.”
Acosta would become the first Hispanic member of Trump’s cabinet. Notably, he has been confirmed by the Senate for three prior positions.
Although Secretary-Nominee Acosta has not opined on the DOL’s Fiduciary Rule, last week, the DOL submitted a proposed rule that would delay the applicability date of the Fiduciary Rule by 180 days.
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