November 19, 2012
Background Paper on Health Care Reform
Related Studies & Resources
Regulations implementing “The Affordable Care Act” (“ACA”) (Pub. L. No. 111-148 and 111-152) related to specific benefit and insurance requirements.1
Potential Impact of Regulation
These regulations, whether implemented or soon to be proposed, all relate to requirements on employer-sponsored health plans and the health insurance marketplace generally. Business Roundtable has raised and will continue to raise concerns with these regulations if we determine that they add unnecessary costs or impact employers’ ability to continue offering health benefits to their employees, limit employers’ ability to innovate in providing health benefit coverage to their employees, or inhibit innovation. In addition, the ongoing implementation of Health Insurance Exchanges will be important to ensure there is competition and choice in the marketplace for health insurance coverage for individuals and small employers in the early years and potentially for larger employers after 2017.
As the ACA continues to be implemented, the agencies should not propose or adopt regulations that impose unnecessary costs on employer-sponsored health coverage or the health insurance market generally. Recognition of employers’ good faith efforts and ability to meet new requirements through existing plan designs must be part of the agency analysis. Employers need flexibility to meet the challenges expected of them under the ACA. Business Roundtable will continue to make specific recommendations to the Administration on ways to develop these rules so that there are no unnecessary costs, unintended consequences or failure to acknowledge current employer efforts and actions. Specifically:
- Final rules on Full-time/Part-time employee determinations and dependent coverage should implement the least burdensome approach to making such determinations and should provide clear guidance to employers regarding these obligations. These rules should acknowledge that employers are always free to offer coverage to employees’ dependents, but retain the right to manage coverage offerings to ensure that employees have access to affordable, high quality plans.
- Final rules on HIPAA Wellness requirements should afford employers significant flexibility to design incentive-based worksite wellness programs that meet the needs of their unique workforces. Final regulations around the minimum value of employer-sponsored coverage should appropriately account for employers’ contributions to their employees’ HSAs or HRAs. Additionally, rules should provide explicit guidance on any cost-sharing limits that are applicable to employer-sponsored plans. Plans should also be afforded ample advance warning and flexibility with respect to any future coverage requirements arising out of the U.S. Preventative Task Force’s recommendations.
- The Administration should act quickly to issue guidance to employers on how to comply with the law’s requirement that all employees be provided notice in March 2013 about Health Insurance Exchanges, so that employers can best prepare for and manage this new obligation and expense. Additionally, final regulations determining how the Transitional Reinsurance Fee will be apportioned across insurance issuers and third party administrators should ensure that the cost is not overly burdensome and is appropriately allocated. Additionally, future regulations on Health Insurance Exchanges must not be overly restrictive and should allow for truly competitive insurance markets. As the Administration finalizes formal regulations on “Essential Health Benefits” for the Exchanges, it must prioritize affordability and flexibility over desires to create mandated rich benefit packages.
- Regulations related to payment reform must encourage efficient delivery of care without inhibiting private sector innovation or facilitating provider consolidation that would increase prices.
For a further description, see the tables in the pages below.
1. ACA Regulations, BRT Chart Dated 05/03/13.