Round and Round and Round We Go, Where the Health Care Bill Will End Up...Nobody Seems to Know!

By Lehr Middlebrooks Vreeland & Thompson, P.C.

May 25, 2017

On May 4, 2017, the U.S. House of Representatives finally voted on and passed the much debated  American  Health  Care Act, H.R. 1628 (“AHCA”). The next step, of course, is for the Senate to consider the bill, but one thing appears to be certain – vast changes to the current bill are expected. However, recent news reports indicate that the House may actually need to vote on the bill again, before it can  officially be sent to the Senate. Speaker of the House, Paul Ryan, has not even sent the bill to the Senate yet, as House leaders want to make  sure that the bill conforms with the Senate’s rules for reconciliation, which would  allow the bill to be passed by a simple majority. The delay is in part due to the need for an estimate from the  Congressional Budget Office on the possible effects of the bill. If the CBO’s “score” establishes that the bill does not  meet the reconciliation test, the House will have to vote on the bill again, but only after changes are made to satisfy  the budget assumptions. This means more negotiations, which we all recall were hotly debated in the last few months. So for now, we do not know what the ultimate outcome of the AHCA will be, but we do know that the  Affordable Care Act (ACA) currently remains the law.

One  aspect of the ACA which may see changes soon is the  much  debated  and  litigated  “contraceptive  mandate.” President Trump issued an executive order on May  4,  2017, taking steps toward rolling back regulations that interfere with religious liberty. Health and Human Services Secretary  Tom Price has said that the HHS will take prompt action to follow this Order’s intent “to safeguard thedeeply held religious beliefs of Americans who provide health insurance to their employees.” It is anticipated that  HHS may fully exempt religious organizations, such as the Little Sisters of the Poor, from the contraceptive mandate.

Other regulatory “fixes” addressing the ACA are also contemplated, such as removing the “SHOP” (Small Business Health Options Program) enrollment portal from If this proposal passes, the change would take  effect  in  2018.  SHOP  has  largely  been  unused  (only  0.1 percent of small businesses participate) and the idea is for small employers to have access to SHOP plans through agents, brokers, or their insurer, rather than through the site. The federal Centers for Medicare and Medicaid Services (CMS)  says that its goal is  to  make  it  simpler  for  small  business  to  purchase coverage for their employees.

Since the ACA is still the law of the land, employers should take note of the 2018 cost-of-living adjusted limits for health savings accounts (HSAs) and high-deductible health plans (HDHPs) issued recently by the IRS. They are as follows:

• HSA Contribution Limits. The 2018 annual HSA contribution limit for individuals with self-only HDHP coverage will be $3,450 (a $50 increase from 2017), and the 2018 limit for individuals with family HDHP coverage will be $6,900 (a $150 increase from 2017).

• HDHP Minimum Deductibles. The 2018 minimum annual deductible for self-only HDHP coverage will be $1,350 (a $50 increase from 2017), and the 2018 minimum annual deductible for family HDHP coverage will be $2,700 (a $100 increase from 2017).

• HDHP Out-of-Pocket Maximums. The 2018 limit on out-of-pocket expenses (including items such as deductibles, copayments, and coinsurance, but not premiums) for self-only HDHP coverage will be $6,650 (a  $100 increase from 2017), and the 2018 out-of-pocket limit for family HDHP coverage will be $13,300 (a $200 increase from 2017).

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