1. The Affordable Care Act Repeal, Replace, Reconciliation: a Roadmap
Shenandoah Valley Society For Human Resource Management
March 7, 2017

2. Overview What is this presentation? What this presentation is NOT?
An attempt to explain, and perhaps anticipate, the many moving parts of GOP efforts to repeal or modify the Affordable Care Act post-Trump’s inauguration
What this presentation is NOT?
A political commentary
All efforts will be made to caveat editorial statements
A civics lesson
SVSHRM extended invitation to present on ACA-related topic on Oct 20, 2016
Presidential Election: Nov 8, 2016

3. Health Care Reform
Purpose – Assist the 54M uninsured in obtaining medical insurance.
Also known as:
Patient Protection and Affordable Care Act (PPACA)
Affordable Care Act (ACA)
ObamaCare
What is it?
Sweeping Health Care legislation that:
Requires Individuals to purchase medical insurance
Requires Employers to provide it (or pay a penalty)
Establishes access mechanisms in the form of insurance exchanges, i.e., the MarketPlace
Expands Medicaid eligibility (state by state decision) 3 3

9. Trump/Congress Order and Efforts

10. Item Likely Not Subject to Reconciliation…

13. CIAB Intelligence Notes
The Clarity on Repeal is Ripening…or is it?
The best line we’ve heard from one of the most influential health staffers in the Senate this week: If somebody is saying they know what’s going to happen, they’re lying
Repeal might be expanded to include several other provisions that are listed in Title I of the ACA, which notable could include the repeal of the Medical Loss Ratio.
Repealing the Cadillac Tax is nearly certain, but it will likely be compromised with a hit to the employer tax exclusion to recoup lost revenue.
It looks increasingly likely that the employer mandate penalty will be reduced to zero dollars, essentially repealing the mandate.
Reconciliation rules won’t allow for a repeal of the associated employer reporting requirements to also be repealed. We’ve been advised there will be a two-step process on this – one legislative and one regulatory – whereby the Administration would work in tandem with Congress and issue a notice that the reporting requirements would not be enforced. History tells us that relying on regulatory actions in tandem gets complicated and tricky, but we’re optimistic that this gets done and solves the complicated reporting requirements.

19. Plan to Comply until Further Notice
2017 Compliance
Plan to Comply until Further Notice
New Overtime Rules
In effect Dec. 1, National injunction issued 11/23 leaves us in limbo
W-2 Reporting
Employer Shared Responsibility Offers of Coverage – 95%
1095/1094-C Filings
Reinsurance Payments (final year)
Section 1557 Nondiscrimination Injunction issued 12/31/16
Issue new SBC in April, 2017

20. Medicaid Expansion
Provided coverage to approximately 14 million individuals
GOP Freedom Caucus
Adamant it will not support alternatives that preserve Medicaid expansion
Moderate Republicans in Congress feel just as determined to keep Medicaid expansion
Many states that Trump carried in the general election, and have heavy GOP representation in Congress, benefited greatly from Medicaid expansion
Kentucky, Arkansas, West Virginia
Sustainability
President Trump and his advisors have indicated that they will pursue a Medicare block grant as part of their attempt to repeal the Affordable Care Act.  20 20

21. What To Watch For… Medicaid expansion Advanced refundable tax credits
How subsidies work today on the Marketplace; GOP representatives are split on whether they should continue
Income-based vs. Age-based subsidies
Trump’s involvement
Selling policies across state lines
Will insurance companies be willing to “play ball”?
One-third of counties currently have just one insurance company option on the Exchange/Marketplace 21 21

22. BB&T Insurance Services
Scot A. Chancy
BB&T Insurance Services
(540)