The ground-breaking Health Care Reform legislation – the Patient Protection and Affordable Care Act – was signed into law in March 2010. This legislation (commonly referred to as Health Care Reform and/or the Affordable Care Act (“ACA”)) constitutes a massive overhaul of the United States health care system. It represents the most significant changes to employers’ health benefit plans since ERISA.
The goal of Health Care Reform is to improve access to, and the quality and cost-effectiveness of, health care insurance. The ACA puts comprehensive health insurance reforms into place that are intended to:
- Increase individuals’ and employers’ access to health coverage
- Require that minimum levels of coverage are available
- Provide more health care choices
- Hold insurance companies more accountable to provide cost-effective coverage
Our Health Care Reform Team is committed to guiding and counseling our clients as we help them successfully navigate through the complexity and ambiguity of the ACA and the tremendous impact it has on their businesses both financially and strategically.
We are comprised of attorneys from many of the Firm’s well-established practice groups including:
- Elder Law – Medicaid Planning
- Employee Benefits and Executive Compensation
- Employment Health Care
- Fraud and Embezzlement Recovery
- Health Care Providers
- Health Care Reimbursement
In order to help our clients be in compliance with the ACA, our Health Care Reform Team reviews, analyzes, and monitors legal developments and timely informs clients of new regulations as they are released. This is accomplished, in part, through our Health Care Reform Priority Alert newsletter and our Client Alert emails, in addition to webinars and seminars that we conduct. We specifically monitor the following:
- Legislative developments The American Health Care Act and other repeal and replace proposals.
- Insurance market reforms These reforms include greater access for individuals with pre-existing health conditions, more comprehensive coverage of preventive care, extension of dependent coverage to older children and prohibitions on lifetime and annual limits.
- Revenue raisers Revenue raisers include those that affect medical FSAs, HSAs, and HRAs, in addition to an increase in the Medicare payroll tax, a new premium tax, and an excise tax on the value of “Cadillac” health care plans.
- Pay or play mandates These mandates require states to establish a health insurance “exchange” and provisions which require individuals to enroll in health insurance, and employers to offer coverage or pay a penalty.
- Administrative requirements These requirements include increased reporting to the federal government and notices to employees.
- Elder abuse Reporting and compliance is part of the Elder Justice Act and the Nursing Home Transparency and Improvement Act, which are included in the ACA to help prevent elder abuse and neglect.
- Long term care In addition to the new requirements in the Nursing Home Transparency and Improvement Act, the legislation includes the CLASS Act, which is a voluntary payroll deduction program for government-sponsored long term care insurance.
- Employment and labor Among other issues, employers subject to the Fair Labor Standards Act must provide reasonable break time and a private location for nursing mothers.
- Fraud and abuse A goal of the ACA is to reduce waste, fraud and abuse in public programs. This includes significant expansions of the government’s reach under the federal False Claims Act and other civil and criminal laws. The changes consist of increased penalties for submitting false claims, increased funding for anti-fraud activities, and increased government investigations seeking civil and criminal sanctions against health care providers. With regard to Medicare, among the anticipated improvements are expanded programs, changes to Medicare Part D, limits on the amount of civil monetary penalties to be collected from long term care facilities, faster penalty collections, and modification of payments to hospitals and physicians.
- Tax Although a number of revenue-raising provisions will adversely affect employers and taxpayers, such as the increased Medicare payroll tax, there is a tax credit available to small employers which is currently available.
Post-Election — What Does This Mean for Employers’ Health Care Strategies? Webinar January 12, 2017