On Friday, March 24, 2017, Republican leaders withdrew their overhaul of the nation’s health care system, commonly referred to as repeal and replace, from the House floor. What this means for employers is the employer mandate, tax reporting, measurement periods, and employee tracking remain part of our daily activities. “Obamacare is the law of the land for the foreseeable future,” said speaker of the House Paul Ryan.
The Patient Protection and Affordable Care Act, also known as the ACA and Obamacare, has been law since March 23, 2010. The ACA revolutionized the health care industry by significantly decreasing the number of uninsured Americans and implementing various industry reforms, including:
- An individual mandate requiring Americans to purchase some form of health insurance coverage or face penalties for failure to be insured
- An employer mandate requiring certain employers to offer employees affordable health care coverage that offers at least minimum value
- Prohibiting insurance companies from denying coverage due to pre-existing conditions
- Requiring coverage for “essential health benefits,” such as hospitalization, maternity care, and prescription drugs
- Medicaid expansion
In addition to reshaping the health care industry, the ACA created a deep divide between the Democratic and Republican parties. Since its enactment, Republicans have railed against it, campaigned on promises to dismantle it, and advanced more than sixty legislative attempts to invalidate it.
The fate of the ACA was a hotly debated issue leading up to the 2016 election. Candidate Trump vigorously campaigned on a promise to repeal and replace the ACA and he acted immediately toward realizing those promises upon his election.
On January 20, 2017, during the evening hours of his inauguration day, President Trump acted by signing his first Executive Order, Order #13765, Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal. Executive Order 13765 directed federal agencies to ease what President Trump called the “regulatory burdens” the ACA imposes on consumers, the health care industry, and health care providers. Executive Order 13765 was largely symbolic and set the tone for one of the President’s top priorities.
Following the President’s Executive Order, House Republicans set about drafting alternative legislation to repeal and replace the ACA. On March 6, 2017, the House introduced the American Health Care Act of 2017, also known as AHCA, Trumpcare, and Ryancare. The AHCA sought to:
- Drop the individual mandate
- Repeal the employer mandate
- Repeal the federal essential benefits requirements and empower states to determine what constitutes essential benefits
- Discontinue Medicaid expansion
- Repeal of industry fines and taxes
From March 6 through March 24, 2017, Speaker Ryan and President Trump worked with members of the House to explain, modify, and encourage passage. Those efforts culminated in an unusual and unexpected act of President Trump and Speaker Ryan withdrawing the bill from a scheduled vote due to insufficient support among a majority of House Republicans.
While most Republicans and some Democrats agree the ACA should be revised, there is not yet a majority consensus on what to modify or how to implement such revisions.
In the wake of the breakdown of the AHCA, President Trump concluded that he will allow Obamacare to “explode” and wait for the Democrats to come to him to fix the problem. In his concession press conference on Friday, Speaker Ryan stated that the House would move along to other legislative efforts such as tax reform and border security. While the President and Congress imply that they are prepared to move on from healthcare reform, the President could use Executive Orders to chip away at the ACA, such as he did with the first Order of his presidency.