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Since the Biden Administration took office a few weeks ago, changes to help bolster the Affordable Care Act are already underway.
President Joe Biden has already signed two executive orders that undo the changes the Trump administration made to the ACA. The first will extend the special enrollment period on the federal HR.gov health exchange to run from February 15 – May 15. A total of 36 states currently operate under the federal HR.gov health exchange. In response to the executive order, individual states like California have also issued special enrollment periods that will run for the same duration.
The special enrollment period will be “accompanied by the kind of patient outreach – paid advertising, direct outreach to consumers and partnerships with community organizations, and advocacy groups – that was abandoned by the Trump administration” according to a post by the New York Times.
With the pandemic still at large and an estimated 15 million Americans still uninsured, the special enrollment period will provide individuals an opportunity to obtain quality healthcare. In addition, an analysis conducted by the Kaiser Family Foundation (KFF) finds that the special enrollment period could also add subsidized or free health insurance to nine of the 15 million.
The executive order also rolls back on Association Health Plans and short-term, limited duration insurance. Under the Trump administration, the rules for forming Association Health Plans were lessened for employers and subsequently allowed employers to offer less comprehensive health coverage to employees and exempted employers from the ACA’s small-group health insurance rules.
Short-term, limited-duration health plans similarly offer fewer benefits when compared to longer-term comprehensive insurance plans that are offered on government healthcare exchanges or by employers under ACA regulations. Insurers offering short-term plans can turn down applicants based on their medical history and can charge higher premiums for pre-existing medical conditions.
Biden has given federal agencies the authority to review all existing regulations and identify any aspects that are inconsistent with the ACA, including policies that undermine protections for people with pre-existing conditions, policies that create barriers for individuals attempting to obtain ACA coverage, and policies that reduce affordability.
The second healthcare executive order that President Biden signed, deals with abortion, in what is known as the “Mexico City Policy.” The executive order effectively rescinds the policy which according to KFF, “is a U.S. government policy that – when in effect – has required foreign NGOs to certify that they will not perform or actively promote abortion as a method of family planning” using funds from any source (including non-U.S. funds) as a condition of receiving U.S. global family planning assistance and, when in place under the Trump administration, most other U.S. global health assistance.”
While the rescinding of the policy won’t immediately correct the issue, the move is aimed at supporting and advancing women’s health resources. Biden said, “These excessive conditions on foreign and development assistance undermine the United States’ efforts to advance gender equality globally by restricting our ability to support women’s health and programs that prevent and respond to gender-based violence.”
In under a month’s time and Biden is already making good on his promises to bolster the ACA. We can expect to see a number of other changes in the not too far distance, including the possible reinstatement of the federal Individual Mandate and the expansion of Medicaid and Medicare.
The ACA has seen a lot of change since it was first signed into law in 2010 and having been seen as unconstitutional by Congress two separate times, it’s becoming abundantly clear just how ingrained it is in the American healthcare ecosystem.
An area of the ACA that has not been identified as an area to expand upon is the Employer Shared Responsibility Provisions, also known as the Employer Mandate.
Under the ACA’s Employer Mandate, Applicable Large Employers (ALEs), employers with 50 or more full-time employees and full-time-equivalent employees, are required to offer Minimum Essential Coverage (MEC) to at least 95% of their full-time workforce (and their dependents) whereby such coverage meets Minimum Value (MV) and is affordable for the employee, or be subject to Internal Revenue Code (IRC) Section 4980H penalties.
Employers should know that the ACA remains in place. If your organization isn’t complying with the healthcare law’s Employer Mandate, you could be subject to ACA penalty assessments from the IRS. The IRS is currently issuing Letter 226J penalty notices for the 2018 tax year and Letter 5005-A penalty notices for the 2017 tax year.
If you’re unsure of your organization’s compliance status, contact us to have a complimentary ACA Penalty Risk Assessment performed at no cost to your organization.
For information on ACA penalty amounts, affordability percentages, important filing deadlines, steps for responding to penalty notices, and best practices for minimizing IRS penalty risk, download the ACA 101 Toolkit.
