Democrats in the House of Representatives have shared their plans for ACA healthcare expansion as part of a proposed $3.5 trillion package.
Included in the proposal are several provisions that would create significant changes to the U.S. healthcare infrastructure. Arguably the most impactful is a new program that would expand Medicaid/Medicare coverage in the 12 remaining states that have refused to expand eligibility.
A total of 39 states, including the District of Columbia, have passed Medicare/Medicaid expansion under the ACA. Most recently was Oklahoma and Missouri during the peak of the COVID-19 pandemic last summer. According to The Commonwealth Fund, roughly $49 billion in additional revenue would be generated and over 1 million jobs would be created if the remaining states expanded their Medicare/Medicaid programs.
The goal of the federal program to expand medicare is to allow more Americans to obtain quality, affordable healthcare, as we’ve seen already in the states that have expanded. The program would begin in 2025 and would provide affordable healthcare to more than 2 million individuals, according to The Hill.
Also included in the $3.5 trillion House Democrat proposal are measures to lower prescription drug prices. Specifically, the plan would allow the Secretary of Health and Human Services to negotiate lower prices in a provision known as H.R.3.
The House Democrat proposal would allocate $190 billion to provide home healthcare options for seniors and individuals with disabilities. An additional $15 billion would go towards future pandemic preparation.
House Democrats are also looking to make the PTC expansion permanent. First introduced under the American Rescue Plan, and currently only slated to run through the end of 2022, the PTC expansion allows individuals with household incomes up to 150% of the Federal Poverty Level (FPL) to receive healthcare coverage for $0 a month. Individuals with income at 400% or beyond the FPL are also eligible for ACA subsidies under the PTC expansion and can obtain coverage for no more than 8.5% of their household income.
New York Times quoted President Biden defending the plan, “If your primary concern right now is the cost of living, you should support this plan, not oppose it… A vote against this plan is a vote against lowering the cost of health care, housing, child care, elder care and prescription drugs for American families.”
The package is still being worked out and is an ongoing development. Senate Democrats have a slightly different agenda for the $3.5 trillion dollar package and thus far, it is unclear how the package will continue to take shape. One thing is for certain, the blueprint of the plan supports Biden’s agenda to strengthen the ACA heading into the 2022 open enrollment.
As the ACA continues to receive long-overdue advancements, employers should revisit their responsibilities under the landmark law’s Employer Mandate.
Under the ACA’s Employer Mandate, employers with 50 or more full-time employees and full-time equivalent employees, known as Applicable Large Employers (ALEs) must:
- Offer Minimum Essential Coverage (MEC) to at least 95% of their full-time employees (and their dependents) whereby such coverage meets Minimum Value (MV); and
- Ensure that the coverage for the full-time employee is deemed affordable based on one of the IRS-approved methods for calculating affordability.
Failure to adhere to these two requirements could subject ALEs to Internal Revenue Code (IRC) Section 4980H penalties.
If you need assistance setting up your ACA healthcare plans for the 2022 tax year, contact us to learn about how we can help with our comprehensive, full-service ACA Complete solution.
To learn more about your ACA responsibilities as required by the Employer Mandate, including how to best meet the reporting and furnishing deadlines for the 2021 tax year, download the 2021 ACA Essential Guide for Employers.
We’re committed to helping companies reduce risk, avoid penalties, and achieve 100% ACA compliance. For questions about the ACA contact us here.