House passes bills to expand HSAs, delay health insurance tax

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The House of Representatives passed a pair of bills on Wednesday that would loosen regulations around health savings accounts and delay the health insurance tax for two years.

The Restoring Access to Medication and Modernizing Health Savings Accounts Act (H.R. 6199) passed 277-142. The legislation would give plans additional flexibility to cover services before a deductible is met. It would also permit spouses to contribute to an HSA and allow members to purchase over-the-counter drugs.

The Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act of 2018 (H.R. 6311), which passed 242-176, would increase the amount beneficiaries can contribute to an HSA. But it also includes provisions to add catastrophic or “copper” plans to the ACA exchanges.

Additional solutions to strengthen Health Savings Accounts will provide Americans with more choices, more control and better flexibility to invest their healthcare dollars in ways that best fit their personal needs,” AHIP president and CEO Matt Eyles said in a statement.

H.R. 6311 also includes a two-year delay on the health insurance tax, something insurers have pushed against for some time. In an earnings call last week, UnitedHealth Group CEO David Wichmann said the insurer was advocating for a “delay or outright repeal of the insurance tax” which he claimed would drive up premiums.

In 2015, the most recent year the tax was in effect, insurers lost about $11 billion.

“Providing another temporary reprieve, as work continues to fully repeal this harmful tax, will help reduce premiums for families, small business owners, seniors and states,” Eyles said.

HSAs have been largely supported by Republicans, although some bipartisan bills have sought to use high-deductible plans and HSAs to improve chronic disease treatment. HSAs combined with high-deductible plans have seen steady growth over the last several years, increasing more than 400% since 2007, according to AHIP.

Critics have pointed out that HSAs don’t work well for low-income individuals who don’t have the money to put into an HSA.
On Thursday, following a speech at the Heritage Foundation, Department of Health and Human Services Secretary Alex Azar lauded the use of HSAs as a way to involve consumers in their care.

“We are very supportive of efforts to strengthen HSAs to allow more money to be put in there, to enable the HSA money to be used for more preventive services, and to expand the reach of those,” he said. “I think it’s a critical counterpart to high-deductible plans and a critical element to how we bring that kind of consumerism to a third-party payer system.”

 

 

GOP unlikely to repeal ObamaCare mandate in tax measure

GOP unlikely to repeal ObamaCare mandate in tax measure

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The House is unlikely to repeal the mandate to buy insurance under ObamaCare as part of its tax-reform bill, GOP sources say, though the issue could return down the road.

President Trump and conservative lawmakers are pushing for the individual mandate to be repealed in the bill, but House Ways and Means Committee Chairman Kevin Brady (R-Texas) has expressed worry that the controversial measure would jeopardize the broader tax-reform bill, given the Senate’s failure on health care earlier this year.

“It hasn’t ever been in the [House] bill,” said one Republican on the Ways and Means Committee who has been taking part in the negotiations. “I expect that it will be added somewhere down the sausage-making venture.”

“I agree there is a chance, but I think if it gets included, it would be on the Senate side,” added a second Ways and Means Republican.

Senate GOP leaders said they plan to roll out their own tax bill on Thursday. Sen. Tom Cotton (Ark.) has been the leading GOP senator pushing to include repeal of the mandate in the tax bill.

House leaders emerging from a meeting Monday evening said no final decision has been made on the individual mandate issue, and Brady and Speaker Paul Ryan (R-Wis.) both said in interviews in recent days that they have not ruled out the idea.

“We have an active conversation with our members on a whole host of ideas on things to add to this bill and that’s one of the things being discussed,” Ryan said during an appearance on “Fox News Sunday.”

But Brady expressed concerns about including the mandate’s repeal at an event last week.

“There are pros and cons to this,” Brady said at an event Friday hosted by Politico. “Importing health care into a tax-reform debate has consequences.”

If Congress doesn’t act, Trump has vowed that he will. The president is reportedly considering taking executive action on the insurance mandate if Congress leaves it out of the tax-reform bill.

A lobbyist told The Hill the administration is working on guidance, which might not be in the form of an executive order, that would expand what are known as “hardship exemptions” that allow people to be exempted from the mandate’s requirement to have health insurance or pay a fine.

Brady said Monday that repeal of certain ObamaCare taxes would not be included in tax reform. Instead, he said he is working with Democrats on temporary relief from measures like the medical device tax and health insurance tax.

“We are working on common-sense temporary and targeted relief from many of these taxes to be acted on in the House before the end of the year,” Brady said.

Repealing the mandate could destabilize health insurance markets, experts warn, by removing an incentive for healthy people to enroll. The Congressional Budget Office has previously estimated that repealing the mandate would increase premiums by 20 percent.

Trump has been pushing to repeal the mandate in the tax-reform bill. Brady said last week that Trump had asked for it twice on the phone and once in person. Trump also told a meeting of Republican lawmakers at the White House last week that he wanted to repeal the mandate in tax reform and floated adding it in the Senate, attendees said.

Two conservative leaders, House Freedom Caucus Chairman Mark Meadows (R-N.C.) and Republican Study Committee Chairman Mark Walker (R-N.C.), have been pushing leadership to repeal the mandate in the tax bill. Walker has been slightly more aggressive, calling it a “good move.”

“When given the opportunity to actually address even part of an ObamaCare repeal with a simple majority, our leadership consistently finds excuses to justify their failure,” said a conservative House lawmaker who favors adding repeal to the bill.

“The individual mandate will be repealed by the president while Congress makes excuses.”

A number of lawmakers — both on and off the Ways and Means panel — are predicting the tax legislation Brady unveiled last week would attract the 218 GOP votes needed for passage.

While a handful of vocal New York and New Jersey Republicans are objecting to a provision of the bill that scraps or limits state and local tax deductions, most moderate Republicans have signaled they will go along with the legislation rather than derail one of the GOP’s top campaign promises of the 2016 elections.

So there is a reluctance among GOP vote-counters to add the insurance provision and upset that fragile balance.

“I believe it’s going to be a very strong vote based on my interactions with members and their passion to reform the tax code,” Rep. Jason Smith (R-Mo.), who serves on both the Ways and Means Committee and Ryan’s leadership team, said of the current version of the bill.

Insurance and device taxes back on the chopping block

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It’s time once again for the insurance and medical device industries to ramp up their lobbying against the ACA’s taxes on their products. Congress has frozen both taxes, but both are set to kick in again next year.

  • A trio of Senate Democrats — Heidi Heitkamp, Jeanne Shaheen and Joe Donnelly — introduced a bill last week to delay the insurance tax for another two years. House Republicans are also hoping to find some bipartisan support for a similar measure, though they also still need to finalize the policy details.
  • Opposition to the device tax is also bipartisan, and heating up. More than 175 House members, including 43 Republicans, signed on to a letter yesterday urging Speaker Paul Ryan to bring up a bill fully repealing the device tax.

Reality check: Both industries, but especially insurers, are more likely to win another delay than see their taxes repealed.

And though there will be public pushes here and there for stand-alone bills, or for inclusion in tax reform, getting onto Congress’ massive end-of-year package is their best bet. Measures to delay the insurance or device taxes could be added to Alexander-Murray, if it comes up, as a way to win more Republican votes without losing Democrats.

ObamaCare: Six key parts of the Senate bill

ObamaCare: Six key parts of the Senate bill

Image result for Obamacare: Six Key Parts of the Senate Bill

While Senate Republicans are drafting their healthcare plan behind closed doors, they’ve given reporters a general idea of what might be in it.

The bill is shaping up to have a similar structure as the House’s bill, while more reflecting the principles of centrist Republicans in both chambers.

Senators are still hashing out the specifics, but here’s a look at where they appear to be headed.