Affordable Care Act Generally - American Benefits Council

Platform Review: Health Care AMERICAN BENEFITS COUNCIL 2016

Quick Links to Positions & Platforms

Table of Contents

REPUBLICAN PARTY (GOP)

DEM OCRATIC PARTY (DEM S)

2016 REPUBLICAN PARTY PLATFORM

2016 DEM OCRATIC PARTY PLATFORM

TRUM P

CLINTON

DONALD TRUM P'S VISION: HEALTH CARE

HILLARY CLINTON'S COM M ITM ENT: UNIVERSAL, QUALITY, AFFORDABLE HEALTH CARE FOR EVERYONE IN AM ERICA

HOUSE GOP

BIPARTISAN POLICY CENTER (BPC)

A BETTER WAY

IM PROVING AND EXPANDING HEALTH INSURANCE COVERAGE THROUGH STATE FLEXIBILITY

Quick Links to Positions & Platforms......................1 The Issues: Affordable Care Act Generally ................................ 2 Health Care Costs and Tax Treatment ................... 2,3 "Cadillac Tax" on High-Cost Coverage.....................3 Consumer-directed Health Care.............................. 4 Prescription Drugs.................................................... 4 Usage of State Innovation Waivers......................... 5 Public Option.............................................................5 Mental Health/ Drug and Alcohol Addition.............. 6 Delivery System Reform & Medicare....................... 7 Medicaid ...................................................................7 Purchase of Insurance Coverage Across State Lines........ 8 Wellness/ Telehealth ................................................ 8

AM ERICAN BENEFITS COUNCIL A 2020 VISION & M AGNIFYING A 2020 VISION

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AMERICAN BENEFITS COUNCIL 2016

Affordable Care Act Generally GOP

TRUM P

Health Care Costs and Tax Treatment

HOUSE GOP

GOP

Repeal ACA

- Promote price transparency - Empower small businesses to form purchasing pools in order to expand coverage to the uninsured - Tort reform: supports state and federal legislation to cap non-economic damages in medical malpractice lawsuits - Allow states to regulate local insurance markets, limit federal requirements on both private insurance and Medicaid - Call on state officials to reconsider costly medical mandates

DEM S Strengthen and expand ACA

BPC DEM S

Assure access to affordable coverage for spouses and children by fixing the so-called ?family glitch? and fully offsetting the cost at the federal level

- Make premiums more affordable, reduce OOP expenses, cap prescription drug costs - End surprise billing and other practices that lead to out-of-control medical debt - Fight against insurers trying to impose excessive premium increases

CLINTON - Strengthen and expand ACA - Provide a refundable tax credit of up to $5,000 per family or $2,500 for an individual for excessive out of pocket (OOP) costs (if OOP health expenses are in excess of five percent of income and are not eligible for Medicare); paid for by demanding rebates from drug manufacturers - Fix the "family glitch" so that families can access coverage when their employer's family plan is too expensive

TRUM P - Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system - Require price transparency from all health care providers

CLINTON COUNCIL - Make sure the HHS has the authority to block or modify unreasonable health insurance premium rate increases so that coverage is more affordable - Require plans to provide three sick visits every year without counting toward deductiblesExpand disclosure requirements and new cost-sharing protections that will ensure patients pay no more than in-network cost-sharing in an emergency - Further enforce ACA transparency provision; adopt further steps to make sure that employers, providers and insurers provide this information through clear and accessible forms of communication

- As decisions are made allowing large employers to participate in exchanges, it should be done in a way to provide maximum coordination among states to ease administrative burdens - Modify the employer shared responsibility requirement and simplify employer reporting - Simplify and standardize data requests from states - Fix the "family glitch" to assure access to affordable coverage for spouses and children

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Health Care Costs and Tax Treatment (cont'd)

"Cadillac Tax" on High-Cost Coverage

BPC

GOP

TRUM P

Repeal ACA

- Replace Cadillac Tax with a limit on the income-tax exclusion for employer-sponsored health benefits, or a paid claims tax (see "Cadillac Tax") - Clarify consolidation guidance for private-sector payers and providers - Promote price transparency

DEM S Repeal "Cadillac Tax" and "find revenue to offset it because we need to contain the long-term growth of health care costs, but should not risk passing on too much of the burden to workers."

HOUSE GOP - Replace Cadillac Tax with a cap on the employee exclusion (see "Cadillac Tax") - Provide a universal advanceable, refundable, monthly tax credit for individuals and families (adjusted for age and indexed over time; credit amounts exceeding the cost of coverage would be deposited into an HSA - Enact medical liability reform, including caps on noneconomic damage awards - Establish ?association health plans? (AHPs), as well as ?individual health pools,? which would provide similar advantages for groups of individuals - Allow employers to contribute funds to an HRA for the purchase of insurance on the individual market

CLINTON Repeal "Cadillac Tax," offset by additional health care reforms

HOUSE GOP Repeal ACA and replace "Cadillac Tax" with a cap on the income and payroll tax exclusion of employer-sponsored health insurance "at a level that ensures job-based coverage continues unchanged for the vast majority"; includes geographic adjustment; omits employee contributions to HSAs from counting toward the cap

COUNCIL - Maintain current tax favored treatment of employer-sponsored health coverage - To ensure all individuals can obtain needed security for health protection needs, favorable tax treatment should be provided for individuals outside the employer system as well - Permit employers to establish stand-alone HRAs that can be used to purchase individual coverage inside or outside insurance exchanges - Permit employees to purchase individual coverage through a public exchange on a pre-tax basis using the employer's cafeteria plan - Repeal or modify COBRA - Enact medical liability reform at federal and state levels - Enable employees to have quality and cost calculators and other tools that provide specific data about quality and OOP costs of services - Enable employers to access information needed to design and operate plans and help employees use these tools - Support progress in advancing national goals and benchmarks for health care quality improvement including through outcomes-based research and evidence-based measures. Employers should be protected from liability associated with reliance on such standardized measures

BPC Replace "Cadillac Tax" with a limit on the income-tax exclusion for employer-sponsored health benefits

COUNCIL Repeal "Cadillac Tax" in full, as soon as possible

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Consumer-directed Health Care

Prescription Drugs

GOP

DEM S

Grow Health Savings Accounts and Health Reimbursement Accounts

- Cap the amount individuals have to pay out-of-pocket every month on prescription drugs - Prohibit anti-competitive "pay for delay" deals - Allow individuals, pharmacists and wholesalers to import prescription drugs from licensed pharmacies around the world - Require Medicare to negotiate better prices with drug companies

TRUM P - Allow individuals to fund HSAs - Accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty - Allow funds to be used by any member of a family without penalty

TRUM P - Allow importation of drugs from abroad - Allow Medicare to negotiate drug and biologic prices

HOUSE GOP Expand consumer-directed health care options, such as HSAs and HRAs

CLINTON - $3,000/ yr cap on covered out-of-pocket prescription drug costs - Cap what insurers can charge consumers in out-of-pocket costs - Deny tax breaks for direct-to-consumer advertising - Require drug companies to invest in R&D in exchange for taxpayer support (If they do not meet targets, boost their investment or pay rebates to support basic research) - Encourage competition to get more generics on the market and create a Federal backstop when there are excessively high-priced drugs that face no competition - Clear the FDA generic drug application backlog - Lower the biologic exclusivity period from 12 to 7 years - Suggest FDA give prioritized, expedited review to biosimilar applications that only have one or two competitors in the marketplace - Prohibit "pay for delay" deals - Allow importation of drugs from abroad - Evaluate value, quality and comparative effectiveness of new drugs - Require pharmaceutical companies to provide higher rebates in the Medicare low-income subsidy program - Ensure that rebates are at Medicaid levels - Allow Medicare to negotiate drug and biologic prices

COUNCIL - Specify that high-deductible health plans used with HSAs meet the minimum essential coverage requirement and satisfy the employer shared responsibility requirements for ?minimum value? created in ACA - Clarify that certain prescription drugs are preventive care that will not be subject to an HSA-eligible plan deductible - Repeal the prohibition on the use of HSA (and FSA) funds for over-the-counter medications unless prescribed by a physician - Permit individuals and families to use HSA funds for medical expenses for adult children under age 26 - Allow employers to provide care at on-site medical clinics free of charge to employees enrolled in HSA-eligible High Deductible Health Plans

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Usage of State Innovation Waivers

Public Option

DEM S

GOP

Empower states to use innovation waivers under the ACA

No

BPC

DEM S

- States should actively promote health-system innovation and transformation - Convene governors and the secretaries of Health and Human Services and Treasury to seek agreement on a reasonable interpretation of ?guardrails? for Section 1332 State Innovation Waivers. The secretaries should issue guidance based on those convenings. - Define the guardrail requiring federal deficit neutrality to permit the requirement to be applied across programs waived (i.e., tax-credits and Medicaid), to demonstrate neutrality over the entire term of the waiver, and require strong standards to assure federal deficit neutrality

CLINTON

Yes

COUNCIL During debate of the ACA , the Council opposed a public health care option

COUNCIL - Do not allow states to regulate design and administration of self-funded ERISA plans - Limit scope of waivers to specific ACA provisions such as insurance coverage - Do not allow states to impose new definitions of "minimum essential coverage" or new reporting requirements

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Mental Health/ Drug and Alcohol Addiction GOP

CLINTON

- In response to heroin and opioid abuse, support Comprehensive Addiction and Recovery Act - Ensure that no physicians will be penalized for limiting opioid prescriptions

On mental health: - Fully enforce & implement Mental Health Parity - Integrate mental and physical health care systems to enhance community-based treatment - Strengthen federal monitoring of health insurer compliance with network adequacy requirements - Promote early diagnosis and intervention, including launching a national initiative for suicide prevention

DEM S - Ensure that all children have access to mental health care - Expand community-based treatment - Move toward the HHS-promoted Zero Suicide commitment - Expand access to prevention and treatment - Ensure insurance coverage equal to any other condition - Fully enforce & implement Mental Health Parity and Addiction Equity Act, including requiring insurers to disclose how they make medical management decisions

On drug and alcohol addiction: - Re-evaluate payment methods in Medicare and Medicaid to remove obstacles to reimbursement and accelerate integration of addiction care into standard health care practice - Direct federal agencies to more aggressively inspect and, where appropriate, bring enforcement actions against non-complying insurer policies; promulgate federal guidance to states and consumers on parity enforcement and how to file complaints, both in Medicaid and private insurance; and direct the Departments of Labor and Health and Human Services to make its parity enforcement actions more transparent

TRUM P COUNCIL

On mental health: "There are promising reforms being developed in Congress that should receive bipartisan support."

- Support mental health parity and the important role of behavioral health coverage in promoting workforce health and productivity - Advocate on behalf of plan sponsors and service providers who face significant compliance challenges given the complexity of regulations for determining parity, particularly with respect to the use of ?non-quantitative treatment limits? (these include medical necessity criteria or preauthorization requirements) - Future regulations or guidance on mental health parity should use a process that provides opportunity for stakeholder comment - Advocate for evidence-based standards for certain behavioral health services

On opioid epidemic: - Reduce the amount of Schedule II opioids that can be made and sold in the U.S. - Lift the cap on the number of patients that doctors can treat with recovery medication, provided they follow safe prescribing practices and proper treatment supervision

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Medicaid

Delivery System Reform & Medicare DEM S

GOP

Extend Medicare as an option to Americans 55 years and older

Block grant Medicaid and other payments

CLINTON

TRUM P

- Extend Medicare as an option to Americans 55 years and older - Shift away from the "fee for service" payment system - Expand existing systems that pay for an entire episode of care or "bundle" - Expand systems that incentivize doctors and hospitals to coordinate care in an Accountable Care Organization - Root out fraud and abuse

Block grant Medicaid to the states

DEM S

CLINTON

Expand Medicaid to every state

BPC HOUSE GOP

- Modernize fee-for-service Medicare; - The Department of Health and Human Services (HHS) Secretary should be authorized to ensure adequate reimbursement levels to fee-for-service providers in areas that can not set up alternative delivery systems - Preserve and improve Medicare care delivery and payment systems

Per capita allotment and block grants

BPC HOUSE GOP Align oversight of programs serving dual-eligible beneficiaries within the Centers for Medicare and Medicaid Services

- Repeal many ACA changes to Medicare - Implement Medicare Advantage value-based insurance design - Implement Medigap reform - Combine Medicare parts A + B - Implement premium support

COUNCIL - Facilitate collection/ reporting of reliable and standardized provider data so purchasers will be better equipped to make informed decisions regarding cost and quality - Improve Star Rating system to encourage value-based contracting and delivery reform - Request the Center for Medicare and Medicaid to phase-in any additional changes to the Risk Adjustment Model, as well as release more analyses on the changes

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Purchase of Insurance Coverage Across State Lines

Wellness/ Telehealth DEM S

TRUM P

Help state and local leaders establish evidence-based, age-appropriate, and locally tailored prevention programs

Allow consumers to buy insurance across state lines

TRUM P

HOUSE GOP

Encourage use of telehealth (Proposal included in Veterans Administration agenda) Permit the purchase of insurance across state lines

CLINTON

BPC

Make more health care providers eligible for telehealth reimbursement Implement federal law permitting states to form interstate compacts to sell insurance across state lines (Section 1333 of the Affordable Care Act)

HOUSE GOP Clarify that offers of financial incentives do not violate the Americans with Disabilities Act and the voluntary collection of medical information from an employee?s family member as part of a wellness program does not violate the Genetic Information Nondiscrimination Act

BPC Promote prevention and healthful lifestyles and wellness programs in the workplace

COUNCIL - Federal agencies promulgating wellness regulations should proceed in a consistent, collaborative manner that supports participatory and outcomes-based wellness initiatives - Clarify that offers of financial incentives do not violate the Americans with Disabilities Act and the voluntary collection of medical information from an employee?s family member as part of a wellness program does not violate the Genetic Information Nondiscrimination Act

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