Although other aspects of health reform occasionally crop up, the Affordable Care Act continues to represent the centerpiece of efforts to transform the delivery of health care, reduce costs, and increase the number of individuals who have an adequate amount of insurance coverage. As the years have gone by, Republicans through legislation introduced in Congress and in law suits filed by Attorneys General in several states have been successful in making some changes, such as eliminating the individual mandate, but they have not been able to repeal and replace this law.

As discussed below, with the passage of time it is relatively easy to lose sight of some of ACA’s elements. An example is the so-called “Cadillac tax.” Originally scheduled for implementation in 2018, postponements have occurred. More recently involving a separate matter, the U.S. Department of Labor in June 2018 was successful in having a rule finalized to expand the ability of employers to join together to offer health coverage through Association Health Plans, which provide short-term limited insurance coverage that may be less adequate in comparison to consumer protections in the ACA. Opposition by Democrats continues to be expressed to making these plans available. Meanwhile, the U.S. Senate maintains an interest in supporting primary care to lower health costs and improve patient outcomes.

The Cadillac Tax As A Means Of Offsetting Health Care Costs

The Cadillac tax is a provision in the ACA that affects high-cost employment-based health plans. It consists of a non-deductible 40% excise tax imposed on the portion of health coverage costs that exceeds $10,200 for single coverage and $27,500 for family coverage. Initially scheduled to become effective last year, it since has been delayed twice and presently is scheduled to take effect in 2022. By that year, the amounts will change to $11,200 for single coverage and $30,150 for family coverage. The original plan was to generate tax revenues that could help mitigate increasing health care costs and assist in financing other ACA provisions. If and when it ever becomes operational, nothing can be known until then regarding whether this tax can lead to the achievement of financial objectives.

Short-Term Association Health Plans And State Regulations

The Commonwealth Fund has issued concerns that short-term policies may be deceptively marketed, with some sellers leading consumers to believe they are buying a comprehensive policy when they are not. Efforts by the states to regulate these plans may be undermined by a loophole that limits their ability to perform basic consumer protection functions because many short-term plans are being sold through out-of-state associations that are exempt from state regulation. These entities are able to file insurance products for approval in one state and then sell the same policies in other states that have exempted policies, such as benefit mandates. In those jurisdictions, the association is then regulated by the state of approval, rather than the state in which the coverage is purchased.

How Primary Care Can Affect Health Care Costs And Outcomes

The U.S. Senate Health, Education, Labor, and Pensions (HELP) Committee held a hearing on February 5, 2019 in Washington, DC to discuss the role of primary care in influencing health care costs and patient outcomes. Individuals offering testimony included:

  • Tracy Watts, a Senior Partner and U.S. Healthcare Reform Leader at Mercer. Her remarks focused on ways employers are working to improve employee health and manage healthcare costs through onsite clinics and other innovative strategies.

  • Katherine Bennett, Assistant Professor of Medicine and Program Director of the Geriatric Medicine Fellowship at the University of Washington, described Project ECHO, the Extension for Community Health Outcomes, an effort launched in more than 160 locations in the U.S. to address complex conditions, such as HIV, tuberculosis, and mental illness.

  • Sapna Kripalani, Assistant Professor of Medicine at Vanderbilt University Medical Center, provided an example of the value of primary care for an obese patient with complex conditions involving diabetes, hypertension, seizure disorder, and bipolar disorder.

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