Walorski Pushes for New Repeal of Medical Device Tax; Messer’s Reverse Transfer Concept Amended Into Reauthorization Bill

Congresswoman Jackie Walorski (IN-02) has brought forth legislation to suspend the medical device tax for five years. She joined Rep. Erik Paulsen (R-MN) in co-authoring the bill, H.R. 4617, which would delay the implementation of the 2.3% tax that was originally created through the Affordable Care Act. In 2017, Congress delayed the tax for two years, but without intervention it is set to take effect January 1, 2018.

“The job-killing medical device tax would have a devastating impact on Hoosier workers and patients across the country who depend on life-saving medical innovation,” Walorski said. “I am committed to permanently ending this burdensome tax. As we continue working toward repeal, we must protect workers and patients by preventing it from taking effect.”

Congressman Luke Messer (IN-06) and Congresswoman Jackie Walorski (IN-02)

Walorski’s bill was part of a group of legislation introduced by members of the House Ways and Means Committee aimed at stopping Obamacare taxes set to take effect in 2018. The other four measures are:

• H.R. 4618, introduced by Rep. Lynn Jenkins (R-KS), provides relief for two years from the tax on over-the-counter medications, expanding access and reducing health care costs by once again allowing for reimbursement under consumer-directed accounts;
• H.R. 4620, introduced by Rep. Kristi Noem (R-SD), provides relief in 2018 from the Health Insurance Tax (HIT) that drives up health care costs;
• H.R. 4619, introduced by Rep. Carlos Curbelo (R-FL), provides needed relief from HIT for two years for health care plans regulated by Puerto Rico; and
• H.R. 4616, introduced by Reps. Devin Nunes (R-CA) and Mike Kelly (R-PA), delivers three years of retroactive relief and one year of prospective relief from the harmful employer mandate paired with a one-year delay of the Cadillac tax.

Earlier this year, Congressman Luke Messer (IN-06) introduced legislation that encourages a more seamless transition for community college transfer students earning degrees. Messer’s proposal would make it easier for students to earn a degree through a “reverse transfer,” where students who transferred from a community college to a four-year-institution but haven’t completed a bachelor’s degree can apply those additional credits back toward an associate’s degree.

Originally titled the Reverse Transfer Efficiency Act of 2017, it was recently added as an amendment to the Higher Education Re-authorization by the House Committee on Education and Workforce. The provision would streamline credit sharing between community colleges and four-year institutions so transfer students can be notified when they become eligible to receive an associate’s degree through a reverse transfer.

“An associate’s degree can make a huge difference for working Hoosiers,” Messer said. “By making it easier for transfer students to combine credits and get a degree they’ve earned, Hoosiers will have more opportunities to get good-paying jobs and succeed in today’s workforce.” This legislation was supported not only by the Indiana Chamber, but also by Ivy Tech Community College and the Indiana Commission for Higher Education.

Donnelly Co-Sponsor of Chamber Policy Priority – Delaying Health Insurance Tax

Great news on a long-term policy priority for the Indiana Chamber! A bill has been introduced to delay the implementation of the Affordable Care Act’s Health Insurance Tax (HIT) until 2020 and to make the fees tax-deductible. As things currently stand, the tax would come into effect in early 2018 and bring with it increased health care costs.

Joe Donnelly

Senator Joe Donnelly is one of two co-sponsors of the measure from Sen. Heidi Heitkamp (D-ND).

The Indiana Chamber opposes HIT because of its impact on the small business community. HIT rests entirely on the insured marketplace, so that means businesses and their workers will feel the brunt. Higher premiums for consumers, including small and family-owned businesses – no thanks! And to make matters worse, the tax does not sunset but increases through 2024 and is adjusted for premium growth.

A recent report funded by UnitedHealth Group says that HIT would “increase 2018 health care costs by $158 per person on the individual market, and by $245 for Medicare Advantage participants.”

The HIT has been a bipartisan bone of contention for years, with a previous one-year delay in implementation already having passed Congress.

The Heitkamp-Donnelly bill, S. 1978, now will be reviewed by the Senate Finance Committee.

The Indiana Chamber will continue to voice its approval for this measure to our delegation members.

Senate Health Care Reform – Act III

A bipartisan agreement has been reached in the Senate to help stabilize health care markets – from Senate Health, Education, Labor and Pensions Committee Chairman Sen. Lamar Alexander (R-TN) and ranking member Sen. Patty Murray (D-WA).

Among other things, the Alexander-Murray agreement would:

  • fund cost-sharing reduction payments, which help lower consumers’ deductibles and co-pays, for two years;
  • broaden the pool eligible for a “copper plan” (catastrophic medical) coverage option, which would help reduce the mandate implications for essential benefits;
  • include funding to help Americans navigate signing up for health insurance, which had been cut by the Trump administration; and
  • set up high-risk pools that will allow for continued coverage for these individuals.

What this is not is a “repeal and replace”. That said, the two-year funding promise is good news for insurers and would help alleviate their unease, which would also be felt by consumers. But this bill does nothing to address the core problems in the individual marketplace that threaten its sustainability.

Indiana Sen. Joe Donnelly, who has been pushing for bipartisan fixes to the Affordable Care Act (ACA), has thrown his support behind the Alexander-Murray agreement and is a co-sponsor of the legislation. He stated, “This is the product of hard work from members on both sides of the aisle, and it’s an important step in providing much needed stability to the market. I’m proud to be part of the effort, and I will continue working with Republicans and Democrats to move this much-needed legislation forward.”

President Trump has alternately met the agreement with both optimism and skepticism. Overall, he’s indicated that he would favor a short-term subsidy fix; however, he doesn’t want to help insurers either.

It would appear the bipartisan legislation would garner most, if not all, Senate Democrat votes (as Minority Leader Chuck Schumer alluded to on Thursday), so that would leave a lot of wiggle room for passage if some, or even many, Republicans vote against it. The question is what Senate Majority Leader Mitch McConnell will do and what he says to his caucus.

Meanwhile, Sens. Bill Cassidy (R-LA) and Lindsey Graham (R-SC), the authors of the Senate’s second ACA reform attempt, have been working with Alexander and Murray on ways the bill can be made palatable to the very conservative arm of the congressional Republicans – most notably in the House.

In other words, this is far from a done deal.

New Senate Health Care Bill An Improvement for Employers

The U.S. Senate appears to be gearing up for another health care vote, with a measure from Sens. Bill Cassidy (R-LA) and Lindsey Graham (R-SC) headed to the floor as soon as the middle of next week.

At its core, the Graham-Cassidy proposal creates a block grant program, taking much of the funding provided in the Affordable Care Act (ACA) and sending it to the states for them to set up their own health care systems and determine where to direct the funds.

It also does away with several pillars of the ACA, including the mandate for individuals to have insurance or pay a penalty. The true ramifications of that are uncertain, but could mean higher premiums for those in the health care exchanges (aka those who don’t have insurance through their workplace).

From the standpoint of employers, the Indiana Chamber believes Graham-Cassidy is an improvement over the ACA. This is primarily due to two changes:

  1. The removal of the employer mandate to offer coverage. If that goes away, so too does the ACA’s definition of a full-time employee as someone working an average of 30 hours per week; this has negatively impacted businesses and workers – many of whom saw their hours reduced.
  1. The permanent elimination of the medical device tax, which is detrimental to vital Hoosier employers like Cook Medical in Bloomington, Zimmer Biomet in Warsaw and many others.

Overall, those in favor of increased state control are more receptive to the Graham-Cassidy effort.

As Vice President Mike Pence put it on Fox News yesterday: “…The question that people ought to ask is, who do you think will be more responsive to the health care needs in your community? Your Governor and your state legislator, or a congressman and a President far off in the nation’s capital?…”

 What has opponents worked up is two-fold: affordable coverage for pre-existing conditions isn’t specifically guaranteed; and population size will determine the amount of the block grant, which will reduce funding for a number of states – including some in the Rust Belt and more rural states in general.

Republican Sen. Jeff Flake of Arizona told MSNBC on Thursday he has absolute faith that governors will keep pre-existing condition protections, because of the severe political cost if they don’t. Opponents are less convinced.

At this point, Kentucky Sen. Rand Paul is the lone Republican who has sworn opposition to the Graham-Cassidy bill publicly – in part because his state appears to be set to lose funds in this model.

Likewise, Indiana is expected to see less federal dollars, but the Hoosier state has been preparing for what it saw as an eventuality for several years – setting aside hundreds of millions of dollars to subsidize its Healthy Indiana Plan (HIP) 2.0.

The HIP model is unique in the country; it requires participants to have “skin in the game” with their health care decisions and allows for capping the number of participants. Both of these make it an inherently more nimble program. And ultimately, the state Legislature can also determine to put more funds into HIP 2.0, if it’s deemed necessary.

These facts and the lure of more state control were likely factors in Gov. Eric Holcomb’s decision to sign a letter supporting Graham-Cassidy; he was one of 15 state executives to do so. The reality is other states may not be as fiscally prepared for a possible funding reduction as Indiana is.

That leads us to who may end up being the pivotal figure in the floor vote: Sen. Lisa Murkowski of Alaska. She joined Sen. Susan Collins (Maine) and Sen. John McCain (Arizona) in voting no on the last health care reform measure. Collins is seen as a likely “no” again, joining Paul, while McCain is a predicted (or at least hoped for) “yes.”

As a result, the bill authors are pulling out all the stops and making special accommodations for Alaska in the bill to woo Murkowski’s vote – because they can’t lose her and have the bill survive for Vice President Pence to break the tie. If no specific provisions for Alaska are made, the state would be a big loser in the bill in funding because of its size vs. population and geography.

The Indiana Chamber plans to talk about health care reform with Sen. Joe Donnelly, who has announced his opposition to Graham-Cassidy, and Republican Sen. Todd Young during Wednesday’s D.C. Fly-in event.

UPDATE: This afternoon, McCain announced he would oppose the Graham-Cassidy bill, making passage of the bill seemingly very difficult.

Donnelly, Walorski Working to Define Full-Time as 40 Hours Per Week

Since the passage of the Affordable Care Act (ACA), employers in Indiana and across the country have been forced to cut employees’ hours due to the law’s definition of a full-time employee as someone working an average of 30 hours per week.

The Indiana Chamber recognizes this as a significant issue for the Hoosier business community and has been pushing for a change back to the 40-hour work week. We are pleased to see that our delegation is leading efforts to make that happen.

Recently, Sen. Joe Donnelly reintroduced a bipartisan proposal that would change the definition of a full-time employee under the ACA to someone who works an average of 40 hours per week. Donnelly partnered with Sen. Susan Collins (R-ME) on this legislation.

Senator Joe Donnelly and Congresswoman Jackie Walorski greet Vice President Mike Pence as he arrives in South Bend to deliver the May commencement address at the University of Notre Dame (photo courtesy WSBT).

“I believe that we can work together to fix issues with the health care law and improve our health care system. I have heard from part-time workers across many industries, like school cafeteria managers to grocery store employees to adjunct professors at colleges, that have seen their hours cut to comply with the health care law,” Donnelly said.

“In Indiana, common sense holds that a full-time employee is someone who works an average of 40 hours a week, and the health care law should reflect that. I’m proud to partner with my friend and colleague Sen. Collins to reintroduce the Forty Hours is Full Time Act, and I am hopeful the Senate will consider this bipartisan bill soon.”

Meanwhile, a similar effort was introduced Thursday in the House led by Republican Congresswoman Jackie Walorksi (IN-02) and Congressman Dan Lipinski (D-IL).

The Save American Workers Act (H.R. 3798) also would restore the traditional 40-hour work week under the ACA.

“Obamacare’s burdensome employer mandate and its redefinition of full-time workers are hurting middle class American families and crushing our job creators,” Walorski said. “The Save American Workers Act will provide much-needed relief to hardworking Hoosiers who have faced reduced hours and fewer jobs. This bipartisan, commonsense bill will give businesses the certainty they need to create jobs, and it will give workers the opportunities they need to succeed.”

Background
The ACA currently requires employers with more than 50 full-time equivalent workers to offer health insurance to full-time employees (working 30 hours weekly) or face a penalty. This requirement has forced businesses to reduce hours and slow hiring in order to avoid unaffordable new costs or the ACA’s substantial fines. The 30-hour definition has affected workers in the private sector as well as city, state and school employees, with a particularly severe impact on hourly, part-time, and seasonal workers.

So What’s Going On With Obamacare?

NOTE: This video was recorded before Donald Trump’s election, which has likely changed the course of the Affordable Care Act going forward. But these comments are on the ACA as it now stands. 

Libertarian magazine Reason interviewed its features editor, Peter Suderman, about the status of the Affordable Care Act. He explains how the rising prices will impact consumers and taxpayers. Is this Obamacare’s “death spiral?”

ChamberCare Solutions Program Provides Health Care Answers

chambercare

More than six years after the Affordable Care Act was signed into law, it’s still not an easy process for companies to determine the best health care choices. Important assistance and options are now available through the ChamberCare Solutions program.

The Indiana Chamber has partnered with Anthem Blue Cross and Blue Shield since 2004 on ChamberCare – an insurance discount offering for businesses with between two and 99 employees. More than 25,000 employee lives (and 50,000 lives when spouses and dependents are included) were covered through ChamberCare.

Now, ChamberCare Solutions takes that partnership to an even higher level with a suite of solutions to help meet insurance needs.

“The Indiana Chamber-Anthem partnership has been an excellent one for our member companies, as well as their employees and families,” says Jennifer Elkin, Chamber senior vice president of marketing. “There have been more questions than answers since the Affordable Care Act was signed. We’ve been listening, discussing and searching for the right tools and products – and we’ve found them in this evolution to ChamberCare Solutions.”

The ChamberCare Solutions options include:

  • ChamberCare Savings: This is the previous ChamberCare discount program – now available for companies with between 51 and 99 employees. This was made possible by the late 2015 signing of the PACE Act (Protecting Affordable Coverage for Employees), which returned the definition of a small business back to one with fewer than 100 employees.
  • ChamberCare Exchange: For companies with fewer than 50 employees and a potentially unhealthy, higher-risk population, the exchange might be the best alternative. Important guidance and navigation is available through Anthem.
  • ChamberCare Business Resources or a PEO (Professional Employer Organization): This is an attractive option for companies that, in addition to a competitive health care product, are looking to outsource some of their human resources functions. The multiple employers in the PEO allow the advantage of using a company’s experience rating compared to the generally more volatile community rating.

The Indiana Chamber and Anthem are teaming with Indianapolis-based Human Capital Concepts (HCC) on the PEO. Harlan Schafir, CEO of HCC, started the state’s first PEO in the early 1990s; he and his team have more than 125 years of experience in the industry.

“We are in the midst of an unprecedented talent war,” Schafir explains. “A PEO allows companies to attract and retain talent by improving employee benefit offerings and helps these organizations mold an attractive culture. Working with a PEO allows companies to focus on their core mission. The PEO takes care of compliance with ever-complex laws and regulations; company leaders focus on running their business.”

  • ChamberCare Shared Savings: This is a future offering under development by Anthem. It is expected to allow for self-funding for employers with as few as 25 employees. To date, such plans have only been available for organizations with at least 100 employees.

“The Indiana Chamber has advocated and educated on health care issues for many years. We’re pleased to add this in-depth navigation benefit,” Elkin adds. “Being able to offer these choices – with more to come – will save members money and allow to further invest in their people and businesses.”

Learn more or contact Nick Luchtefeld at (800) 824-6885.

Sen. Donnelly: “Roads Aren’t Republican or Democrat”

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In a visit with the Indiana Chamber’s Congressional Affairs Policy Committee today, Sen. Joe Donnelly (D-Indiana) said he believes a new long-term highway infrastructure bill should be enacted yet this year.

Citing “desperate, crying” infrastructure needs, the senator said two imperatives are to “make sure we (Indiana) get our share” and “make sure we get it funded. We’re talking about  a six-year deal. I’ll take a five-year deal (if need be).”

Indiana is currently receiving 95 cents back on each tax dollar that it sends to Washington. In recent discussions, Donnelly voted no on a proposal that would have included Indiana’s share dropping to between 90 cents and 92 cents on the dollar. The goal, he says, is for no state to be funded at a lower percentage level than in the last long-term deal.

Transportation funding has been dependent on a series of short-term extensions that have not provided the resources needed for states to act with any certainty. Donnelly cited several instances of the damaging impact in Indiana, including the current closure of Interstate 65 near Lafayette due to bridge instability.

“Roads aren’t Republican or Democrat; they’re roads,” he explains. “There’s no way to do this without investment. I’m for seven different ways to fund this thing. Just pick one (or more). I just want to build roads.”

Donnelly also discussed potential changes to the Affordable Care Act (including his support for elimination of the medical device tax), the consequences of Washington legislating through Executive Orders, the debt limit, immigration, Iran, global environmental concerns and more.

Congress is scheduled to resume its work in Washington after Labor Day. Indiana Chamber members will be traveling to Washington on September 16-17 for the annual D.C. Fly-in. You can still register to participate.

Congress Can Do It, But You Can’t

An interesting blurb in a recent Kiplinger newsletter on one of the privileges of congressional service:

Congress can do what employers can’t when it comes to health coverage: use tax-advanced funds to reimburse workers who buy individual health care policies on exchanges. Employers face a tax penalty of $100 a day per worker for violations.

Yet the government gives lawmakers and Capitol Hill staffers tax free contributions to help offset insurance premiums, covering about 72% of exchange-bought insurance. The government allowed the payments because of concerns about higher premiums and the loss of the government subsidy for insurance for both lawmakers and staff.

The IRS restated its view that such subsidies aren’t permitted in the private sector after some vendors told employers that the pretax payments would allow them to meet the mandate to provide insurance. The double standards isn’t likely to change.

Chamber Members: New ACA Helpline can Help Alleviate Your Health Care Stress

Concern over the Affordable Care Act (ACA) — from its complexity to actual implementation — is something we continue to hear a lot about from the business community. To better assist with those inquiries, we are pleased to introduce a new service exclusively for Indiana Chamber members.

The Indiana Chamber's ACA Helpline is now here to help your organization navigate through the complicated health care reform processes and obligations. This FREE service is similar to the popular HR Helpline; we encourage employers of ALL sizes to use this member benefit.

Mike Ripley, Chamber vice president of health care policy, will be answering your questions. He is a former insurance agency owner and was chairman of the House Insurance Committee as a state representative.

Ripley says while employers are faced with a more reasonable timeline overall due to the employer mandate being delayed until January 2015, there is still plenty that needs to be taken care of between now and then. Virtually all the rest of the employer responsibilities and various levels of compliance remain the same — as other ACA provisions were unchanged.

Among the common questions from employers:

  • Who is considered a full-time employee?
  • What if we offer coverage but our employees don't take it?
  • What is the employer shared responsibility payment?
  • Do we have to provide notice to our employees?
  • How do we know if our coverage is affordable/provides minimum value?
  • Will our company qualify for small business tax credits?

Make your own list of issues and start using the Chamber's ACA Helpline today! Call Mike Ripley at (317) 264-6883 or send an email to mripley@indianachamber.com.