Learn more about Health issues of interest to American Benefits Council members.
The tax incentives for employer-sponsored health and retirement plans are commonly at risk of being curtailed or eliminated to generate federal revenue in the context of tax or budget reform. The Council is constantly working to preserve these tax incentives by underscoring their economic value.
This section includes legislation and guidance related to the original passage and enactment of the Affordable Care Act, as well as any proposed measures to replace it.
Affordable Care Act Section 4980H requires employers to offer affordable, minimum-value health coverage to full-time employees or pay a penalty if at least one full-time employee obtains subsidized health coverage in a state health insurance exchange. This entails substantial reporting requirements under Internal Revenue Code sections 6055 and 6056. This section covers these provisions as well as related topics including the definition of "essential coverage," the definition of "full-time employee" and the administration of waiting periods.
The Affordable Care Act established a number of taxes and fees on employers, including the 40 percent “Cadillac Tax” on plans above certain cost thresholds. This section also covers such fees as the Transitional Reinsurance Program fee, the Patient-Centered Outcomes Research Institute (PCORI) fee and the health insurer fee under ACA Section 9010.
This section covers the regulation of employee wellness programs, which aim to improve and promote workforce health and fitness, often through rewards and incentives.
Workplace arrangements like Health Savings Accounts (HSAs), Flexible Spending Arrangements (FSAs) and Health Reimbursement Arrangements (HRAs) give participants more choice with respect to health care decisions and provide incentives for seeking out the most cost-effective care. The Council supports public policy that gives plan sponsors the flexibility to offer these arrangements.
ERISA provides for federal preemption of any state law that relates to an employee benefit plan, with the exception of insurance laws. Beginning in 2017, however, states are permitted to seek "state innovation waivers" under Section 1332 of the Affordable Care Act (ACA), under which federal regulators may waive certain aspects of the health care law. The Council has called for limiting the applicability and scope of these waivers.
Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), workers and their families who lose health benefits, under certain circumstances, have the right to choose to continue group health coverage for limited periods of time. This section addresses the requirements associated with the provision of COBRA coverage.
This section covers health and welfare offerings that employers provide to their retired workers, whether or not they are integrated with Medicare.
One goal of health reform has been to lower costs by improving the quality of care. Performance measurement, new payment models and value-based insurance design, which seeks to align patients' out-of-pocket costs with the value of services, can help lower costs and improve medical outcomes.
Under ERISA, a fiduciary has the legal responsibility to act solely in the interest of its participants and beneficiaries. This section covers enforcement, amendment and litigation of these responsibilities, including matters related to the provision of retirement-related investment advice.
This section addresses employee benefit offerings or practices that are perceived to run afoul of age or disability nondiscrimination rules, including the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA).
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) governs the security and privacy of "protected health information" (PHI). This section addresses matters related to such data, including applicability to the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH).
This section covers enforcement and other matters related to the Mental Health Parity Act of 1996 (MHPA) and the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which require parity in health coverage between mental health and substance abuse disorders and physical illnesses.
This section covers items related to the federal Medicare program providing health care to seniors, including matters where the program integrates with employer plans, such as Medicare Advantage, and matters where Medicare's pricing and payment processes affect health care costs.
This section addresses miscellaneous and routine health plan administrative matters.