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Major legislative changes to Patient Protection and Affordable Care Act unlikely

Ongoing Republican opposition to the landmark health care reform law and repeal efforts expected

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Major legislative changes to Patient Protection and Affordable Care Act unlikely

While there is no shortage of bills in Congress to amend the health care reform law, the odds of any of them getting congressional approval and being signed into law in 2014 are very low.

Those proposals include:

• Repealing a $25 billion reinsurance fee that will be paid by all group health care plan sponsors.

• Barring special exemptions from the reinsurance fee.

• Delaying by yet another year — to 2016 — the requirement that most employers offer affordable coverage to their employees or be hit with a stiff financial penalty.

• Revamping the definition of a full-time employee to determine if employers are offering coverage.

The chief reason, Washington observers say, for the likely lack of congressional action to approve measures to amend the Patient Protection and Affordable Care Act, is politics.

“I really can't imagine” significant changes, said Judy Bauserman, a partner with Mercer L.L.C. in Washington. “While President Obama expressed a willingness to make changes, Republicans say their strategy is to get rid of the law, not make it better. It doesn't look like Republicans have given up on that strategy.”

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Other benefits experts concur. “Election years are not known as times when a lot of stuff gets done,” said J.D. Piro, a senior vice president at Aon Hewitt in Norwalk, Conn.

On the other hand, some say congressional action is possible on some relatively narrow, though costly, provisions in the health care reform law.

One example is the requirement that group health care plan sponsors pay to the federal government a $63 fee for every person enrolled in their health plans starting in 2015. The fee is to decline to $44 in 2016, while the amount to be paid in 2017 — the last year of Transitional Reinsurance Program — has yet to be set by the U.S. Department of Health and Human Services.

The fee has angered employers that say it is unfair to assess them when the $25 billion in generated fee revenue is to be used to partially reimburse commercial insurers that cover individuals with high health care costs.

“It is a direct hit to employer plans,” said Steve Wojcik, vice president of public policy for the National Business Group on Health in Washington.

Some lawmakers agree. For example, Rep. Pat Tiberi, R-Ohio, who introduced the reinsurance fee repeal bill — H.R. 3489 — said at the time he proposed the measure that “it is simply outrageous that employers will be forced to pay the tax while they will get nothing in return.”

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Mr. Wojcik said there is a reasonably good chance that lawmakers could act on the proposal, especially because, with enrollment in public exchanges much lower than expected, the need for revenue to offset insurers' costs will be less.

Others, though, are less sanguine about the prospects for repeal.

“The challenge is finding other revenue sources” if the fee is repealed, said Amy Bergner, managing director of human resources solutions at PricewaterhouseCoopers L.L.P. in Washington.

“I don't expect to see it (the repeal legislation) go anywhere,” said Rich Stover, a principal with Buck Consultants L.L.C. in Secaucus, N.J.

Experts also say the odds do not favor a congressional delay in the law's requirement that employers with at least 50 full-time employees offer coverage or be liable for a $2,000 penalty for each full-time employee, minus the first 30 employees.

That requirement, which was to have gone into effect on Jan. 1, 2014, was delayed to Jan. 1, 2015, by U.S. Treasury Department regulators, who said it was necessary to give the agency more time to simplify how employers are to file health care plan enrollment information with the government.

Some lawmakers say compliance with the “play-or-pay” mandate should be delayed to 2016. Delaying the employer mandate until 2016 is necessary “to give businesses time to learn about” the Patient Protection and Affordable Care Act, said Sen. Mark Begich, D-Alaska, when he introduced legislation to delay the mandate.

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Experts, though, say there is nothing close to a congressional consensus for delaying the mandate to 2016.

“I don't think an employer compliance strategy should be based” on an assumption that the mandate will be delayed again, Aon Hewitt's Mr. Piro said.

Observers also are not optimistic that Congress will approve a measure that would liberalize the definition of a full-time employee. Under the law, a full-time employee is defined as working an average of at least 30 hours per week.

That measure introduced by Sens. Joe Donnelly, D-Ind., and Susan Collins, R-Maine, would change the definition of full-time employees to those working an average of 40 hours per week.

The health care reform law's definition of a full-time employee “has caused significant confusion among employers who are struggling to understand and comply with the new requirements,” Sens. Donnelly and Collins wrote in a letter to President Obama.

While there is some bipartisan support for the measure, “I wouldn't hold out much hope for the change to be made in 2014,” Ms. Bergner said.

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