Healthcare Roundup: A Look Back, Look Ahead on Key Issues

Date: November 14, 2018

Here’s a look at small business legislative and regulatory updates, and what to look out for with the 2019 open enrollment period.

NFIB believes that small business owners deserve access to affordable, flexible, and predictable health insurance for themselves and for their employees.

Here is a roundup of small business legislative and regulatory updates, and things to look out for as the year closes out.

Legislative Updates

To end a shutdown of the federal government in January 2018, Congress delayed the Cadillac tax, the medical device tax, and the health insurance tax:

Delay of the Cadillac Tax

Congress delayed the Cadillac Tax, the 40 percent excise tax on high-value employer-sponsored health insurance plans, for an additional two years so that it will not take effect until 2022.

Step Toward Repeal of the Medical Device Tax

In January, the medical device tax was delayed until 2020. The House also voted to repeal the medical device tax in mid-July, but its future in the Senate remains uncertain. Packaged under the Affordable Care Act, the medical device tax adds a 2.3 percent excise tax on the value of medical devices sold domestically. According to the Tax Foundation, the medical device tax led to a loss of approximately 21,800 jobs between 2013 and 2015 and lowered industry research and development spending by $34 million in 2013.

Delay of the Health Insurance Tax (HIT)

The health insurance tax was suspended for 2019 as part of the January law. Before the 2018 August recess, the House also passed a bill that delayed the health insurance tax for an additional two years for 2020 and 2021. The HIT is passed along to small business owners in the form of higher premiums, to the tune of $500 per employee, Kuhlman says.

RELATED: NFIB webinar on healthcare legislation, regulation, market changes and election outcomes

Executive Orders

President Trump signed an executive order in Oct. 2017 to promote healthcare choice and competition across the United States. The order instructed federal agencies to implement four key items: expand short-term limited duration health insurance (proposed and finalized), expand health reimbursement arrangements (proposed), expand association health plans (proposed and finalized), and issue a cost transparency report. To date, the United States Departments of Labor, Treasury, and Health and Human Services have acted on the requested expansions by the president.

“Small business owners and employees need affordable options, and these regulations offer choices toward that goal,” says Kevin Kuhlman, NFIB’s Senior Director of Federal Government Relations. “These [healthcare options] have existed where there’s a vibrant association health plan market, for example, in the state of Washington. They co-exist with the existing small group and individual markets. They don’t disrupt the apple cart, like many critics say they will.”

It’s likely that each request within the executive order will require time to go into motion, Kuhlman says.

Expansion of Short Term Limited Duration Insurance (STLDI)

In August, the U.S. Departments of Treasury, Labor, and Health and Human Services expanded the maximum duration of short-term limited duration insurance from three to 12 months, and potentially up to 36 months with renewals. Duration can still vary by state, so speak to a licensed insurance agent to understand the terms of STLDI policies in your state.

STLDI is probably the most turnkey health insurance option available for small business owners who purchase coverage in the individual market, Kuhlman says. It’s not as comprehensive as health plans that are fully compliant with the Affordable Care Act, but it can be more affordable, both from a premium perspective and a deductible perspective. Starting in 2019, the tax penalty for purchasing non-compliant plans will be reduced to $0. “If folks are really feeling squeezed by high health insurance costs, they may want to—especially in the individual market—explore short-term limited duration health insurance,” he says.

The 2019 open enrollment period began Nov. 1, 2018 and ends Dec. 15, 2018. Start with the NFIB Health Insurance Exchange to explore your options.

RELATED: Visit the NFIB Health Insurance Exchange.

“Given the midterm election results, healthcare will be a priority in the next year,” Kuhlman says. “It’s too early to know exactly what Congress will do, but NFIB will continue to advocate for affordable, flexible, and predictable health insurance for small business owners.”

If you or your employees are looking for health insurance options, contact the NFIB Health Insurance Exchange to see what plans may be available.

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