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.

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.

Federal Health Care – Republicans Can’t Do It Alone

Progress on health care reform by Senate Republicans came to a halt very early this morning as the so-called “skinny repeal” of the Affordable Care Act (ACA) narrowly failed 49-51. All Democrats were joined in their opposition by Republican senators Susan Collins (Maine), John McCain (Arizona) and Lisa Murkowski (Alaska).

While Collins and Murkowski’s votes came as no real surprise, the GOP hope was for McCain to allow the bill to proceed to an expected conference committee for further work. But in McCain’s statement explaining his decision, he mentions the lack of complete certainty provided by House Speaker Paul Ryan that the bill wouldn’t be voted on as-is and passed by the House instead – as well as his opposition to voting on what he considered to be a “shell of a bill.”

Essentially, this outcome means the only path to reform now would appear to be a bipartisan approach, as Senate Majority Leader Mitch McConnell (Kentucky) alluded to in his remarks following the defeat.

Indiana’s Democratic senator, Joe Donnelly, has been pushing for this path all along and reiterated those thoughts after today’s vote:

“I still believe that by working together we can improve our health care system and, at a minimum, Congress and the administration should do no harm to the millions of Americans’ whose health and economic well-being are at stake. I share the frustration of Hoosiers and Americans who are tired of partisan proposals that fail to address issues with our existing health care system and the continued legislative uncertainty that is undermining the insurance markets.

“We should do the hard and necessary work to gather the input of doctors, nurses, hospitals and patients, and work in a bipartisan manner to make coverage more affordable and accessible for Hoosier and American families.”

Of note: Donnelly attended a dinner Wednesday evening with a bipartisan group of senators to discuss ways to work together on health care. In May, Donnelly also had a similar meeting.

Our junior senator, Todd Young, voted for the “skinny repeal” bill as “another step towards relieving Hoosiers and millions of Americans from the burdens of Obamacare. Too many Hoosiers have been left with too few options and rising costs. It is more important than ever that we keep our promise to them and fundamentally reform our health care system.”

Like Donnelly, Young is eager to strengthen the ACA and work in a bipartisan fashion to get that done.

“Going forward, I will participate in hearings in the HELP (Health, Education, Labor and Pensions) Committee and continue to work with my colleagues, on both sides of the aisle, to come up with a solution that provides long-term stability to our health care system and gives each and every Hoosier the opportunity to access quality and affordable insurance.”

Additionally, Young has previously looked for ways to find common ground. In the spring, he sent a letter to all Democratic senators urging them to share their views on what’s working and what’s not with the ACA.

Indeed, there are aspects of the ACA that both Democrats and Republicans have acknowledged as problematic; the medical device tax, which needs to be permanently repealed, is among them. So hopefully these areas can serve as a starting point for crafting a bipartisan solution.

From the Indiana Chamber’s perspective, the reality is that the ACA has not made life easier or costs cheaper for businesses (or many Hoosiers).

Separately, the ACA’s pending collapse – with insurers pulling out – isn’t surprising based on its inherently flawed assumptions. Unfortunately, very little of the congressional debate so far has focused on shoring up the ACA at its core, or how to put forth a replacement program that is stronger foundationally. Hopefully, that will occur in future discussions.

Indiana Delegation Talks Affordable Care Act Repeal

The vote to repeal and replace the Affordable Care Act (ACA) couldn’t get off the ground in the U.S. Senate. But President Trump, Vice President Pence and many members of Congress instead have called for a simple repeal of the ACA – with a replacement coming at a later date.

Congressman Luke Messer (IN-06) is on board with that process. “Hoosiers are sick and tired of endless debate on the Obamacare repeal bill, and the failure of Congress to act. This is D.C. politics as usual, and exactly why Americans sent the President to Washington to shake things up and get something done.

“We’ve had more than enough time to deliver on this promise to Americans, who have sent us here for three election cycles to repeal this failed law. I agree with President Trump that we must repeal Obamacare NOW and then work together on a plan to ensure Hoosiers get the health care they want and deserve.”

Meanwhile, Sen. Joe Donnelly urged bipartisanship in finding common ground. “The proposed Senate health care bill would have been disastrous for Hoosiers. The latest plan to repeal without any replacement is downright reckless, playing politics with the health and economic well-being of millions of American families.

“It is time to do the hard work of forging a bipartisan bill to strengthen our current health care system, so that we can reduce costs for Hoosier families, continue to protect people with pre-existing conditions, and preserve the good work states like Indiana have done to expand affordable health care. The American people are counting on us to take a thoughtful approach together, and I urge the Senate to take this path in the coming days.”

Congressman Larry Bucshon (IN-08) had a different take. “Obamacare is collapsing and as a result patients across the country are at risk as premiums skyrocket and insurers flee the exchanges. In Indiana, premiums have increased an average of 74% and two of our state’s four insurers recently announced their departure from the Obamacare exchanges. Hoosiers are being priced out of the insurance market, if they can find insurance at all. This is not the health care Americans were promised by President Obama and congressional Democrats when they passed Obamacare, and certainly not what they deserve.

“To me, this is personal. I spent more than a decade as a surgeon before coming to Congress. This is about the well-being of my constituents who are struggling to access quality, affordable health care under Obamacare. That’s why I made a promise to repeal and replace this failed law to help drive down costs, expand access, and get the federal government out of decisions that should be left up to patients and their doctors. The House did its job to fulfill our promise. I’m extremely disappointed that, thus far, the Senate has failed to live up to its commitment to the American people. It’s time for the Senate to act.”

Health Care: Donnelly Co-Authors Bipartisan Bill to Speed Up FDA Approvals for Devices; Young Reaches Across the Aisle on ACA

Senators Joe Donnelly (D-IN) and Cory Gardner (R-CO) have re-introduced the bipartisan FDA Regulatory Efficiency Act, which would allow the Food and Drug Administration (FDA) to bring innovative medical devices to market more quickly.

Donnelly stated, “As scientists and innovators across Indiana and our country work to find new cures and therapies, we should be making it easier for them to bring these products safely to those who need them. I’m proud to work with Sen. Gardner on this bipartisan legislation to cut through the red tape at the FDA and safely speed up the approval process.”

The FDA Regulatory Efficiency Act would help the FDA concentrate on high-priority activities by authorizing third parties to approve quality systems of device companies. Authorized third parties could only approve changes that do not involve major technology changes or changes in the use of the product. The legislation would still hold companies accountable for their quality systems, while also helping to alleviate the overwhelmed FDA. Donnelly and Gardner first introduced the legislation in October 2015.

Health Care Reform Notes
Freshman Sen. Todd Young has reached across the aisle in an attempt to find common ground on health care. He recently sent a letter to all Democratic senators urging them to share their views on what’s working and what’s not with the Affordable Care Act. Young is a member of the Senate Health, Education, Labor and Pensions Committee, which will have a key role in shaping the Senate’s version of health care reform.

Congresswoman Jackie Walorski (IN-02) is touting the American Health Care Act (AHCA), as passed in the U.S. House of Representatives, and how it “brings us closer to a better health care system that puts patients first.” Her editorial appeared Sunday in the South Bend Tribune.

Congressman Larry Bucshon, M.D. (IN-08), who sits on the House Committee on Energy and Commerce where he is a member of the Subcommittees on Health, is using his web site to promote the Washington Post’s fact-checking of several recent claims about the AHCA. One is on coverage for those with pre-existing conditions and the other on classification of assault as a pre-existing condition; both claims were deemed untrue.

Around the Horn With What Happened in D.C. Last Week

As expected, President Trump signed many executive orders this past week aligning with campaign promises for sweeping change. Some of these include:

  • Encouraging federal agencies to dismantle large parts of the Affordable Care Act, including the very controversial individual mandate requiring people to purchase insurance
  • The official withdrawal of the U.S. from the Trans-Pacific Partnership – a move the Indiana Chamber opposes
  • Freezing federal hiring
  • Advancement of the Keystone XL and Dakota Access oil pipelines
  • Illegal immigration activities – directing dollars to begin construction of a wall on the southern border and the boosting of federal agency efforts to stop illegal immigration
    On a related note, the President’s chief of staff, Reince Priebus, issued a memo telling federal agencies to put a freeze on any new regulations and a 60-day hold on regulations that have not yet taken effect.

The members of the President’s cabinet that have been sworn in to date by Vice President Mike Pence: retired Marine General James Mattis as Defense Secretary, retired Marine General John Kelly as Secretary of Homeland Security, Rep. Mike Pompeo (R-Kansas) as Director of the CIA and Governor Nikki Haley (R-SC) as UN Ambassador.

Rex Tillerson’s nomination for Secretary of State made it out of the Senate Foreign Relations Committee and is awaiting consideration by the full Senate. Meanwhile, Betsy DeVos, nominee for Education Secretary, had her committee vote postponed until January 31. Indiana’s senior senator, Joe Donnelly, has announced that he will not support her nomination; watch his announcement of that decision.

Questions About Open Enrollment? The Indiana Chamber has Answers

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Open enrollment for health care insurance is now upon us, and many businesses are faced with difficult choices for 2017. Premiums are expected to increase sharply under the Affordable Care Act (ACA) according to many experts – the Department of Insurance says some in Indiana have seen premiums go up by almost 70%!

The Indiana Marketplace (Indiana’s federally mandated online health care insurance exchange) has not been the answer many were hoping for. And don’t forget about the penalty for businesses choosing not to offer insurance to their employees – a penalty that will be adjusted each year to account for inflation.

The Indiana Chamber of Commerce has been working since 2004 to provide members with reasonable health care insurance options supported by brands you trust. In 2016 and beyond, we’re excited to offer a new program called ChamberCare Solutions, with a larger portfolio of health plan options.

This partnership between the Indiana Chamber and Anthem Blue Cross and Blue Shield can help you find the coverage that is right for your business. We are committed to coverage that is simple to understand and affordable. All plans comply with the ACA.

ChamberCare Business Resources: A professional employer organization (PEO) administered by Human Capital Concepts (HCC). Why a PEO? PEOs allow employers to outsource their HR functions and employee benefits programs to ensure they’re in compliance with HR laws and the ACA. By outsourcing to a PEO, you can focus on what you do best — running your business. According to the National Association of Professional Employer Organizations, businesses that use a PEO grow 7% to 9% faster, enjoy 23% to 32% lower employee turnover and are over 50% less likely to go out of business.

ChamberCare Savings: An excellent choice for companies with 51-99 employees, with 5% savings on any Anthem plan.

ChamberCare Exchange: Access to flexible, affordable health plans for companies with 2-50 employees.

Which solution is right for you and your employees? Contact your insurance broker today or call/email Brett Hulse, Indiana Chamber, at (317) 264-6858 or [email protected]

ChamberCare Solutions Program Provides Health Care Answers

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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.