Employers are still trying to understand how the U.S. Senate’s Christmas present to the nation — a 2,074 page health care reform bill topped with a 383-page manager’s amendment — will affect them and their employees. (During a highly unusual Christmas Eve session, the Senate passed the bill in a 60-39 party-line vote.) Before the managers amendment was added, the bill was predicted to bury employers in paperwork. When Congress returns in January, members of both houses will work in a conference committee to iron out the differences in the health care reform bills passed by the U.S. House of Representatives and the Senate. So, although we don’t know yet exactly what will be included in the bill that comes out of the conference committee, many predict that the Senate bill will be the backbone of the consolidated bill, and we already know it places many issues affecting employers on the table.
How does the manager’s amendment affect employers?
The manager’s amendment revises the original Senate health care reform bill to include the compromises and alterations that were required to obtain the 60 votes needed to pass the legislation. Among other things, it affects employers by:
- amending the original Senate bill to bar lifetime limits and annual limits on the value of essential benefits;
- allowing lifetime or annual limits on nonessential benefits;
- allowing certain plans with plan years beginning before January 1, 2014, to establish restricted annual limits on the value of certain essential benefits;
- allowing certain plan participants, beneficiaries, and enrollees to choose their primary care provider from any participating primary care providers available to accept them;
- requiring group health plans and health insurance issuers to cover emergency services without forcing plan enrollees to obtain prior authorizations or be subjected to increases in cost-sharing (whether or not such services were provided by in-network or out-of-network providers);
- allowing an individual with a child who is a plan participant, beneficiary, or enrollee to choose a pediatrician as the child’s primary care provider if the provider participates in the applicable plan or issuer network;
- prohibiting group health plans and health insurance issuers from requiring female participants, beneficiaries, or enrollees to obtain authorizations or referrals when seeking coverage for gynecological or obstetrical care provided by specialists in those areas;
- requiring group health plans and health insurance issuers to cover qualified individuals’ routine patient costs for their participation in certain clinical trials;
- subjecting self-insured plans to annual reporting requirements;
- eliminating the penalty for certain employers that have waiting periods of more than 30 days (which was found in the original Senate bill) but retaining the penalty for employers that have waiting periods of more than 60 days;
- providing that certain construction industry employers with at least five full-time employees and whose annual payroll expenses exceed $250,000 will be subject to fines if they have even one employee who receives a federal subsidy to buy health insurance through the new exchanges; and
- requiring certain employers to provide qualified employees with “free choice vouchers” to be used to purchase qualified health care plans on an exchange.
Where does health care reform go from here?
The U.S. House of Representatives passed its own version of health care reform in November, and the Senate bill will have to be reconciled with the House legislation. If an identical bill is approved in both chambers, it will go to the President to be signed into law. The House and the Senate are set to begin negotiations in January, and the President has indicated that he wants to sign a health care bill before his State of the Union address, which normally takes place in January.
Keep up with the latest legal changes affecting employer benefits and trends in employee benefits with the Benefits Complete Compliance and with changes in federal employment laws in the Federal Employment Law Insider.