Mandating employer paid health coverage

These requirements apply to all private plans – including individual, small group, large group, and self-insured plans in which employers contract administrative services to a third party payer – with the exception of those plans that maintain “grandfathered” status.

In order to have been classified as “grandfathered,” plans must have been in existence prior to March 23, 2010, and cannot make significant changes to their coverage (for example, increasing patient cost-sharing, cutting benefits, or reducing employer contributions).

On June 22, 2017, Senate Majority Leader Mitch Mc Connell (R-KY) released the Senate GOP’s version of Affordable Care Act repeal, the Better Care Reconciliation Act of 2017.

The Senate bill is in many respects quite different from the House’s American Health Care Act (AHCA), which was introduced on March 6, 2017; AHCA passed on May 6 by a narrow, mostly party line 217 to 213 vote after lengthy negotiations and a series of amendments.

Like it or not–and I mostly don’t–Americans will wind up with some sort of government-centric model, likely one that provides basic coverage at a fixed price with some option for private supplemental coverage for those who can afford it.Although the Senate bill has the same bill number at the House, it entirely strikes the House bill and adopts a new bill with a new title.All of its amendments are amendments to the ACA itself or of other existing laws, not to the House bill.So those with a clean genomic result might go for a cheap catastrophic plan, while those with a high risk of developing pricey illnesses will opt for more comprehensive insurance. And, unless the Supreme Court strikes it down, Obama Care essentially requires people to carry health insurance.The result would be, in insurance terms, an “adverse-selection death spiral,” as the healthy opt out of expensive insurance, the sick opt into it, and premiums spin out of control. But the combination of federal laws mandating coverage regardless of pre-existing conditions and forbidding insurers to discriminate on the basis of genetic testing does further skew whatever “market” exists in healthcare.In 2014, 26% of workers covered in employer sponsored plans were still in grandfathered plans, and it is expected that over time almost all plans will lose their grandfathered status.


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