September 2017

State of Reform and Potential Next Steps for Congress

With Congress back in session after its summer recess, both the House and Senate are working to address several high priority issues – including some, such as the budget resolution to repeal and replace some parts of the Affordable Care Act (ACA), that require action by the end of the fiscal year, Sept. 30. At this point, the ACA remains the law of the land, despite several attempts within Congress to pass a repeal bill under the 2017 budget reconciliation process. While health care talks are ongoing in the Senate, the Senate Health, Education, Labor and Pensions (HELP) Committee also began holding bipartisan hearings the week of Sept. 4 to discuss “actions Congress should take to stabilize and strengthen the individual health insurance market” in 2018. These hearings, while specifically focused on the Marketplaces, may play a role in shaping future repeal and replace efforts.

Legislative Focus
In addition to any new proposals and ideas that may come from the hearings, the American Health Care Act passed in the House on May 4 and bills proposed in the Senate all include several common themes that highlight the Republican legislative focus for health care reform. Since repeal, delay or modification of the provisions listed below have historically been included in draft legislation, it’s anticipated any future Republican-led proposals in the Senate will continue to focus on:   

  • Individual and employer mandate penalties
  • Medicaid expansion
  • ACA fees and taxes
  • Premium subsidies and cost-sharing reductions (CSRs)
  • Continuous coverage requirements
  • Age-band ratios
  • State waivers
  • HSA/FSA enhancements

Potential Next Steps
As the debate around whether to repeal, replace, or modify the ACA continues, it is unclear what Congress’s next steps will be. Congress could continue to pursue the repeal and replace strategy under the budget reconciliation process, propose changes to the ACA through comprehensive tax reform legislation, or attempt a bipartisan effort to “fix” the ACA. No matter which path it pursues, an identical bill must pass both the House and the Senate before the President can sign it into law.

Republican leadership in Congress or the Administration may also pursue other ways to dismantle, replace or reform the ACA including regulatory action, regulatory non-enforcement or other options.

ACA Compliance Required
Unless and until official guidance to the contrary is issued, ACA compliance is required. For more information on ongoing ACA compliance requirements please read our eNewsletter, Reform360.

Staying Informed
To stay up to date on the evolving state of health care reform, visit our new Repeal and Replace Update webpage on This page offers a snapshot of the latest regulatory and legislative activity.