Happy 2018!  

While you were enjoying the holidays, you may have missed some important news regarding the ACA. Hopefully you’re aware that Congress passed and President Trump subsequently signed a major tax bill that lowered corporate and individual rates. If you missed this information or need a refresher, here is a short summary.  

What do taxes have to do with healthcare?  

Buried in the tax package was language repealing the individual mandate included in the ACA which required every American to be covered by health insurance. The IRS administers and enforces the mandate in the form of an additional fine or tax applied when Americans file their taxes annually.  

Fun fact: The Supreme Court ruled in NFIB v Sebelius that the U.S. government did not have the power to impose a mandate to buy insurance, however, the Court upheld the mandate in the form of the tax. 

The repeal of the individual mandate has long been sought by Republican opponents of the ACA. It was the focus of much attention when Congress was voting on its “Repeal and Replace” legislation last summer.  

What will the impact of repeal be?  

You may recall that it was the repeal of the individual mandate that led outside observers to project a significant increase in the number of Americans who are uninsured and increasing premiums in the ACA Marketplace. Supporters of repeal counter by highlighting that enrollment in the Marketplace is significantly lower than initially projected and enrollees are currently seeing double-digit premium increases. Given the broad exemptions currently in place to excuse those subject to the individual mandate penalty, one could also point to the Obama Administration’s lackluster enforcement and question the mandate’s true impact to date.  

Truth is, only time will tell what the impact of the individual mandate repeal will have on the American healthcare delivery system. Unlike other aspects of the tax legislation, the individual mandate repeal does not go into effect until 2019.  

What’s the impact on URAC?  

The ACA’s requirement that insurers offering coverage on the exchange be accredited has been a major driver of URAC’s Health Plan Accreditation. There will likely be no direct impact on URAC from repeal of the individual mandate. However, the number of insurers choosing to offer coverage on the Marketplace continues to shrink and this may further spur this trend. Any policy change that furthers this will likely result in fewer insurers pursuing URAC’s Health Plan Accreditation.  

As this trend has been known to us for some time, it was incorporated into URAC’s strategic plan and URAC is well positioned to offset the uncertainty in the ACA with new accreditation programs focused on success in a value-based payment environment.  

As always, if you have any questions or wish to discuss anything in more detail please do not hesitate to contact me!