Latest Update on Congressional Health Reform Activity

This week, the Senate released two bills as part of its efforts to repeal the Affordable Care Act (ACA):

  • A revision to the Better Care Reconciliation Act (BCRA) eliminating the “Ted Cruz Amendment” which provided funding to create coverage alternatives for high-risk individuals (see our revised chart) and;
  • The Obamacare Repeal Reconciliation Act (ORRA), a bill that would repeal many of the major provisions of the ACA within a two-year period, but does not offer plans to replace those provisions.

We summarize the ORRA below. More activity, including a possible vote or further bill changes, is expected from the Senate next week. NASHP will continue to update and analyze developments as they emerge

Summary of the ORRA (as published 7/19/2017)

Insurance Reform

Individual tax penalty/mandate: Zeroed (2016)
Employer tax penalty/mandate: Zeroed (2016)
Advance Premium Tax Credits (APTC): Repealed (2020); includes repeal of all requirements related to conducing eligibility for APTC.
Cost-sharing Reduction (CSR): Appropriated through 2019. Repealed in 2020
Restrictions related to abortion:

  • Revises definition of QHP to not include plans that include coverage for abortion except in cases necessary to save the life of the mother or in cases of pregnancy resulting from rape or incest (as of tax year 2018).
  • Disallows use of small employer tax credit for use of coverage that includes abortion except in cases necessary to save the life of the mother or in cases of pregnancy resulting from rape or incest (as of tax year 2018).
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs):

  • Allows reimbursement for over-the-counter medications (2017)
  • Repeals restrictions on use of FSA for cafeteria plans (2018)
  • Repeals limitations on contributions to FSA accounts (2018)
  • Reduces taxes on HSA accounts (2017)


Medicaid expansion: Repealed (2020); includes:

  • Repeal of state option to expand to individuals >133% FPL,
  • March for newly eligible expansion population, and
  • Enhanced match for expanded Medicaid prior to 3/23/10
Presumptive eligibility:

  • Repealed for (2020)
    • Medicaid expansion population
    • Mandatory foster care up to age 26
    • Other low-income individuals
  • Repeals authority for hospitals (2020)
Medicaid benefits

  • Repeals enhanced match for Community-based Attendant Services and Supports (2020)
  • Repeals Essential Health Benefit requirement for alternative benefits plans (2020)
FMAP: Changes to 50% for territories (2020)DSH cuts: Repealed (2018)Eligibility and Enrollment: Repeals state requirement to coordinate eligibility and enrollment systems. (2020)


Cadillac tax: Repealed from 2020-2025; Reinstates Tax in 2026
Net investment tax: Repealed (2017)
Chronic care tax: Repealed (2017)
Tanning tax: Repealed (September 2017)
Tax on health insurance executives: Repealed (2017)
Medical device tax: Repealed (2018)
Prescription medication tax: Repealed (2018)
Annual fee on health insurance carriers: Repealed (2018)
Medicare surtax: Repealed (2018)
Employer retiree drug benefit tax deduction: Reinstated (2017)
Delivery system
Funding freeze on prohibited entities (Planned Parenthood): Imposes a one-year freeze on mandatory funding to prohibited entities which include non-profit, essential community providers primarily engaged in family planning and reproductive health services, that provide abortions in cases that do not meet the Hyde amendment exception for federal payment and received over $350 million in federal and state Medicaid dollars in fiscal year 2014.
Community Health Centers: Provides an additional $422 million for the Community Health Center Program in 2017.
Prevention and public health
Prevention and public health fund: Eliminated (2019)
State Substance Use/ Mental Health Fund: Appropriates $75 million in each of 2018 and 2019 for grants to states to address the substance abuse public health crisis or urgent mental health needs.