There's momentum to halt an Affordable Care Act mandate requiring employers with 51 to 100 employees to offer plans on the small-group market.
The Protecting Affordable Coverage for Employees Act unanimously passed the House on Monday.
All eyes are on the Senate now to see if it will follow the House's lead. House members are optimistic that unanimous support will mean quick action, said Paul Kincaid, communications director for Rep. Tony Cárdenas (D-Calif.), a co-sponsor of the bill.
The PACE Act allows states to choose to expand the small-group market to include businesses with up to 100 employees.
Small employers are defined as those with up to 50 employees, but for plan years beginning in 2016, the ACA expands the definition of small employers to include those with up to 100 employees.
PACE Act supporters say expanding the small group market would put restrictions on plans offered by mid-size businesses, and that would result in higher premiums and less flexibility in benefits.
Also, those mid-sized businesses may, in the face of increased costs, decide to self-insure, a move the Obama administration warns would be detrimental to the ACA exchanges.
This would leave the smallest employers in the market with less healthy, more expensive pools, which could force them to increase premiums.
It is estimated that under current law, more than 3 million employees will experience a double-digit percent increase in their health care premiums, according to Health Subcommittee Chairman Joe Pitts (R-PA).
“Unless this current law is reversed, the disruption in the marketplace will be significant,” he said in a statement.
Political insiders chances are good that the Senate will agree with the House.
“I do not believe Congress will allow Jan. 1 st to pass by without some action being taken,” said Bradley Blakeman, a Republican strategist and principal at the 1600 Group, a consulting firm.
While the White House usually promises a veto on any law that would seek to alter the ACA, they have remained mum on this legislation, according to Timothy Jost, a professor at Washington and Lee University School of Law in Virginia and supporter of the health reform law.
Unlike other Congressional anti-ACA attempts like voiding the device tax or scrapping the employer or individual mandate, the PACE Act is actually expected to have a positive impact on the federal budget, Jost added.
The Congressional Budget Office estimates that the bill would increase federal revenues by $400 million over 10 years because it estimates premiums would fall as a result, which would reduce the share of employees' non-taxable compensation and increase the taxable share.
A White House spokesperson didn't immediately respond to a request for comment.
Jost noted that it's a bit late for Congress to be weighing the legislation because plans will have finalized their rates by the time it passes. Congress will have to act very quickly if it hopes to have any practical effect, Jost said.
He also said that even if the legislation moves on to the President's desk, it might have limited effects in some states.
That's because some states have expanded the definition of small businesses on their own.
“In those states, the change would happen unless their state legislatures amend the law, so I think it will be a bit of an uneven result even if this passes,” Jost said.
Also, HHS says it will not enforce certain small group market regulations for existing plans purchased by employers with 51 to 100 employees if plans are renewed by Oct. 1, 2016, which would effectively put off the new regulations until 2017.
Most states have said they plan to use that transition option, according to the National Association of Insurance Commissioners.
Still, the association is urging Congress to pass the legislation to ensure future stability and consistency for existing and new purchasers of plans.
The House has been busying this week.
On Tuesday, Republicans in the chamber used the reconciliation process to prevent Senate Democrats from blocking legislation to dismantle the ACA.
Under Senate rules, minority Democrats can block most legislation because it requires 60 votes to advance a bill, and Republicans have only 54 senators. Under reconciliation, the Senate can pass legislation with just 51 votes.
President Barack Obama can still veto it, but the vote could provide a blueprint for dismantling the law if Republicans retake the White House in 2016.
The House GOP has voted more than 50 times to repeal all or parts of the health law. Almost all the bills died in the Senate.
Reconciliation is limited to certain tax and spending measures, so Republicans can't use it to repeal the entire health law. But they can gut it.
Senate Democrats used the process of reconciliation to pass part of health care law in 2010.
The Associated Press contributed to this report.
