Recent Successes

CAHC is on a mission to lower health costs for all Americans. We helped convince Congress and the Administration that rising health costs continue to pose a serious threat to employers and their workers, families, individuals and our nation’s finances. We are proud of the hard work and progress that went into our most recent successes, which include:

  • Small Business Health Care Relief Act (Provision in 21st Century Cures- P.L. 114-255). CAHC helped develop legislation to protect small employers who offer benefits to workers through voluntary Health Reimbursement Arrangements (HRAs) from outrageous IRS fines.
  • PACE Act (P.L. 114-60). CAHC helped enact the Protecting Affordable Coverage for
    Employees (PACE) Act, which eliminated the requirement that forced states to change the small group market definition from 50 to 100 employees. This simple change will lower health costs for small businesses by 18 percent.
  • CMS QE Program (P.L. 114-10). CAHC’s Clear Choices Campaign successfully advocated for the inclusion of a provision in the Medicare Access and CHIP Reauthorization Act (MACRA) that provides for the expanded use of Medicare, Medicaid and CHIP data to make health care more transparent and affordable. This big data approach provides information to private sector experts to identify cost hot spots and develop strategies to address them.
  • Small Group Deductible Cap (P.L. 113-93). CAHC helped draft and enact a bipartisan proposal that repealed the ACA’s statutory cap on deductibles for health plans in the small group market. The ACA capped the maximum deductible for small group health plans at $2,000 for individuals and $4,000 for families, but applied only to small group health plans, driving up health costs relative to those of large employers and individuals. Driving advocacy through an ad hoc, 20-member effort, CAHC got the cap repealed.

Health Reimbursement Arrangements (HRAs)

Health Reimbursement Arrangements (HRAs) are account based plans that many small businesses use to help their workers pay premiums or fill in cost sharing obligations. In 2014, the IRS defined HRAs as group health plans, meaning these accounts have to meet insurance rules. Because HRAs are not insurance products, employers offering them are in violation of the ACA’s market rules, and can be fined $100 per day per employee. This fine – up to $500,000 per employer – is 18 times more than the fine for large employers who drop coverage.

Small businesses offering HRAs are trying to help their workers, but the IRS says their effort violates ACA requirements.

CAHC helped develop the Small Business Healthcare Relief Act (H.R. 5447/S. 3060). This critical legislation will allow small businesses with less than 50 employees to provide HRAs to help their workers and their families pay for health insurance premiums and other medical expenses without facing outrageous fines. 

The bill text was incorporated into the 21st Century Cures Act (P.L. 114-255), which President Obama signed into law at the end of 2016.


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  • P.L. 114-255: 21st Century Cures Act; HRA provision- SEC. 18001

PACE Act (P.L. 114-60)

CAHC led advocacy efforts to allow states to maintain the small group market definition in order to prevent an 18% premium increase and major disruptions for small and mid-sized businesses.


Data Sharing (P.L. 114-10)

CAHC’s Clear Choices Campaign successfully advocated for a MACRA provision that provides expanded access to Medicare and commercial claims data to support big data projects that pinpoint cost problems and their solutions.


    Small Group Deductible Cap (P.L. 113-93)

    CAHC directed efforts to repeal the ACA’s statutory cap on deductibles for health plans in the small group market, lowering premiums for small businesses and their employees.