ACA Watch January 31, 2017
Today marks the last day of open enrollment to sign up for health coverage plans on the federal Marketplace for 2017 under the Affordable Care Act (ACA). CNN Money reports that the final number of people enrolled in ACA will provide a critical indicator of the ACA’s value to American citizens. Figures have been higher than last year, with 11.5 million enrolled as of December 24.
Searching for Agreement
Last week congressional Republicans attended a policy retreat in Philadelphia, hoping to shape details and a timeline for repealing the ACA and replacing it with an alternate plan. After missing the January 27 deadline for repeal legislation called for by the budget resolution bill, GOP Congress members are under pressure to deliver on their party’s platform and campaign promises.
Sources report the GOP is working through differing opinions within its party and struggling to create a viable alternative for the ACA (Bloomberg). Despite that, House Speaker Paul Ryan (R-WI) and Senate Majority Leader Mitch McConnell (R-KY) announced that they have a “fast-track” process to implement health care reform. They hope to have this reconciliation package ready for a vote by the first week of March (Washington Post). Beyond that, Ryan has stated he has a long-term plan, supporting the Republicans’ new goal of completing reforms to the law in 2017.
Bills Pose ACA Alternatives
The Patient Freedom Act of 2017, introduced by Senators Bill Cassidy, MD (R-LA), Susan Collins (R-ME), Shelley Moore Capito (R-WV), Johnny Isakson (R-GA), and Lindsey Graham (R-SC) seeks to replace federal power and return it to the individual states by giving each state choices for keeping or eliminating certain ACA components. The proposal has been criticized by both Democrats and Republicans alike, with most Republicans indicating the bill is not conservative enough.
Rand Paul (R-KY) introduced his Obamacare Replacement Act bill to encourage his fellow Republicans to have a replacement plan ready for when the ACA is repealed. The bill “charts a new path forward that will insure the most people possible at the lowest price,” the Senator said. Paul’s bill would eliminate all ACA mandates and protections for those with pre-existing conditions. While Paul considers his bill the conservative option to unify Republicans, the bill was not supported by any co-sponsors (The Hill).
ACA Committee Hearings
House committees are scheduling hearings to examine and dismantle the ACA. These hearings are expected to set the tone for the House GOP health care efforts, according to the Washington Post. This week, the House Energy and Commerce Committee will meet to discuss lowering insurance costs and reforming Medicaid. Meanwhile, the House Ways and Means Committee plans to examine the efficacy of the individual mandate of the ACA.
HHS Secretary Nominee on ACA Questions
Last Tuesday the Senate Finance Committee held a hearing for Tom Price, the nominee for Secretary of the Department of Health and Human Services. Price has faced public scrutiny after allegations that his business holdings in medical stocks presented a conflict of interest (Wall Street Journal [subscription required]).
During the hearing Price was questioned about a number of key topics regarding health care reform and the ACA. Price supports the ACA ban on denying coverage due to preexisting conditions, the Mental Health Parity, and the extension of CHIP and the Pediatric Quality Measures Program. Price said he was open to changes to the Cadillac Tax and Medicare solvency, strongly opposed to burdensome HHS regulations imposed by Obama, and supports reforming health care for Veterans. He is also in favor of any Medicaid block-grants that Congress may pass, including Section 1115 Waivers.
Price had nonspecific input in regards to questions about the ACA’s individual mandate, fair drug pricing, and participation in global health efforts. When asked what the Republicans would use to replace ACA, Price remarked it would “[be] accessible, [be] affordable, incentivizes, and provide the highest quality of health care for every American.” See a full summary of the hearing.
The Senate Finance Committee’s vote will determine whether Price can advance to the Senate, which requires a majority of committee members’ votes. Republicans currently have a 14-12 majority against the Democrats. The committee is scheduled to bring Price's nomination to a vote on Tuesday, January 31 (Washington Post).
Medicaid Block Grants
Medicaid, the federal-state program providing health care to low-income citizens, was expanded by the ACA. It now covers nearly 75 million Americans (Kaiser Health News).
Block-granting, as a strategy for Medicaid reform, is gaining traction with some legislators including HHS Secretary Nominee Tom Price. This older strategy for managing Medicaid gives control to the States to manage the program with a cap on federal funding each year. Medicaid would no longer be an entitlement, meaning that qualified individuals would not be guaranteed to receive coverage. States would have more freedom to decide who qualifies for Medicaid and specific services.
With block-granting, the cap on federal Medicaid funding would grow each year for inflation; but not using medical inflation rates, which are projected to be greater than overall inflation.
According to Congressional Quarterly (subscription required), the Medicaid and CHIP Payment and Access Commission (MACPAC) is studying the complex decisions that lawmakers would face if Medicaid block grants for states were established. The panel is working to inform lawmakers about alternate approaches to paying for Medicaid. MACPAC chair Sara Rosenbaum says that the grants would be a “major shift in federal policy” regarding the cost of care for vulnerable populations including those living in poverty and those with disabilities.
California Governor Jerry Brown has vowed to protect California’s gains under the ACA, including the expansion of Medi-Cal, the state’s low-income Medicaid program. Brown cites that the loss of federal funding would bring a devastating economical hit to California in an energized State of the State Address last week.
Health Insurers Respond
Health insurers are also providing input to the GOP members working on policy to replace the ACA. According to Reuters, Blue Cross and Molina Healthcare are recommending ways to give states more control over insurance and retaining government subsidies for low income people.
Insurers are reportedly reaching out to calm fears resulting from President Trump’s Executive Order regarding the ACA. Industry leaders are concerned about the disruption of the individual market, fearing general chaos in the insurance industry as a result of misinterpreting the Order. Insurers are helping to educate consumers, who tend to misunderstand their continued options to purchase insurance on the Exchange and individual insurance marketplaces (The Hill).
As a long-time member of the Employers Council for Flexible Compensation (ECFC), Employee Benefits Corporation will continue to provide ACA Watch updates as legislation continues to evolve.