Top Takeaways from this week – (1) Sen. Collins continues to negotiate with leadership for a vote on two market stabilization bills as Congress finalizes tax reform and fiscal year 2018 appropriations; and (2) the House is also working on delaying several ACA taxes through the Medicare extenders package.

Congressional Action–

On Saturday, the Senate passed by a vote of 51-49 the Tax Cuts and Jobs Act (S. 1), which includes a repeal of the individual mandate. The bill will now move into Conference in order to resolve the differences with the House’s version of tax reform (H.R. 1).

Sen. Collins (R-ME) was one of the last Senators to announce support, and ultimately voted for the bill after negotiating with Senate leadership for a commitment to also pass the Alexander-Murray market stabilization bill and a bill she negotiated with Sen. Nelson (D-FL), the Lower Premiums through Reinsurance Act (S. 1835), which would provide funding to states to establish reinsurance programs or high-risk pools. This week, Sen. Collins also negotiated increased funding for the reinsurance bill; S. 1835 would now provide $10 billion over fiscal years 2018 and 2019 to states. Senate Majority Leader McConnell (R-KY) noted on Sunday, “I’ve committed to Senator Collins to offer Alexander-Murray and another bill that she and Sen. Nelson from Florida are offering to one of these year-end bills that we’ll be doing in the next couple of weeks, the president is committed to signing it, and we intend to keep our commitment.”

Sen. Collins said today that she believes her agreement with Senate Majority Leader McConnell (R-KY) also requires the House to pass the bills. However, House Speaker Ryan (R-WI) made clear earlier this week that he was not part of the deal, indicating a potentially difficult path forward for both bills in the House. The House Freedom Caucus on Wednesday proposed supporting the inclusion of the market stabilization bills in the next spending bill in exchange for certain discretionary payment cuts. Freedom Caucus Chair Meadows (R-NC) noted yesterday, “If Alexander-Murray would break the defense and non-defense wall, that may be a price that many would be willing to pay.”

But Senate Democrats are increasingly raising concerns with the bills as they have become paired with tax reform and a deal on discretionary spending caps for fiscal year 2018 appropriations.

Meanwhile, on Tuesday, House Ways & Means Committee Chair Brady (R-TX) said that both Republicans and Democrats are negotiating a bill that would include Medicare extenders and would delay some ACA taxes, “My sense is that Democrats want to tackle the medical device tax, delay it; the health insurance tax is very damaging; and the Cadillac tax as well.” The House is reportedly considering delaying the health insurance tax only for limited markets next year, excluding small businesses and private Medicaid plans from the delay; it would be suspended for all markets in 2019. Other taxes under consideration include the medical device tax, the Cadillac tax, and loosening restrictions on health savings accounts.

 Administrative Action –

Yesterday, CMS released updated enrollment data for the fifth week of Open Enrollment, finding that over 823,000 people selected plans using, including over 271,000 new consumers, totaling over 3.6 million since the beginning of open enrollment. Press release: