Top Takeaway from this week – (1) Senate Finance Committee Chair Hatch (R-UT) and House Ways & Means Committee Chair Brady (R-TX) introduced a more conservative market stabilization bill; (2) the Congressional Budget Office released its analysis of the Alexander-Murray bill; and (3) a federal judge has denied a request to require the Administration to make CSR payments pending adjudication of the larger lawsuit brought by 19 Attorneys General.
This week, Senate Finance Chair Hatch (R-UT) and House Ways & Means Committee Chair Brady (R-TX) announced a plan to introduce a more conservative market stabilization bill than the bill currently being championed by Senate HELP Committee Chair Alexander (R-TN) and Ranking Member Murray (D-WA) and cosponsored by 22 bipartisan Senators. However, both bills will have to compete against the White House and Republicans’ intent to pass a comprehensive tax reform package by the end of the year
Senate Action –
Yesterday the Congressional Budget Office released an analysis of the Bipartisan Health Care Stabilization Act, the bill introduced by Senate HELP Committee Chair Alexander (R-TN) and Ranking Member Murray (D-WA), providing some positive news for its sponsors. CBO found that the bill would decrease the deficit by $3.8 billion over the next decade, and that it would not substantially change the number of people with health coverage. Analysis: http://bit.ly/2yMJb2G HELP Committee Press release: http://bit.ly/2yOxiZZ
Over the weekend, Senate Majority Leader McConnell (R-KY) committed to bringing the Alexander-Murray market stabilization bill to the floor for a vote as long as the President supported it, noting, “I’m not certain yet what the President is looking for here, but I’ll be happy to bring a bill to the floor if I know President Trump would sign it. If there is a need for some kind of interim step here to stabilize the market, we need a bill the President will actually sign.”
The White House has reportedly told legislators that it would support a bill that includes “retroactive relief” from the ACA’s employer and individual mandates and that provides greater flexibility with respect to association health plans and health savings accounts.
On Tuesday, Senate Finance Chair Hatch (R-UT) and House Ways & Means Committee Chair Brady (R-TX) announced a “bicameral agreement to pair concrete, structure Obamacare reforms with a temporary two-year funding extension for the health law’s cost-sharing reduction (CSR) program,” which seems to broadly align with the Administration’s stated priorities.
Although legislative text and cosponsors have not been released, according to the press release, the proposal would provide:
- Funding for CSRs through 2018, with pro-life protections;
- Relief from the individual mandate from 2017-2021;
- Relief from the employer mandate from 2015-2017; and
- Expanded contribution limits for health savings accounts.
The Hatch-Brady bill is far more amenable to conservative members of Congress, however it will be difficult for its sponsors to gather the 60 votes needed for Senate passage. Its introduction this week, despite the broad bipartisan support for the Alexander Murray bill speaks to the continued division among Republicans on a path forward on the ACA. Sen. Thune (R-SD) noted, “I think it proves we should be focused on tax reform right now, because obviously we haven’t gotten out act together on health care.” And in an interview yesterday, referring to the Senate’s healthcare efforts, House Speaker Ryan (R-WI) noted, “I think that is something we should do next year.”
Meanwhile, Sen. Schatz (D-HI) and 18 cosponsors introduced the State Public Option Act (S. 2001), which would establish a state public option through Medicaid to be offered on the insurance marketplace. Rep. Lujan (D-NM) and 24 cosponsors representatives introduced a companion bill in the House (H.R. 4129). Press release: http://bit.ly/2yMjIq0
House Action –
180 bipartisan House members joined a letter to House Speaker Ryan (R-WI) on Tuesday, urging him to prioritize repealing the ACA’s 2.3 percent tax on medical devices, which is set to take effect on January 1. Press release: http://bit.ly/2yOvlNi Letter: http://bit.ly/2yOvxMw
Administration Action –
On Monday, Iowa announced its intention to withdraw its section 1332 waiver, citing the length of time the Administration has said it would need to review the total federal pass-through funding that can be allocated to the state. With the open enrollment period beginning in a week, it left the state with little time to determine whether it would be able to meet any unanticipated funding shortfalls. IA Press release: http://bit.ly/2yLsDJP Senate HELP Committee Chair Alexander Press release: http://bit.ly/2y4CFCm Senate Judiciary Committee Chair Grassley (R-IA) Press release: http://bit.ly/2y4tzFB
Additionally, CMS sent a preliminary notice of incompleteness to Massachusetts regarding its section 1332 waiver. In the notice, CMS noted that in order to be deemed complete, Massachusetts would have needed to account for the full 45 days minimum that the federal government needs in order to open up the waiver for public comment and to make its determination. As Massachusetts was hoping to have the Administration’s decision by the beginning of open enrollment, the Administration determined that the timeline could not be met. Notice: Senate HELP Committee Ranking Member Alexander Press release: http://bit.ly/2y40URg
Yesterday, the HHS Office of the Inspector General (OIG) released a report finding that the Administration’s January decision to cancel open enrollment advertisements and outreach cost the Administration at least $1.1 million. Report: http://bit.ly/2yNLzX1
CMS released a fact sheet yesterday outlining several improvements to the Healthcare.gov website, including a new direct enrollment option, updated help content, updated provider and prescription drug search functionality, and updated eligibility notices. Fact sheet: http://go.cms.gov/2yQ0tvJ
Also yesterday, a federal judge denied a request to immediately require the Administration to continue making cost-sharing reduction payments pending the outcome of the case filed by Attorneys General in 19 states. In his ruling, Judge Chhabria noted that “because of the measures taken by the states in anticipation of a decision be the Administration to terminate CSR payments, the large majority of people who purchase insurance on exchanges through the country will either benefit or be unharmed. In particular, many lower-income people stand to benefit.” The larger case brought by the Attorneys general is ongoing.