Top Takeaways from this week – (1) Senate GOP leaders have postponed a vote on the Graham-Cassidy-Johnson-Hiller bill due to insufficient support; (2) Senate HELP Committee leadership announced their intent to restart market stabilization negotiations; and (3) President Trump announced he is considering an Executive Order to allow the sale of insurance across state lines.
Despite last week’s momentum towards a vote, this week Senate GOP leaders found themselves short of votes to pass the Graham-Cassidy-Heller-Johnson proposal and announced that they will postpone a vote on the bill, effectively ending a months-long push to fulfill a years-long Republican Party pledge. In a press conference announcing the decision, Senate Majority Leader McConnell (R-KY) remarked, “We haven’t given up on changing the American health care system. We are not going to be able to do that this week, but it still lies ahead of us, and we haven’t given up on that.”
Graham-Cassidy Proposal –
Support for the Graham-Cassidy-Heller-Johnson proposal waned over the past week, despite continued efforts by the White House and its sponsors to find consensus.
On Friday, Sen. McCain (R-AZ) become the second Republican senator after Sen. Paul (R-KY) to publicly announce his opposition to the bill, arguing, “As I have repeatedly stressed, health care reform legislation ought to be the product of regular order in the Senate…I cannot in good conscience vote for the Graham-Cassidy proposal. I believe we could do better working together, Republicans and Democrats, and have not yet really tried. Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it.” Statement: http://bit.ly/2xGmldX
On Sunday, Sens. Cruz (R-TX) announced that he also doesn’t support the Graham-Cassidy proposal, and suggested that Sen. Lee (R-UT) opposes it as well, given that the bill does not go far enough to repeal the ACA’s insurance rules. Sen. Paul (R-KY) also reiterated his opposition to the bill and released a list of changes needed in order to win his support for the bill. List: http://bit.ly/2xGLoO3
Later Sunday evening, Sens. Graham (R-SC), Cassidy (R-LA), Heller (R-NV), and Johnson (R-WI) released an updated version of their proposal in the hopes of assuaging wavering senators. The revised text included several changes to the funding formula providing additional funding to states like Alaska and Arizona and broadly revising the waiver provisions to provide states with greater regulatory flexibility. Updated section-by-section and bill text: http://bit.ly/2xGpFWw and http://bit.ly/2xGd99q
The Senate Finance Committee held a hearing on the Graham-Cassidy-Heller-Johnson proposal on Monday afternoon, in which they heard from both Sens. Graham (R-SC) and Cassidy (R-LA) as well as Sen. Hirono (D-HI), Former Sen. Santorum (R-PA), and a number of current and former state and federal health care officials and stakeholders. The hearing was largely partisan, but the wide-ranging discussion included debates of the bill’s impacts on cost and coverage in Medicaid and the private marketplaces, on access to opioid treatment and services, the potential for state flexibility and innovation, and the challenges states are likely to face given the short implementation timeline. Opening statements from the Chair and Ranking Member: http://bit.ly/2xGI45q and http://bit.ly/2xGsE1a
During the hearing, the Congressional Budget Office (CBO) released its preliminary analysis of the bill, finding that the bill would reduce the deficit by at least $133 billion between 2017 and 2026, and that the number of people with comprehensive health coverage would be reduced by millions. CBO previously announced it would be unable to provide point estimates on coverage or premiums for several weeks. Analysis: http://bit.ly/2xGtpre
Also during the hearing, Sen. Collins (R-ME) released a statement opposing the health care bill, noting “Sweeping reforms to our health care system and to Medicaid can’t be done well in a compressed time frame, especially when the actual bill is a moving target,” and highlighted three main concerns with the proposal: (1) it would make sweeping changes and cuts to the Medicaid program, (2) it would open the door for states to weaken protections for people with pre-existing conditions, and (3) a wide range of healthcare stakeholders all oppose the bill. Statement: http://bit.ly/2xGFYCA
Given the number of senators in opposition to the bill and the short timeframe left to gain consensus, on Tuesday afternoon Senate Republican leadership announced their intention to postpone a vote on the bill, arguing that more time is needed to ensure success.
Sens. Graham, Cassidy, Heller & Johnson released a joint statement noting the “As a result of our efforts in the past few weeks, it’s not a question of ‘if’ Graham-Cassidy-Heller-Johnson replaces Obamacare – it’s only a question of ‘when’…The most frequent frustration we heard from our colleagues ranging from Senator McCain to Senator Murkowski was that time and process were the biggest obstacles to their support. There is no doubt to their commitment to repeal and replace Obamacare and no doubt about their support of local control.” Statement: http://bit.ly/2xGMA3Z Sen. Murkowski Press release: http://bit.ly/2xGWBOR
Although the fiscal year (FY) 2017 reconciliation instructions allowing for fast-track of ACA repeal and replace legislation ends on Saturday, several Republicans have proposed including similar language in the draft FY 2018 Budget Resolution, which would allow the Senate to consider both tax reform and healthcare reform over the next year. The Senate has yet to vote on next year’s budget resolution, and several Senate leaders, including Senate Majority Whip Cornyn (R-TX) oppose the idea, arguing that the Senate should focus solely on tax reform.
However, President Trump indicated an interest in returning to ACA repeal early in 2018 yesterday, noting “We’re going to do it in January or February…But very importantly…during this period of a couple of months, I’m also going to meet with Democrats, and I will see if I can get a health plan that’s even better.”
Market Stabilization –
Meanwhile, Senate HELP Committee Chair Alexander (R-TN) and Ranking Member Murray (D-WA) have indicated interest in restarting market stabilization discussions. On Tuesday Chair Alexander noted, “I will consult with Senator Murray and with other senators, both Republicans and Democrats, to see if senators can find consensus on a limited bipartisan plan that could be enacted into law to help lower premiums and make insurance available to the 18 million Americans in the individual market in 2018 and 2019.” Statement: http://bit.ly/2xGNM7t
Today, Chair Alexander reiterated his support for a bipartisan stabilization deal, noting, “Maybe by the end of next week we will go and hand a piece of legislation to Senator McConnell and Senator Schumer,” but cautioning that other Republicans and Democrats will need to sign on in order to be successful.
The Chairman and Ranking Member are reportedly working out a deal to provide two years of funding for cost-sharing reduction payments to issuers, as well as additional process improvements for 1332 waivers, including an expedited process and allowing for states to submit copycat waivers.
Yesterday, the Problem Solvers Caucus, a group of 43 moderate, bipartisan members, wrote to Congressional leadership to “reiterate their desire to see Congress consider and implement bipartisan, common sense health care principles to lower premiums and stabilize the health insurance marketplace for American families and businesses.” Press release with text of letter: http://bit.ly/2xJbLmB
The National Governors Association also released a statement yesterday applauding and applauding the renewed commitment of the HELP Committee Chair and Ranking Member to ensure the immediate stabilization of the insurance market. Statement: http://bit.ly/2xIQwBg
Administrative Action –
Yesterday, President Trump announced an imminent Executive Order that would allow the purchase of insurance across state lines, saying “I’ll probably be signing a very major executive order where people can go out across state lines, do lots of things and buy their own health care, and that will probably be signed next week. It’s being finished now. It’s gonna cover a lot of territory and a lot of people – millions of people.” It is unclear how the executive order will provide additional authority given that according to the National Association of Insurance Commissioners, health insurers already have the ability to sell insurance across multiple states as long as they comply with state consumer protection and licensing laws in those states.
Yesterday, Sens. Schatz (D-HI), Warren (D-MA), Booker (D-NJ), and Murphy (D-CT) sent a letter to HHS Inspector General Levinson and CMS Administrator Verma expressing concern regarding reports that CMS will temporarily shut down healthcare.gov for extended periods during the upcoming open enrollment period. Press release: http://bit.ly/2xGf7GY Letters: http://bit.ly/2xHjIZz and http://bit.ly/2xGKCR2
Also yesterday, Senate Homeland Security and Governmental Affairs Committee Chair Johnson (R-WI) sent letters to CMS Administrator Verma and the governors of eight states asking for information related to Medicaid expansion and “the soaring costs that go far beyond initial projections.” Press release: http://bit.ly/2xJAuqT
Finally, last Friday CMS approved Minnesota’s section 1332 waiver, the third waiver to be approved. The waiver would allow the state to establish a reinsurance program funded with federal pass-through dollars effective January 1. Approval letter: http://go.cms.gov/2wRkFe5