ACA Repeal and Replacement Update 2-23-17

Top Takeaways from the Week: 1) Lawmakers are in recess, holding town halls across the country; 2) Republicans continue to aim to release repeal and replace legislation after returning next week; 3) Governors come to town this weekend for NGA with Medicaid expansion a central issue for discussion; and 4) the Trump Administration has pushed the deadline for issuers to file rates for the Marketplace for the 2018 plan year from May 3 to June 21.

Both chambers of Congress are in recess this week, shifting the debate over the fate of the ACA from Capitol Hill to town halls across the country. Constituents frustrated with efforts to repeal and replace the ACA have publicly confronted lawmakers, indicating a difficult path forward when Congress returns on Monday, February 27.

Signaling the challenges in gaining consensus and sufficient support for replacement legislation, Senate Majority Leader McConnell (R-KY) told reporters on February 17 that he does not expect any Democratic cooperation in replacing the ACA, noting that “it’s clear that in the early months it’s going to be a Republicans-only exercise.”

On February 22, President Trump stated that he expects a replacement plan to come forward in March, a timeline that aligns with Speaker Ryan’s plan to introduce a repeal and replace bill in the House after this week’s recess. It remains unclear whether the Trump Administration intends to release its own plan, or will support a joint plan with Congress.

One the major sticking points for repeal and replace legislation is how to address the 31 states and the District of Columbia that expanded Medicaid under the healthcare law. Republican Governors have taken mixed positions on the issue, with Ohio Governor Kasich (R-OH) on February 19 calling legislation repealing Medicaid expansion a “very bad idea.” Additionally, Sen. Murkowski (R-AK) on February 22 said that she would not vote to eliminate the law’s expansion of Medicaid.

Meanwhile, the United Conference of Mayors weighed in on the debate on February 23, sending a letter signed by more than 100 bipartisan Mayors to Congressional leaders, urging them to take into consideration the effect that the repeal of the ACA will have on cities. Letter:

Administrative Activity –
Following the release of a proposed rule to stabilize the Marketplaces, on February 17 CMS released a proposed bulletin announcing new rate filing deadlines, a revised list of key dates for insurers for 2017, and an addendum to its 2018 letter to federally-facilitated Marketplace issuers incorporating the new certification dates. Issuers now have until June 21 to file their rates with the Marketplace. Comments are due by March 7. Bulletin: Key dates: Letter:

The Trump Administration also released guidance on February 23 providing a one year extension for ‘transitional’ health plans, allowing issuers to offer certain plans in the Marketplace that would not otherwise comply with all of the ACA’s regulations through December 31, 2018. Guidance:

Meanwhile, the Trump Administration and the House of Representatives this week asked for a three-month hold on an ongoing lawsuit over payments for cost-sharing reductions, now called House v. Price.  A federal judge previously sided with House Republicans in 2016, prompting the Obama Administration to appeal. An appeals judge stayed any decision until February 21, 2017, however the joint motion by both the House and the Department of Justice asks for the case to remain on hold until at least May 22. In the meantime, insurers will continue to receive CSR payments.

Senate Activity –
On February 17, Senate Finance Committee Ranking Member Wyden (D-OR) and HELP Committee Ranking Member Murray (D-WA) sent a letter to HHS Secretary Price expressing concern that content providing consumer information and resources were removed from, making it difficult to consumers to understand critical protections available to them under the law. Letter:

House Activity –
On February 16, House Freedom Caucus member Rep. Sanford (R-SC) and five cosponsors introduced the Obamacare Replacement Act (H.R. 1072), which would repeal the ACA and replace it by expanding Health Savings Accounts, providing tax deductions for the purchase of insurance, and allowing for the purchase of insurance across state lines. Sen. Paul (R-KY) previously introduced a similar bill in the Senate (S. 222). Press release:

Also on February 16, House Energy & Commerce Committee Chair Walden (R-OR) and 42 cosponsors introduced the Pre-Existing Conditions Protection Act of 2017 (H.R. 1121), which would prohibit the application of pre-existing coverage exclusions and would guarantee availability of health insurance coverage in the individual and group market, contingent on legislation repealing the ACA. Press release: Bill text: