Top takeaways from the week: (1) The Senate is running out of time to be able to vote on the AHCA before the July 4 recess, (2) Several Republicans are now urging the White House to continue funding cost-sharing reduction payments, (3) The House passed three bills as part of the “third phase” of repeal and replace, and (4) Next Wednesday is the deadline for insurers to submit rates for participation in the federally-facilitated marketplace in plan year 2018.

Senate Action –

This week, Senate Republicans continued to negotiate key pieces of their draft health care bill, although few details of the plan have been publicly released and legislative text is not expected to be released until shortly before Majority Leader McConnell (R-KY) brings the bill to a vote. The timing of that vote is uncertain, and the July 4 deadline to pass the bill, as proposed last week, seems more and more unlikely. Sen. Thune (R-SD) estimated there is now a “50-50”chance of passing the bill by the end of the month, and on Tuesday, Senate Majority Whip Cornyn (R-TX) likened the process to “having a baby; it’s not here yet, but it’s coming”

Ongoing policy hurdles include:

  • Timeframe for ending Medicaid expansion;
  • Per capita cap growth rates – Senators are reportedly considering varying the growth rate by state;
  • Structure and generosity of the tax credits;
  • Level of funding for the opioid crisis;
  • Funding for Planned Parenthood;
  • Structure and level of funding for reinsurance programs; and
  • Repeal of ACA taxes.

Despite the secrecy in negotiations, legislators have shared certain pieces of the bill with the Congressional Budget Office (CBO) in order to expedite the CBO’s review and to help guide ongoing discussions about the impact of the bill on coverage and the deficit. The Senate cannot vote on the bill without a score from the CBO, which is expected to take 2-3 weeks once the full legislative text is shared.

On Tuesday President Trump met with 13 Republican Senators to discuss repeal and replace efforts. He praised the Senate’s efforts to make the House-passed AHCA bill more generous, describing the House version as “mean.” After the meeting, he predicted that the Senate will pass “a phenomenal” health care bill for Americans, and adding, “The results are going to be fantastic, and hopefully it will be announced at the appropriate time and everyone’s gonna be happy.” President Trump also criticized Democrats for failing to contribute to the effort.

Democrats have raised concern about the secret nature of the healthcare reform deliberations, lack of hearings or markups. At the Senate HELP Committee’s hearing on drug prices on June 13, Sen. Murray (D-WA) noted that “people deserve a public debate on the future of the health care system.” Senate Minority Leader Schumer (D-NY), Finance Committee Ranking Member Wyden (D-OR), HELP Committee Ranking Member Murray (D-WA) and Sens. Sanders (I-VT) and Merkley (D-OR) also announced their intention to introduce the No Hearing, No Vote Act of 2017, which would ensure that all fast-tracked reconciliation bills are subject to a committee hearing. Bill text:

In response to criticisms, some Republicans have noted the many hearings and discussions on health care over the last seven years and the need to build consensus on the bill before its release. Sen. Scott noted, “I think we’ve had a lot of exposure to health care bills, frankly. I think we have had adequate time to understand and appreciate the primary issues and the nuances of the health care [debate].” However Sen. Cassidy noted, “The sooner I see language, the better I feel about it” and Sen. Johnson (R-MN) said “I want to know exactly what’s in the Senate bill. I don’t know yet. It’s not a good process.”

Meanwhile, Senate GOP leaders also inquired about White House intentions on continuing cost-sharing reduction payments during their meeting with President Trump on Tuesday. Sen. Thune noted that the President seemed “open to suggestions” and during an appropriations hearing on the HHS budget today, HELP Committee Chair Alexander (R-TN) urged the Administration to continue funding CSRs for the next two years.

And on Wednesday, Sens. Carper (D-DE), Kaine (D-VA), Shaheen (D-NH), Nelson (D-FL), Hassan (D-NH) and Cardin (D-MD) introduced the Individual Health Insurance Marketplace Improvement Act (S. 1354), which would establish an individual market reinsurance fund to provide funding for state individual market stabilization reinsurance programs. Press release:  Bill text:

House Action –

This week, the House voted on a series of bills that are being framed as part of the “third phase” of the repeal and replace strategy. On Tuesday, the House passed by a vote of 238-134 the Verify First Act (H.R. 2581), which would require the provision of social security numbers as a condition of receiving the health insurance premium tax credit. Today, the House passed by a voice vote the VETERAN Act (H.R. 2372), which would clarify the rules relating to veteran health insurance and eligibility for the premium tax credit, and passed by a vote of 267-144 the Broader Options for Americans Act (H.R. 2579), which would allow the premium tax credit to be used for unsubsidized COBRA coverage. The bills now move to the Senate for consideration. Press release:

Administrative Action –

On Monday, CMS released two reports on health care marketplace enrollment. The first report found that as of March 15 the total effectuated enrollment in the ACA Marketplaces for 2017 is 10.3 million; of the 12.2 million people that selected plans during open enrollment, 1.9 million people, or about 15 percent, failed to pay their monthly premium and were dropped from coverage. The report also notes that 84% of consumers receive tax credits and 57% of consumers receive cost-sharing reduction subsidies. The second report describes exit survey data from consumers who canceled or terminated their coverage, noting that cost and affordability were large factors. Press release: Effectuated Enrollment Report: Trends Report:

On Tuesday, CMS Office of the Actuary released a report on AHCA, projecting that the bill would leave 13 million more Americans uninsured over the next decade, and would reduce federal spending by $328 billion. The estimate differs considerably from CBO’s score of the House-passed AHCA, which estimated 23 million more uninsured and spending reductions of $119 billion over the same period. Report:

Several insurers have announced their intention to withdraw from several state marketplaces, leaving an estimated 47 so-called ‘bare’ counties for next year, according to a county-by-county analysis released by CMS on Wednesday. In contrast, Centene announced on Wednesday its intention to expand its 2018 offerings. Next Wednesday, June 21, is the deadline for insurers to file rates with the federally-facilitated Marketplace (FFM), which covers 39 states, for the 2018 plan year. CMS Press release: Map:

Meanwhile, Ranking Members of the Senate Finance and HELP Committees, and House Energy & Commerce and Ways & Means Committees sent a letter to the Government Accountability Office (GAO) Comptroller on Wednesday describing their concern with “the legality of the use of the Department of Health and Human Services’…communications channels to promote health care legislation currently pending before Congress” and requesting that GAO review HHS communications for compliance with appropriations laws. Press release:  Letter:

State Action –

On Tuesday, Iowa released a proposal to help stabilize its insurance Marketplace. The plan would set up a new health plan with standardized benefits, a reinsurance program to offset costs from expensive patients, and premium subsidies. It will require $352 million in additional federal funding and needs HHS approval to be implemented. The State is aiming to implement its plan by the upcoming open enrollment period. Proposal: