Top takeaways from the week: 1) The CBO published its analysis of the House-passed AHCA; 2) Senate Republicans plan to begin drafting their own ACA repeal and replacement legislation; 3) The House Committee on Ways & Means advanced three bills as part of the “third bucket” of their ACA repeal and replace strategy; and 4) The Trump Administration and Congress filed a motion to again delay the lawsuit on CSR payments.

This week, the Senate continued its work on its version of legislation to repeal and replace the ACA, despite continued divisions. In an interview on Wednesday, prior to the release of the Congressional Budget Office’s score of the House-passed American Health Care Act (AHCA) (H.R. 1628), Senate Majority Leader McConnell (R-KY) remarked “I don’t know how we get to 50 [votes] at the moment. But that’s the goal.”

Congressional Budget Office –

Yesterday, the Congressional Budget Office (CBO) published its analysis of the AHCA, as passed by the House. The updated analysis incorporates several last minute amendments to the bill, which gave states the option to apply to waive certain additional ACA requirements, including essential health benefits, provided $8 billion to states taking up the waiver to help reduce out-of-pocket costs, provided an additional $15 billion for a federal invisible risk sharing program, and gave $15 billion to states for maternity coverage, newborn care, and behavioral health.

The analysis found that 23 million more people would be uninsured in 2026 than under current law, one million fewer than the CBO’s earlier analysis. The analysis also finds that the AHCA would result in higher premiums initially, but that over the long run average premiums are expected to be lower. Premiums and other out-of-pocket costs are also expected to vary widely based on income level, age and state of residence. CBO further found that the AHCA would reduce the federal deficit by $119 billion over the period from 2017-2026, as compared to the $150 billion in savings estimated in the previous analysis. CBO analysis:

Senate Democrats decried the score’s estimated large coverage losses, and several Senate Republicans also weighed in to express concern. Sen. Heller (R-NV) noted the AHCA “does not do enough to address Nevada’s Medicaid population or protect Nevadans with pre-existing conditions.” Sen. Cassidy (R-LA) also criticized the bill for failing to protect those with pre-existing conditions, noting
“Congress’ focus must be to lower premiums with coverage which passes the Jimmy Kimmel Test. The AHCA does not. I am working with Senate colleagues to do so.” Other Republicans pointed to efforts to craft the Senate’s own repeal and replacement legislation, framing the AHCA as “old news.”

Senate Action –

Although Senate Republicans continue to be divided both on the future of Medicaid expansion as well as how to protect consumers with pre-existing conditions in the individual marketplaces, leadership staff and staff from the Budget, HELP and Finance Committees are set to begin drafting bill language next week over the recess. Sen. Thune (R-SD) noted, “Now we have enough direction, we’ve had enough meetings, we’ve hot enough input from our members to know sort of what the main issues are, and kind of where the moving points are and how we can dial things. We’ll start putting stuff together and get it out there and let people react to it.”

Meanwhile, Senate HELP Committee Chair Alexander (R-TN) is continuing his push for short-term measures that would help to stabilize the insurance markets for the next couple of years. And on Monday, Sen. McCaskill (D-MO) introduced S. 1201, which would allow individuals living in areas without qualified health plans offered through an Exchange to have similar access to health insurance coverage as members of Congress and congressional staff. Press release:

House Action –

On Wednesday, House Committee on Ways & Means held a markup and advanced three bills that are part of the so-called third-bucket of the ACA repeal and replace strategy – legislation that cannot move through reconciliation but which seeks to complement the AHCA. The Veterans Equal Treatment Ensures Relief and Access Now Act (VETERAN Act) (H.R. 2372) would clarify rules relating to veteran health insurance and eligibility for the premium tax credit. The Broader Options for Americans Act (H.R. 2579), would allow the premium tax credit with respect to unsubsidized COBRA continuation coverage. The Verify First Act (H.R. 2581), would require the provision of social security numbers as a condition of receiving the health insurance premium tax credit. Press release: Bill texts: H.R. 2372 – H.R. 2579 – H.R. 2581 –

Administrative Action –

On Monday, the Trump Administration and the House of Representatives filed a motion requesting a 90-day delay in their ongoing lawsuit over cost-sharing reduction (CSR) payments, noting “The parties continue to discuss measures that would obviate the need for judicial determination of this appeal, including potential legislative action.”

While CSR payments have been made for the month of May, the Administration has not yet clarified whether it intends to continue making CSR payments or whether it plans to drop its defense of the lawsuit, leading to uncertainty among insurers. An HHS Spokesperson on Monday said “Congress could resolve any uncertainty about the payments by passing the AHCA and reforming Obamacare’s failed funding structure.” Insurers have until June 21 to file rates for participation in the federally-facilitated marketplaces.

On Tuesday, 196 House Democrats sent a letter to President Trump urging him to commit to paying the CSRs, noting that “equivocation on this matter destabilizes the market and hurts American families by directly increasing their health care costs.” Press release: Letter:

Meanwhile, HHS Office of the assistant Secretary for Planning and Evaluation (ASPE) released a report examining individual market premium changes between 2013 and 2017. The report looked at the 39 states that use the federal marketplace and found that average premiums more than doubled between 2013 and 2017. Report: