News Update for March 21, 2017
House Freedom Caucus Won’t Vote as a Bloc, But That Doesn’t Mean a Yes Vote
The conservative House Freedom Caucus has around 3 dozen members, enough to kill the healthcare reform bill in the House if they voted against it as a bloc. However, chairman of the Freedom Caucus Rep. Mark Meadows (R-NC) has announced that the group will not be voting in bloc. “We’re not taking any official positions. I’m going to encourage them to vote for their constituents,” Meadows told reporters.
But this doesn’t mean the Freedom Caucus will be voting for the AHCA. Because of ongoing concerns with the bill, many members have expressed that they will vote against it in the House. A co-founder of the Freedom Caucus, Rep. Jim Jordan (R-OH) said after negotiations with the White House, “Nothing’s changed. We’ve still got lots of problems with this bill. … The president’s a good man, and the White House has been great to work with, but opposition is still strong with our group.”
Republicans Changing AHCA to Strengthen Chances of Passing It
While Democrats are set to oppose the AHCA bill, the White House is making changes to try and win more Republican votes.
- A provision may be added to lower prescription costs with a “competitive bidding process”
- An amendment may:
- Remove a provision allowing consumers to move excess tax credit funds into health savings accounts (HSAs). Anti-abortion groups fear the provision allows taxpayers to fund abortions.
- Accelerate the repeal of around a dozen Affordable Care Act (ACA) taxes.
- Delay implementing the Cadillac tax again (from 2025 to 2026).
- In addition to allowing states to choose block grants and requiring enrollees to provide proof of employment, Medicaid enrollees may:
- Be required to renew their coverage every six months.
- Lose the ability to request retroactive coverage.
While some have changed their votes based on recent changes to Medicaid, subsidies for older Americans, and ACA taxes, these changes aren’t enough to sway all lawmakers. Justin Amash, Michigan Rep. and strong critic of the bill, tweeted, “They haven’t changed the bill’s general framework. They don’t have the votes to pass it. They have seriously miscalculated.”
Republicans Reintroduce Small Business Healthcare Legislation
A bill passed by the House in 2003, which did not advance, has been reintroduced in help improve small businesses’ health insurance purchasing power. At the time, the bill was criticized because it “would do little to enhance the coverage options or control costs of many small businesses, especially those that employ older, sicker workers, while at the same time weakening consumer protections against plan insolvency and fraud.” “Health policy experts say there’s no reason to change that assessment now.” The bill would:
- Establish nationwide “association health plans,” allowing small business owners to join associations and purchase health insurance in larger groups. In turn, this would ideally lower costs.
- These plans have existed, but were not regulated well and neither states nor the federal government had clear authority over them. Fraud and insolvency cases in the ’70s and ’80s lessened the appeal of these plans.
- Federal law was amended to let states regulate them, and in 2010 the ACA required them to meet qualified health plan standards.
- Remove state regulations and give the federal Department of Labor oversight of association health plans.
- Remove ACA group health insurance requirements but maintain individual health insurance ACA requirements for association health plans.
- Allow association health plans to charge companies with more unhealthy workers higher premiums.
News Update for March 20, 2017
Likely Changes for the American Health Care Act (AHCA)
Under strong opposition, House Speaker Paul Ryan and other Republican leaders have opened the door to making changes to the AHCA. Particularly, the bill will likely see changes to states’ flexibility with Medicaid and individual coverage for older Americans. The House is expected vote on the bill this Thursday. Here is more on the proposed changes.
States’ Flexibility With Medicaid
- States may gain the option to require “able-bodied Medicaid recipients to work” in order to receive coverage. Health & Human Services Secretary Tom Price and Administrator of Centers for Medicare and Medicaid Services Seema Verma have stated in letters to governors that they are open to this option.
- States may have the option of receiving federal funding in the form of block grants, meaning they would receive a set amount of funding regardless of the state’s number of enrollees. The current legislation calls for per capita funding, meaning a set amount per enrollee.
Individual Coverage for Older Americans
- Older Americans, those in their 50s and 60s, shopping on the individual market may see enhanced tax credits compared to the AHCA’s original proposal. Sunday, Ryan said, “We believe that we do need to add some additional assistance with people in those older cohorts.”
- Americans in their 50s would receive $3,500 in refundable tax credits.
- Americans in their early 60s would receive $4,000 in refundable tax credits.
- There is no mention of how allowing insurance companies to charge older individuals more may change, but the CBO projection does not bode well, even with the increased subsidy amount. A 64-year-old with an income of $26,500 might end up paying up to $14,600 in 2026 under the AHCA. Compare this to the projected Affordable Care Act (ACA) cost of $1,700 in 2026.
Republican Governors Argue the Current AHCA “Hurts States”
Ohio, Michigan, Nevada, and Arkansas governors sent a joint letter to the House and Senate leaders arguing against the current version of the AHCA. Republican governors John Kasich (OH), Rick Snyder (MI), Brian Sandoval (NV), and Asa Hutchinson (AR) all signed the letter, which states that the AHCA “provides almost no new flexibility for states, does not ensure the resources necessary to make sure no one is left out, and shifts significant new costs to the state.” Each of these states expanded Medicaid under the ACA, and the governors outlined alternative approaches to Medicaid reform.
States Will Take Greater Share of Medicaid Costs Under AHCA
Moody’s Investors Service theorizes that states’ credit ratings could suffer under the AHCA. States would take on a larger share of Medicaid funding, increasing their borrowing costs and lowering the current value of bonds. Any funding decrease from the federal government would force states to reduce spending on their individual Medicaid programs, raise taxes, or do both.
Rand Paul Does Not Believe the AHCA Will Pass
Senator Rand Paul sat down with ABC’s “This Week” on Sunday to voice his feelings about the AHCA and its chances of passing through Congress: It won’t happen. “I think there’s enough conservatives that do not want ‘Obamacare Lite.’ … None of us ran on this plan,” Paul said.
News Update for March 17, 2017
Are You Confused by Terms in the Obamacare Repeal and Replacement Process?
Kaiser Health News has released a new article that helps clear up some of the more confusing terms pertaining to the Obamacare repeal and replacement process going on right now. Here are some of those terms. Check out the article for more details.
- Budget Reconciliation: An obscure legislative process that permits bills to pass through Congress with just a simple majority. Budget reconciliation bills only deal with budgetary issues and can’t be filibustered.
- Health Savings Accounts: HSAs allow consumers to save money on a tax-free basis for healthcare expenses.
- High-Risk Pools: Insurance groups that cover individuals with pre-existing conditions. These individuals tend to have high health insurance costs.
- Individual Market: The individual market is where people who don’t have health insurance through their employer or the government can get a plan from an insurance company.
- Medicaid Block Grants: A block grant is when the federal government gives states a “set amount of money to pay for coverage for Medicaid recipients.” Right now, the federal government matches a percentage of a state’s Medicaid spending to help alleviate states’ costs.
- Per-Capita Caps: With per-capita caps, states would get a fixed amount of money each year, but that fixed amount would be determined by how many people are enrolled in each Medicaid program.
American Health Care Act Narrowly Passes House Budget Committee
The Republican plan to repeal Obamacare passed a key hurdle on Thursday. The House Budget Committee “narrowly voted to move [the bill] to the House floor and recommended a series of changes to the plan reflecting concerns from conservatives and centrists.” The committee voted for two motions supporting more cuts to Medicaid beyond what is currently in the bill, as well as a third motion “endorsing a requirement that ‘able-bodied’ participants in [Medicaid] work in exchange for their benefits.” This is in line with what many conservatives have wanted from this bill. The committee voted 19 to 17 to advance the bill. All the Democrats and three Republicans voted against moving the bill to the House floor. All the dissenting Republicans are members of the conservative House Freedom Caucus. More revisions are expected soon.
Republican Leaders Planning Vote on AHCA Bill Next Thursday
GOP leaders have told reporters at CNN that they are planning on holding a vote on the American Health Care Act in the House of Representatives on Thursday. Thursday also happens to be the 7th anniversary of former President Barack Obama’s signing of the Affordable Care Act. The bill is currently being reworked to include Medicaid work requirements. Other changes “may also include making tax credits for older Americans more generous” in order to appease moderate Republicans.
Many in Disabled Community Worried About Medicaid Cuts
Medicaid covers some in-home and transportation services for disabled people in every state. However, the federal government doesn’t require those things to be covered. It does require that states cover “doctor’s visits, nursing home care and laboratory tests.” In-home and transportation services are important for providing disabled people with a degree of independence throughout their everyday lives. These services aren’t required by the federal government. Many people are worried that if federal Medicaid funding decreases, these services would be the first to go and disabled people will see their quality-of-life and independence greatly decreased.