Thursday, April 13, 2017

Update: ACA replacement, Medicaid, ABLE, CHIP

from National Family Voices:

ACA Replacement Legislation
After the March 24 cancellation of a vote on the American Health Care Act (AHCA) - the House Republican bill to repeal and replace the Affordable Care Act (ACA) - it seemed that efforts to repeal and replace the ACA were on the back burner for the foreseeable future. But, last week, the legislation seemed to rise from the dead. At the beginning of last week, Vice President Mike Pence visited Capitol Hill to see if an agreement could be worked out with the House Freedom Caucus, the group of conservative Republicans who had objected to the AHCA. The administration proposed allowing the Secretary of Health and Human Services (HHS) to let states waive certain ACA provisions, particularly the requirement that insurance plans cover ten "Essential Health Benefits," and the "community rating" requirement, which prevents insurers from charging higher rates to individuals with pre-existing conditions. But the Caucus leaders were not ready to make any commitments until they could see legislative language.
 
On Wednesday, the president met with House Speaker Paul Ryan (R-WI) and Majority Leader Kevin McCarthy (R-CA), reportedly pressuring them to see if they could get a bill through the House before adjourning before a two-week recess, scheduled to begin on Friday. As a result, there was a last-minute rush to develop some legislation that might be approved. An amendment to the AHCA was proposed to create a "Federal Invisible Risk Sharing Program," through which funds would be provided to insurers to compensate them for very high-cost individuals, with the goal of reducing premiums in general. See House GOP Moves to Add 'Invisible Risk Sharing Program' to AHCA; Other ACA Developments (Health Affairs Blog, 4/6/17); To Revive Health Bill, GOP Adds an Obamacare-Like Subsidy (Bloomberg, 4/6/17). Nonetheless, there was not a sufficient consensus to get a bill through the House.
 
Given the president's desire to get something done on health care, some House Members and staff will be working during the current recess to see if they can negotiate a bill that can pass the House. There has even been talk of the House cutting short its recess to come back for a vote if a viable bill is negotiated. At this point, that does not seem likely, however. In an interview reported on April 5, Speaker Ryan said he thought the process of developing alternative legislation would take weeks, not days, and that there is no artificial deadline. Finding a plan that will please both ends of the Republican spectrum will not be easy. Many House Members of both parties want to retain the ACA's protections for people with pre-existing conditions, while Freedom Caucus Members would like to eliminate this and other regulations, such as the ACA-required Essential Health Benefits.
 
Medicaid
In addition to repealing and replacing the Affordable Care Act (ACA), the American Health Care Act (AHCA) (see above) would have made fundamental changes to the Medicaid program - capping federal Medicaid payments to states through per capita caps, with an option for states to choose block grants and fewer federal regulations instead. (See Washington Update of March 29.) In addition, the AHCA would have made significant cuts to the program -- $880 billion over ten years, which would amount to a cut of about 25 percent by 2026, compared to current law. The nonpartisan Congressional Budget Office (CBO) estimated that, by 2026, about 14 million fewer people would be eligible for Medicaid if the AHCA were enacted than if current law remained in place. These Medicaid changes could be made whether or not the rest of the ACA is repealed or modified. Given the significant amount of federal savings that these changes would yield, it may be tempting for Congress and/or the administration to propose the Medicaid changes to pay for the tax cuts that are high on their agendas. Reportedly, some members of the Senate are discussing this possibility. See If Trumpcare stays dead, Medicaid overhaul could come back to life. At Arizona Symposium on Children with Special Health Care Needs recently held in Phoenix, the head of the Arizona chapter of the American Academy of Pediatrics spoke about the harms that Medicaid cuts could have on children and youth with special health care needs. See Doctors say repeal of Obamacare would stop Medicaid coverage for children with disabilities (Cronkite News, April 10, 2017)
 
Budget/Appropriations
A major task ahead of Congress when it returns from its spring recess on April 24th(Senate) and Tuesday the 25th (House) is to fund the government for the remainder of FY 2017, which ends on September 30. Current funding expires on Friday, April 28, pursuant to a "continuing resolution" (CR), which has basically kept appropriations at FY 2016 levels. It will especially difficult to reach a deal if some Members push for significant policy changes or initiatives, such as the defunding of Planned Parenthood or the construction of a wall between the U.S. and Mexico. If no deal is reached by April 28, another short-term CR could be enacted while negotiations continue, there could be a temporary government shutdown, or a CR could be enacted to last through the end of the fiscal year. If the House, Senate, and White House can all agree to changes from FY 2016 spending levels, then there will probably be an "omnibus" appropriations bill, one large bill combining the appropriations bill for many federal departments and agencies. Meanwhile, the appropriations process for FY 2018 has begun. In March, the president submitted to Congress his proposed FY 2018 budget, which was dubbed a "skinny budget" because it provided little details and covered only appropriated spending (not taxes or mandatory spending). He will submit a more complete budget proposal in May. Congress will then hold hearings and develop its own spending bills.
 
ABLE Act Bills
[from AUCD's Disability Policy News in Brief, 4/10/7)]
On April 4th, a bi-partisan group of Members of Congress, including Senators Burr (R-NC), Casey (D-PA), Moran (R-KA), and Van Hollen (D-MD), and Representatives Pete Sessions (R-TX), Cathy McMorris Rodgers (R-WA), Tony Cardenas (D-CA) and Mike Doyle (D-PA) re-introduced the package of bills aimed at enhancing the benefits provided through the Stephen Beck Jr., Achieving a Better Life Experience (ABLE) Act. This package of bills consists of the following three pieces of proposed legislation: The ABLE Age Adjustment Act (S. 817/HR 1874) would raise the age limit for ABLE accounts to age 46 (currently 26); ABLE Financial Planning Act (S. 816/HR 1897) would allow families to rollover savings in a 529 college savings plan into an ABLE account (and would still be subject to the annual contribution limit of $14,000); ABLE to Work Act (S. 818/HR 1896) would allow individuals and their families to save more money in an ABLE account if the beneficiary works and earns income.
 
For more information, see Members of Congress Re-Introduce ABLE Improvement Bills, from the ABLE National Resource Center.
 
CHIP
Also coming up on the congressional agenda is an extension of funding for the Children's Health Insurance Program (CHIP). Although the program is authorized through FY 2019, it is funded only through FY 2017 (which ends on September 30), pursuant to legislation enacted in 2015. Child health advocates have been working to educate Congress - particularly new Members and staffers -- about the importance of the CHIP program to ensuring children's coverage. The program now insures about 9 million children, many of whom would not have access to affordable insurance otherwise. The Medicaid and CHIP Payment and Access Commission (MACPAC), recently released a new analysis projecting when states will begin to exhaust their federal CHIP funds, which is an update of projections made in the Commission's January 2017 Recommendations for the Future of CHIP and Children's Coverage. MACPAC recommended that CHIP funding be extended for an additional five years.

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