Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


Republican Alternative to ACA Unveiled

Top Republicans in the House of Representatives have endorsed the outline of a plan to repeal and replace the Affordable Care Act (ACA) with a more market-driven approach. Speaker of the House Paul Ryan (R-Wis.), along with four committee chairmen – Kevin Brady (R-Texas), John Kline (R-Minn.), Tom Price (R-Ga.), and Fred Upton (R-Mich.) – released the 37-page plan last week. The proposal pledges to reduce consumers’ average health care premiums by double digits, and to generate significant savings for the health care system at large. After repeal of the individual and employer mandates, the proposal would encourage health insurance coverage with a flat, advanceable, refundable tax credit adjusted for age. The plan also proposes $25 billion for state-based high-risk pools. The plan would enable the purchase of health insurance across state lines. Insurance companies would be prohibited from denying patients due to pre-existing conditions, but only if individuals keep continuous insurance coverage. Young adults would be allowed to stay on their parents’ health plans until the age of 26. The proposal also includes plans for medical liability reform. The tax deduction for employers providing health insurance to their employees would be capped. In terms of Medicare reforms, the plan would increase the program eligibility age to 67, and Medicare would be transitioned to a premium support model where seniors receive financial assistance to purchase either a private insurance plan or traditional Medicare. States would receive block grants with per-person spending caps to administer the Medicaid program, with accommodations for high-cost patients. The Republican plan would increase the rating bands allowed for older Americans. Currently, insurers must limit the cost of older Americans’ plans to no more than three times what a younger person pays in premiums; this proposal would increase that ratio to no more than five times. The plan would eliminate the Center for Medicare and Medicaid Innovation (CMMI), alluding to the agency’s proposed Part B payment demo, and concerns that “CMMI’s experiments on seniors’ health services could limit access to care…and disrupt how health care providers serve patients in the future.” The Independent Payment Advisory Board (IPAB) would also be repealed. The white paper does not include details on cost or savings amounts, time frames, or lives covered. As expected, the plan was denounced by both the White House and congressional Democrats, who stressed that the plan would negatively impact patient access to affordable care.

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