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.


Budget Resolution, with ACA Repeal Instructions, Unveiled

A fiscal year (FY) 2017 budget resolution was released on the first day of the 115th ongress. It is a bare-bones outline of Republican spending priorities, but also contains econciliation instructions for two committees in both the House and Senate to repeal the Affordable Care Act (ACA). The House Ways and Means Committee, House Energy and Commerce Committee, Senate Finance Committee, and Senate Health, Education, Labor and Pensions (HELP) Committee would have until January 27 to submit language to the Senate Budget Committee, which would merge each panel’s proposal to dismantle the ACA. Each chamber’s committees are instructed to come up with $1 billion in deficit reduction over the 10-year budget resolution window. The budget resolution includes reserve funds for the purpose of preserving savings resulting from ACA repeal, in order to offset the cost of a replacement plan – instead of putting the savings toward deficit reduction. The budget resolution also grants exceptions from certain rules in the case that the cost of ACA replacement exceeds savings from repealing the current law. The House of Representatives also passed a rules package that sets the stage for ACA repeal. The package, which was approved by a vote of 234-193, includes exceptions similar to those contained in the budget resolution, and would allow the health law to be repealed even in the case that it adds to the deficit. The rules package also includes a statement noting that the Independent Payment Advisory Board (IPAB) will not apply in the 115th Congress.

Republicans are still divided on which, if any, elements of the law to preserve, and how long of a transition period should follow ACA repeal. Some conservatives are supportive of only a few months delay, while others hope the transition period will extend through the 2018 elections. Sen. Susan Collins (R-Maine), who is up for reelection in 2018, said that she is undecided on voting for repeal without a replacement plan. Sen. Bob Corker (R-Tenn.) has expressed concern about the uncertainty that could result in the insurance market should repeal occur without a replacement. Sen. Rand Paul’s (R-Ky.) vote is also undecided. Along with Sen. Tom Cotton (R-Ark.), Rand has also signaled that he supports repealing and replacing the ACA simultaneously. The reason Sen. Paul would vote against the budget resolution, however, is because it does not balance the budget within a decade and it would increase the debt by $9.7 trillion. Other fiscal conservatives, including Sen. Ted Cruz (R-Texas), Sen. Mike Lee (R-Utah), and Sen. Marco Rubio (R-Fla.) have said that while they will support the resolution in favor of ACA repeal, they also are seeking assurances that the FY 2018 budget resolution will balance the budget. While there is a growing group of lawmakers who have expressed a preference for simultaneous repeal and replace, no one has yet to commit to voting against repeal if their demands aren’t met. Some have also suggested that a broad outline for replacement, rather than full legislative text, would be sufficient in quelling concerns about moving forward with repeal.

The budget resolution passed its first procedural vote for consideration in the Senate by a vote of 51-48. This sets the chamber up for a marathon voting session – fifty hours of debate known as vote-a-rama – during which Democrats plan to use every hour to force votes on politically charged amendments regarding health care policy. The vote-a-rama is expected to begin on Wednesday. While the final Senate vote may be close, the vote on the House floor vote is not expected to be. Republicans hold 241 seats compared to Democrats’ 194 seats in the House. House Republicans hope to complete the reconciliation process and have a repeal bill on the President’s desk by February 20. President-elect Trump has said that he plans to move forward with executive actions to immediately start the transition away from the ACA following his inauguration, but the incoming administration has not offered any details on what those actions may entail.

AMA Urges Construction of ACA Replacement

The American Medical Association (AMA) has asked Congress to wait to repeal the Affordable Care Act (ACA) until a replacement to the 2010 health care law has been designed. “We believe that before any action is taken through reconciliation or other means that would potentially alter coverage, policymakers should lay out for the American people, in reasonable detail, what will replace current policies,” Chief Executive Officer and Executive Vice President James L. Madara, M.D. wrote, in a letter to congressional leadership. He asserts that a replacement plan should maintain health insurance coverage, and that the public should have the opportunity to compare new measures to the ACA’s existing provisions. The letter is the AMA’s strongest position so far on Republican plans to dismantle the law.

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