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.


House of Representatives Passes Obamacare Repeal and Replacement

The House of Representatives narrowly passed legislation to repeal and replace the Affordable Care Act (ACA) by a vote of 217-213 on Thursday. H.R. 1628, the American Health Care Act (AHCA) has been the subject of Republican negotiations for weeks following the cancellation of a scheduled vote due to lack of support within the GOP. The bill’s prospects were revived following the addition of two amendments. An amendment from Rep. Tom MacArthur (R-N.J.), which would allow states to waive some Obamacare insurance regulations, including essential health benefits and community rating, helped secure the support of conservatives. But due to continued concerns about the impact of the bill on those with pre-existing conditions, Rep. Fred Upton (R-Mich.) secured an amendment that would increase funding by $8 billion over five years to help patients pay insurance premiums and copays. President Trump put intense pressure on House leadership to schedule the vote, and lobbied GOP members of Congress to support the bill. The House voted without a report on the cost of the bill from the Congressional Budget Office (CBO), which was the subject of much last minute contention. The score is expected to be released as soon as this week. Twenty Republican representatives voted against the measure: Andy Biggs (Ariz.), Mike Coffman (Colo.), Barbara Comstock (Va.), Ryan Costello (Pa.), Charlie Dent (Pa.), Dan Donovan (N.Y.), Brian Fitzpatrick (Pa.), Jaime Herrera Beutler (Wash.), Will Hurd (Texas), Walter Jones (N.C.), Dave Joyce (Ohio), John Katko (N.Y.), Leonard Lance (N.J.), Frank LoBiondo (N.J.), Thomas Massie (Ky.), Patrick Meehan (Pa.), Dave Reichert (Wash.), Ileana Ros-Lehtinen (Fla.), Chris Smith (N.J.), Mike Turner (Ohio). No Democrats voted in favor of the bill. The bill’s passage was celebrated at the White House rose garden by House Republicans and President Trump. Majority Leader Paul Ryan (R-Wis.) acknowledged that there is still much work to be done, while the President expressed optimism that health care reform would pass the Senate. Senate Majority Whip John Cornyn (R-Texas) has said that the House bill will be the starting point for the Senate’s deliberations. There is no timeline for the consideration of the bill in the Senate, though it may face procedural hurdles in its current form. Senator Roy Blunt (R-Mo.), also a member of GOP leadership, however, has stated that the Senate will be writing its own health care bill, rather than taking up the House legislation. The bill is not expected to garner any Democratic support in the Senate, so Republicans can only afford to lose two members of their own caucus. Sen. Rob Portman (R-Ohio) has already expressed opposition to the AHCA as currently constructed, and Sen. Lisa Murkowski (R-Alaska) has also been very critical of the bill. There is currently a group of 13 Republican senators who have begun work on the Senate health care bill, comprised of Ted Cruz (R-Texas), Lamar Alexander (R-Tenn.), Mike Lee (R-Utah), Tom Cotton (R-Ark.), Cory Gardner (R-Colo.), Rob Portman (R-Ohio), Pat Toomey (R-Pa.), Mike Enzi (R-Wy.), Orrin Hatch (R-Utah), Mitch McConnell (R-Ky.), John Cornyn (R-Texas), John Thune (R-S.D.), and John Barrasso (R-Wyo.). Sen. Cornyn stressed that there is no deadline to pass a health care bill, and that legislation will not be brought to the floor without assurance of 51 votes for passage. Avalere Health has released an analysis of the House-passed AHCA, which finds that the legislation’s funding for high risk pools would fall far short of helping the 2.2 million Americans with pre-existing conditions afford health insurance. According to Avalere, the funding would cover 600,000 people at most. Groups like AARP, the American Medical Association (AMA), and the American Nurses Association remain in opposition to the AHCA, given concerns that millions of Americans will lose access to affordable, quality health insurance under the bill.

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