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.


Senate Republicans Weigh Health Care Options

The Senate has begun work on its own bill to repeal and replace the Affordable Care Act (ACA) after the House of Representatives narrowly passed H.R. 1628, the American Health Care Act (AHCA), earlier this month. Majority Leader Mitch McConnell (R-Ky.) has acknowledged that the process in the Senate will be neither simple nor quick, but pledged to continue work on a repeal and replace measure without outlining a timeframe for the bill.

Senate Democrats have been critical of the Republican strategy for writing the legislation, characterizing it as taking place behind closed doors. They have also criticized the fact that the Senate GOP health care working group consists of only male Republican senators. Majority Leader McConnell has countered that negotiations are open to his entire caucus – he can only afford to lose two members of his own party in order to secure Senate passage. The bill, however, is not expected to go the route of the hearing and markup committee process, despite a request from the ranking members of the committees of jurisdiction.

Members of the Republican working group have begun revealing policies they are considering for inclusion in their version of repeal and replace. Sen. John Cornyn (R-Texas) has said that Republicans are looking into how to repeal the ACA’s insurance regulations, such as the essential health benefit coverage requirements and community rating. Another option touted by Sen. Rob Portman (R-Ohio) is a new tax credit to assist those who are recently coming out of the Medicaid program with purchasing health insurance. Sen. Portman hopes the Senate bill will be better than AHCA in targeting the population close to the poverty line. Along with Sen. Pat Toomey (R-Pa.), Sen. Portman has been tasked by the Majority Leader with determining how to deal with Obamacare’s expansion of Medicaid. Both senators come from states that accepted expansion of the program. The senators will need to determine how to wind down expansion, how quickly the cap on Medicaid payments should grow, and where additional flexibility should be provided to states in the administration of the program. Republicans in the upper chamber are far
more divided than their House colleagues about how to handle the Medicaid program. Members like Sen.
Portman are concerned about the effects of scaling back funding for the program due to the possible
effects on enrollees as well as public health priorities like combatting the opioid epidemic.

The entire Senate Democratic caucus sent Majority Leader McConnell, Senate Finance Committee Chairman Orrin Hatch (R-Utah), and Senate HELP Committee Chairman Lamar Alexander (R-Tenn.) a letter asking Republicans to stop their work on Obamacare repeal and instead work together to fix the current health care system. They believe that Republican plans to repeal and replace the ACA will result in an increase in the cost of insurance for the patients who most need it, while also lowering the quality of coverage. The lawmakers express a willingness to work on decreasing drug costs and insurance premiums, and making it more affordable for small business to provide health insurance, without cutting
coverage benefits. Majority Leader McConnell, however, responded that the status quo is unsustainable and requires more drastic action by Congress.

Secretary of the U.S. Department of Health and Human Services (HHS) Tom Price committed to working with the Senate and expects the upper chamber to vote on its health bill before August recess. Speaker of the House Paul Ryan (R-Wis.) made a similar prediction, stating that Congress would complete health-care legislation by the end of the summer, while allowing several years for implementation of the bill. Sen. John Cornyn (R-Texas) has also pledged that the Senate will pass a bill repealing and replacing Obamacare this year. A cost estimate of the House-passed AHCA by the Congressional Budget Office (CBO) is expected to be released next week.

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