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 Postpones BCRA Vote

The Senate Republican’s “Better Care Reconciliation Act of 2017” (BCRA) was updated last week to include requirements related to continuous coverage. While the bill does not contain the 30 percent surcharge for a lack of continuous coverage, it does have a newly added provision that would require a six-month waiting period if there is a gap of 63 days or longer in coverage in the prior year, for health insurance coverage that is in effect beginning January 1, 2019. The provision is intended to stabilize the marketplace and replace the individual mandate which penalizes those who do not purchase insurance.

The Congressional Budget Office (CBO) released an estimate of the revised bill, noting that the legislation would reduce the deficit by $321 billion over a decade, which is larger than the CBO estimate of the House-passed American Health Care Act (AHCA) ($119 billion). In addition, CBO estimates that the number of uninsured individuals will increase to 49 million by 2026 (compared to 51 million under the House bill and 28 million under current law). The CBO projects that under BCRA, Medicaid spending would be cut by 35 percent by 2036, and 15 million fewer people would be enrolled in the program over the next decade. Insurance premiums would increase by 20 percent in 2018 and 10 percent in 2019. By 2020, premiums would fall by 30 percent. By 2026, premiums would be 20 percent lower than under Obamacare. Republicans have responded to the CBO’s score by pointing out the difficulty of predicting human behavior, and thus accurately forecasting the coverage effects of the legislation.

Despite pressure from President Trump, Majority Leader Mitch McConnell (R-Ky.) announced that the Senate would not begin debate of the bill before the July 4th recess due to ongoing concerns from both conservative and moderate Republicans. Despite the fact that lawmakers were unable to reach a new agreement on further revisions before the July 4th recess, the White House and GOP leadership continue to be optimistic about the chances of Senate passage.

Some senators like Susan Collins (R-Maine), Mike Rounds (R-S.D.), and Bob Corker (R-Tenn.) are questioning whether the bill should repeal the Affordable Care Act‘s (ACA) 3.8 percent tax on wealthy Americans’ net investment income. Keeping the tax would allow Republicans to increase subsidies for low-income enrollees in the individual market. Changes to how federal funding for Medicaid is determined are also under discussion. Linking funding to the medical component of the consumer price index (CPI) would shore up additional funding for the program relative to the current Senate proposal. Additionally, some senators are signaling that leadership could dramatically increase funding for the state innovation fund in order to secure the votes of moderate Republicans.

Other lawmakers, like Sen. Rand Paul (R-Ky.) continue to push for the bill to be more conservative. Sen. Paul is demanding that the continuous coverage provision be removed from the bill, along with the removal of stability fund appropriations and repeal of Obamacare insurance regulations, including preventing discrimination against individuals with preexisting conditions. Some lawmakers are even beginning to back a strategy of repealing the health care law first, and replacing it at a later point in time.

According to sources familiar with the ongoing negotiations, the White House and GOP leadership are leaning toward the inclusion of at least a $45 billion response to the opioid epidemic, up from the current $2 billion, in order to get members like Sens. Rob Portman (R-Ohio) and Shelley Moore Capito (R-W.V.) on board. Leadership is also considering a provision to allow consumers to use health savings accounts (HSAs) to pay for their premiums.

The American Medical Association (AMA) came out in opposition to the Senate health bill last week, saying that subsidy and waiver provisions would expose patients to higher costs and greater difficulty affording care. The AMA also criticized the Planned Parenthood and Medicaid policies contained in the bill.

The Senate will reconvene on July 10, with 14 legislative days in July before the scheduled five-week August recess. Senate Majority Whip John Cornyn (R-Texas) has now identified August 1st as a “drop-dead” deadline to vote on the bill.

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