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 Releases Revised BCRA, Delays Vote for Another Week

Senate Republican leadership released a revised version of the Better Care Reconciliation Act (BCRA), which would repeal and replace Obamacare, last week. The measure now includes Sen. Ted Cruz’s (R-Texas) Consumer Freedom Act, which would allow the sale of plans that don’t comply with the Affordable
Care Act’s (ACA) insurance regulations on pre-existing conditions and essential health benefits (EHBs). The revised bill includes an additional $70 billion in new funding over the next seven years aimed at reducing costs for individuals who remain in the regulated-insurance plans. Beginning in 2022, states would begin having to share an increasingly higher portion of this cost. The new BCRA would keep in place several ACA taxes on the high earners, which would result in a revenue stream of nearly $232 billion over the next ten years. The revised measure includes the addition of $45 billion to combat the opioid epidemic. It would also allow individuals to use health savings accounts (HSAs) to pay for insurance premiums. Additionally, individuals would be allowed to purchase high deductible catastrophic coverage plans with federal tax credits. Medicaid payments to hospitals for coverage of uncompensated care would be calculated according to the state’s uninsured population, instead of the state’s Medicaid enrollment, as originally drafted.

Majority Leader Mitch McConnell (R-Ky.) announced that the Senate will continue working two weeks into the month-long August recess, which had been scheduled to begin on July 29, in order to complete work on important priorities, including health care reform, reauthorization of the Food and Drug Administration’s (FDA) user fee programs, and raising of the debt ceiling. Speaker of the House Paul Ryan (R-Wis.) has stated that the House will also remain in session should the Senate pass a health care bill and send it to the lower chamber. A floor vote on BCRA this week was expected to be a possibility, until Sen. John McCain (R-Ariz.) announced over the weekend that he would be absent from the Senate as he recovers from surgery.

The revised bill does not seem to have swayed many Senate Republicans, particularly the most moderate members of the party who remain opposed to the scaling back of the Medicaid program. The senators that remain undecided are awaiting the Congressional Budget Office (CBO) score of the latest proposal, while Sens. Susan Collins (R-Maine) and Rand Paul (R-Ky.) remain firmly in opposition to the bill. The American Medical Association (AMA) also announced that it remains opposed to the Senate bill, praising the additional money for opioid addiction but criticizing proposed cuts to the Medicaid program.

Sen. Lindsey Graham (R-S.C.) is working to develop a new approach to ACA replacement with Sen. Bill Cassidy (R-La.). Their plan would repeal the individual and employer mandates, but transform federal funding for Obamacare – $500 billion over 10 years – into block grants to the states. Insurance regulations on preexisting conditions would be maintained, and taxes created by the ACA, with the exception of the medical device tax, would also remain in place. Sen. Cassidy has suggested offering the plan as an amendment to the BCRA.

Absent the successful passage of a repeal and replace package, lawmakers will be faced with two options: passage of a repeal-only bill, or working in a bipartisan manner on health care reform. Democrats in both chambers are urging their Republican colleagues to begin negotiating bipartisan reforms to the health care system, and some moderate Republicans, like Sen. Susan Collins (R-Maine), appear ready to listen.

The top four Democrats in the Senate – Minority Leader Chuck Schumer (D-N.Y.) and Sens. Dick Durbin (D-Ill.), Patty Murray (D-Wash.), and Debbie Stabenow (D-Mich.) – sent a letter to Majority Leader McConnell suggesting ideas that members on both sides of the aisle could support in order to stabilize the insurance market. Proposals include costsharing subsidies to help cover expenses for low-income enrollees, assistance for those who have just missed the cutoff to receive subsidies, and allowing Americans with no insurance options on their local exchange to buy insurance in the D.C. marketplace.

Sen. Tom Carper (D-Del.) is also working to connect members from both sides of the aisle on a bipartisan bill to fix the problems he sees facing the ACA, such as the cost of premiums and the strength of the exchanges. Sen. Carper says he has already spoken with one-third of GOP senators about introducing a bill that would be moved through the Senate through regular order.

In the House, a group of 10 Democrats have unveiled a plan titled “Solutions Over Politics.” They propose to create a $15 billion permanent reinsurance program, reduce copays and deductibles for low-income families, provide premium assistance, and continue cost sharing reduction payments to insurers. The group supports the creation of a Medicare buy-in option for those nearing retirement age, and are pushing for the expansion of tax credits based on age, geography, and income. They also support aligning the open enrollment period with tax filing season, along with robust marketing strategies to increase enrollment. They would also expand the availability of catastrophic health plans that include EHBs and coverage of primary care for young enrollees. The group is led by Reps. Kurt Schrader (D-Ore.), Ami Bera (D-Calif.), and Ann McLane Kuster (D-N.H.), co-chairs of the Affordable and Accessible Health Care Task Force. They plan to petition for cosigners on a letter to Speaker of the House Paul Ryan (R-Wis.) requesting the creation of a task force on stabilizing the individual marketplace.

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