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.


Fate of Latest Repeal and Replace Proposal Unclear

Republican Senate leadership spent time last week gauging support among their caucus for the Graham-Cassidy-Heller-Johnson proposal, while the White House worked to rally support for the legislation. The plan is the latest attempt to repeal and replace the Affordable Care Act (ACA). It would replace ACA funding with block grants to states, which would then determine how to offer health insurance coverage to their populations. Senators are weighing how the bill will impact their states specifically, often looking to their governors for guidance. A hearing has been scheduled today in the Senate Finance Committee. Numerous health care stakeholders, including the American Heart Association, the American Cancer Society, March of Dimes, America’s Health Insurance Plans, the American Hospital Association, AARP, and the American Medical Association have announced their opposition to the bill – arguing that the proposal would endanger access to care for millions of Americans.

The Congressional Budget Office (CBO) aims to release a partial analysis of the legislation early this week. The CBO report will help the Senate Parliamentarian determine whether the proposal meets the rules for use under the reconciliation procedure. But a complete score including the bill’s effect on coverage, insurance premiums, and the deficit could take an additional several weeks. Republicans’ ability to use the fast-track budget reconciliation process expires on September 30th, and Democrats are threatening to use every delay tactic within their power to expend Senate floor time.

Should the Senate be successful in passing the repeal and replace proposal, supporters hope that the House of Representatives would pass it without changes. Speaker of the House Paul Ryan (R-Wis.) has indicated his support for bringing the bill to the House floor without plans for a conference committee.

Many Senate Republicans were optimistic about the bill’s chances of passage as momentum built throughout last week.On Friday afternoon, however, Sen. John McCain (R-Ariz.) announced that he would not be supporting the proposal. McCain’s statement called for regular order for any future health care legislation and stressed the importance of bipartisan cooperation. While Sen. Rand Paul (R-Ky.) was the first senator to announce his opposition to the bill, other conservative lawmakers are working to ensure that the state waivers and other provisions of the plan will be implemented as intended. Sen. Ted Cruz (R-Texas) has said that he is not prepared to support the bill, but will continue to push for these changes to the legislation. Sen. Susan Collins (R-Maine) has said that she is leaning against the plan. She has expressed concerns about the impact of the bill on Medicaid coverage and those with pre-existing conditions. She does not support voting on the bill without a full CBO report. Cassidy and Graham are working to gain Sen. Lisa Murkowski’s (R-Alaska) vote, and there has been talk of a revised bill that could carve out special Medicaid accommodations for her state. Republicans can only afford to lose two members of their caucus for the proposal to pass. Senate Majority Leader Mitch McConnell (R-Ky.) had announced his intention for the Senate to vote on the bill this week, but it is unclear whether recent developments will have an impact on his decision to schedule floor consideration.

Over the weekend, Sen. Graham threatened that neither he nor Sen. Johnson would vote for a budget resolution that does not include new reconciliation instructions for health care reform. This would, however, complicate Republican’s intention to use reconciliation to pass tax reform by a simple majority in the coming year.

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