Roundup of federal health policy developments

The debate over the future of the Affordable Care Act (ACA) is well-underway and there are a number of significant developments that warrant a closer look. Here we provide a roundup of recent developments.

Administrative Action

Upon entering office, President Trump signed two Executive Orders. The first, on January 20, entitled “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal” stated his commitment to repealing the Affordable Care Act (ACA) and directing administration officials to avail themselves of existing authority to provide flexibility in administration of the ACA.

On January 30, the President also issued an Executive Order requiring that federal agencies identify two existing regulations to be repealed for any new regulation they propose.

Read more about these Executive Orders here.

Congressional Update

Following passage of a budget resolution paving the way to partial repeal of the Affordable Care Act (ACA) via budget reconciliation (as explored in our recent news post, here), Speaker of the House Paul Ryan announced a plan to mark up a reconciliation package that includes ACA repeal and replace provisions within the limitations of reconciliation. While a draft of the reconciliation package – initially expected by the last week of January – has not been released and questions of timing and whether the focus should be “repeal and replace” or “repair” have been raised more broadly, Ryan has said that he expects a budget reconciliation package to be on the House floor by the end of February or early March.

While much uncertainty remains, a number of other legislative proposals have also been announced. While none of these bills are likely to be the final package that is enacted, the summaries below are designed to familiarize you with the proposals being floated for consideration. These summaries provide a very high-level overview of complex bills. Contact us at Healthpolicynews@pcgus.com for more information.

Senators Bill Cassidy and Susan Collins introduced the Patient Freedom Act of 2017 to largely repeal and replace Title 1 of the ACA, which includes insurance reforms. Certain ACA reforms would remain, including changes to the Medicaid program (e.g., Medicaid expansion) and Medicare as well as ACA revenue provisions. In addition, the bill would immediately reinstate come of the most popular ACA private market reforms. Click here to continue reading about the Patient Freedom Act.

Just days after Senators Cassidy and Collins introduced their bill, Senator Rand Paul introduced the Obamacare Replacement Act, which would repeal much of Title 1 of the ACA, including individual and employer coverage mandates, Essential Health Benefits, rating restrictions, and others. The bill would restore certain market rules, such as coverage under family plans for young adults up to age 26, HIPAA preexisting condition protections to the group market, and others. Continue reading about the Obamacare Replacement Act here.

The Access to Insurance for All Americans Act, introduced by Congressman Darrell Issa, would fully repeal the ACA while allowing all Americans to buy coverage through the Federal Employee Health Benefit Program (FEHB). FEHB premiums are not underwritten, including based on preexisting conditions, age, gender, etc., and include national plans. Employers and states could subsidize FEHP plans (including for Medicaid beneficiaries) and premium contributions would be tax deductible. While states could maintain their Medicaid expansions, the individual and employer coverage mandates would be eliminated.

The House has also held hearings on four piecemeal bills aimed at making incremental changes to the ACA:

• The State Age Rating Flexibility Act of 2017 would expand permissible age rating bands to 5:1 (currently 3:1) under the ACA or a different ratio adopted by the state.
• The Plan Verification and Fairness Act of 2017 would prohibit insurers from making coverage effective for new enrollees who enroll during a special enrollment period (SEP) for plan years beginning on or after January 1, 2018 until the U.S. Department of Health & Human Services (HHS) has verified the individual’s eligibility.
• The Health Coverage State Flexibility Act of 2017 would reduce the current 90-day grace period for those individuals receiving Advanced Premium Tax Credits (APTC) who miss premium payments to the time period established by state law or one month for plan years beginning in 2018.
• The Preexisting Conditions Protection and Continuous Coverage Incentive Act of 2017 would maintain—though in a more limited manner than under the ACA—a ban of preexisting condition clauses and a requirement for guaranteed availability in the individual and group markets.

Read more about these four House bills here.

House v Burwell Update

As we recently shared, the case over whether CSR reimbursements from the federal government to insurers are being legally provided was stayed pending the new administration. At the end of 2016, two beneficiaries of the CSRs sought to intervene in the case given their interest in the decision. On January 12th, the court denied the motion to intervene, leaving the defense of the CSRs in the hands of the new administration. While the change of administrations clearly impacts the dynamics in this case, dropping the case without a transition plan would lead to the type of market chaos all leaders have said they will avoid.

Published by Lisa Kaplan Howe

Lisa Kaplan Howe (J.D.) is a Senior Advisor who has spent her career working in health law and policy. At PCG, she focuses on statutory and regulatory analysis and strategic advising, particularly related to health care policy. Lisa has provided subject matter expertise to support state health care reform efforts, including policy development and regulatory support for health insurance Marketplaces and state insurance plan management efforts, Medicaid expansion and Medicaid Waivers (including DSRIP Waivers) and State Innovation Waivers. Lisa led PCG’s work with the New Hampshire Insurance Department relative the state’s Section 1115 Medicaid Waiver to provide coverage to newly-eligible adults through the Marketplace and continues to support the states’ Marketplace plan management work. In those roles, Lisa has served as the chief advisor and policy expert related to Medicaid and private insurance law to the New Hampshire Insurance Department, helping to identify, analyze and lead strategic consideration of federal opportunities and requirements. Lisa is also part of the team helping to design Colorado’s Delivery System Reform Incentive Payment (DSRIP) program. Ms. Kaplan Howe also provides broad policy and regulatory support to PCG’s other health care clients across the country, analyzing policy and regulatory developments, providing strategic advice relative to regulatory questions, and drafting policy briefs and position papers. Lisa is a managing editor of PCG’s monthly health practice area newsletter, Health Policy News. Prior to joining PCG, Lisa served as Policy Director at New Hampshire Voices for Health, where she led legislative and regulatory analysis, strategic planning, and implementation of the organization’s policy agenda. Her work included drafting bills, amendments, testimony, and communications and testifying at hearings. Lisa also held the positions of Private Market Policy Manager and Consumer Health Policy Coordinator at Health Care for All of Massachusetts. While there, she managed private insurance market policy work and was a member of the organization’s internal health reform team. Lisa also practiced law in the Ropes & Gray health care department, advising health care provider and insurer clients. View all posts by Lisa Kaplan Howe