National Oct 27, 2017
Health-care update
Health-care legislation
Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., proposed new Patient Protection and Affordable Care Act repeal legislation in early September that would have scaled back the federal government’s role in the health-care system and instead provide block grants to states. The bill would have replaced the PPACA’s tax subsidies with block grants, end the law’s individual insurance mandate and scale back its Medicaid expansion. It was the final last-ditch attempt to repeal the PPACA before the GOP’s power to pass health-care legislation through a party-line vote in the Senate expired on Sept. 30. Senate Majority Leader Mitch McConnell, R-Ky., stated that if the bill failed to gain support of at least 50 of the 52 GOP senators, he would not bring it to the floor for a vote. Republicans failed to get the requisite 50 votes needed to defeat a democratic filibuster. This effectively killed the repeal-and-replace effort of the PPACA.
U.S. Sens. Michael Bennet, D-Colo. and Tim Kaine, D-Va., introduced legislation on Oct. 18, to create Medicare-X, a public plan that would offer families, individuals and small businesses additional, low-cost health-insurance choices and create more competition in the marketplace. The Medicare-X Choice Act would build on the Medicare framework to establish a public insurance plan offered on the individual and small-business health exchanges, allowing Americans to choose among the existing private-insurance plans or a public one. Medicare-X would use Medicare’s network of doctors, require similar reimbursement rates and guarantee the essential health benefits established in the PPACA for families, such as maternity care and mental health services. Additionally, it would ensure access to affordable prescription drugs by offering prices negotiated in conjunction with the Medicare Part D program.
In addition to the Bennet-Kaine plan, the Senate also introduced bipartisan legislation by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash. The Alexander-Murray proposal has built in the cost-sharing reduction payments through 2019. It also speeds up the approval process for states that apply to adjust PPACA program rules through the waiver process; allows states to come up with new ways to use existing federal payment streams to fund waiver programs; requires states to make sure that any waiver program changes allow people with serious health problems to get major medical coverage "of comparable affordability" to what they could get without the changes; and requires the U.S. Department of Health and Human Services to implement an existing section of the PPACA, which allows states to join together to form interstate health-insurance product filing compacts. President Donald Trump has shown support for the Alexander-Murray bill. McConnell has promised to bring it to the floor for a vote should the president promise to sign the legislation.
Presidential Executive Orders
Trump issued two Executive Orders on Oct. 12. The first increases the availability of short-term, limited-duration insurance and health reimbursement arrangements, which are limited by the PPACA. The order also expands access to association health plans to allow small businesses to band together to purchase large group plans.
The second order immediately eliminated cost-sharing payments aimed to assist lower income enrollees on the individual markets purchase health care. According to the order, the Department of Health and Human Services has determined there is no appropriation for cost-sharing reduction payments to insurers under the PPACA law.
Following the issuance of the subsidy order, 18 state attorneys general banded together and sued the Trump administration to prevent the order from taking effect and force Trump to make the next payment. The states claim that if the subsidies vanish, low-income Americans who obtain insurance through PPACA online marketplaces where insurers can sell policies would face higher insurance premiums and out-of-pocket medical costs. It would particularly hurt lower-middle-class families whose incomes are still too high to qualify for certain government assistance. The new lawsuit would be separate from a case pending before an appeals court in the District of Columbia in which 16 Democratic state attorneys general are defending the legality of the payments. The House in 2014 sued the Obama administration, claiming the reimbursements were illegal given the lack of congressional appropriation. A federal judge ruled in the House’s favor last year, but the decision was stayed by an appeal of the ruling.
A federal judge in California, on Oct. 25, rejected the state’s request to order the Trump administration to make the subsidy payment due that day. Judge Chhabria, who was appointed by President Barack Obama, held a hearing on Oct. 23 at which both sides presented arguments. His initial ruling states that although it is early in the proceedings, it seems that the Trump administration has the stronger legal argument. This doesn’t dismiss the case; it merely allows the Trump administration to carry out the Executive Order while awaiting any further proceedings in the court. The case is scheduled to stay in Judge Chhabria’s court.