By Lyle Dennis, Cavarocchi – Ruscio – Dennis Associates, Consultants to AASLD
Thanks to any and all AASLD members who contacted their senators prior to the recent votes on legislation to repeal and replace, and then to just repeal, the Affordable Care Act (ACA). By now you know that the Senate leadership’s last-ditch efforts to repeal and replace the Affordable Care Act (ACA) was defeated when they were unable to get 50 votes for any version of the legislation.
The Health Care Freedom Act, dubbed the “skinny” repeal, would have permanently eliminated the individual mandate to purchase coverage and suspended the employer mandate for eight years. According to the nonpartisan Congressional Budget Office, the bill would have saved about $180 billion, but would have caused 16 million Americans to lose health insurance over the next decade.
After days of intense negotiations and a suspenseful few hours of debate culminating after 1:30 a.m., the final vote led Senate Majority leader Mitch McConnell (R-KY) to declare that the Senate would move on to other business.
But the larger debate over ACA is far from over.
Shortly after the vote, President Trump warned that he would unilaterally end the ACA’s cost-sharing reduction (CSR) payments if Congress doesn’t pass repeal/replace legislation. Insurers and other stakeholder groups responded that continuation of the CSRs is essential for keeping individual premiums from spiking up to 20 percent next year—and for keeping more insurers from pulling out of markets.
At this writing, we are waiting to learn whether the president will follow through on his threat. If he does, some lawmakers have proposed to bring CSRs under congressional control through the annual appropriations process to assure that the program continues.
Apart from that, a bipartisan group of 40 to 50 lawmakers, calling themselves the House Problem Solvers Caucus, has been working on their own proposal to resolve the current stalemate. Their proposal would stabilize the insurance market by:
- Funding CSRs through congressional appropriations;
- Raise the threshold for the employer mandate to 500 employees, up from the 50 employees in the current law;
- Eliminate the medical device tax;
- Establish Health Care Choice Compacts, which would allow insurers to sell across state lines; and
- Ensure that states that expanded Medicaid are secure.
Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Lamar Alexander announced that his committee will hold hearings after Labor Day on how to stabilize and strengthen health insurance markets. This marks a potential return to regular order and an opportunity for a bipartisan agreement.
Senators Bill Cassidy (R-LA) and Lindsey Graham (S-SC) have also unveiled a proposal that would create block grants for all ACA spending based on a new approach that moves towards equal funding across the states. However, this proposal would run into many of the same obstacles as the previous Senate ACA repeal attempts, most notably radically changing and limiting Medicaid funding.
AASLD will continue to closely monitor developments. If necessary, we will call on AASLD members to weigh in reflecting what is need for your patients and your practices, as you have done so effectively in the past.