What Will the Senate Replace the ACA With?
There are a great many unknowns, including which version of the health care reform bill will be considered. To date, there have been at least four possibilities floated – the House-passed American Health Care Act (AHCA), the Senate’s Better Care Reconciliation Act (BCRA), a straight repeal called the Obamacare Repeal Reconciliation Act (ORRA), or an updated BCRA that includes the “Cruz amendment” that would allow insurers to sell scaled-down plans lacking essential health benefits. ANCOR has developed a quick reference guide comparing the three main proposals.
With the various bill versions have come various Congressional Budget Office (CBO) scores. Most recent estimates from CBO include loss of health insurance coverage by 17 million people and cuts of $756 billion from the Medicaid program. These numbers are slightly lower than some previous estimates had been, but still represent a gutting of Medicaid by shifting costs to states that cannot possibly make them up. One idea that has been floated to partially mitigate those cuts is the addition of $200 billion in Medicaid “wraparound” funding that would allow states to provide subsidies for low income individuals to purchase private insurance. Budget analysts are quick to point out that adding $200 billion does not replace taking out $756 billion from a program.
The CBO also released an estimate on a straight ACA repeal, which is the ORRA. That bill would result in an additional 32 million people to lose insurance coverage and end the Medicaid expansion in 2020, but would not include the structural changes to Medicaid that other plans have included. At this time, there is no replacement plan proposed to accompany a straight repeal.
Meanwhile, the Senate parliamentarian has made determinations on several pieces of the BCRA and whether they run afoul of the “Byrd rule”, which requires that bills in the Senate that come through the budget reconciliation process must not contain “extraneous” provisions. In the parliamentarian report, items that run afoul of the Byrd rule include restrictions on tax credits being used for insurance plans that cover abortion, the defunding of Planned Parenthood, and sun-setting essential health benefit requirements in Medicaid alternative benefit plans. Any provision that violates the Byrd rule may not be considered through the reconciliation process, but would have to be deliberated on in regular order, which means a higher bar of 60 votes would be required to pass. Some provisions in the current BCRA that the parliamentarian has ruled do not violate the Byrd rule are Medicaid work requirements, establishing a state stability and innovation fund, and repealing cost-sharing subsidies.
Advocates are encouraged to continue phones call and visited around the nation, however, New Jersey’s Senators, Menendez and Booker, have been vocal advocates against the Republican version of healthcare reform and NJACP has encouraged members to thank them.
Congressman MacArthur: No Regrets on Role of Moving Healthcare Bill Forward
With Republican efforts to repeal and replace the Affordable Care Act on life support, Rep. Tom MacArthur said he had “no regrets” about his efforts to push the legislation forward.
“I’m doing what I can as a member of Congress to solve problems,” MacArthur (R-3rd Dist.) said after Senate Republicans acknowledged that their legislation didn’t have the votes to pass. “That’s why I came here. I didn’t come here to be a potted plant. I didn’t come here to decorate a chair.”
MacArthur said the blame rested with the Senate Republicans who refused to follow the lead of House GOP lawmakers and approve a bill doing away with the existing health care law.
“The Senate still has a chance to fix this,” MacArthur said. “That is surely better than letting it collapse because in the meantime millions of people will over time be losing ability to buy insurance. That’s not a good outcome.”
After House Republicans pulled their bill off the floor due to lack of support, MacArthur, a former insurance executive, proposed allowing states to seek waivers from federal requirements that insurers offer a specific package of benefits and do not charge higher premiums to sicker patients.
The Congressional Budget Office said the bill would leave 23 million more Americans without health insurance and cause some with pre-existing conditions to be “unable to purchase comprehensive coverage with premiums close to those under current law and might not be able to purchase coverage at all.”
In MacArthur’s own district, the number of uninsured would more than double by 2026, a higher percentage than anywhere in the state, according to New Jersey Policy Perspective, a progressive research group.
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NJACP staff, along with members, visited Congressman MacArthur’s district office earlier this month and discussed the need to carve out individuals with disabilities from the healthcare bill. However, his staff did not have a response and little time was set aside for discussion. NJACP will continue to advocate for no cuts to Medicaid and to carve people with IDD out of the per capital cap proposal.
CBO Score/Analysis Shows Medicaid spending to Fall by 35% Over 20 Years Under Healthcare Bill
A revised Congressional Budget Office (CBO) report, which estimated that the BCRA would cut Medicaid by $772 billion and result in approximately 22 million people becoming uninsured. These numbers are lower than the CBO estimates on the House-passed health care bill, the American Health Care Act (AHCA), but still deeply troubling for people with disabilities that rely on Medicaid benefits. Democrats pushed CBO to perform a 20-year analysis, instead of its usual 10-year estimate, saying that the BCRA hid many of its long-term costs by pushing them to after the 10-year mark. As reported by Modern Healthcare, the 20-year analysis shows that Medicaid spending would fall by thirty-five percent over two decades.
NYT Piece Highlights Critical Role of Medicaid for Millions of Americans with Disabilities
On July 1, the New York Times published an article titled, “For Millions, Life Without Medicaid Services Is No Option.” The piece highlights the personal care services that Medicaid pays for to assist people with disabilities with activities of daily living (ADLs). The article points out that these types of services are optional under Medicaid law, with states choosing how much to spend on them or whether to offer them at all. Given that states have the option whether to provide these services, they could be scaled back or eliminated to meet budget pressures. Though optional for states to provide, these services are far from “optional” for the people who use them, including Frances Isbell, who was profiled in the article. Without these services, Isbell, a 24 year old who uses a motorized wheelchair due to her spinal muscular atrophy, says that the purpose of the programs she benefits from “is to give people options and freedom.”
The article goes on to discuss the number of people that receive long-term Medicaid services in the country, including particularly statistics for Alabama, which spends less on average for Medicaid and gets a higher federal share, which puts its program at particular risk from the proposed health care law changes. The article concludes by discussing the importance of Medicaid for family members who rely on the program to allow them to keep their loved ones at home and in the community rather than in nursing homes.
The Centers for Medicare & Medicaid Services (CMS) seeks public input on reducing the regulatory burdens of the Patient Protection and Affordable Care Act (ACA)
The Centers for Medicare & Medicaid Services (CMS) has issued a Request for Information (RFI) seeking recommendations and input from the public on how to create a more flexible, streamlined approach to the regulatory structure of the individual and small group markets. The goal is to identify and eliminate or change regulations that are outdated, unnecessary, or ineffective; impose costs that exceed benefits; or create inconsistencies that otherwise interfere with regulatory reform initiatives and policies.
The Department of Health and Human Services (HHS) is looking for feedback on regulations under the ACA to determine whether each rule advances or impedes priorities for stabilizing the individual and small group health insurance markets; empowers patients and promotes consumer choice; enhances affordability; and returns regulatory authority to the states. Regulations under review include Essential Health Benefits and Actuarial Value, among others. Feedback can include providing input to improve rules, maintain rules, change rules, remove rules, and more. Some areas for specific requested feedback, include:
- Empowering patients and promoting consumer choice. What activities would best inform consumers and help them choose a plan that best meets their needs?
- Enhancing affordability. What steps can HHS take to enhance the affordability of coverage for individual consumers and small businesses?
- Protecting individual independence. How can HHS enhance the opportunities of older adults and people with disabilities to participate in their communities and access the supports they need?
Aging and disability community-based organizations and other groups may wish to provide feedback for these populations and their caregivers and/or family members. The RFI will be open for public comment for 30 days. View the Request for Information and details for submitting public comment.
TRUMP’s MEDICAID OVERHAUL IS FACING TOUGH TEST IN TRUMP COUNTRY
The administration is likely to approve Kentucky Gov. Matt Bevin’s plan requiring poor adults to work to enroll in Medicaid in a first test of the GOP idea. That could spark a domino effect in other Republican-led states. But the plan could backfire on many Trump voters, as POLITICO’s Rachana Pradhan found when she traveled to coal country in Kentucky – and found a county of 17 percent unemployment and persistent poverty.
‘How do you force poor people to work for health coverage when there aren’t any jobs?’ – That’s the question that Rachana encountered again and again, with unemployed adults telling her they wouldn’t even know where to look if they needed a job to get health coverage. “Most people would work if they could find a job,” said the mayor of one small town (who also runs its health department). “I have people come in here every day wanting a job.” As reported by Politico.