Most of what is happening on ObamaCare replace and repeal is happening behind the scenes. The House — because of soon to come numbers from the Congressional Budget Office (CBO) — may have to vote on it again and make some changes. If it doesn’t save at least $2 billion then there’s no point sending it to the Senate.
Rep. Greg Walden’s House Energy and Commerce Committee put most of the Republican repeal language together. He said, “We’ve got to wait for the CBO score to prove that you meet the reconciliation test.”
Some are wondering why it is taking the CBO so long to come forth with the numbers. It is assumed the CBO can’t quite figure out what the states will do with all that flexibility.
Another wrinkle? The attorneys general of 15 states and the District of Columbia have filed suit to get involved in the suit over the payments to insurers so they can stay involved in the exchanges of the Affordable Care Act. The original suit challenges how money is paid to insurers.
The governors of those states say they can’t trust the Trump administration.
For months insurers say they’ve been trying to get answers from Congress and now from the Trump administration about the future of those payments that help lower the co-pays and deductibles of the poorest among us.
Among the states involved are the PIA Western Alliance states of California who — along with New York — filed the main motion. They were then joined by PIA Western Alliance states of Washington and New Mexico as well as Connecticut, Delaware, Hawaii, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Minnesota, Pennsylvania, Vermont and the District of Columbia.
“The President has increasingly made clear that he views decisions about providing access to health insurance for millions of Americans — including the decision whether to continue defending this appeal — as little more than political bargaining chips. The number of uninsured Americans would go back up, hurting vulnerable individuals and directly burdening the States. The wrong decision could trigger the very systemwide 'death spirals' that central ACA features, such as stable financing, were designed to avoid,” the attorneys general contend.
The National Association of Insurance Commissioners (NAIC) agree. It sent a letter to all members of the Senate and to White House Budget Director Mick Mulvaney. The letter said those payments are critical. “This is not a theoretical argument — carriers have already left the individual market in several states, and too many counties have only one carrier remaining. The one concern carriers consistently raise as they consider whether to participate and how much to charge in 2018 is the uncertainty surrounding the federal cost-sharing reduction payments.”
Meanwhile in the slow-moving Senate, Finance Committee Chairman and Utah Republican Orrin Hatch says he is open to a delay in doing away with the individual mandate — a key ObamaCare policy that originally irked the Republican Party leadership.
Hatch said he’s open to letting it stay until 2020 or even permanently, “I don't mind the individual mandate being expanded. But it all comes down to budgetary concerns and how it's going to be written.”
Other rebels in the Senate are Republicans Sen. Susan Collins of Maine and Sen. Bill Cassidy of Louisiana. They have introduced the Patient Freedom Act of 2017. It is appealing to many Democrats — including Democratic Party Whip Sen. Dick Durbin of Illinois.
The Collins-Cassidy bill returns health care and health insurance power to the states while keeping important consumer protections. It does away with some of the controversial mandates the two consider burdensome. They are the individual mandate and employer mandate and requirements that all health insurance plans be in one of four groups.
The bill keeps prohibitions on lifetime limits and the preexisting conditions rules of ObamaCare as well as letting young adults stay on their parents’ plans until age 26. Money for mental health and substance abuse disorders are also kept.
Collins said, “The ACA has been in full effect for three years, yet nearly 30 million people still do not have health insurance coverage. Those who do have coverage are experiencing huge spikes in premium costs, deductibles, and co-pays. Simply put, doing nothing is not an option.”
To solve that problem, all citizens are automatically enrolled whether they want to be enrolled or not.
Cassidy — who is a doctor — agrees. “We have been stressing the importance of making sure we have a replacement plan ready to go with the repeal of Obamacare, in order to ensure that no one sees a gap in their health care coverage. With the introduction of the Patient Freedom Act of 2017, I believe we now have that plan.”
Durbin likes the idea of working with Collins and Cassidy. “I think Collins and Cassidy have shown more good faith than most when it comes to that very issue. I’ve talked to both of them privately and I want to continue that dialogue because I think they're beyond repeal; they're talking about making it stronger,” he said.
The last two items that stood out last week. Many Senate Republicans aren’t happy with the — described as skimpy — subsidies for lower income, middle income and older people in the House bill.
Republican Sen. Bob Corker of Tennessee said, “What I want to ensure is that the subsidies or tax credits are enough so that lower-income, middle-income people have the ability to actually purchase healthcare. The way the subsidies were in the House bill, it really wasn’t enough to help people who were on the lower end of the economic spectrum to be able to actually purchase it.”
The House plan has $2,000 to $4,000 credits based on age and not income.
The last — and maybe most shocking — item in the evolution of U.S. health care comes from Aetna President and CEO Mark Bertolini. He said it’s time to look at a single-payer system and start the debate. His concept is a single-payer system has insurers administering the program.
“If the government wants to pay all the bills, and employers want to stop offering coverage, and we can be there in a public-private partnership to do the work we do today with Medicare and Medicaid at every state level — we run the Medicaid programs for them — then let’s have that conversation,” Bertolini said.
The reason for Bertolini’s push is because he thinks that’s where we’re headed so why wait? “We’re going to pay for it one way or another. What we have to do is we have to get the costs right. We have to get people healthy. It’s not about who is paying the bill. It’s about what we’re doing to get the costs down.”
Source links: The Hill — link 1, link 2, link 3, Insurance Business America — link 1, link 2, The Washington Post