Congress will return from its August recess after Labor Day with a number of items on their agenda, including dealing with the ACA and the Republican promise to repeal and replace the law. The Senate HELP Committee has bipartisan hearings scheduled for September 9th and 10th. These hearings will include testimony from insurance commissioners and governors on ways to attract and keep insurers in the insurance marketplaces and how to lower premiums. Colorado Gov. John Hickenlooper is scheduled to testify on a proposal he has developed with Ohio Gov. John Kasich that has the support of six other governors. The governors’ proposal includes a number of recommendations for stabilizing the market, lowering premiums, and encouraging state-level innovation, including: funding greater outreach to young adults, more comprehensive verification of special enrollment periods, paying for care based on quality rather than quantity, fixing the ACA’s family glitch and basing affordability calculations on the cost of coverage for a family rather than an individual, exempting insurers from a health insurance tax if they are the only one left in a market, funding cost sharing subsidies through 2019, creating a stability fund to help insurers with expensive patients, streamlining the waiver process to allow states greater flexibility, and allowing states to change the essential health benefit requirements in their state.
There is also one additional GOP health care plan that has yet to be voted on by Congress: the Cassidy-Graham proposal. Cassidy-Graham would repeal the ACA’s premium subsidies, cost sharing reductions, and Medicaid expansion in 2020. These programs would be replaced with a grant program that would give states lump sums of money for them to put towards health care. States could then choose to use the money for activities such as to fund high-risk pools, to pay insurers to stabilize premiums, to directly pay health care providers, to fund programs that reduce out-of-pocket costs for individuals with individual market coverage, to establish a program to help individuals purchase coverage, to provide wrap-around coverage for those already in a state medical assistance program, or whatever the various states decided is in their best interests. The Center on Budget and Policy Priorities estimates that there would be 34 percent (or $83 billion) less funding available by 2026 under Cassidy-Graham than under the ACA. States would also be required to provide some of the funding on their own, matching 3 percent of their grant in 2020 and 5 percent by 2026. The proposal would also convert the Medicaid program to a per capita cap model. Finally, the funding included in the bill would end altogether in 2026. The proposal would need to gain support from both more conservative and centrist Republicans in order to pass the Senate.
There is still some debate, however, as to how much longer Republicans will be able to use the reconciliation process to pass health reform. Democrats argue that a 2019 budget bill cannot be passed after the 2019 fiscal year is over on September 30th, while Republicans argue that the reconciliation instructions are valid until a bill passes or a new budget is approved. The Senate Parliamentarian will have to make the final decision on the matter if a bill comes up for vote after September 30th.
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