The packed agenda for Congress promised us a whirlwind of a month, and it certainly came with its share of surprises. Despite the appearance of progress, however, we still don’t have answers to any of the pressing healthcare legislation questions as we conclude our third week of September. With one week remaining, action looks pretty grim for many of the government health programs, including the Children’s Health Insurance Program (CHIP) and the Affordable Care Act (ACA), mainly due to the sudden resurgence of ACA repeal talks.
Though the leaders of the Senate Finance Committee (SFC) released a plan for a five-year extension of CHIP, the new effort to repeal the ACA is once again putting the status of the program in jeopardy by taking time off the schedule. With one week remaining, we still don’t have a House counterpart to the bill as Congressmen continue to argue over how to approach ACA repeal. The SFC also has not scheduled a mark-up of the bill. This inaction creates uncertainty over whether CHIP can be extended in time, putting the possibility of a three- month extension back into the realm of possibilities.
A number of promising bills that made their way through their respective committees are also stuck in limbo as ACA repeal agenda takes over the spotlight. Last week, the Increasing Telehealth Access to Medicare Act passed unanimously in the U.S. House Ways and Means Committee. The bill would increase access to telehealth services for Medicare Advantage enrollees and allow plans to build telehealth services into their bids. The SFC also unanimously passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 to the Senate floor, a bill that would make changes to the Medicare program to allow plans and providers to better tackle chronic health issues and outcomes. Despite the overwhelming support for both bills, their likelihood of making it to the floor is low unless tied to another piece of legislation.
The resurgence of the ACA repeal discussion also derailed promising bipartisan ACA marketplace stabilization discussions. The Senate HELP Committee, led by Senators Alexander (R) and Murray (D), came to a halt yesterday with the announcement by the White House and House Speaker Ryan that they would not support such legislation. Senator Alexander released a statement that the two sides could not reach an agreement, while Senator Murray placed the blame on the Graham-Cassidy proposal, stating the Democrats agreed to significant Republican proposals, such as great 1332 waiver flexibility and catastrophic bronze plans. The bill’s main purpose was largely seen as a way to secure funding for cost-sharing subsidies and provide short-term marketplace stabilization. The failed bipartisan effort means tremendous uncertainty for insurers and the Exchanges in the foreseeable future.
With this, it looks like the Senate will run down the clock next week with a nail-biting focus on ACA repeal. Despite the sudden attention on the bill, it still faces some large obstacles. First, the bill must still secure 50 votes. With Senator Rand Paul still vocally opposing, the GOP can only lose two votes for Vice President Pence to cast a tie-breaker. The major senators to watch are Senators Collins, McCain, and Murkowski, with Senator Murkowski likely holding the vote that will determine the outcome. The bill will also need to once again pass through reconciliation guidelines and pass the Byrd Rule. Finally, the bill has until the reconciliation clock runs out on September 30. Democrats can attempt to block passage through the introduction of scores of amendments, leading to grueling debate sessions extending into the morning hours. Either way, next week should prove to finally provide some finality to the ACA repeal debate. Stay tuned for developments.
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