Many thought, with the failure of the U.S. Congress to repeal the Affordable Care Act (ACA) at the end of the 2017 fiscal year, the act was safe from another repeal effort under this Congress. While the names in the Senate may remain the same, the effective plan may have now changed. Former Centers for Medicare & Medicaid Services (CMS) Administrator Andy Slavitt has described this as “synthetic repeal.”
The new efforts are aimed at a multilevel approach to address major parts of the ACA, with actions taken by both the administration and Congress.
- CSR Payments – With the Trump administration’s announcement they will cease to make the cost-sharing reduction (CSR) payments (which they had only committed to on a month-to-month basis), the expectation is rates will increase 15-30% for plans in the Health Insurance Marketplace. Indications are, while there might be some effort to pass a bipartisan short-term CSR payment measure in the Senate, House Speaker Paul Ryan remains opposed to such a measure, along with many members of the House Freedom Caucus, and the administration has sent mixed signals on the Alexander-Murray CSR solution.
- Association Health Plans – The administration seeks to further make the Marketplace unpopular by creating a market for so-called association health plans through their Executive Order. This would create the ability for such plans to be offered with no pre-existing protections. The hope is such plans offered would attract younger, healthier enrollees and make the Marketplace products, which will have more requirements as well as an older population, more expensive and thus less popular, essentially turning the Marketplace into a high risk pool.
- Outreach and Enrollment Efforts – The administration’s efforts to severely cut the outreach budget by 90%, as well as cut in half the enrollment period, will make it more difficult for individuals to enroll into the Marketplace. The Alexander-Murray compromise measure calls for much of these funds to be restored.
- Medicare and Medicaid Cuts – The budget resolution being considered by the Senate includes $1.3 trillion from Medicaid (and other premium and cost-sharing subsidies to make coverage affordable) and $470 billion from Medicare. Used for tax cuts in the proposed budget, estimates are it would increase the budget deficit by $1.5 trillion over the next decade. Fast-track reconciliation is the process that would allow for the sought-after tax cuts costing $1.5 trillion over 10 years that requires only a simple majority to pass. Proposed budget cuts overall would equal $5.8 trillion over the next decade.
This approach would allow the goals of the ACA repeal effort to be largely met, coupled with separate tax cut goals, all under the budget process, which might be less recognizable to the public. This combined approach could affect Marketplace participation by plans in future years and accomplish many of the major goals sought by the ACA repeal effort.
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