With the failed Affordable Care Act (ACA) repeal effort, senators packed their bags and headed off for August recess. Their return will be met with a significantly packed healthcare agenda: Children’s Health Insurance Program (CHIP) Reauthorization, ACA Stabilization Bill, Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, as well as last ditch efforts to repeal the ACA through bills that have yet to be voted on such as Graham-Cassidy.
-Despite the ACA being removed from the spotlight for the time being, the past few weeks have still provided for some important developments outlined below.
-While the Cost Sharing Subsidies battle brews, the Trump administration has extended the deadline for insurers to finalize rates from August 16 to September 5. Given that we will not receive a final answer on the permanent or extended funding of the subsidies by this deadline, we will likely see higher rates as a result.
-Meanwhile, a highly anticipated Congressional Budget Office (CBO) report estimates withholding subsidy payments would increase premiums 20% in 2018 alone and raise the federal deficit $194 billion over 10 years.
-The Trump administration has confirmed it will make the subsidy payments for the month of August. The administration and House are both due for a status update in the House v. Price lawsuit by August 20, which could provide some clarity or more likely delay the case yet again.
-Behind the scenes, CMS has quietly been reducing enrollment efforts. Consumer and outreach groups have complained contracts from CMS are either being rescinded, or they have stopped receiving correspondence from CMS entirely, an ominous hint of what’s to come for the already shortened 2018 Open Enrollment Period.
-Concerned about enrollment sabotage, several Democrats requested a Government Accountability Office (GAO) investigation into the individual mandate enforcement by the administration. Specifically, the Democrats wish to know how the Executive Order affected IRS enforcement on the mandate and what effect on enrollment this will have.
-Nevada will no longer have “bare counties,” counties with no insurer on the Exchanges, for 2018. Centene stepped up to cover the 14 bare counties and 8,000 people who would have lost coverage next year. This means there are now just two counties nationwide remaining with no insurer for 2018 at this time.
-Finally, we continue to follow bipartisan stabilization bill developments. The Senate HELP Committee is set to have several hearings on ACA stabilization upon the Senate’s return. The House has several working groups hinting at a bipartisan bill, including the “Problem Solvers,” and a partnership between Reps. Meadows and McArthur. While the details remain unclear, we will probably see a focus on the following:
- Cost sharing subsidy funding – either for several years or permanent
- Reinsurance funds
- Repeal of taxes such as the medical device tax
- Ease in regulations for the employer mandate
- 1332 waiver authority
- While not addressed by any Republican working group, the issue of enrollment efforts is also likely to surface
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