Following the Trail of the Affordable Care Act Debate: Part 2

By Zach Cahill and David White

As we promised last week in our inaugural “Following the Trail,” we are going to keep you on track with the ACA repeal/repair/replace debate. We’ll review key events and introduce you to a new player, Seema Verma.

Key Events This Week:

The Tax Man Cometh – or Not

The IRS announced this week that it will no longer require tax filers to indicate whether they had health coverage or paid a penalty set under the ACA on their tax returns.  The IRS’ action was based on an executive order signed by President Trump on January 20 to freeze regulations and ease burdens imposed by the ACA.  Under ACA, taxpayers had been required to include their health coverage status when filing tax forms.

Trump Administration Moves to Stabilize Health Insurance Markets

The Trump administration, through a new CMS proposed rule released Wednesday, February 15, moved to stabilize health insurance markets that insurers said had been shaken by efforts to repeal the Affordable Care Act, by big increases in premiums, and by the exodus of major insurers like Humana.

The stated goal of the rule is to increase patients’ health insurance choices for next year.  However, the proposed rule, backed by insurance companies, would tighten certain enrollment procedures, and cut the health law’s open enrollment period nearly in half.  Proposed changes also include steps to discourage people from dropping coverage after they receive care and allowing insurers to refuse to cover a person who has not paid their premiums. 

Experts suggest the Trump administration may be making alterations requested by insurers in hopes that a smaller but healthier consumer base will put the marketplaces on sounder financial footing and attract more insurance companies in states with limited choices.

House GOP Leadership and Members Look for Common Ground

Republicans control both houses of Congress and the White House; thus they control the early stages of this process.The ACA debate among House Republicans o continued this week when GOP leaders distributed to Republican lawmakers, in a closed-door session, a policy packet outlining the top ideas leadership wants to see in a final bill. 

The policy document contained tax credits, an expansion of health-savings accounts, money for high risk pools to care for the sick, and major restructuring of Medicaid to cap federal payments.  Theprovision that drew the strongest objection from House Republicans allowed the government to tax employers providing higher-end insurance coverage.

House Republicans are far from united. A large block of conservative members advocated this week forfor full repeal of the ACA with minimal replacement measures.

A New Key Player, Seema Verma, Nominated to Head CMS

This week Seema Verma, a health care consultant, testified before the Senate Finance Committee for her confirmation hearing to lead CMS.  Verma’s testimony was light on details, but she seemed to take a page out of the book of HHS Secretary Tom Price, who said frequently during his own confirmation hearing that he supported access to care but declined to provide specifics about ACA reform.

Verma, who is from Indiana, worked with a variety of states to reform their Medicaid systems and is most known as the primary designer of Indiana’s Medicaid expansion known as the Healthy Indiana Plan (HIP).  She expressed a commitment to providing seniors care, access to affordable drugs, a desire for state flexibility in administrating Medicaid programs, and support for access to affordable insurance coverage.

Medicaid was a frequent topic of questions. Verma maintained that states do not currently have the flexibility to administer a program that best fits their citizens needs.. When asked about Medicaid block granting, Verma reiterated that administrators and legislators need to be open to all ideas including per capita caps and block grants to reform the system.

Regarding Medicare, Verma indicated she did not support a voucher system but that she was open to any reform that increased choice, provided affordability, and kept the program viable for the future.

In an exchange with Senator Ron Wyden (D-OR) about implementation of the Quality Payment Program (QPP) created by MACRA and its implication for rural providers, Verma acknowledged there were significant challenges for rural physicians and small practices particularly in accepting financial risks and in creating virtual groups. 

Verma clearly indicated that she would not rule anything out in reforming Medicare and Medicaid, and in addressing individual insurance markets. Those statements and her history in Indiana indicate that she is not afraid to strike out on a different path than previous administrators.

Members of Congress are in their home districts for their District Work Week the week of February 20-24.  ASN members are encouraged to call or visit your member of Congress to share your thoughts or concerns about ACA or any other issue of concern to you.

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As we promised last week in our inaugural “Following the Trail,” we are going to keep you on track with the ACA repeal/repair/replace debate. We’ll review key events and introduce you to a new player, Seema Verma.

Key Events This Week:

The Tax Man Cometh – or Not

The IRS announced this week that it will no longer require tax filers to indicate whether they had health coverage or paid a penalty set under the ACA on their tax returns.  The IRS’ action was based on an executive order signed by President Trump on January 20 to freeze regulations and ease burdens imposed by the ACA.  Under ACA, taxpayers had been required to include their health coverage status when filing tax forms.

Trump Administration Moves to Stabilize Health Insurance Markets

The Trump administration, through a new CMS proposed rule released Wednesday, February 15, moved to stabilize health insurance markets that insurers said had been shaken by efforts to repeal the Affordable Care Act, by big increases in premiums, and by the exodus of major insurers like Humana.

The stated goal of the rule is to increase patients’ health insurance choices for next year.  However, the proposed rule, backed by insurance companies, would tighten certain enrollment procedures, and cut the health law’s open enrollment period nearly in half.  Proposed changes also include steps to discourage people from dropping coverage after they receive care and allowing insurers to refuse to cover a person who has not paid their premiums. 

Experts suggest the Trump administration may be making alterations requested by insurers in hopes that a smaller but healthier consumer base will put the marketplaces on sounder financial footing and attract more insurance companies in states with limited choices.

House GOP Leadership and Members Look for Common Ground

Republicans control both houses of Congress and the White House; thus they control the early stages of this process.The ACA debate among House Republicans o continued this week when GOP leaders distributed to Republican lawmakers, in a closed-door session, a policy packet outlining the top ideas leadership wants to see in a final bill. 

The policy document contained tax credits, an expansion of health-savings accounts, money for high risk pools to care for the sick, and major restructuring of Medicaid to cap federal payments.  Theprovision that drew the strongest objection from House Republicans allowed the government to tax employers providing higher-end insurance coverage.

House Republicans are far from united. A large block of conservative members advocated this week forfor full repeal of the ACA with minimal replacement measures.

A New Key Player, Seema Verma, Nominated to Head CMS

This week Seema Verma, a health care consultant, testified before the Senate Finance Committee for her confirmation hearing to lead CMS.  Verma’s testimony was light on details, but she seemed to take a page out of the book of HHS Secretary Tom Price, who said frequently during his own confirmation hearing that he supported access to care but declined to provide specifics about ACA reform.

Verma, who is from Indiana, worked with a variety of states to reform their Medicaid systems and is most known as the primary designer of Indiana’s Medicaid expansion known as the Healthy Indiana Plan (HIP).  She expressed a commitment to providing seniors care, access to affordable drugs, a desire for state flexibility in administrating Medicaid programs, and support for access to affordable insurance coverage.

Medicaid was a frequent topic of questions. Verma maintained that states do not currently have the flexibility to administer a program that best fits their citizens needs.. When asked about Medicaid block granting, Verma reiterated that administrators and legislators need to be open to all ideas including per capita caps and block grants to reform the system.

Regarding Medicare, Verma indicated she did not support a voucher system but that she was open to any reform that increased choice, provided affordability, and kept the program viable for the future.

In an exchange with Senator Ron Wyden (D-OR) about implementation of the Quality Payment Program (QPP) created by MACRA and its implication for rural providers, Verma acknowledged there were significant challenges for rural physicians and small practices particularly in accepting financial risks and in creating virtual groups. 

Verma clearly indicated that she would not rule anything out in reforming Medicare and Medicaid, and in addressing individual insurance markets. Those statements and her history in Indiana indicate that she is not afraid to strike out on a different path than previous administrators.

Members of Congress are in their home districts for their District Work Week the week of February 20-24.  ASN members are encouraged to call or visit your member of Congress to share your thoughts or concerns about ACA or any other issue of concern to you.

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