Major Health Policy Developments coming out of the Federal Administration

While Congressional efforts to change or repeal the Patient Protection and Affordable Care Act (ACA) continue to be stalled, the federal administration announced two significant health policy developments at the end of last week – an Executive Order aimed at promoting access to plans not subject to the full range of ACA protections as well as the decision to stop making cost-sharing reduction payments immediately. [More]

Congress takes steps to reauthorize CHIP

On October 4, 2017, the U.S. Senate Finance Committee approved a bill that would reauthorize federal funding through FFY 2022 for the Children’s Health Insurance Program (CHIP), a program that currently serves over nine million low-income children. New funding authorization for CHIP expired on September 30, 2017. For now, states are operating CHIP on federal allotments left over from prior years. Those reserves vary widely from state to state. [More]

Senators introduce ACA repeal legislation

On September 13, 2017, U.S. Senators Lindsey Graham, Bill Cassidy, Dean Heller, and Ron Johnson introduced legislation to scrap many provisions of the Affordable Care Act (ACA) while imposing funding caps on the traditional Medicaid program. The bill could become law under budget reconciliation rules that block a Senate filibuster. The bill could pass the Senate and House on a majority vote before September 30, 2017.

The non-partisan Congressional Budget Office (CBO) says that it can’t comprehensively analyze the bill’s potentially adverse impact on health insurance premiums and coverage until next month. Congress will be acting this month based on a preliminary CBO analysis expected to show long-term federal budget savings. [More]

Governors outline market stabilization strategy

On August 30, 2017, a bipartisan coalition of Governors issued a letter to Congress on steps needed to restore stability and affordability in coverage to 22 million Americans served through individual health insurance markets under the Affordable Care Act (ACA). The Governors’ letter sets the stage for testimony before a US Senate committee on September 7, 2017, by Massachusetts Governor Charlie Baker, Montana Governor Steve Bullock, Tennessee Governor Bill Haslam, Utah Governor Gary Herbert, and Colorado Governor John Hickenlooper. [More]

Update on the Senate’s efforts to Repeal parts of the ACA

After releasing the Better Care Reconciliation Act at the end of last week, leadership in the U.S. Senate announced this week that it will not be voting on the bill before the July 4th Congressional recess as planned. Instead efforts are underway to overhaul the bill, with a vote is expected sometime after the recess. Senate Majority Leader Mitch McConnell has said that he intends to submit a new version of the bill to be scored by the Congressional Budget Office today. [More]

Section 1332 State Innovation Waiver – Recent developments and the newly-released checklist

In follow-up to its letter to Governors regarding the Section 1332 Waiver opportunity, the Centers for Medicare and Medicaid Services (CMS) and the Department of Treasury released a Section 1332 checklist on May 16 designed to help states pursue ACA State Innovation Waivers. Section 1332 of the ACA allows states to waive specific ACA provisions as long as they apply according to the process set out in regulations and meet the following comparability requirements:

• The waiver will provide coverage to at least a comparable number of the state’s residents as would be provided without the waiver;
• The waiver will provide coverage and cost-sharing protections that are at least as affordable as would be provided without the waiver;
• The waiver will provide for coverage that is at least as comprehensive as would be provided without the waiver; and
• The waiver will not increase the federal deficit. [More]

21st Century Cures Act

On December 7, 2016 Congress passed the 21st Century Cures Act (the “Act”), which was signed into law on December 14, 2016. The Act is aimed at modernizing health care delivery, improving quality and targeted improvements in the area of cancer treatment, mental health care, opioid addiction, and other focused areas. One such modernization effort requires states to implement Electronic Visit Verification (EVV) systems for personal care services and home health care services providers by 2019 and 2023, respectively. These EVV systems will help ensure that beneficiaries receive the care that is being billed to Medicaid. Additionally, the Act allocates over $1 billion in grant funding over the next two years for states to combat the opioid epidemic. States began the application process for grant funds in early 2017, and efforts are now underway in a number of states to implement new programs and services focused on treatment and prevention. Below we highlight one way PCG has identified to leverage existing claims data to implement reforms. This Act is largely funded through the Prevention and Public Health fund established in the Affordable Care Act (ACA). For more information on additional modernization and reform elements of the Act, please click here. [More]

CBO estimates that AHCA would severely increase the number of uninsured persons

On May 24, 2017, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released estimates on the impact of the proposed H.R. 1628, the American Health Care Act of 2017 (AHCA), as passed by the U.S. House of Representatives on May 4, 2017. AHCA would partly repeal the Affordable Care Act (ACA). The CBO estimates that AHCA would severely increase the number of persons without health coverage, as compared to the ACA... [More]

States seek to intervene in House v. Price lawsuit

On May 18, 2017, 15 states and the District of Columbia filed a motion to intervene in House v. Price, a lawsuit threatening the availability of federal funds (about $9 billion in 2017) for cost-sharing reduction (CSR) payments to health insurers under the Affordable Care Act (ACA). The lawsuit pertains to whether or not CSR payments are subject to annual Congressional appropriations. It was initially filed in November 2014 in U.S. District Court, which ruled in favor of the U.S. House of Representatives in May 2016, but held its decision in abeyance pending appeal. It is now before the U.S. Circuit Court of Appeals in the District of Columbia. [More]