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]

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]

New ACA-Related announcements from the Federal Administration

The administration is taking more limited steps to influence implementation of the law, including two upcoming changes to enrollment through Marketplaces announcements last month. On May 15, the Centers for Medicare and Medicaid Services (CMS) announced that it will be proposing a rule to have enrollment into Federally-facilitated Small Business Marketplace (known as Small Business Health Options Program or “SHOP”) health insurance plans go directly through insurers as of 2018. Two days later, on May 17, CMS released guidance enabling (but not requiring) full direct enrollment in individual market Federally-facilitated Marketplace (FFM) plans starting for open enrollment for plan year 2018. [More]

States continue to pursue Section 1332 State Innovation Waivers

With repeal of the Affordable Care Act (ACA) stalled, states are increasingly considering Section 1332 Waivers as a way to expand upon or customize the ACA to best address the unique circumstances within the state. Alaska and Oklahoma are the two most recent states to take formal steps toward State Innovation Waivers, both states following on the heels of the recent Section 1332 Waiver approval granted to Hawaii, which we summarized in the February edition of Health Policy News. [More]

HHS encourages Governors to consider state innovation waivers

On March 13, 2017, the U.S. Secretary of Health and Human Services (HHS) released a letter to all governors outlining the parameters under which states can obtain waivers under section 1332 of the Affordable Care Act (ACA). HHS notes that state innovation waivers to implement high-risk pools and state-operated reinsurance programs may be an important opportunity to lower health insurance premiums for consumers, to improve health insurance market stability in the state, and to increase consumer choice. [More]

Amended ACA repeal legislation headed for critical vote in the U.S. House of Representatives

On March 20, 2017, the leadership in the U.S. House of Representatives released amendments to the proposed American Health Care Act (AHCA), which would repeal many provisions of the Affordable Care Act (ACA). The new amendments to AHCA would allow states to impose work-related activity requirements on specified categories of adult Medicaid recipients as a condition of eligibility. The work-related activity requirements would not apply to the aged, disabled, pregnant women, and certain other Medicaid eligibility groups; and would incorporate broad definitions of work-related activities and exemptions aligned with longstanding TANF requirements. An enhanced Medicaid administrative matching rate (a five percentage point increase on top of the usual 50 percent rate) would be available for Medicaid administrative expenditures necessary to implement the work-related activity requirements. [More]

Transitional health plans to continue through 2018

In November of 2013, the Centers for Medicare & Medicaid Services (CMS) introduced the concept of “grandmothered plans,” coverage in place prior to 2014 that would have been prohibited as of 2014 as a result of changes under the Affordable Care Act (ACA). CMS issued guidance permitting those plans to be renewed for existing policyholders if permitted by states. Specifically, such plans are not considered to be out of compliance with ACA provisions related to... [More]

Proposed ACA repeal legislation would increase persons without health coverage

On March 13, 2017, the Congressional Budget Office (CBO) released estimates on the impact of the proposed American Health Care Act (AHCA). The CBO indicates that AHCA would increase the number of persons without health coverage by 24 million persons in 2026: 52 million persons without coverage in 2026, as compared to 28 million persons in 2026 under the Affordable Care Act (ACA). [More]

Proposed ACA repeal legislation would impose new restrictions on state Medicaid programs

On March 6, 2017, the U.S. House of Representatives released its initial draft legislation to “repeal and replace” the Affordable Care Act (ACA). The initial draft legislation would impose significant new restrictions on state Medicaid programs. The legislation would impose annual per capita caps on federal financial participation (FFP) in state Medicaid expenditures beginning with the federal fiscal year (FFY) 2020 (October 1, 2019 – September 30, 2020). The Centers for Medicare and Medicaid Services (CMS) would impose separate per capita caps for six Medicaid eligibility categories: the aged, blind, disabled, children, Medicaid expansion adults, and non-expansion adults.
For FFY 2020, CMS would... [More]