ACA

3/25

This week’s big news this week is that Friday, March 24, the Republicans pulled their overhaul of the healthcare bill from the House floor even before a vote.  To get a sense of what happened see http://www.vox.com/2017/3/24/15014202/house-ahca-vote-canceled-trump

3/18

Thursday, March 16, the overhaul of the Affordable Care Act now called the American Health Care Act cleared a vote in the House Budget Committee with a vote of 19 to 17.  The vote was along party lines and the bill can move to the House floor. See a good analysis at https://www.washingtonpost.com/powerpost/obamacare-revision-moves-to-next-step-thursday-house-budget-committee/2017/03/15/31fa1ec8-09f5-11e7-93dc-00f9bdd74ed1_story.html?tid=ss_tw&utm_term=.73ea152b0dff

Paul Ryan will need 216 Republicans to vote for the bill, but there are already 20 who are leaning against support of the bill.  It seems the bill will need to make some changes to appeal to get it passed on the House floor.  CNN’s analysis is at http://www.cnn.com/2017/03/16/politics/health-care-bill-leadership/

3/11 Update

This week Republicans presented their version of a healthcare plan that would repeal the Affordable Care Act.  H.R. 277 will repeal the Patient Protection and Affordable Care Act.  https://www.govtrack.us/congress/bills/115/hr277

Some Key Facts on the “Repeal and Replace” Bill can be found at https://govtrackinsider.com/key-facts-on-the-repeal-and-replace-bill-7f9ca20ce578#.1v9s4yzes

The Washington Post does a great visual of what will be kept, how coverage would be paid, changes to Medicaid, and plans for Planned Parenthood.   https://www.washingtonpost.com/graphics/politics/how-aca-replacement-compares/

The new healthcare plan has stirred up quite a bit of controversy Congress members.  Not surprisingly the Democrats oppose the new plan to replace ACA, but some Republicans are resisting the new plan as well.  Conservative Republicans want a full repeal of the ACA, which is something the bill doesn’t do.  It reforms it.  Moderates are often from swing states and feel that the changes to Medicaid are too harsh.  It will freeze the program immediately and won’t allow any new enrollments.  They are also worried about the elimination of funding for Planned Parenthood for a year where rural areas use the organization to provide health care to women who may not have access to it.  The tax credits are another sticking point for them.

Interest groups such as the AARP, AMA (American Medical Association), and AHA (American Hospital Association)  are also in opposition to the new healthcare plan.  http://fortune.com/2017/03/08/gop-healthcare-plan-aarp-ama-aha/

Despite the controversy, the revised version of the ACA has already cleared two House committee  and is being promoted by Pence in Kentucky this weekend.

https://www.washingtonpost.com/powerpost/obamacare-revision-clears-first-hurdle-in-house-committee-early-thursday/2017/03/09/579586b4-04c2-11e7-b9fa-ed727b644a0b_story.html?utm_term=.41fe1be94a57

2/25 GA Legislative update:

Surprise billing legislation progresses in both chambers

Both SB 8 and HB 71 were passed out of their respective Senate and House committees late last week. SB 8 has been held up because of a dispute between insurers and health care providers about reimbursement. The bill was amended to establish out of network payment for disputed charges at the 80th percentile of the “Fair Health” metric and was subsequently passed by the Senate Health & Human Services committee. HB 71 seeks to compel physicians who are credentialed at hospitals to accept an in-network rate when the patient is in-network at the hospital, even if the physician is not. It was passed unamended by the House Insurance Committee. Both bills await approval in the Rules Committees to receive floor debates and votes.

The House of Representatives passed its version of the FY2018 budget on Friday. The budget includes increased reimbursement rates for certain primary care codes for Medicaid providers. Increased reimbursement rates are also funded for certain dental codes in PeachCare for Kids and Medicaid. The budget includes funds for two new federally qualified health centers in Cook and Lincoln counties, and 97 new primary care residency slots. The FY 2018 budget is now being considered by the Senate, which is expected to make its own changes before issuing its final approval. Check out Georgia Budget and Policy Institute’s blog and budget primer for more detailed information about how Georgia spends its health care dollars.

HB 54, introduced by Rep. Duncan, would expand the new rural hospital tax credit program from a 70% credit to a 90% credit, among other minor changes. The tax credit program went into effect this year, after enabling legislation was passed in 2016. The proposal to increase the tax credit to 90% came after legislators received feedback that the 70% credit was too low to entice potential donors. HB 54 was approved by the House Ways & Means committee on Feb. 9, and now awaits passage in the House Rules Committee.

SB 81 remains in the Senate Rules Committee waiting for approval for floor debate and passage after committee approval late last week. The current version of the bill requires that all physicians register and consult the Prescription Drug Monitoring Program (PDMP) under certain prescribing conditions. It also requires that providers report certain opioid-based Schedule II, III, IV, and V prescriptions to the PDMP. The bill sets the penalty for willfully non-compliant providers on a continuum that ranges from a warning to a felony and fine for a fourth offense and beyond. The bill also requires the tracking and reporting of Neonatal Abstinence Syndrome (NAS) and codifies the Governor’s emergency order on an overdose reversal drug (naloxone), making it available without a physician prescription.

 

 

Patient Freedom ActSenator Isakson co-sponsored

Our thoughts on the bill:

We appreciate the Senator wanting to retain the patient provisions but this bill doesn’t address affordability issues, or guarantee that the plans will cover everything people need (eg, hospitalization, preventive screenings, prescriptions, mental health, maternity, chemo, etc).

It gives the states flexibility to retain their own exchanges if they want, which is a good idea in theory, but you need some sort of federal oversight to make sure the plans the marketplaces are offering good coverage.

The proposal seeks to maintain the package of insurance market protections that are so critical for people with serious illness including:

– prohibitions on pre-existing condition exclusions,

– bans on lifetime and annual caps,

– allowing young people to stay on their parents’ plan until age 26,

– ban on insurers dropping you because you get sick

We also agree that states should have the option to retain the ACA marketplace and the patient protections.

It is not entirely clear that the state options included in the proposal – such as allowing states to set up their own markets – will guarantee that people will have coverage for those services essential to quality care, including:  no-cost prevention and screening, hospitalization, specialized care (eg, chemo), prescription drugs, maternity, and mental health services.

Health insurance premiums should be affordable, and coverage is not helpful if patients can’t afford their copays, coinsurance and pre-deductible expenses.  It is not entirely clear how the proposal would work to ensure that people – especially low-income individuals and families – are able to afford premiums and cost-sharing.

While there are some advantages to state flexibility, there needs to be some federal oversight to guarantee that people have access to an affordable and appropriate federal standard of coverage in every state.

The GOP has been pledging to repeal the Affordable Care Act ever since it became law, and now that they control the White House, they are under pressure to put their money where their mouth is. Despite having voted 60+ times to repeal Obamacare, it’s clear they never had any expectation of actually doing so, as they are scrambling to get their ducks in a row on a replacement plan. They know that they’re going to own whatever they come up with to replace it.

One aspect of the ACA that does not appear to be in immediate danger is the one about kids staying on their parents’ plans until age 26; both parties are supportive of this, so this will likely stay. Republicans have also promised to uphold the ban of pre-existing condition exclusions, but it’s not at all clear how that will work without the mandate being in place – because without a mandate, wouldn’t everyone just wait until they got sick to get covered?

More ideas we’ll hear a lot about from Republicans in the coming weeks/months:

– High risk pools, which will have $$$ premiums since it’s a pool of just sick people.

– High deductible health plans, which discourage people from seeking care and end up costing a ton out of pocket if you actually use them.

– HSAs, which are fine but not at all sufficient for covering expenses like hospitalization or surgery.

– Paring back the essential health benefit provisions in the ACA, which could mean that cheaper plans could exclude coverage for things like pregnancy, chemo, or hospitalization.

– Repealing the rule that says you can only charge higher premiums for older people. Some replacement plans being considered would allow insurers to once again charge sick people higher premiums.

– Rolling back the subsidies and Medicaid expansion that have offered options to millions of low-income people.  

The Senate will take up the partial repeal of the ACA in a reconciliation vote, which can’t be filibustered. This vote may happen as soon as late Feb/early March. Replacement discussions look likely to continue for several months.

 

Health Care Action:

Call Senator Isakson and ask him: “Please do not repeal the ACA without a simultaneous replacement that is at least as good for xxxx (pick your subject of choice: cancer patients, people with MS, people who need insurance and can’t afford it without subsidies, etc)”

 

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