House Leadership Releases Outline for ACA Reform

On February 16, Republican House leadership circulated a 16-page blueprint for ACA reform. The proposal, which was not in legislative form, is intended to provide an outline of what the House will attempt to pass by their informal deadline of April 6. The measure’s highlights include: reforming Medicaid to a per capita cap model while allowing states to receive a block grant if they choose; expanding the use of health savings accounts; repealing the ACA’s cost-sharing subsidies and replacing them with a universal health tax credit to purchase individual policies; repealing the Medicaid Disproportionate Share Hospital cuts; and repealing Medicaid expansion with a transition period for states that expanded under the ACA.

Despite a lack of consensus on the Medicaid issue and a number of unanswered questions, the House leadership will use the upcoming recess week to turn the proposal into legislative text. The House will then attempt to use the budget reconciliation process to repeal as much of the ACA as possible. The House Ways and Means and Energy and Commerce committees are still targeting February 28 as the date of which they will mark up the replacement bills. The Senate timeline for ACA replacement is less ambitious with most Republican senators hoping to pass a bill before the end of the year. Meanwhile, the White House has indicated it will unveil its replacement plan by early to mid-March.

Finance Committee Holds Confirmation Hearing for CMS Nominee

On February 16, the Senate Finance Committee held the confirmation hearing for Seema Verma, President Trump’s nominee for the next Administrator of CMS. Verma is an Indiana-based health consultant who designed the state’s Medicaid expansion program. In the course of her testimony, she made clear that she supports giving states more flexibility to design their own programs but did not indicate whether she supports congressional efforts to limit federal spending through a per capita cap approach or by shifting Medicaid to a block grant system. While consensus is lacking, Republicans on Capitol Hill have made Medicaid reform a centerpiece of their ACA repeal and replace proposals.

Verma rejected the idea of shifting Medicare to a voucher system, which is supported by House Speaker Paul Ryan (R-WI), but didn’t rule out changes that would provide seniors more coverage choices. She also voiced support for helping rural providers avoid unnecessary burdens from federal regulatory requirements, including meaningful use of electronic health records. Despite difficult questioning, Democrats gave little indication they would attempt to filibuster the nomination. Final Senate confirmation could come as early as the end of February.

CMS Releases Proposed Rule to Stabilize Health Insurance Marketplace

On February 15, CMS issued a proposed rule to stabilize the Health Insurance Marketplace. The new policies are intended to make certain coverage options more affordable to consumers, reduce certain administrative burdens on plans and reduce adverse selection to improve the risk pools. Most of the policies would go into effect for the 2018 plan year, but several would be implemented in 2017. The changes would not apply to states that operate their own marketplaces.

The proposed rule comes a day after Humana announced plans to withdraw from the Health Insurance Marketplace in 2018. Among other reasons, Humana cited the growing unbalanced risk pool. Democrats were critical of the proposed rule, calling it overly friendly towards insurance companies.

Health-Related Bills Introduced This Week

Rep. Diane Black (R-TN) introduced a bill that seeks to ensure fairness in Medicare hospital payments by establishing a floor for the area wage index applied with respect to certain hospitals. While the text is not yet available, Rep. Black introduced a similar bill last Congress to create a national minimum area wage index of 0.874 for Medicare reimbursement of inpatient and outpatient health care services. The intent of the bill is to ensure that hospitals in rural and underserved areas with lower average wages do not receive lower reimbursement rates. Sen. Johnny Isakson (R-GA) introduced a companion measure in the Senate (S. 397).

Rep. Billy Long (R-MO) introduced a bill (H.R. 1166) that would amend Title XIX of the Social Security Act to provide states greater flexibility through Medicaid cost-sharing waivers.

Rep. Lynn Jenkins (R-KS) introduced a bill (H.R. 1155) that would amend Title XVIII of the Social Security Act to allow physician assistants, nurse practitioners and clinical nurse specialists to supervise cardiac, intensive cardiac and pulmonary rehabilitation programs.

Rep. Morgan Griffith (R-VA) introduced a bill (H.R. 1148) that would amend Title XVIII of the Social Security Act to expand access to telehealth-eligible stroke services under the Medicare program. Sen. John Thune (R-SD) introduced a similar bill in the Senate (S. 431).

Next Week in Washington

The House and Senate will be out of session next week for the President’s Day recess. Both chambers return the week of February 27 when House Republicans are expected to introduce ACA replacement legislation. President’s Trump first State of the Union to a joint session of Congress is scheduled for February 28.

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