ACA Replacement Picture Remains Unclear

Details on how the incoming Trump Administration will replace the Affordable Care Act ("ACA") remain unclear as President Donald Trump was sworn in on January 20 as the 45th president. Trump indicated in a recent press conference that his replacement plan will be unveiled once Rep. Tom Price (R-GA) is confirmed as HHS Secretary (see below). Many believe the nomination of Price to lead HHS could make his Empowering Patients First Act (H.R. 2300 in the 114th Congress) as the guiding document to replace the ACA.

At his nomination hearing on Wednesday, Price indicated the administration's ACA replacement plan could include health savings accounts, high deductible plans and association health plans. Price also showed support for the current 1332 waivers that provide states added flexibility for health care innovations.

Senate Health Committee Chairman Lamar Alexander (R-TN) indicated that the ACA replacement process, including implementation, could go on for several years and stated it will consist of a series of bills rather than a single comprehensive bill. Sen. Bill Cassidy (R-LA) noted that he'll release his ACA reform proposal on January 23. The Cassidy proposal will include elements of his previous ACA replacement bills, which drew the support of Senate Majority Leader Mitch McConnell (R-KY) and others in the Senate leadership. The proposal gives states the option of continuing in the ACA or choosing to opt out during a four-year transition period.

Senate Committee Holds Hearing for HHS Nominee

On January 18, Rep. Tom Price (R-GA) testified before the Senate HELP Committee in what turned out to be the longest nomination hearing the committee has held in over two decades. Secretary-designate Price answered questions for over four hours from senators on both sides of the aisle. Despite the difficult line of questioning, Price's nomination remains on track as no Republican has publicly expressed reservations. Without Republicans crossing over to oppose Price, Democrats lack the votes to block the nomination.

Price fielded a range of questions covering the health care spectrum. Senate Democrats questioned the Georgia lawmaker for legislation he sponsored in the House that would cut Medicare and block grant Medicaid funding to the states. Price responded that he would not pull the rug out from beneficiaries. He also touted the Indiana Medicaid expansion program that Vice President Pence developed with CMS Administrator-nominee Seema Verma as a "best practice" for Medicaid reform.

In responding to a question from HELP Chairman Lamar Alexander (R-TN), Price agreed that there was a "bipartisan consensus" in the 21st Century Cures Act, which was signed into law in December, to reform meaningful use, in particular the third stage.

Price also spoke in support of telemedicine during his hearing, noting that "exciting innovation" was improving access to doctors around the country. Price delivered tempered praise for the Center for Medicare & Medicaid Innovation when asked if he would eliminate the ACA-created body to test new ways to pay hospitals and other providers.

The HELP Committee hearing is the first of two nomination hearings for Price. The Senate Finance Committee will hold a hearing on January 24 and vote on whether Price's nomination should proceed to the full Senate for approval.

Health-Related Bills Introduced This Week

There were no health-related bills introduced this week.

Next Week in Washington

Congress returns on Monday for a full week of legislative action. The House Ways and Means Oversight Subcommittee will hold a hearing on January 24 to discuss options to replace the ACA's mandate to purchase health insurance coverage. Among the Republican ACA replacement proposals, there has been a consensus to repeal the individual mandate. On January 24, the House Energy and Commerce Committee will hold an organizational meeting to formally adopt subcommittee leadership, member rosters and a resolution setting forth subcommittee jurisdiction.