America’s Health Insurance Plans Oppose “Skinny Repeal” of Individual Mandate, Urge Funding for Marketplace Subsidies

In a letter sent today to Senate Majority Leader Mitch McConnell and Senate Minority Leader Charles Schumer, America’s Health Insurance Plans (AHIP), the leading trade association representing health insurance plans, opposed the “skinny repeal” of the Affordable Care Act’s (ACA) individual mandate and urged the funding of federal cost-sharing subsidies to make health insurance more affordable. And in its economic self-interest, AHIP also continued to urge the repeal of the ACA tax on health insurance plans.

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Congressional Budget Office: “Skinny Repeal” Would Result in 16 Million Losing Health Insurance

Earlier this evening, the Congressional Budget Office (CBO) issued a revised estimate of the impact of a “skinny repeal” of the Affordable Care Act (ACA), concluding that, by 2026 (in ten years),  16 million would lose their health insurance. The analysis is primarily based on the repeal of the individual mandate, which the CBO had previously estimated to result in 15 million Americans losing their health insurance.

It is still unclear what other provisions might be included in the “skinny repeal” bill, which will likely be voted on this Friday after the 20 hours of general debate ends.

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Text of Senate Obamacare Repeal Reconciliation Act to be Voted On July 26

Here is the text of the “Obamacare Repeal Reconciliation Act” that will be voted on by the U.S. Senate on Wednesday, July 26, 2017:

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Except for the handwritten changes made by Senate Budget Committee Chair Mike Enzi, it is the same as the earlier version made available. Republican Senators Susan Collins, Lisa Murkowski, and Shelly Moore Capito have publicly stated their opposition to this bill, so it is likely to fail.

 

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As Senate Prepares to Vote, Congressional Budget Office Previously Found “Skinny Repeal” of Individual Mandate Would Result in 15 Million Americans Losing Health Insurance

As the Senate plans to vote later today on repealing and/or replacing the Affordable Care Act (ACA), the idea of a “skinny repeal”, or just repealing the individual and employer mandate and ACA tax on medical devices, is now being floated as a last-minute idea. Last December, the Congressional Budget Office (CBO) already analyzed the impact of just repealing the individual mandate, concluding that, by 2026 (after 10 years), this would result in 15 million Americans losing their health insurance and premiums in the individual health insurance marketplace increasing by 20%.

The Senate will be called into session at 12pm Noon EDT, and the vote on the motion to proceed to debate (the American Health Care Act, HR 1628, passed by the House on May 4), is expected to begin around 2pm EDT. All the Senate bills that have been proposed (the Better Care Reconciliation Act, the Obamacare Repeal Reconciliation Act, and now this idea of a “skinny repeal”) would be proposed, debated, and voted on as amendments to the whole to the House bill.

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U.S. Senate: Latest Revision to Better Care Reconciliation Act Would Still Increase Uninsured by 22 Million

The text of the latest revision to the U.S. Senate’s bill to repeal and replace the Affordable Care Act has been released publicly:

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Based on this latest revision, the Congressional Budget Office has updated its estimate of the impact the bill, maintaining its estimate that, by 2026 (after ten years), the bill would increase the number of uninsured Americans by 22 million. The national rate of uninsured would nearly double from 10% to 18%. However, the revisions would mean that the number of Americans losing their health insurance would occur slightly slower, with 15 million losing their coverage next year, compared with 17 million under the prior version of the bill. Medicaid spending would be cut by $756 billion, resulting in 15 million Americans losing Medicaid coverage. $396 billion in tax credits to assist low-income and working Americans afford their health insurance would be cut.

Since the revised bill retains some of the ACA taxes (primarily $172 billion from the surtax on certain high-income taxpayers’ net investment income accounting and $59 billion from the Medicare payroll tax for certain high-income taxpayers, the amount of total cost savings/deficit reduction does increase under the revised bill, to $420 billion over ten years.

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Senate Majority Leader Mitch McConnell has announced that he intends to call for a vote on a motion to proceed with an alternative bill that simply repeals the health insurance and Medicaid expansions under the ACA (and all its taxes). However, if that legislative strategy changes again and there is a vote on a motion to proceed with a “repeal and replace” bill, this is the text that would now be voted on. If either bill passes the motion to proceed (still highly unlikely given unanimous opposition from all the Democratic Senators and publicly announced opposition by sufficient numbers of Republican Senators  that would fall short of the 51 votes needed for any motion to proceed), there would be opportunity to introduce, debate, and vote on additional amendments during  the proceedings on the Senate floor.

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U.S. Senate: Text of Obamacare Repeal Reconciliation Act

Here is the text of the U.S. Senate’s “Obamacare Repeal Reconciliation Act”, which would repeal the key health insurance and Medicaid expansion provisions and all the revenue-generating taxes of the Affordable Care Act, with no replacement. The bill would explicitly appropriate funds for federal cost-sharing subsidies through the end of 2019 and provides $1.5 billion in new funding over the next two fiscal years to address the opioid prescription crisis.

This is the text that the Congressional Budget Office used to estimate that by 2026 (in ten years), the legislation would result in 32 million Americans becoming uninsured, premiums in the individual health insurance markets increasing 100%, and ¾ of Americans residing in health insurance markets where NO health plans would be offering any individual health insurance coverage.

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Senate Majority Leader Mitch McConnell continues to say that he will call for a procedural vote to proceed to debate this latest version of the bill on the Senate floor next week, even though at least four Republican Senators (Susan Collins, Lisa Murkowski, and Shelly Moore Capito, and Rob Portman) already have stated their opposition to the bill, and the status of Senator John McCain’s health (and timing of his return to the Senate to participate in any votes) remains highly uncertain. If all the Senate Democrats oppose the motion to proceed as expected, and these five Republicans do not (or, in the case of Senator McCain, are not present to) vote in support, the motion would be defeated.

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Hawaii v. Trump: U.S. Supreme Court Allows Broader Family Exception to Muslim Ban But Upholds Limited Refugee Admissions

In an short order today, the U.S. Supreme Court declined to overturn last week’s decision and modified preliminary injunction issued by the Hawaii federal district court, which broadened the family exception that the Supreme Court itself had ordered to the implementation of President Donald Trump’s executive order banning travel and immigration from six Muslim-majority countries. However, the Court did overturn or “stay” the Hawaii district court’s broadening of the exception to the executive order’s temporary moratorium on refugee admissions based on relationships with refugee resettlement agencies.

The order is unusual because the Court is on its annual summer recess and very rarely makes substantive decisions during such recesses. The Court issued its decision on June 26 (the last day of its 2016-2017 term) to accept review of the two nationwide preliminary injunctions against the Muslim ban, but then essentially re-wrote the executive order by creating an exception for any individuals from the six Muslim-majority countries who have a “bona fide relationship with a person or entity in the United States”. In their dissent to that order, Justices Thomas, Alito, and Gorsuch predicted that this Court-created exception would result in additional litigation. After the Supreme Court decision, the U.S. government interpreted the exception narrowly to only include spouses, fiancés, parents, parents-in-law, siblings, and children, children-in-law.

The dissent’s prediction came true as the State of Hawaii and other plaintiffs challenged the narrow definition of family relationships.  On July 13, the federal district court in Hawaii agreed and modified its preliminary injunction to comply with the Supreme Court’s decision but then 1) expanded the definition of family relationships to include grandparents, uncles and aunts, nephews and nieces, cousins, siblings-in-law, and grandchildren, and 2) included refugees who had an individualized “formal assurance” of resettlement (or sponsorship) from a refugee resettlement agency as bona fide relationships.

In today’s order, the U.S. Supreme Court declined to overturn the Hawaii district court’s expansion of the family relationship exception but did overturn the implementation of an expanded exception based on formal assurances from refugee resettlement agencies. Not surprisingly, the three justices who dissented from the Court’s original order on June 26 – Justices Thomas, Alito, and Gorsuch – would have overturned or stayed both expansions of the exception.

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Hawaii v. Trump: Modification of Preliminary Injunction Expands U.S. Supreme Court’s Family-Based Exemptions from Muslim Travel, Immigration, and Refugee Ban

Here is the July 13, 2017 decision and order by the federal district court in Hawaii modifying its preliminary injunction against the partial implementation of President Donald Trump’s revised executive order banning travel and immigration from six majority-Muslim nations and temporarily halting all refugee admissions after the U.S. Supreme Court partially reversed another nationwide preliminary injunction and accepted review of both preliminary injunctions.

On June 26 (the last day of its 2016-2017 term), the U.S. Supreme Court agreed to accept review of the two nationwide preliminary injunctions against the Muslim ban, but then essentially re-wrote the executive order by creating an exception for any individuals from the six Muslim-majority countries who have a “bona fide relationship with a person or entity in the United States”. In their dissent to that order, Justices Thomas, Alito, and Gorsuch predicted that this exception would result in additional litigation. The U.S. government interpreted the exception narrowly to only include spouses, fiancés, parents, parents-in-law, siblings, and children, children-in-law.

On July 13, the federal district court in Hawaii issued this decision modifying its preliminary injunction to comply with the Supreme Court’s decision but then 1) expanded the definition of family relationships to include grandparents, uncles and aunts, nephews and nieces, cousins, siblings-in-law, and grandchildren, and 2) included refugees who had an individualized “formal assurance” of resettlement (or sponsorship) from a refugee resettlement agency as bona fide relationships.

The U.S. government immediately requested the the U.S. Supreme Court issue an emergency “stay” or halt to this latest decision and modified preliminary injunction.

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Congressional Budget Office: Repealing Affordable Care Act without Replacement Would Result in 32 Million Uninsured

The Congressional Budget Office (CBO) wasted no time in reporting that a repeal of the Affordable Care Act (ACA) without any replacement plan would result in 32 million Americans becoming uninsured by the year 2026. A significant percentage of that impact would be immediate, with 17 million Americans losing their health insurance next year.  The rate of uninsured would jump from 10% to 16% in 2018. The CBO also estimates that average health insurance premiums in the individual market would increase by 25% next year and by nearly 100%, or double, by the year 2026.  Because the repeal (without any replacement) would eliminate the requirements for health plans to offer affordable health insurance, as well as the federal subsidies that help individuals pay for that health insurance, those individual health insurance markets would gradually collapse because of a lack of affordability. The CBO estimates that in ten years (by the year 2026), 3 out of every 4 Americans would live in health insurance markets where NO health plans would be offering ANY individual health insurance at all. By 2026, a staggering 21% of Americans, or 59 million individuals, would be uninsured, significantly higher than the percentage of uninsured Americans prior to the enactment of the ACA.

Repeal of the ACA without any replacement would result in a $842 billion cut to the Medicaid program, shifting those billions of dollars in costs to states (who would have to find state revenues to pay for these health care costs their states), health care providers (who would see lower reimbursement rates), and those low-income, disabled, and elderly Americans who now rely on Medicaid (who would lose coverage for some types of health care, have much higher co-payments, or lose coverage altogether). The CBO estimates that 19 million Americans would lose Medicaid coverage by the year 2026.

The CBO issued these estimates just hours after Senate Majority Leader Mitch McConnell made available the latest legislative proposal to repeal the ACA. These estimated impacts are highest levels of uninsurance and premiums – the worst outcomes – than any prior legislative proposal to repeal and/or replace the ACA.

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Centers for Medicare and Medicaid Services: Proposed Rule for MACRA Quality Payment Program Year 2

Here is the proposed rule for the second payment year (2020) of the Quality Payment Program (QPP) established by the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA) .  Since there is a two-year lag between the performance year and the payment year, these proposed changes would apply to performance year 2018, beginning January 1, 2o18.  There are many complex and detailed changes proposed for both the Merit-Based Incentive Payment System (MIPS) that would be used by most physicians and other Medicare providers, as well as the Alternative Payment Models (APMs), including what is required, how scoring is done, use of certified electronic health records, reporting through “virtual groups”, and exemptions for small physician practices.

Comments are due by August 21, 2017.

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