It’s hard to keep up with all the health care legislation news lately. That’s why we’re providing regular summaries of the latest news, reflecting the current state of health care in the United States or how it may be changing in the not-too-distant future. Here’s a recap of some of the latest stories:
While Speaker Paul Ryan (R-WI), Senate Majority Leader Mitch McConnell (R-KY), and President Donald Trump have all indicated that health care is on the back burner, conversations amongst members of the house and senate continue to simmer.
As late as Wednesday evening, House Freedom Caucus members and the moderate Tuesday Group were meeting to discuss possible compromise legislation that would gain the broad Republican support to pass repeal and replace legislation on partisan lines. While the talks did not result in any apparent deal, the push to repeal and replace the Affordable Care Act (ACA) continues.
It has become increasingly clear that the American Health Care Act (AHCA) will not be reintroduced and that the ACA “the law of the land for the foreseeable future.” House Ways and Means Chairman Kevin Brady (R-TX) said that the Party is “moving on” from the AHCA and indicated that the Senate should take up the mantle on drafting a new piece of legislation.
However, Majority Leader McConnell indicated that the Senate would not and should not tackle repeal and replace of the ACA at this moment in time. McConnell said that “where we are on Obamacare, regretfully at the moment, is where the Democrats wanted us to be.” The White House similarly signaled that they are not planning an immediate strategy to pass legislation, but remain part of the conversation.
Following the failure of the AHCA, Congressional leadership and the White House seem to be shifting their focus to other legislative priorities such as passing a budget resolution by the end of April, drafting and passing comprehensive tax reform, and confirming Neil Gorsuch to the Supreme Court.
HHS Secretary Tom Price spoke with members of the House Appropriations Committee on Wednesday, March 29. Secretary Price pointed to the text of the ACA which says 1,442 times that the Secretary of HHS shall or may make regulatory changes to lower the cost of insurance; however, he offered few details on what steps his department might take to reform the ACA through administrative action.
HHS could make changes including alteration of coverage requirements, eased enforcement of the individual and/or employer mandate, and diminution of subsidies provided to low income customers on the health care exchange.
Representatives from the Department of Health and Human Services indicate that they are “committed to doing everything in our power to provide relief immediately” and that they are “going through every page of the regulations and seeing guidance…to determine whether they work for patients.” This push is a result of the Executive Memoranda signed by President Trump on his first day in office.
Secretary Price’s power of the pen was always seen as an important component to repeal and replace the ACA. Administrative changes were deemed “Phase 2” of the three-part plan put forth by the Administration. While “Phase 1” (the AHCA) failed to pass, Phase II may still be a viable option to substantively change the ACA.
With complete control of Congress and the White House, Republican lawmakers have embraced an opportunity to pass comprehensive reform of the tax code. While a focus on tax reform will likely mean health care reform goes on ice, there are many health care related changes that could be included in a reform of the tax system.
A full repeal or delay of the Cadillac Tax is a prime example. The Cadillac Tax would impose an excise tax on expensive employer provided health plans beginning in 2018.
Repeal or delay of this provision is popular on both sides of the aisle and could be an important piece in lowering the corporate tax burden. The administration ran on a plan of lower corporate taxes, so a repeal of the Cadillac tax would be an on-message addition to comprehensive tax reform.
Less likely, but still possible, are changes to health savings accounts. HSAs are a creation of the tax code. These triple-exempt accounts lessen the tax burden of individuals and employers. Many of the changes to HSAs included in the AHCA could be included in comprehensive tax reform as well. The increase in contribution limits, allowance of catch-up contributions to the same account, and lowered excise tax would all decrease the tax burden of individuals and companies.
President Trump has tweeted that “ObamaCare will explode” and only then will his Administration pick up the pieces. While an explosion or implosion of ObamaCare is widely spoken about, such an event would have little effect on the employer marketplace.
This explosion or implosion references the end of what some describe as the “death spiral” of the individual marketplace.
Employers and employees would likely remain unharmed by such an event. This is because employer health insurance premiums, though continuing to increase under the ACA, have been increasing at a slower rate than before passage of the Bill.