This Week in Washington

Overview
This week the Senate is debating its version of legislation to repeal and replace the Affordable Care Act (ACA).  The House’s plans for this week include consideration of: the “Protecting Access to Care Act of 2017” (H.R. 1215); the “Coast Guard Improvement and Reform Act of 2017” (H.R. 1726); the “Veterans Expanded Trucking Opportunities Act of 2017” (H.R. 2547); and the “Disaster Assistance Support for Communities and Homeowners Act of 2017” (H.R. 1684).

Health Care Developments
On June 22, Senate Republicans released their draft bill which would repeal and replace portions of the Affordable Care Act.  The Senate bill, entitled the “Better Care Reconciliation Act of 2017,” will be a substitute amendment to the House-passed “American Health Care Act (AHCA).”  According to a summary from the Senate Budget Committee, the Senate bill will:

  • “Help stabilize collapsing insurance markets…”;
  • “Free the American people from the onerous Obamacare mandates…”;
  • “Improve the affordability of health insurance…”;
  • “Preserve access to care for Americans with pre-existing conditions, and allow children to stay on their parents’ health insurance through age 26”; and
  • “Strengthen Medicaid”.

The Congressional Budget Office is expected to complete its score early next week with Republican leadership expecting to vote before the July 4th recess.

The Senate bill would provide a short-term stabilization fund to help address access and coverage disruption with $15 billion per year provided in 2018 and 2019 and $10 billion provided per year in 2020 and 2021.  Cost-sharing reduction payments would continue through December 31, 2019.  The bill would eliminate most of the ACA taxes except the “Cadillac” tax which would be delayed until 2026.  It also would repeal both the individual and employer mandates.

The Senate bill would phase-out Medicaid expansion over three years. States would have the option to choose between per-capita funding or a block grant. Beginning in 2025, the spending growth rate would be tied to the rate of increase in the consumer price index for urban consumers (CPI-U). The CPI-U generally has a slower rate of increase than medical CPI which was used in the House bill.

Beginning in 2020, the tax credit will be available to those whose income does not exceed 350 percent of the federal poverty line.  The tax credit would be tied to a benchmark plan with an actuarial value of 58 percent, a decrease from the 70 percent required by current law.  The credit would also vary based on the individual’s rating area and age.

The bill would also:

  • Amend the ACA’s Section 1332 waivers to give states even more flexibility to modify their insurance markets;
  • Change the age band ratio to five to one or other ratio the state may determine; and
  • Maintain the current requirements related to pre-existing conditions and coverage for young adults up to age 26.

Some conservative Senate Republicans have already come out against the draft text.  Senators Ted Cruz (R-TX), Ron Johnson (R-WI), Mike Lee (R-UT), and Rand Paul (R-KY) stated “it does not appear this draft as written will accomplish the most important promise that we made to the American people: to repeal Obamacare and lower their health care costs.”  Senator Cruz has called for an amendment that would allow catastrophic, low premium plans.

Health care groups such as the American Hospital Association, Federation of American Hospitals, American Academy of Pediatrics, and the American Association of Medical Colleges have spoken out against the Senate bill.

Committees
On June 27, the House Transportation and Infrastructure Committee was scheduled to debate and vote on the “21st Century Aviation Innovation, Reform, and Reauthorization Act” (H.R. 2997).  Committee Chairman Bill Shuster (R-PA) unveiled the legislation last Wednesday. The bill would reauthorize the Federal Aviation Administration for six years, and would privatize the Air Traffic Control (ATC) system.  While President Trump has also called for ATC privatization, the concept is strongly opposed by congressional Democrats.  The Senate Commerce Committee released its “Federal Aviation Administration Reauthorization Act of 2017’’ last Thursday.