Hi, all.
While you’re busy packing for #AGS18, here’s some great #geriatrics reading to keep you occupied: A summary of health reform action to-date from our consultants with Arnold & Porter in D.C.
Happy reading!
Nancy
* * *
What’s Happened
When the 115th Congress began, Republicans were very well-positioned to pass their ACA repeal/Medicaid reform package, as they controlled both chambers of Congress and the Administration. Their multiple attempts, however, got stuck in the Senate, which was unable to pass ACA repeal even under the budget reconciliation, which requires only a majority vote, as opposed to the standard three-fifths majority (60 votes) that is traditionally required for Senate passage.
Last fall, the conversation then shifted from health reform to stabilizing the individual market, which at least at one point, had both Republican and Democrat support. HELP Committee Chair Lamar Alexander (R-TN), Ranking Member Patty Murray (D-WA), and Sen. Susan Collins (R-ME) largely led this effort, and had reached a deal with leadership for the market stabilization package to come up for vote before the end of 2017. The vote kept getting pushed. Most recently, negotiations over attaching the market stabilization measures to the omnibus fell apart after Republicans added abortion restrictions to the measure.
Current Status
As the midterm elections approach, congressional Republicans have been backing off of health reform, and trying to shift the focus to their achievements (e.g., passage of tax reform). Health reform not only flared partisan tensions, but also led to party in-fighting between moderates who were opposed to Medicaid cuts and conservatives who wanted to take it further. Additionally, many Republicans ran on repealing the ACA, and want to move the focus away from their unfulfilled promise.
Practically, Republicans are in a tougher position to pass partisan health reform legislation than they were in 2017. Their majority control of the Senate has slimmed from 52-48 to 51-49, as Sen. Doug Jones (D-AL) took over former Sen. Luther Strange’s (R-AL) seat at the beginning of 2018. Sen. John McCain (R-AZ) has also been receiving medical treatment in Arizona, and has not been in DC to cast a vote for the past several months.
All of that said, this doesn’t mean that there won’t be another congressional attempt at ACA repeal/entitlement reform. As we saw last year, there were multiple instances when ACA repeal discussions quieted, and then quickly gained momentum. Additionally, if after the midterm elections, Republicans lose their majority in the House, we could see a last ditch push for health reform during the lame-duck session.
Also important to note, the Administration has been quietly implementing health reforms where it’s within their authority. In addition to the work requirements Executive Order (EO), the President also issued an EO last fall to advance Association Health Plans (AHPs) and Short-Term Limited Duration Insurance (STLDI) (aka “skinny plans”), both of which could lead to further instability in the marketplace. The Department of Labor has since issued proposed rules, which would expand AHPs and STLDIs.
Summary
Lawmakers are not really talking about healthcare reform anymore, but that doesn’t mean that it’s completely dead. Congressional Republicans may take another shot at health reform, and the Administration will continue to use its authority to weaken the ACA.