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October 31, 2017

ACA’s future uncertain as president uses executive powers

Frustrated that Congress has been unable to make progress toward repealing and replacing the Affordable Care Act (ACA), President Trump addressed health care reform through executive action this month.

His first step was an executive order Oct. 12 requiring federal agencies to develop rules to make it easier for small businesses and associations to offer low-cost and short-term limited health insurance plans that would not be subject to current ACA requirements and protections. He then ordered the elimination of subsidies provided to insurance companies that are intended to help low-income Americans pay for their health insurance plans.

Following the president’s actions, Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), who had been working together for months on legislation to stabilize the individual insurance markets, announced Oct. 17 that they had reached a bipartisan agreement that would continue the subsidies for two years and give states flexibility to use existing ACA waivers to approve alternative affordable plans.

Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) and House Ways and Means Committee Chairman Kevin Brady (R-Texas) followed that announcement Oct. 24 with their own plan for temporary two-year funding for the subsidies if certain structural reforms to the ACA are also enacted.

These actions came after the Senate dropped its efforts Sept. 26 to pass legislation that would have partially repealed the ACA and included provisions opposed by the ABA to make significant changes to the Medicaid program, which provides a lifeline for millions of low-income seniors, parents and children.

“The ABA has long recognized the financial burden and responsibility of maintaining the Medicaid program, as well as the need for innovation in shaping more cost-effective health care systems. But we strongly oppose structural or financial changes in the Medicaid program that would weaken the current entitlement nature of the program or the shared legal obligation that the federal and state governments have to provide comprehensive benefits to all individuals who meet eligibility criteria,” ABA Governmental Affairs Director Thomas M. Susman wrote to the Senate Finance Committee as the Senate prepared to consider its bill.

In his Sept. 25 letter, Susman emphasized that significant cuts in Medicaid would impact a large swath of vulnerable Americans across the country, including those who have already spent down their resources paying out of pocket for long-term care and rely on Medicaid for critical home- and community-based services (HCBS), nursing home care, or other services for a family member with disabilities. 

The Senate legislation, which had not yet been analyzed by the Congressional Budget Office (CBO), would have replaced the ACA’s subsidized insurance coverage and Medicaid expansion with block grants to the states, where decisions would be made on how to spend the money. Susman expressed the ABA’s opposition to converting federal funding for Medicaid into block grants that might allow states to deny coverage or make coverage out of reach for those with pre-existing conditions.

He pointed out the negative impact of ACA repeal and Medicaid cuts on care provided by HCBS, which is not covered by Medicare or private health insurance but is currently optional under Medicaid to allow older Americans and people with disabilities to stay in their homes. Currently, Medicaid dollars support nearly three older people and adults with disabilities with HCBS for every person in a nursing home, where Medicaid coverage is required.

Susman also warned that weakening Medicaid could devastatingly diminish health care coverage for 30 million children who are covered by Medicaid and survivors of violence, who are more likely to be living in chronic pain and other chronic health conditions that require continuing screening and services.

The decision to pull the proposal from Senate consideration marked the second time that the Senate was unable to garner the votes necessary to pass legislation to repeal and replace the ACA. The first attempt in July included several proposals, including a bill developed by Senate Majority Leader Mitch McConnell (R-Ky.) and a group of Republican senators that failed by one vote.

The leadership was hoping to pass the most recent legislation, crafted by Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.), before Sept. 30. After that date, the Senate would no longer be able to consider the legislation under Senate rules as a budget reconciliation bill that would require only a majority of 51 votes to pass.

The House narrowly passed its version of ACA repeal in May. The CBO projected that more than 20 million would lose their health care coverage under both the House bill and the Senate bill that failed in July.                                           

Back to the October 2017 Washington Letter