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April 4, 2017

White House floats changes in effort to resurrect ACA repeal bill

Daily Briefing

    White House officials on Monday met separately with moderate and conservative Republicans to discuss potential changes to the House GOP's Affordable Care Act (ACA) repeal legislation that could open the door to reviving the bill.

    Last month, House GOP leaders pulled ACA repeal legislation, the American Health Care Act (AHCA), from consideration last month after failing to gain enough votes. Members of the conservative House Freedom Caucus opposed the bill because they felt it did not do enough to repeal the ACA. However, some moderate GOP lawmakers objected to the bill over concerns it would repeal provisions that provide health benefits to their constituents.

    How the bill could change

    In an afternoon meeting with Republicans in the moderate Tuesday Group and an evening meeting with the Freedom Caucus, White House officials floated proposals that would allow states to request waivers to opt out of the ACA's:

    • Community rating provision, which prevents insurers from charging sick consumers higher premiums; and
    • So-called "Essential Health Benefits," provision, which mandates that insurers cover 10 broad categories of services—including hospitalization and rehabilitation—for plans sold in the individual and small group markets.

    According to Rep. Chris Collins (R-N.J.), a member of the moderate Tuesday Group who attended Monday's meeting, under the suggested changes, governors would be granted waivers to drop the requirements if they could demonstrate that doing so would reduce costs and improve coverage.

    Opponents of the ACA's community rating and essential health benefits provisions say they increase insurance premiums.

    Margot Sanger-Katz writes for the New York Times' "The Upshot" that the changes would "undermine" the ACA's protections for people with pre-existing conditions. "If both of the Obamacare provisions went away, [a] hypothetical cancer patient might be able to buy only a plan, without chemotherapy coverage, that costs many times more than a similar plan costs a healthy customer," Sanger-Katz writes.

    The White House also is considering changes to the ACA's $115 billion Patient and State Stability Fund. According to Axios' "Vitals," the changes would narrow the scope of the fund in a way that would prioritize funding for high-risk pools.

    According to Freedom Caucus Chair Rep. Mark Meadows (R-N.C), the funding could help subsidize premium costs for sick customers.

    "The fundamental idea is that marginally sick people would pay with risk associated with their coverage," Meadows said Monday. "Those that have, you know, premiums that would be driven up because of catastrophic illness or long-term illnesses, we've been dealing with that for a long time with high-risk pools."

    Next steps

    After the meeting, Meadows said he was "encouraged" but emphasized that nothing had been agreed to. He said, "No one made any definitive changes in terms of moving from 'no' to 'yes,' primarily because there's not enough detail to do that, but I can tell you that all the 'nos'—every one of the 'nos'—expressed a willingness to look at this in a very detailed manner."

    He said on Monday that lawmakers expected to see text sometime "within 24 hours," and he suggested he would be open to delay the upcoming House recess to vote on a bill if a deal is reached in time, the Washington Post's "Power Post" reports.

    Collins, who attended the Tuesday Group meeting, said discussions about community rating waivers were "to be continued" but said that other proposed changes might get moderates to support the measure.

    House Speaker Paul Ryan (R-Wis.) said Tuesday, "It's premature to say where we are or what we're on because we're at that conceptual stage right now. We don't have a bill text or an agreement yet, but this is the kind of conversations we want."

    According to The Hill, it is unclear whether the proposed changes would meet the Senate's reconciliation rules, which the chamber could use to pass a bill without it being subject to a filibuster (Sanger-Katz, "The Upshot," New York Times, 4/4; DeBonis/Wagner, "PowerPost," Washington Post, 4/3; Blade et al., Politico, 4/3; Sullivan, The Hill, 4/3; Nather, "Vitals," Axios, 4/4; Cowan/ Chiacu, Reuters, 4/4). 

    With 'repeal and replace' on hold (for now), what’s next for health reform?

    Eric Cragun

    The House GOP's first proposal to repeal and replace the Affordable Care Act was withdrawn without a vote, but that doesn't mean the discussions around health reform are over.

    Join our panel of experts on April 10 to hear about up-to-the-minute developments, what President Trump and Congress still may do to stabilize or roll back the ACA, what other policy issues might now enter the spotlight, and what this all means for provider strategy.

    Register now

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