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October 25, 2017

The bipartisan ACA 'fix' now has a partisan rival

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    Two top Republican lawmakers on Tuesday unveiled a bicameral proposal that would fund the Affordable Care Act's (ACA) cost-sharing reduction (CSR) payments and provide "relief" from the law's coverage mandates.

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    Proposal details

    The proposal by Senate Finance Committee Chair Orrin Hatch (R-Utah) and House Ways and Means Committee Chair Kevin Brady (R-Texas) seeks Republican-backed changes to the ACA that go beyond those included in a bipartisan bill introduced last week by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.). 

    As with the bipartisan bill, the Hatch-Brady proposal would fund the CSR payments through 2019 and would require insurers that receive CSR payments in 2018 to "meet certain conditions" intended to prevent insurers from 'double dipping,'" according to a release. However, the CSR payments would include "pro-life" protections, which Business Insider reports could mean plans that cover abortions would be barred from receiving the payments.

    The proposal also would suspend the ACA's individual mandate penalties from 2017 through 2021 and retroactively suspend the ACA's employer mandate penalties from 2015 through 2017—proposals similar to those reportedly being sought by the White House. In addition, the proposal would increase the maximum contribution limit on health savings accounts.

    According to the release, suspending the individual mandate would generate enough on-budget savings to cover the cost of suspending the employer mandate and increasing health savings account contributions. Those savings, according to the Health Affairs Blog, would stem from fewer people being insured through Medicaid or the exchanges, where they could qualify for federal subsidies to help offset the cost of coverage. The CBO in July projected that repealing the law's coverage mandates without a replacement would reduce spending but significantly increase the number of uninsured U.S. residents.

    The release did not address whether the Hatch-Brady proposal would incorporate other elements of the bipartisan bill, such as increased flexibility for the ACA's so-called "state innovation waivers" or increased open enrollment outreach funding. The release stated that full legislative text for the proposal "will be released in coming days." 

    Future of both Hatch-Brady, bipartisan bill remains unclear

    While Alexander and Murphy's bipartisan bill appears to have at least 60 votes in the Senate, the bill has faced opposition in the House, and it is unclear whether President Trump would sign the bill, CQ News reports. Similarly, it is not yet clear if the Hatch-Brady proposal has enough backing to advance in Congress, according to CQ News.

    Hatch in a statement said, "If Congress is going to appropriate funds for CSRs, we must include meaningful structural reforms that provide Americans relief from Obamacare." However, CQ News reports some conservative Republicans remain opposed to funding the CSRs even with those additional reforms.

    Further, Axios' "Vitals" reports that Democrats are unlikely to support proposals that would roll back the ACA's individual and employer mandates. Murray in a statement said, "We already know that partisan proposals to take coverage away from millions of people, spike premiums, and inject even more uncertainty into health care markets cannot pass the Senate," adding, "The facts are clear, and the Senate should do the right thing for patients, take up our bipartisan agreement, and pass it" (Howell, Washington Times, 10/24; Bryan, Business Insider, 10/24; Senate Finance Committee release, 10/24; Tracer, Bloomberg, 10/24; King, Washington Examiner, 10/24; Abutaleb, Reuters, 10/14; Baker, Axios, 10/24; Baker, "Vitals," Axios, 10/25; Jost, Health Affairs Blog, 10/24; Ellen McIntire, CQ News, 10/24 [subscription required]; Scott, Vox, 10/24).

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