Iowa has asked the federal government to approve a proposal to make troubling changes to its marketplace that will increase coverage costs for low- and middle-income Iowans. It essentially takes federal funds intended to help people afford the cost of health insurance and uses them to pay insurance companies and to offer subsidies to relatively high-income people. The risky and harmful proposal fails to meet key requirements and should be rejected.
Several states are now pursuing 1332 waivers. We have heard about several helpful proposals, and at least one that is troubling.
On the positive side, Alaska’s reinsurance waiver was recently approved. This waiver will allow Alaska to pass through federal savings resulting from the state’s reinsurance system. Partly as a result of this system, Alaska’s individual market insurer has proposed a 22 percent reduction in premium rates for next year.
Section 1115 of the Social Security Act gives the Secretary of Health and Human Services (HHS) the discretion to let states waive certain Medicaid requirements to carry out an “experimental, pilot or demonstration project which, in the judgment of the Secretary, is likely to assist in promoting the objectives of” the Medicaid program.
Congress has left D.C. for the summer without passing legislation to repeal the Affordable Care Act (ACA) or cut Medicaid. Leadership and rank-and-file representatives and senators on both sides of the aisle appear to be looking past the repeal fight that has embattled Congress for the past year and looking ahead toward efforts to stabilize the insurance market. Are these overtures of bipartisanship to be believed? Are the ACA and Medicaid finally safe? As always, it’s complicated.
Coming off the Senate failure to repeal the Affordable Care Act (ACA) last week, President Trump has threatened an immediate cutoff of payments to insurance companies that support the reductions in the amount lower-income people must pay out of their own pockets for their marketplace plans. The president threatened to stop these cost-sharing reduction (“CSR”) payments both personally via Twitter and through multiple administration representatives.
The recent approval of Alaska’s 1332 waiver to fund a reinsurance system shows an approach that other states could also take under current law to lower premiums in their marketplaces and better distribute the costs of the very sick.
We always believed in our hearts that it would not be possible for Congress to pass repeal—that we could stop these harmful efforts because too many people rely on the Affordable Care Act and Medicaid for it to be so easy to rip coverage away through a sweeping piece of legislation.
Yesterday, two major proposals that would have rolled back the Affordable Care Act’s progress in expanding coverage were defeated by bipartisan majorities, Senate leadership is now pulling together a so-called “skinny” bill, which they hope will attract the 50 votes needed to pass the chamber and move to a conference committee with the House.
The “skinny” bill would likely end selected ACA provisions—the requirement that individuals have health coverage, the employer coverage requirement, and the tax on medical device manufacturers. No legislative language has been released, so we do not know the bill’s precise contents. But the CBO produced a score showing that, if passed, such a bill would immediately cause 14 million Americans to lose their health insurance in 2018 by destabilizing the individual insurance market and sharply increasing marketplace premiums.
The House Republican bill to repeal the Affordable Care Act (ACA) and cut the Medicaid program would cause immediate and critical problems for American Indian and Alaska Native peoples. Repeal would take funding away from federally recognized tribes and tribal organizations that now provide comprehensive health services in Alaska.
It’s been a dramatic 24 hours and we’re all bleary-eyed today after tracking the Senate’s activity last night. What’s important to remember is that the flurry of activity over the next 48 hours is a mere sideshow. The real action is the behind-the-scenes lobbying Majority Leader Mitch McConnell is doing to rally Republicans around the likely so-called "skinny" repeal which would result in a horrible final bill that would be written in secret.