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Friday, May 6, 2016

Health on the Hill: Good and Bad Proposals in Congress This Spring

Jane Sheehan

Senior Federal Relations Manager

The big news from Capitol Hill this spring comes courtesy of House Republicans, who are still mulling over plans to replace the Affordable Care Act. As we’ll explain, although no formal plan has been released, several harmful proposals have sprung up. But this spring also brought some fresh ideas from members of Congress that would, if passed, improve our health care system.

GOP replacement proposals may target preexisting conditions

Six years after winning control of the House of Representatives and countless repeal votes later, House Republicans have yet to introduce a comprehensive plan to replace the Affordable Care Act (ACA). Given the fact that the landmark health care law has helped millions of Americans obtain insurance, it is no wonder opponents of the law are having a hard time coming up with a plan that can match these important coverage gains. 

Speaker Ryan convened a task force earlier this year to develop a platform for a GOP-sanctioned ACA replacement plan. As usual, the House GOP has vowed that any alternative would begin with a complete repeal of the ACA, including the Medicaid expansion. While few details about the task force's progress have emerged, what we have heard is concerning.

Last week, Speaker Ryan made troubling remarks outlining his vision to undo the ACA’s protections for people with serious illnesses. His proposal to instead place these individuals in high-risk pools would be a hardship as these high-risk pools have been shown to be prohibitively expensive and offer substandard coverage.

Last month, the conservative Republican Study Committee (RSC) released its wish list of what its members would like Speaker Ryan’s task force to include in a replacement plan. Along with harmful provisions that would endanger coverage for people with preexisting conditions, the RSC proposes combining Medicaid and CHIP into a single block grant for states. Converting Medicaid into a block grant program all but ensures severe, draconian cuts in coverage and benefits for vulnerable families and children, as well as shifting more costs to states. The RSC also proposes work requirements for Medicaid, which would only create more costs to states and financial insecurity for people with Medicaid. 

It is possible that Speaker Ryan will reveal a plan this summer. Of course, no plan would become law this year as Republicans would not be able to overcome a filibuster in the Senate and President Obama would be very unlikely to sign anything that repeals the ACA.

Any plan proposed this year will serve as a table setting for the GOP if it retains control of Congress and wins the White House in November. As we’ve outlined, any such plan could not replicate the historic progress made by the ACA, and could in fact do consumers and the health care system a lot of harm. 

Legislation introduced to encourage Medicaid expansion and to protect consumers

We are happy to report on some of the constructive health care proposals emanating from Congress this spring:

Medicaid expansion: Last month, Senator Mark Warner (D-VA) introduced legislation to extend the offer of federal funding to the 19 states that have not yet expanded Medicaid. Companion legislation was introduced earlier this year in the House by Congressman Gene Green (D-TX).

Both bills would codify President Obama’s budget proposal to give all states three years of full federal funding when they expand Medicaid. This would enable those states that have not yet adopted expansion, or recently expanded states, to receive three full years of the 100 percent federal match.

Prescription drug costs: Another bill that would make important strides for health care consumers comes from Senator Ron Wyden (D-OR). Introduced just last week, this bill would help Medicare beneficiaries who struggle every year with out-of-pocket drug costs. The “Reducing Existing Costs Associated with Pharmaceuticals for Seniors” (RxCAP) Act of 2016 would place an out-of-pocket cap on the cost-sharing for prescription drugs required of Medicare Part D beneficiaries. These caps would align Medicare more with commercial payers who had patient caps cost-sharing imposed under the ACA.

Coverage for at-risk youth: Also last week, Representative Tony Cárdenas (D-CA) introduced legislation that helps at-risk youth retain health coverage. This bill has support in both the House and the Senate and is cosponsored by both Democrats and Republicans, and it would ensure that children in the juvenile justice system do not lose their Medicaid coverage. 

House struggles to pass harmful budget

Meanwhile, House Republicans have not been able to build a consensus for their controversial budget resolution. Earlier this year, House Budget Chairman Price introduced a budget resolution containing significant cuts and restructuring to Medicaid and the health care system as a whole. House leadership has since struggled to drum up enough support for passage of such a resolution because some in the conservative wing of the caucus believed the bill did not go far enough in cutting federal programs. 

While we monitor continued attempts by conservatives to undermine the ACA and health care safety-net programs, we are pleased by the elected officials in Congress who are proposing thoughtful plans to improve the health care system. Though both the good and bad proposals remain messaging pieces for now, the outcome of this year’s elections could change the likelihood of any of the bills becoming law.