House and the Administration Begin to Show Their Hands

Among the ideas proposed in the policy brief are:

Moving Subsidies to Reflect Age and Not Income. Although the plan is short on specifics, it would replace the ACA’s current tax subsidies for purchasing insurance on the exchanges with tax credits. Limited detail is provided regarding these tax credits except that they would be refundable (similar to the current subsidies) and would be age-rated. These tax credits, however, would not scale to reflect an individual’s income. This means that lower income individuals will receive the same amount of support as middle or upper class Americans. While this support may be enough to help higher income individuals, it will likely not be enough to provide meaningful access to care for a person who is unable to supplement the tax credit with his or her own income. This is especially alarming for access to care for individuals living with chronic illnesses and disabilities because lower income Americans tend to be sicker and more likely to be disabled than higher income individuals.

Encouraging Health Savings Accounts (HSAs). Republicans have long been proponents of HSAs, especially coupled with high deductible health plans, and the policy brief is no exception. The plan allows for individuals to contribute more to health savings accounts, which are tax free, and to deposit any tax credit funds left over after purchasing a health care plan, to their HSA. HSAs often do not work for lower income individuals, who cannot adequately fund such accounts. They also do not work for individuals with high anticipated health care costs, such as those living with certain chronic illnesses and disabilities, because their medical spending quickly outstrips any savings they can contribute to their HSA. While HSAs can allow higher income individuals with low medical costs to save, they should not be considered a good solution to access to care problems for vulnerable individuals.

Sharply Curtailing Federal Support of Medicaid. The policy brief calls for the federal government to limit its financial support of Medicaid. The plan calls for repealing the ACA’s Medicaid expansion. Additionally, it calls for the federal government to fund expansion enrollees at the basic Medicaid level, rather than at the 90% level currently promised by the ACA. This would force states to bear more of the cost of their expansion populations, which may lead states to limit their eligibility for Medicaid or end expansion altogether. The policy brief also gives states the choice of moving their Medicaid program to a block grant or per capita cap funding formula. Block grants would limit federal financial support of Medicaid programs, and likely force states to tighten enrollment requirements or cut benefits. The Congressional Budget Office determined that a similar block grant proposal would cut federal Medicaid spending by 35%.

Because the policy brief is so short, advocates interested in understanding these proposals in depth should review Speaker of the House Paul Ryan’s A Better Way” plan, which covers the same elements in greater depth. Although Congressional Republicans have yet to coalesce around a particular proposal, the policy brief is a good indication of which elements will likely be included in a “repeal and replace” bill. Advocates should make sure they understand the impact these elements, could have on vulnerable individuals.

Administration Proposes First Major Health Care Regulation Intended to Stabilize the 2018 Marketplaces

On February 15, 2017 the Department of Health and Human Services (HHS) released its first major health care regulation under new Secretary Tom Price. The purpose of this proposed rule is to stabilize the individual health insurance Marketplaces until Congress is able to repeal, replace, or repair the ACA. Unfortunately, however, many of the major components of the new regulation may have the opposite effect on the Marketplaces and actually curtail access to care.

The proposed new regulation would implement the following changes in the Marketplaces:

Shortening Open Enrollment for 2018: The proposed rule moves the end of the 2018 open enrollment period from January 31, 2018 to December 15, 2017. HHS promises that they will “conduct extensive outreach to ensure that all consumers are aware of this change.” Advocates should be sure to hold HHS accountable for this promise because

otherwise many consumers, who are used to much longer open enrollment periods from the past several years, may find themselves shut out of enrollment for 2018.

Tightening Special Enrollment Periods (SEPs): The ACA provides for SEPs to recognize that major life changes, such as loss of employer based coverage or the birth of a child, necessitate changes in health insurance coverage. Under President Obama, HHS was already working to fine tune SEPs, in response to insurer complaints, such as requiring documentation for certain SEPs and initiating a pilot program requiring verification for other SEPs. The proposed rule further tightens requirements to qualify for an SEP by: 1) requiring pre-enrollment verification of eligibility for all SEP categories as of June 2017 and expanding on the pre-enrollment verification program to cover about 650,000 individuals; 2) limiting the ability of enrollees to upgrade from one metal level (i.e. gold, silver, bronze) to another during a coverage year by using an SEP; 3) limiting eligibility for certain SEPs such as requiring at least one partner to have minimum essential coverage within the last 60 days prior to marriage for both spouses to qualify for a marriage SEP; and 4) limiting the use of the exception circumstances SEP (although more guidance on this issue will be forthcoming). Advocates should make sure that enrollment assisters and consumers are aware of the tightened restrictions around SEPs. Consumers should not assume that because they qualified for an SEP in the past that they will be able to do so in the coming years and should be strongly encouraged to obtain coverage during the open enrollment period whenever possible.

Establishing Continuous Coverage Requirements: The proposed regulation asks for input on establishing continuous coverage requirements, designed to discourage adverse selection. The ACA has generally relied on the individual mandate instead of a continuous coverage requirement to encourage healthy individuals to maintain coverage. This request for input likely reflects the popularity of continuous coverage requirements as an alternative to the individual mandate among the Administration and Congressional Republicans. Unfortunately, continuous coverage requirements disproportionately burden people living with chronic illnesses and disabilities because any lock out period can prevent them from accessing the care they need to manage their often life-long conditions. The proposed rule does not contain a specific continuous coverage proposal, suggesting that HHS is unsure of whether to proceed on this issue. Advocates should be very vocal on this issue, making it clear to the Administration that a requirement that burdens vulnerable individuals rather than spreading the responsibility among all Americans is unacceptable. Now is the best time to intervene to halt the implementation of continuous coverage requirements in the Marketplaces, before a proposal is fully fleshed out.

Undermining Guaranteed Availability: Under the current regulations and the ACA, consumers who fall behind on their premium payments cannot be terminated by insurers until the end of a three month grace period. During the first month of this grace period the insurer will pay claims as normal and in the second two months the insurer will pend claims until the individual catches up on payments. Under the ACA’s guaranteed availability provision, insurers must offer coverage to any consumer during open enrollment periods or appropriate special enrollment periods regardless of whether they owe the insurer for last year’s coverage so long as they are picking a different plan. This is intended to preserve access to care for many low income individuals who may fall behind on their premium payments. Under the proposed rule, however, an insurer would be able to attribute payments from a reenrolling consumer to last year’s debts and refuse to effectuate further coverage until outstanding premiums were paid. This change may prevent individuals from obtaining coverage because their plans will not begin until they can clear their debts from last year’s coverage. For those living with conditions that require continuous care and management to control properly, like diabetes or HIV, this change could result in a disruption of care.

Relaxing Actuarial Value (AV) Requirements: The ACA requires that each metal level of qualified health plans achieve a certain AV. AV is the percentage of the total cost of health care expenses of a standard population that are covered by the insurer using premiums rather than by the enrollee using cost sharing and deductibles. A higher AV protects people with high medical spending, such as those living with chronic illnesses and disabilities, by requiring insurers to spread the costs of treatment around their entire enrollment population rather than asking vulnerable individuals to pay large sums out of pocket. The ACA allows some variation in AV among plans of the same metal

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level. The proposed rule would allow for greater variation in AV among these plans, which would allow insurers to market qualified health plans with higher cost sharing but lower premiums on the Marketplaces. These plans would be attractive to healthy higher income consumers but would potentially dissuade higher cost sicker individuals who could not afford the increased out of pocket costs. The crowding effect would in turn raise premiums on the plans that did not use the change in AV requirements to offer lower premiums because these plans would have a disproportionately sicker enrollment group. The Center on Budget and Policy Priorities estimates that the proposed change in AV requirements would require a family of four with an income of $65,000 to either pay $327 more per year in premiums for a plan that meets the current AV requirements or face an $550 increase in their deductible if they purchased a plan with the new, lowered AV. Advocates should understand how AV requirements affect their communities, especially when it comes to lower income individuals who cannot shoulder higher out of pocket costs for their medical care. Advocates should submit comments to educate HHS on how AV requirements protect the most vulnerable and how relaxing these restrictions could affect these individuals.

Relaxing Network Standards: Under the ACA, insurers must offer a sufficient choice of providers in their plans’ networks. The proposed regulation seeks to weaken this provision by relying on state regulators and accreditation organizations to ensure network adequacy rather than HHS itself. There are some state regulators who will be able to handle this task, but other regulators are ill-equipped to do so. HHS also proposed to relax the requirement for insurers to include essential community providers, such as community health centers, safety-net hospitals, Ryan White Providers and Indian Health Services Centers, by requiring insurers to include within their network only 20% of essential community providers in their area rather than the 30% currently required. Advocates should reach out to their state regulators to understand how they anticipate reviewing network adequacy and pressuring insurers to include as many essential health providers who serve low-income medically-underserved individuals as possible in their networks.

One interesting aspect of the proposed rule is that it encompasses many of the demands presented by America’s Health Insurance Plans and the Blue Cross Blue Shield Association of America. This perhaps reflects the Trump Administration’s desire to keep as many insurers in the Marketplaces for 2018, especially with Humana’s high profile pull back from the 2018 Marketplaces. Advocates should make sure that the Administration does not forget that insurers are only one key stakeholder in the Marketplaces and that it is important for any new regulations also to reflect the need of consumers, particularly those living with chronic illnesses and disabilities who depend the most on their insurance to deliver the care they need.

Comments are due to HHS on March 7, 2017 and may be submitted electronically here. Advocates should also keep their eyes open for a comment template focused on access to care concerns, to be released by the Center for Health Law and Policy Innovation in the next few days, and which can be easily modified to facilitate submission of comments.

Health Care in Motion is written by:

Caitlin McCormick-Brault, Associate Director at the Center for Health Law and Policy Innovation; Carmel Shachar, Clinical Instructor at the Center for Health Law and Policy Innovation; and Phil Waters, Clinical Fellow at the Center for Health Law and Policy Innovation.

For further questions or inquiries please contact Carmel Shachar, cshachar@law.harvard.edu.

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House and the Administration Begin to Show Their Hands

February 23, 2017

House Republicans Unveil a Health Care “Policy Menu”; Trump Department of Health and Human Services Proposes First Major Health Care Regulation

 

Although there is still no specific ACA repeal and replace proposal from the hill, both Congressional Republicans and the Trump Administration released documents last week articulating their approach to replacing the ACA and addressing concerns with the Marketplaces in the meantime. Congressional Republicans released a Health Care Policy Brief that is intended to serve as a menu of potential elements for a forthcoming ACA replacement bill. This Brief includes elements that have been found in previous ACA replacement proposals and that present concerns for access to care. Further, the Department of Health and Human Services (HHS) released a proposed rule entitled “Patient Protection and Affordable Care Act; Market Stabilization” (proposed rule), which is intended to help stabilize the Marketplaces until an ACA replacement is completed. Unfortunately, some of its changes may limit access to care for vulnerable individuals and make the Marketplaces less friendly to those living with chronic illnesses and disabilities. Advocates should be sure to understand both documents as well as send comments on the proposed rule to HHS by March 7, 2017.

Advocates Should:

1. Review the Health Care Policy Brief released by House Republicans last week to better understand which ideas are popular among Congressional Republicans and likely to make it into any ACA repeal and replace proposal.

2. Understand the proposed Market Stabilization regulation released by the Department of Health and Human Services and how it will impact access to care in the 2018 qualified health plans.

3. Submit comments on the proposed rule to HHS urging them to consider the impact the proposed regulations will have on access to care for vulnerable individuals.

House Republicans Unveil Health Care Policy Brief

On February 16, 2017, after a closed-door meeting, House Republicans unveiled a policy brief and resource document to explain major elements of their plan to repeal and replace key programs and protections of the ACA. House Leadership is terming this strategy “repeal plus.” The policy brief should not be considered an actual legislative proposal but rather a “menu” of replacement ideas such as tax credits for purchasing health care, health savings accounts, and high risk pools. Part of the intention of this document is to encourage Congressional Republicans, who have found it difficult to coalesce around a health care policy strategy, to find consensus on these issues. Unfortunately, many of the components of this “repeal plus” strategy would curb access to care for vulnerable individuals, including those living with chronic illnesses and disabilities.

 

When The HIV Community Speaks, Congress Better Learn to Listen

 

If the Republican majority in Congress, emboldened by its control of both chambers and the White House, thought it would be easy to roll back health reform and other progressive gains, they have begun to learn a lesson taught to Obama early on, that it is easier to articulate hope than it is to affect change. Over the first few weeks of Mr. Trump’s presidency, a massive and in many ways spontaneous resistance movement has formed all across the country, with millions of people taking to the streets to express their unwillingness to tolerate a White House and a Congress that pursues policies that are anti-woman, anti-immigrant, anti-Muslim, and would turn our social safety net to tatters.

One of the policies that has received some of the most vocal and passionate opposition has been the repeal and as-yet-unspecified replacement of the Affordable Care Act Repealing the ACA is a policy goal that served as the Republican Party’s white whale under the Obama administration, but one which their rhetoric and desire to implement have lagged in recent weeks. The lack of enthusiasm to promptly repeal the ACA is due to congressional Republican’s inability to design a replacement plan that doesn’t strip 18 million Americans of their health insurance in a year’s time and, perhaps more importantly, the fear of the collective outrage of millions of Americans should their health care be taken from them.

Over the past few weeks, numerous stories have been circling around both traditional and social media, showing Representatives going to extreme measures to avoid the wrath of a public that is rightfully incensed by plans to block grant Medicaid and tear apart the ACA with no concrete plans on how to sufficiently replace it. Whether it’s sneaking out of an event via a side exit or simply refusing to engage in town halls due to the anger of their constituents, members of Congress are clearly unnerved by the breadth and the intensity of the protests that have greeted them in their home districts. In fact, House Republicans were so shaken by the backlash against the prospect of ACA repeal that they convened a closed-door meeting this past Tuesday to discuss how to “protect themselves” from protesters.

It may not feel like it at times, but the power of collective resistance and protest is proving unparalleled in affecting change. If we are to save the ACA, or at least ensure that its most vital  benefits survive in a replacement plan, people living with HIV and those who advocate alongside them are going to have to engage in sustained, vocal opposition to any politician who tries to snatch our health care from us. This means suiting up and showing up to town halls and rallies, even when we don’t feel like going. It means calling your members of Congress at their offices and refusing to take no for an answer when you’re told a line is busy or a mailbox is full. The HIV community’s opposition to the destruction of the ACA must be unrelenting because the only way our elected officials will act in our best interest is if they are provided with no alternative.

Yes, changing the will of Congress may seem daunting, but each individual action on the road from where we are to where we aim to be is one step closer. One of the first steps you can take is to commit to meeting with your members of Congress and letting them know the repeal of the ACA is unacceptable. For the week beginning February 20, both the Senate and the House will be out of session and in their home districts and states. Many of them will be hosting town halls or have open hours for visiting and we must make sure that our presence is acutely felt. It is important to remember that they are beholden to us and that the amount of power they wield is indirectly proportional to degree to which we are politically engaged.

If you click here, you will find a substantial, but by no means comprehensive spreadsheet that lists the office hours and scheduled events for many members of Congress in their home districts and states in the near future. Use this list and any other resources you can find to plan an action during Presidents’ Day weekend and the days that follow. Make sure that, whether it’s in person or over the phone, your members of Congress are incapable of ignoring the needs of people living with HIV and all Americans living with chronic diseases.

Question them.
Tell your story.

Share your concerns and ensure that your voice is heard and that the provision of quality health care is nonnegotiable if they want to keep their job for long. And, if you want to continue with your HIV advocacy after the actions around Presidents’ Day, there’s no better way to do so than to register for AIDSWatch, the largest annual HIV/AIDS advocacy event in America. This year, AIDSWatch is more important than ever and we need your help more than ever if we’re going to make Congress recognize the possibility and importance of ending the AIDS epidemic and protecting the policies that allow people living with HIV to get access to quality, affordable care.

Posted By: AIDS United, Policy Department – Thursday, February 09, 2017

HIV Infection Numbers Drop For First Time in Decades, But Not Everyone Benefits

 

For the first time since the mid-1990s, the official estimate of annual HIV infections, or incidence, in the United States has decreased notably. According to a study released by the Centers for Disease Control earlier this week, HIV incidence dropped 18% in recent years, going from an estimated 45,700 infections in 2008 to 37,600 in 2014. This reduction in new HIV infections—the first official one in nearly two decades—is a welcome development at a time when good news in health care is becoming hard to come by with the specter of Affordable Care Act repeal looming in Congress.

The study’s findings had their share of troubling aspects as well. The undeniable progress that was made in the fight against HIV infection in America in recent years was not distributed evenly. The largest amounts of reductions in HIV incidence over the 6-year period covered by the study came from heterosexuals and people who inject drugs, who saw their new HIV infections decline by 36% and 56% respectively. Slightly smaller decreases were also seen among certain age groups of gay and bisexual men, with a 26% drop for gay and bisexual men between the ages of 35 and 44, and an 18% drop for gay and bisexual men between the ages of 13 and 24.

Unfortunately there were several populations who saw their new HIV infections remain stable or increase over the course of the study. The HIV incidence among black gay and bisexual men stayed at the still alarmingly high number of 10,100 new infections at the beginning and end of the 6-year period, while there were increases among Latino gay and bisexual men, and gay and bisexual men between the ages of 25 and 34. Latino gay and bisexual men saw a 20% increase in HIV incidence between 2008 and 2014 while gay and bisexual men between the ages of 25 and 34 experienced a 35% increase in HIV incidence over the same period. Similarly, the South continued to be overrepresented in terms of HIV incidence, as the 37% of the US population that lives in the South accounted for 50% of new HIV infections in 2014.

There is reason for cautious celebration in the results of this study, as any significant decrease in new HIV infections should be lauded. But, with the rise in HIV incidence for portions of the population and a health care system currently in flux, it’s important that we recognize that even more vigilant prevention efforts are needed in the future if we are to maintain and improve upon this progress.

Posted By: AIDS United, Policy Department – Friday, February 17, 2017

New Administration, Old Approach: Trump advocates Medicaid Block Grants & ACA Repeal

 

As the shifting legislative landscape of President Trump’s first 100 days continues, two major developments emerged in the health care reform world: that the Trump administration plans to block grant the Medicaid program and that President Trump signed an initial executive order weakening the ACA.

 

From its inception in 1965 under President Lyndon Johnson until the present day, Medicaid has served as a public insurance program for low-income individuals, families, and people with certain disabilities. Unlike Medicare, which was created at the same time and is both federally funded and administered, Medicaid is a federal-state partnership program in which each individual state administers their own Medicaid program using a mixture of state and federal funds, provided that certain services and populations are covered. For the entirety of its existence, Medicaid has been an entitlement program, which means that the government is required to provide coverage for anyone who meets the eligibility rules for enrollment. This means that the amount of money being spent on a state’s Medicaid program fluctuates from year-to-year based on how many people qualify for coverage.

 

Every Republican President since Ronald Reagan has tried, and so far failed, to turn Medicaid from an entitlement program into a discretionary block grant program. Block granting Medicaid would mean the federal government would present states with a predetermined amount of money to serve their low-income and disabled residents at the beginning of each year. Most plans to block grant Medicaid would determine the amount of funding based on previous state and federal Medicaid spending in a given state, with slight changes each year to account for inflation. The states would then be allowed to determine exactly how to spend that money with many fewer requirements than in the current system. This means that if there were a recession, an unexpected disaster, disease outbreak or if general health care costs continued to rise faster than inflation, state governments would not be given extra federal funds.

 

In such a situation, states would address the health care needs of their low income and disabled residents through a variety of means, but most would reduce or eliminate covered services, restrict access to the program, or introduce higher cost-sharing mechanisms. Taken together, this would adversely affect the health and wellbeing of those in need of care. In a best case scenario, states would take on the excess costs themselves. However, this might prove difficult since many states are required to balance their budgets which might require tax increases or additional sources of revenue to meet these increased Medicaid costs. As a result, many states would choose to avoid added costs by changing the Medicaid eligibility criteria, reducing Medicaid benefits, and simply not providing care to people who are eligible. According to an analysis of a previous Republican proposal from 2012, the block granting of Medicaid could wind up dropping anywhere between 14.3 million and 20.5 million people from care.

 

It is nearly impossible to overstate how devastating Medicaid block granting would be for people living with or at risk of contracting HIV. Right now, Medicaid is the largest source of insurance coverage for people living with HIV, covering more than 40% of people with HIV who are in care. At the same time, Medicaid accounts for 30% of all federal HIV spending and when combined with state Medicaid spending, represents the 2nd biggest source of public HIV financing, trailing only Medicare. Under block grant funding, people living with HIV could bear some of the largest burdens of all impacted populations, because state governments may choose benefit designs that disproportionately affect pricey HIV medications. Given the amount of stigma regarding people living with HIV, LGBT people, and lower income populations, it is possible that some states would choose to do so. Although it may sound unlikely that a state government would discriminate against the provision of medical treatment for certain populations, it has been suggested in the past. For example homophobic legislators in Tennessee openly questioned providing funds to treat people living with AIDS due to their “bizarre lifestyle.” AIDS United strongly opposes block granting Medicaid and we urge readers to call their legislators with that message.

 

President Trump’s executive order intended to weaken the ACA may be more important for what it suggests than for what it actually accomplishes. The executive order directs federal agencies to use their current regulatory authority to “minimize the economic burden” and minimize or remove “any provision…that would impose a fiscal burden on any State, or a cost, fee, tax, penalty, or regulatory burden on an individual.” The order would also grant waivers to states that undercut the cost of consumer protections, encourage the sale of health insurance across state lines, and encourages agencies to use discretion to avoid expanding the ACA.

 

By himself, Mr. Trump doesn’t have the power to repeal or directly impede the implementation of the ACA. However, he can instruct the employees of federal agencies to begin chipping away at the law’s effectiveness. For example, the Trump administration can’t formally strike down the ACA’s individual mandate that all Americans be insured, but he can instruct the IRS to simply not fine anyone who doesn’t abide by the mandate, rendering it useless. Similarly, the executive order instructs the Department of Health and Human Services (HHS) to provide states with considerable leeway when it comes to the implementation of their health care programs and encourages HHS to accept waivers from states that would help them get around ACA regulations that they find overly restrictive.

 

On Thursday, the administration reportedly took another step to undermine the ACA. White House officials ordered the Department of Health and Human Services to halt all advertising and outreach efforts encouraging enrollment in ACA health plans purchased on the Healthcare.govmarketplace during the last days of the 2017 open enrollment period. This is significant because in previous ACA open enrollment periods, the final days were among the heaviest for signing up for health coverage. The White House action does not affect people’s ability to sign-up for coverage on the website; open enrollment ends Tuesday, Jan. 31.

 

AIDS United believes that the ACA must remain in place and that no effort to make changes, including this executive order, should attempt to repeal the law without an immediate and effective replacement in place. AIDS United will continue to provide concise analysis of the what’s happening in Washington regarding health care reform and why it should matter to people living with HIV.

 

Posted By: AIDS United, Policy Department – Friday, January 27, 2017
Search Tags: Affordable Care Act , HIV Policy

In Congress, Obamacare Replacement Plans Start To Emerge

 

Just twenty-five days into the 115th Congress, the Republican congressional majority has made significant steps to make good on campaign promises to repeal the ACA and setup President Trump for swift action on his other top priorities. Republicans kicked off a policy retreat in Philadelphia Wednesday that extends through Friday evening where they hope to hash out how to repeal and replace Obamacare.
While Republicans have had the last six years, and five-dozen attempts to overturn the ACA and plot a replacement, no clear consensus has risen on what to do following repeal. Adding to the uncertainty of how they might repeal and replace Obama’s signature law, is the assertion by President Trump that he will send his own plan to Congress, once his Health and Human Services (HHS) Secretary nominee, Tom Price is confirmed. The notion of the White House sending legislation to Congress is unnerving for many lawmakers and calls into question the separation of powers. Senator Rand Paul M.D. (R-KY), who introduced The Obamacare Replacement Act (S.222) this week, said in a statement that, “Sometimes you get ideas from the White House,” which underscores the atypical nature of President Trumps desired path toward repeal.

The Paul Replacement 

Sen. Paul’s bill has several provisions including an immediate repeal of the individual and employer mandates, the essential health benefits requirement, and other insurance mandates. Further the bill would allow unlimited deposits into Health Savings Accounts and broaden options for using those funds; allow the purchasing of insurance across state lines; and create voluntary associations for insurance pooling.

Cassidy-Collins replacement 

Sens. Bill Cassidy (R-LA) and Susan Collins (R-ME) held a press conference Monday to propose three options states could consider moving forward with health care coverage. States could either keep the Affordable Care Act (ACA) but with reduced federal funding for subsidies, switch to a different system to purchase insurance coverage, again with reduced subsidies , or go forward with an alternate plan that does not include federal assistance. The Cassidy-Collins proposal is in direct contrast to plans discussed by House and Senate leadership, which would not let the ACA continue in any form. Cassidy notes that this proposal serves as a middle-way approach that could potentially bridge Democrats’ and Republicans’ concerns. However, the Cassidy-Collins one-page compromise still needs legislative language.

Cassidy noted:
“At some point in this process, we will need a bill that can get to 60 votes. Now you can say to a blue-state senator who is invested in supporting Obamacare, ‘You can keep it, but why force it on us?’” Collins, affirms saying, “I believe most states would embrace this option, which allows states to cover the uninsured by providing a standard plan that has a high-deductible, basic pharmaceutical coverage, some preventive care and free immunizations.”

The question is, what does the rest of Congress think?

Senate Minority Leader Chuck Schumer (D-NY) described the proposal as “an empty facade that would create chaos.” Schumer wasn’t the only Democrat that predicted insurmountable challenges in the Cassidy-Collins proposal. Democratic leadership call into question the idea of giving some states the option to dismantle the current health care law and replace it with something else or nothing at all, for that matter. Conversely, Republican leadership hasn’t publicly commented much on the generality of the bill. Furthermore, Republicans have persistently supported the dismantling of the current health care law’s taxes and fees.

Presidential Executive Order 

As one of his first actions last Friday, Trump signed an executive order intended to minimize the economic burden of the ACA, pending its repeal. The order allows the U.S. Department of Health and Human Services (HHS) and other federal agencies to use their existing powers “to the maximum extent permitted by law” to weaken the ACA. HHS and agencies such as the IRS “were given vast discretion over key parts of the law including the individual and employer mandates,” per Pro Health Care’s Brianna Ehley. What this could mean is that it is possible to stop the individual mandate from being enforced.

In addition to President Trump’s actions, there was a congressional hearing, at which Republican members sought to expose what they perceive to be a decrease in marketplace competition and affordability. The hearing examined the “Failures of Obamacare.” There was also a hearing on theACA Individual Mandate. The hearing on the Price Nomination for HHS Secretary was also a forum for Republican senators to air their ACA-related grievances.

As HIV advocates we remain vigilant in the changing landscape and continue to seek intelligence and influence the proposed changes to our health care systems. It is imperative that the ACA not be repealed without a replacement that protects the expanded access the law has brought. We must insure vulnerable population, including people living with or at risk for HIV, are provided the access to care they deserve.

Posted By: AIDS United, Policy Department – Friday, January 27, 2017

5 Things To Know About Rep. Tom Price’s Health 

Rep. Tom Price has introduced his own alternative to the Affordable Care Act four times. The legislation provides an idea of how he might lead the Department of Health And Human Services.

Andrew Harrer/Bloomberg via Getty Images

Georgia Rep. Tom Price has been a fierce critic of the Affordable Care Act and a leading advocate of repealing and replacing the 2010 health care law.

Price, an orthopedic surgeon from the suburbs of Atlanta, introduced his own legislation to repeal and replace Obamacare in the current Congress and the three previous sessions. Price’s plan, known as the Empowering Patients First Act, was the basis for a subsequent health care proposal unveiled by House Speaker Paul Ryan, with Price’s endorsement, in June.

Price’s major complaint about the ACA is that it puts the government in the middle of the doctor-patient relationship.

“They believe the government ought to be in control of health care,” Price said in June at the American Enterprise Institute event where Ryan unveiled theRepublican proposal to replace Obamacare. “We believe that patients and doctors should be in control of health care,” Price continued. “People have coverage, but they don’t have care.”

Now that President-elect Donald Trump has tapped Price to lead the Department of Health and Human Services, here are five key planks in his own health care proposal.

  1. Price’s plan offers fixed tax credits so people can buy their own insurance on the private market. The credit starts at $1,200 a year and rises with age, but isn’t adjusted for income. Everyone receives the same credit whether they are rich or poor. People on Medicaid, Medicare, the military health plan known as Tricare, or the Veterans Affairs’ health plan could opt instead for the tax credit to buy private insurance.
  2. Price advocates for expansion of health savings accounts, which allow people to save money before taxes to pay for health care. This includes allowing people who are covered by government health programs including Medicare and the VA to contribute to health savings accounts to pay for premiums and copayments. These proposals are included in Ryan’s plan.
  3. People with existing medical conditions couldn’t be denied coverage under Price’s plan as long as they had continuous insurance for 18 months prior to selecting a new policy. If they didn’t, then they could be denied coverage for that condition for up to 18 months after buying a new plan.
  4. The Price proposal limits the amount of money companies can deduct from their taxes for employee health insurance expenses. Companies can deduct up to $20,000 for a family health insurance plan and $8,000 for an individual. The goal is to discourage companies from offering overly generous insurance benefits to their workers. Ryan’s plan proposes a cap on the employer tax deduction but doesn’t specify the level of the cap.
  5. States would get federal money to create so-called high-risk pools under Price’s plan. These are government-run health plans for people with existing medical conditions who can’t get affordable health insurance on the private market. Critics say high-risk pools have been tried in as many as 34 states and largely failed because they were routinely underfunded.

Price has said he’s not wedded to his own ideas and is open to compromise, so the final proposal to replace Obamacare is likely to be a hybrid of his ideas and those hammered out with other Republican House members and presented as Ryan’s plan.

Still, with Price on track to be at the helm of HHS, he would be the one writing the rules to implement whatever legislation is eventually passed.