The Healthcare Policy Debate: Part IV--Last Ditch Efforts

This is the fourth in a series analyzing the political and policy aspects of the recent healthcare debate. Part I was a political analysis of the first House bill. Part II evaluated the second House bill, HR 1628. In Part III, we took up the Senate bill. Here, the major elements of the proposed amendments to the Senate's bills will be presented in chronological order.

AMENDED SENATE HEALTH CARE BILLS

Dubbed the Obamacare Repeal Reconciliation Act, this bill was posted by the Budget Committee on July 17, 2017. This bill:

• Repeals the ACA mandates of 2016
• Removes the premium and cost sharing subsidies due to take effect on 2020
• Retains private market rules
• Prohibits tax credits for plans covering abortion, beginning in 2018
• Keeps health insurance marketplaces and open enrollment periods
• Eliminates the Medicaid expansion
• Disallows Medicaid funding of Planned Parenthood clinics for one year
• Repeals all ACA revenue provisions

The Health Care Freedom Act was proposed in the Senate on July 27, 2017. This bill:

• Repeals the ACA's individual mandate, and suspends the employer mandate until 2025
• Retains private market rules
• Keeps health insurance marketplaces and Open Enrollment periods
• Changes some state waiver process provisions to expedite applications process and extend waiver periods 
• Disallows Medicaid funding of Planned Parenthood clinics for one year
• Increases fiscal year 2017 funding for Community Heath Centers by $422 million
• Suspends the medical device tax for three years
• Increases the maximum annual contribution to Health Savings Accounts for three years

The Graham-Cassidy-Heller-Johnson Amendment (to HR 1628), referred to as Graham-Cassidy, was proposed in September of 2017. This bill:

• Repeals the ACA mandates of 2016
• Removes the premium and cost sharing subsidies
• Replaces these subsidies, as well as Medicaid expansion funding, with a state block-grant program (costing $1.176 trillion over seven years)
• Retains some private market rules, and allows states to set rules for coverage under the block grant program
• Repeal the authority to cover Medicaid expansion for adults by 2020
• Converts federal Medicaid funding to a per capita allotment, and limits federal Medicaid spending growth, starting in 2020
• Adds a state option to require work as a condition of eligibility for Medicaid
• Encourages the use of Health Savings Accounts
• Disallows Medicaid funding of Planned Parenthood clinics for one year
• Increases fiscal year 2017 funding for Community Heath Centers by $422 million
• Repeals some ACA revenue provisions, keeping the medical device tax 

Did I mention that all three failed???





With thanks to KFF