CBO scoring of GOP repeal bill indicates 23 million would lose insurance

From the Hill

The Congressional Budget Office (CBO) released its long-awaited score of the GOP’s American Health Care Act (AHCA). The bill, which recently passed the House of Representatives, is intended to repeal the Affordable Care Act (ACA). The CBO estimates that 23 million more Americans would be uninsured over a decade, 14 million of them coming only a year after the bill’s effective date. The bill would also save $119 billion, which is $32 billion less that the first version of AHCA, and repeal $664 billion worth of taxes and fees that finance the ACA. 

At the agencies

The Centers for Medicare & Medicaid Services (CMS) announced a new proposal to alter the way small businesses enroll in insurance coverage through federal exchanges. According to CMS’ proposed changes, employers would maintain Federally-Facilitated Small Business Health Options Program (FF-SHOP) eligibility but would no longer be able to enroll online through HealthCare.gov. Small employers would instead access coverage through an agent, broker or issuer of their choice. Current FF-SHOP employers for 2017 would continue to use HealthCare.gov for enrollment and premium payment until the current plan year ends. 

In an attempt to simplify and streamline Affordable Care Act exchanges, CMS announced changes to the HealthCare.gov enrollment process. Customers using third-party websites will no longer be required to be directed to HealthCare.gov before completing enrollment. CMS has signaled they will now rely on the third-party websites to verify that customers are eligible to enroll and qualify for subsidies. Insurers and web brokers wishing to have seamless enrollment will be required to hire third-party auditors to certify compliance and must gain CMS approval before directly enrolling customers. CMS will review applications on a first-come, first-served basis. 

CMS will be offering a second round of solicitations for payers to partner with CMS and practices to participate in the Comprehensive Primary Care Plus program (CPC+) from 2018 to 2022. The program is an advanced primary care medical home model that focuses on value and quality with a payment structure to support primary care practices that improve quality, access and efficiency. It offers two tracks with different care delivery requirements and payment methodologies. The four regions selected for the new rounds are in Louisiana, Nebraska, North Dakota and New York (Erie and Niagara counties).

The Department of Health and Human Services (HHS) delayed a pair of Medicare bundled payment models for the second time. The “final rule” pushes back the beginning of the payments models for knee and hip replacements and cardiac care until Jan. 1; it also suggests future changes. The models were initially delayed in March after the new administration posted a regulation freeze. HHS also deferred changes to the 340B drug program which would have set a price ceiling for participating drug companies and clarified how civil monetary penalties would be imposed. 

From the administration

The Trump administration requested a 90-day delay in a lawsuit over cost-sharing reduction subsidies, which reduce the amount plan participants pay in out-of-pocket costs by reimbursing health insurers. The case, House v. Price, was brought by House Republicans during the Obama administration which claimed the cost-sharing program was illegal. The Obama administration appealed a 2016 federal district court ruling prior to the presidential transition. The White House has been unclear of its stance on the subsidies. The subsidies are seen as critical to the stability of the exchanges, and the delay continues to place the future of the marketplaces in limbo. 

The Trump administration released its 2018 budget which contains several cuts to healthcare programs such as Medicaid and the National Institutes of Health (NIH). The budget proposes capping Medicaid’s federal funding, saving $610 billion over the next 10 years. The budget would additionally cut the NIH’s funding by $6 billion, a 20 percent cut, which was initially outlined in the president’s “skinny budget.” The Centers for Disease Control and Prevention (CDC) would see a cut in funding of $1.3 billion including a $500 million health block grant for states to respond to public health threats. 

The White House is also proposing cutting the budget for the Substance Abuse and Mental Health Services Administration (SAMHSA) by nearly $400 million. The Community Mental Health Services Block Grant would see a $116 million cut, and other state mental health grants would be reduced by $136 million. Substance abuse treatment grants for the states would lose $73 million, while additional public awareness programs would be cut by $74 million. The budget recognizes fighting the opioid crisis as a priority but maintains funding at current levels.