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On the Hill: Shutdown Looms, ACA Repeal Efforts Continue

With Congress back from a two-week recess, lawmakers face an extensive agenda of legislative priorities, including health care and tax reform, and most urgent, a continuing resolution (CR) to prevent a government shutdown on Friday.

Cost-Sharing Subsidies Debate

Congress and the administration are weighing whether to fund Affordable Care Act (ACA) cost sharing reduction subsidies (CSRs) in the CR. These subsidies implemented in the ACA marketplace health plans help cover the cost of patients who cannot afford to pay high deductibles and co-payments. The Congressional Budget Office (CBO) estimates that CSRs will cost $7 billion in fiscal year 2017.

These payments have been the subject of an ongoing lawsuit that challenged the Obama administration’s decision to fund the subsidies without a congressional appropriation. If the White House drops its appeal of the lawsuit and Congress refuses to appropriate funding, the CSR payments would end. This could cause health plans to flee the marketplaces and leave millions of people uninsured. America’s Essential Hospitals sent a letter to President Trump and congressional leaders last week urging swift action on CSRs.

ACA Repeal and Replace Efforts

Two Republican lawmakers say they are nearing a deal on an ACA replacement bill: Rep. Mark Meadows (R-NC), chair of the House Freedom Caucus, and Rep. Tom MacArthur (R-NJ), a co-chair of the moderate Tuesday Group. MacArthur’s office released an amendment proposal last week that would give states the option to apply for waivers to opt out of some of the ACA’s core requirements, including essential health benefits and coverage for pre-existing conditions. If a state chooses to allow insurers to charge higher premiums for people with pre-existing conditions, it must offer high-risk pool coverage. The GOP has neither released legislative text nor conducted a whip count of how the House will vote.

Office of Management and Budget Director Mick Mulvaney suggested that the House could pass both a health care and government funding bill in the coming days, and reported that House lawmakers might work through next weekend to get the repeal passed. House Speaker Paul Ryan (R-WI) downplayed the possibility of a health care vote this week during a conference call with Republican lawmakers Saturday.

Other Committee Activity

In committee news this week, the Senate Committee on Health, Education, Labor, & Pensions will vote Wednesday on Scott Gottlieb’s nomination for Food and Drug Administration (FDA) commissioner. There also is a scheduled markup of legislation that would clarify for states when emergency medical personnel may administer certain controlled substances in the field. Also, the House Committee on Energy and Commerce continues to focus on reauthorizing the FDA’s ability to collect user fees from drug and device manufacturers.


About the Author

Erin Delaney is a former legislative affairs associate at America's Essential Hospitals.

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