Greetings from your advocacy team in Washington, D.C.!
The tectonic plates of the U.S. political landscape continue to shift. The latest: President Trump fired FBI Director James Comey on Tuesday, May 16; since then, Congress and journalists have had very little bandwidth for much else. But healthcare advocates remember just several news cycles ago when Congress passed a budget that boosted NIH biomedical research funding by $2 billion; the day before that, the House passed the American Health Care Act, or AHCA (and here I thought it was a zombie, neither dead nor alive). Meanwhile, at the executive branch, the last major health administrator is in place after Scott Gottlieb, MD, Commissioner of Food and Drugs, was sworn in Wednesday, May 17, as FDA Commissioner.
Deciphering the AHCA
For those of you who didn’t read the whole healthcare bill (don’t worry, neither did more than a few members of Congress), here is a quick recap of what the AHCA would do if it became law:
- Repeal mandates to buy insurance, replaced with a penalty for not maintaining continuous coverage;
- Replace the income-based subsidy with age-based tax credits. With age, premiums can rise out of proportion to credits;
- Allow states to obtain waivers that remove essential health benefits and preexisting condition protections;
- Change Medicaid from direct federal funding to a block-grant system and end Medicaid expansion;
- Allocate $115 billion (+8) for high-risk pools; and
- Keep the protection for kids to stay on their parents’ plans until age 26.
A few unique things about the bill: First, the House didn’t score the final bill to see what it would cost before voting on it, and second, after it passed, House Republicans celebrated in the White House rose garden. These actions suggest the bill was more of a political maneuver to keep campaign promises than an actual attempt to effect change. And that’s where things get a little messy.
A new poll shows only 21% of Americans support the bill the House passed. Given its unpopularity, it’s not surprising that Senate Democrats are staying away from ACA reform efforts, and Senate Republicans claim to be starting from scratch and working at a Senate pace, not a House pace with healthcare reform. We are hearing that the Senate might write a bill by August.
Meanwhile, on Wednesday, May 17, Aetna announced that it will pull out of exchange plans in 2018. Humana had already pulled out. On Thursday, President Trump threatened to stop the somewhat controversial but highly stabilizing cost-sharing reduction payments from the Treasury to insurers (approximately $7 billion/year). So there is a lot of uncertainty about the state of the Obamacare statutes, as well as the actual marketplace, as we near the June 2017 deadline for insurers to apply to participate in 2018 exchanges.