As Republicans consider paring back the Affordable Care Act’s federal mandates, they face a difficult question: What does health insurance need to cover?
The 2010 health law created a new set of federal requirements for plans sold to individuals and small businesses, including a list of 10 benefits, among them prescription drugs, mental-health services and laboratory tests. It also mandated that plans cover preventive services such as vaccinations at no cost to enrollees.
The rules, along with other minimum standards set by the law, were meant to ensure that consumers had strong protections and weren’t surprised by unexpected gaps or limits in their coverage. But that also contributed to making individual insurance more expensive in many cases.
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Senate Democrats have pummeled Rep. Tom Price, President Trump’s pick to lead the Department of Health and Human Services, for supporting Medicaid block grants, but it’s a policy unlikely to win a place in Republicans’ Obamacare repeal-and-replace plan.
If Republicans succeed in making significant changes to Medicaid, they more likely would turn to a more moderate per-capita system embraced by a wider swath of Republicans. Like block grants, a per-capita system would limit federal contributions, but it would allow federal assistance to rise with enrollment growth.
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The Republican Study Committee is a group that includes some of the most conservative legislators in Congress. A few years ago, it asked Rep. Phil Roe (R-TN), who co-chairs the Republican Doctors Caucus, to come up with a plan to replace Obamacare.
“I was asked to put together a plan that increased access [and] lowered costs but didn’t increase entitlements, so my hands were a bit tied,” he says.
What he came up with was this: Repeal Obamacare entirely. Get rid of the current tax preference for employer-sponsored coverage too. Regardless of where people get their health insurance, the RSC plan would give all Americans a standard deduction for health insurance — $20,500 for families and $7,500 for individuals.
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Congressional Republicans are facing their first big decision on taxes under President Trump: Which ones to scrap in the repeal of ObamaCare.
Republicans have in the past sought to erase most of the big tax hikes in the healthcare law, and the chairmen of the tax-writing committees have expressed support for eliminating the taxes in a repeal bill.
“After spending seven years talking about the harm being caused by these taxes, it’s difficult to switch gears now and decide that they’re fine so long as they’re being used to pay for our healthcare bill,” Sen. Orrin Hatch (R-Utah), the chairman of the Senate Finance Committee, said Wednesday.
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President Donald Trump walked back his recent vow that Obamacare would be replaced in short order, telling F0x News’ Bill O’Reilly that the process is “complicated” and “maybe it’ll take till sometime into next year.”
“It statutorily takes a while to get,” Trump said in a wide-ranging interview that aired Sunday during the Super Bowl pre-game show. “We’re going to be putting it in fairly soon, I think that yes I would like to say by the end of the year at least the rudiments, but we should have something within the year and the following year.”
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No one’s interested in trying to save Obamacare’s centerpiece as it faces certain death.
Even as the healthcare industry heavily lobbies Republicans to keep the Affordable Care Act’s other main components, such as its subsidies and Medicaid expansion, doctors, hospitals and insurers are stepping away from the law’s individual mandate for people to buy insurance or pay a fine.
Not even Democrats are campaigning to keep the mandate, which was once viewed as the key to making Obamacare successful. The thought was that the mandate would prompt enough healthy young people to buy coverage to keep premiums stable. But nearly everyone agrees it didn’t work as well as intended. And repealing it is top of list for Republicans.
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Tom Price spent years railing against Obamacare. Now he’ll finally have sweeping power to do something about it.
The Georgia Republican congressman is on the verge of becoming the Trump administration’s top health care official, armed with broad authority to begin unwinding Obamacare by using as much executive power as possible, even as Congress struggles to find consensus on a plan to repeal and replace the health care law. First, he could ax Obamacare’s mandate ensuring coverage for contraception and give insurers more latitude to determine which health benefits they will — and won’t — pay for. Those changes will likely be paired with stricter monitoring of Obamacare enrollees, as the administration aims to win over jittery health plan executives with policies that prioritize insurance market predictability and profitability.
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On the question of what should be done about Medicaid expansion under Obamacare, Republicans should combine two ideas popular in their party: block grants and health savings accounts. The former would let states tailor their Medicaid policies to their local communities, while the latter would give enrollees the ability to choose their own insurers and providers. In essence, Washington could give the states Medicaid block grants, allocated per capita, to provide beneficiaries with high-deductible insurance and health savings accounts.
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The Trump administration intends to publish a new regulation soon aimed at stabilizing Obamacare’s marketplaces, just as insurers are weighing whether to participate next year.
The administration hasn’t released the text for the regulations or said whether it could be finalized before insurers face the first deadlines this spring for submitting plans for 2018.
The Office of Management and Budget released a notice on a pending rule received Feb. 1 aimed at stabilizing Obamacare markets.
The rule was received the same day that insurers told Congress that they need to know soon whether cost-sharing reduction payments will be reimbursed in 2018.
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The Affordable Care Act’s insurance exchanges have become too risky for major health insurers, and that’s creating further doubt about coverage options consumers might have next year.
Anthem CEO Joseph Swedish said Wednesday his company is waiting to see whether the government makes some short-term fixes to the shaky exchanges before it decides how much it will participate next year. The Blue Cross-Blue Shield carrier is the nation’s second largest insurer and sells coverage on exchanges in 14 states.
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