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A recap of recent activity related to health care reform as of 03.10.17

GOP Repeal and Replace Proposal
On Friday February 24, a Republican proposal to "Repeal and Replace" the ACA was leaked to the public. Because of the unofficial nature, this version is subject to change, but offers the first concrete look at the House legislative proposal to "Repeal and Replace". It was wide-ranging and consistent with themes of the past several months. In addition to the likelihood of the legislation changing, it should also be noted that the current legislation has different timing for different provisions and also allows state flexibility in a number of areas (which is especially notable for Massachusetts). We will share details as they are confirmed.

Broadly speaking, next steps include:

  • The House committee will make changes to the bill the week of March 6 (this is termed "Mark Up").
  • The Congressional Budget Office (CBO) will "score" the final bill (determine its cost and impact to the budget).
  • Then, the full House will vote on the bill and it will move to the Senate.
  • The Senate parliamentarian will then decide if it passes procedural muster.
  • If the Senate makes any changes to the bill, the House must pass the "reconciled" bill before it can be sent to the President to be signed into law.

This is expected to be complicated process, politically, substantively and procedurally.

President Addresses Congress in formal Joint Session February 28
President Trump addressed the joint session of Congress on Tuesday, February 28, and touched on topics highlighted throughout his campaign, such as controlling immigration, and health care – specifically, the repeal of the Affordable Care Act. Based on previous statements by the President and HHS Secretary Tom Price, a proposal from the White House is expected by mid-March.

March will be an intense month for activity related to health care. In addition to the Market Stabilization regulation expected to become final, the legislative process is expected to move forward at a more significant pace.

Tom Price Confirmed as Secretary of Health & Human Services
On February 10, 2017 the United States Senate confirmed Representative Tom Price (R-GA) as Secretary of the Department of Health and Human Services. While no action has been taken as yet to officially repeal and replace the ACA, Price has been vocal opponent of the law and is expected to make changes. As Secretary of HHS, he will have authority to make changes to current regulations that could have implications for our business and customers. Seema Verma, a health care consultant from Indiana and President Trump's nominee to lead the Center for Medicaid and Medicare Services (CMS) is also expected to be confirmed following Senate hearings. Verma's background is primarily Medicaid, although she will have oversight over multiple programs that CMS administers, including the ACA, Medicare and Medicaid.

CMS issues "Market Stabilization Rule"
On February 15, 2017, the U.S. Department of Health and Human Services (HHS) released a proposed Market Stabilization rule intended to stabilize the individual and small group markets that exist nationally under the Affordable Care Act (ACA). The proposed rule is intended to provide additional stability to this market as insurance companies begin planning for 2018. The exact timing of the release of a final rule from CMS is not clear.

The rule addresses a number of issues that could encourage more plans to remain in the market across the country. This includes wider variation on actuarial value, tightening of special enrollment periods and a change to the open enrollment period that would begin November 1 and end on December 15.

The Rule is not yet final, but GRA expects it to become final by April, in time for health plans to update their 2018 product filings.

ACA ("Affordable Care Act") Still Stands
Questions have arisen about the status of the ACA, for instance whether current reporting requirements are still in effect and whether CMS market rules (also known as payment parameters) for the merged market remain intact. Because no official actions have been taken to legally reverse or otherwise change the law, all current regulations stand and BCBSMA will continue to comply with the current laws until changes are made official.

Governor Baker Includes Health Care Provisions in Budget
On January 25, 2017, Governor Baker unveiled his FY2018 $40.5 billion budget proposal known as House 1. The proposal includes several measures intended to help control spending growth at MassHealth which has grown to approximately 40% of the total state budget due in part to individuals shifting out of commercial coverage. The proposals include a growth cap on provider rates and an overall provider rate cap within the Group Insurance Commission (GIC). Other provisions include a new $300M assessment on employers with 11 or more full time employees that do not provide a minimal level of insurance, an additional $13M assessment on acute hospitals, a new state transparency website, and a five year moratorium on new benefit mandates. The budget will be taken up by the House in April and the Senate in May with a final negotiated version to be submitted to the Governor in late June before the start of the FY on July 1.

MA Health Connector Moving Ahead
While various proposals are discussed and debated at the federal level, locally in Massachusetts the Connector is scheduled to proceed with plans for 2018. The Seal of Approval process will kick-off in March for health plans to be offered on the Exchange starting in January 2018. The biggest change recently announced by the Connector is to partner with the existing state Exchange in Washington DC to create a new shopping platform for small groups. The new platform will include the concept of Employee Choice where an employer selects a plan and the employees may then disaggregate and buy other coverage. Employers will still have the option to buy coverage in the Connector sole source as they do today. The Connector expects to have the new platform ready for employers to purchase plans in November for January coverage.

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