Congress can’t keep kids covered as 2017 comes to a disappointing end

  

Congressional Republicans immediately followed their passage of a tax bill that will have a devastating impact on public health by voting for an irresponsible spending stopgap that needlessly jeopardizes the roughly nine million American children who rely on coverage from the Children’s Health Insurance Program (CHIP). While regrettable, this sequence of events was a fitting conclusion to 2017 on Capitol Hill, where majority lawmakers showed a persistent and troubling desire to limit Americans’ access to health care.

While the stopgap bill passed by the House and Senate will fund CHIP through the end of March 2018, it continues to create reckless uncertainty as state officials who manage the program are forced to run it on a month-to-month basis. Despite the widespread bipartisan support the program has historically enjoyed, congressional leaders proved unable to reach an agreement on the usual five-year long-term spending approval that CHIP has received in the past.

Republicans also chose to punt to 2018 on health marketplace stabilization efforts that are even more urgent in the wake of the tax bill’s passage. While the proposals from Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA), as well as Susan Collins (R-ME) and Bill Nelson (D-FL) will not mitigate all the damage done by individual mandate repeal, they will help lessen the negative impact from President Trump’s unilateral and dangerous decision to end stabilization funding earlier this fall.

And though both measures would have an objectively positive impact on the health marketplace congressional Republicans seem intent on destroying, it remains unclear whether the measures – together or separately – could garner a majority of support in either chamber, particularly the House of Representatives where more conservative members enjoy increasing influence.

Despite these developments, almost nine million Americans reportedly signed up for coverage during this year’s Open Enrollment period that concluded on December 15, nearly matching last year’s total. This took place despite the administration’s efforts to limit enrollment, by cutting the sign-up period in half and slashing funding for promotional efforts to educate the public. The enrollment figures are a clear sign that Washington’s focus in 2018 must turn away from creating roadblocks to health care, and instead find new ways to help Americans get and stay covered.

Tax Reform and Spending Measures Threaten Healthcare for Millions – Including Children

  

Congressional Republicans threaten to put coal in the stockings of millions of Americans this holiday season, as they are poised to pass a massive tax bill – the Tax Cuts and Jobs Act – that promises to significantly reduce the number of Americans with health insurance. Meanwhile, House members have decided to play politics with the health care coverage of 9 million children, as they have placed a provision to re-authorize the Children’s Health Insurance Program (CHIP) into a spending measure that could potentially lead to a government shutdown.

The Tax Cuts and Jobs Act

The push toward final passage of a tax reform bill took a major step forward this week, as House and Senate Republican members of the conference committee  settled on a compromise version of the Tax Cuts and Jobs Act. Among its many provisions, the bill eliminates the Affordable Care Act’s individual mandate, which requires Americans to purchase health insurance or pay a financial penalty. As we have written before, the Congressional Budget Office (CBO) estimates that repealing the individual mandate would result in 13 million fewer Americans having health insurance. Such a reduction in coverage would result in negative health outcomes, higher costs, and a decreased focus on primary care and preventive services.

The bill also lowers the threshold for an individual to claim a medical expense deduction. More Americans will also likely find it necessary to take this deduction – without health insurance coverage, they will be much more likely to experience crippling medical expenses.  The bill allows individuals to deduct medical costs greater than or equal to 7.5% of an individual’s income; this is lower than the 10% threshold under current law. This is deceptive, however, as the threshold to claim the medical expense deduction will return to 10% in tax year 2019 and is only available to tax filers who itemize their deductions.

The likelihood for passage of the Tax Cuts and Jobs Act that came out of conference committee is still fairly uncertain. The conference committee held its only public meeting yesterday. The next steps in the process will be votes on the floors of the House and Senate. The timeline for these votes is not crystal clear, but the expectation is that both chambers will vote on final passage next week. Once this occurs – and assuming that the bill passes both chambers – it will head to President Trump’s desk, at which point he will sign it into law.

Children’s Health Insurance Program

Congress recently passed a continuing resolution to fund the government at current levels through December 22nd. This funding deadline, however, is fast approaching, and Congress will need to pass yet another spending bill by that date in order to avoid a government shutdown. House Republicans have already proposed such a measure, which would extend government funding through January 19th, and provide a crucial five-year extension of CHIP. A point of contention, however, is that the spending measure would fully fund the Department of Defense for the full year with a $73 billion funding increase over current spending levels. This is a non-starter for Congressional Democrats, who have demanded a dollar-for-dollar increase in spending for domestic programs for any spending increase in defense programs.

The funding situation for CHIP is truly dire. Federal spending authorization for the program ran out on September 30th; Congress has failed to act for over two months. While states have been using reserve funding to fill the gap, that excess funding will soon run out. Sixteen states – Washington, Oregon, Idaho, Nevada, California, Texas, Arizona, Colorado, Utah, Minnesota, Virginia, Pennsylvania, Florida, Massachusetts, Delaware, and New Hampshire – anticipate running out of funding by the end of January 2018. It is absolutely critical that Congress pass a CHIP reauthorization immediately; playing politics with the healthcare of 9 million American children is unacceptable.

We urge you to make your voices heard in Washington and to make it known that nurses demand comprehensive and quality care for all of the nation’s citizens, regardless of age or income level. Click here to tell your  representatives loudly and clearly that the Tax Cuts and Jobs Act is bad for Americans’ health and well-being and that CHIP is a crucial program for our children’s health.

 

Senate Attempts to Stabilize Healthcare with Bipartisan Agreement

  

Yesterday, Senate HELP Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) announced they had reached a short-term deal bipartisan healthcare legislation. This legislation would stabilize individual insurance markets and protect patients and families from premium spikes and uncertainty caused by the Trump Administration’s two decisions last week intended to destabilize the ACA marketplaces.

The deal negotiated by Alexander and Murray would fund payments to help lower costs for families, provide added flexibility to states, protect essential health benefits for patients, and restore investments for open enrollment outreach.

The bill would:

  • Restore Cost-Sharing Reduction payments and the certainty that is crucial to continued market stability and affordability for families. Insurers have raised rates by as much as 30% because of the uncertainty around CSR payments and continue to threaten exit from insurance markets.
  • Restore certainty to health care markets by ensuring CSRs will continue through 2017, 2018, and 2019.
  • Include steps to ensure 2018 enrollees receive the financial benefit of CSRs for the coming year.
  • Require the Department of Health and Human Services (HHS) to increase funding for outreach and enrollment assistance activities for 2018 and 2019; this is a top priority for ANA with Open Enrollment beginning November 1.
  • Put in place extensive reporting requirements to make sure HHS is held accountable for implementing Open Enrollment in 2018 and 2019.

Most importantly, the bill would generally keep in place essential health benefits and protections for pre-existing conditions with the exception of consumers who qualify for catastrophic plans.

The legislation will need 60 votes to pass through the Senate and ultimately Majority Leader Mitch McConnell will determine if the bill goes to the floor for a vote. In addition, lawmakers will need to convince the President that this bill will benefit the consumer and not the insurers. To date, the President has responded with mixed reviews.