Update on the Senate’s efforts to Repeal parts of the ACA

After releasing the Better Care Reconciliation Act at the end of last week, leadership in the U.S. Senate announced this week that it will not be voting on the bill before the July 4th Congressional recess as planned. Instead efforts are underway to overhaul the bill, with a vote is expected sometime after the recess. Senate Majority Leader Mitch McConnell has said that he intends to submit a new version of the bill to be scored by the Congressional Budget Office today. [More]

Section 1332 State Innovation Waiver – Recent developments and the newly-released checklist

In follow-up to its letter to Governors regarding the Section 1332 Waiver opportunity, the Centers for Medicare and Medicaid Services (CMS) and the Department of Treasury released a Section 1332 checklist on May 16 designed to help states pursue ACA State Innovation Waivers. Section 1332 of the ACA allows states to waive specific ACA provisions as long as they apply according to the process set out in regulations and meet the following comparability requirements:

• The waiver will provide coverage to at least a comparable number of the state’s residents as would be provided without the waiver;
• The waiver will provide coverage and cost-sharing protections that are at least as affordable as would be provided without the waiver;
• The waiver will provide for coverage that is at least as comprehensive as would be provided without the waiver; and
• The waiver will not increase the federal deficit. [More]

New ACA-Related announcements from the Federal Administration

The administration is taking more limited steps to influence implementation of the law, including two upcoming changes to enrollment through Marketplaces announcements last month. On May 15, the Centers for Medicare and Medicaid Services (CMS) announced that it will be proposing a rule to have enrollment into Federally-facilitated Small Business Marketplace (known as Small Business Health Options Program or “SHOP”) health insurance plans go directly through insurers as of 2018. Two days later, on May 17, CMS released guidance enabling (but not requiring) full direct enrollment in individual market Federally-facilitated Marketplace (FFM) plans starting for open enrollment for plan year 2018. [More]

PCG creates summary of the House-passed health care bill

The American Health Care Act (“the bill”) passed the House of Representatives on May 4, 2017. As outlined in greater detail in the PCG summary, the bill does not repeal the Affordable Care Act (ACA) in full, but rather proposes changes primarily focused on the ACA’s insurance affordability, Medicaid expansion, coverage requirements and revenue provisions. It also proposes changes to Medicaid funding more generally and allows states to waive medical underwriting prohibitions. [More]

States continue to pursue Section 1332 State Innovation Waivers

With repeal of the Affordable Care Act (ACA) stalled, states are increasingly considering Section 1332 Waivers as a way to expand upon or customize the ACA to best address the unique circumstances within the state. Alaska and Oklahoma are the two most recent states to take formal steps toward State Innovation Waivers, both states following on the heels of the recent Section 1332 Waiver approval granted to Hawaii, which we summarized in the February edition of Health Policy News. [More]

House Committees move forward on ACA repeal

The House took a major step in advancing action on the Affordable Care Act (ACA) with the filing of the American Health Care Act. The bill, which was filed in the House of Representatives on March 6, 2017, is a compilation of budget reconciliation packages from the House Ways & Means Committee and the House Energy & Commerce Committee, in follow-up to the budget resolution adopted in January. [More]

Transitional health plans to continue through 2018

In November of 2013, the Centers for Medicare & Medicaid Services (CMS) introduced the concept of “grandmothered plans,” coverage in place prior to 2014 that would have been prohibited as of 2014 as a result of changes under the Affordable Care Act (ACA). CMS issued guidance permitting those plans to be renewed for existing policyholders if permitted by states. Specifically, such plans are not considered to be out of compliance with ACA provisions related to... [More]

CMS issues final 2018 Marketplace guidance

The Centers for Medicare and Medicaid Services (CMS) finalized its annual Notice of Benefit and Payment Parameters for 2018 (NBPP) and its 2018 Letter to Issuers in the Federally-Facilitated Marketplaces (Letter) on December 16, 2016. As is typical, the NBPP addresses a breadth of issues relative to health plan regulation as well as Marketplace operations. The Letter provides operational and technical guidance for issuers seeking to offer Qualified Health Plans (QHPs) and Standalone Dental Plans (SADPs) on Federally-Facilitated Marketplaces (FFMs) and State-Based Marketplaces on the Federal Platform (SBM-FPs). [More]

Hawaii receives approval of 1332 State Innovation Waiver submission

Hawaii requested a 1332 State Innovation Waiver in order to preserve the state’s Prepaid Health Care Act (Prepaid) by exempting the state from requirements related to the Small Business Health Options Program (SHOP). Since the enactment of Prepaid in 1974, employers in Hawaii have been required to provide health insurance coverage that meets the evolving standards of Prepaid to employees working 20 hours or more per week, with some exceptions. In 2011, more than 480,000 non-union employees and their dependents were covered under employer-sponsored Prepaid-compliant plans. [More]

Roundup of federal health policy developments

The debate over the future of the Affordable Care Act (ACA) is well-underway and there are a number of significant developments that warrant a closer look. Here we provide a roundup of recent developments.

Administrative Action
Upon entering office, President Trump signed two Executive Orders. The first, on January 20, entitled... [More]