NYAPRS Note: Just in: OMB Director Mick Mulvaney said the White House is ready to negotiate with Democrats on adding a key Obamacare subsidy to the fiscal 2017 spending package. Mulvaney said this evening that the Trump administration is willing to consider the cost-sharing subsidies in the spending bill if Democrats agree to pay for some of President Donald Trump’s priorities, specifically citing defense and border security money.
White House Officials, Craving Progress, Push Revised Health Bill
By Matt Flegenheimer and Reed Abelsonapril New York Times April 20, 2017
White House officials, desperate to demonstrate progress on President Trump’s promise to repeal the Affordable Care Act, are pushing to resurrect a Republican health care bill before his 100th day in office next week. But Congress usually cannot take on two big things at once. At the same moment Mr. Trump hits his 100th day on Saturday, April 29, Republican congressional leaders face a far more urgent deadline: Much of the federal government will run out of money.
Reaching agreement to keep the government open past midnight that Friday will be the first priority of Republican leaders when Congress returns Monday from a two-week recess…”.
…The latest version of the proposal, published Thursday morning by Politico, would maintain popular benefits in President Barack Obama’s signature domestic achievement, like guaranteed coverage for emergency services and maternity care. It would also preserve the health law’s ban on insurers rejecting customers with pre-existing medical conditions.
But under this Affordable Care Act replacement, states could seek waivers from many of those mandates if they demonstrate that premiums would be lowered, the number of insured people would increase, or “the public interest of the state” would be advanced.
States could request an exemption from the rule intended to ensure that people with pre-existing conditions could not be charged prohibitive premiums — but only if those states establish a high-risk insurance pool.
…The complications that remain in the bill are likely to be far too difficult to finesse at the same time the House and Senate press to pass a giant spending bill. Tussles over the spending deadline — including possible debates over top administration priorities like a border wall and money for immigration enforcement officers — are expected to consume the Capitol.
And Democrats — whose votes will be needed to keep the government open — will have their own demands, most importantly billions of dollars to lower out-of-pocket spending for low-income Americans purchasing health coverage on the Affordable Care Act’s online marketplaces.
Senior Republicans appear unconvinced that a revised health care bill would ensure passage in the House. Mr. Donovan, an opponent of the original Republican health care bill, said the proposed amendment “really doesn’t address the concerns that I had.”
Representative Charlie Dent, Republican of Pennsylvania and a leader of the moderate House Tuesday Group, said it “does nothing to change my views.” He lamented any focus “on an arbitrary 100-day deadline.”
Inside the latest GOP offer on Obamacare repeal
By Paul Demko and Adam Cancryn April 20, 2017
Republicans making a fresh attempt at dismantling Obamacare are hitting up against an old problem: how to take care of the nation’s sickest, most expensive patients.
The GOP’s latest proposal is a concept called “invisible risk sharing,” which would effectively create a federal backstop for health insurers. The idea — modeled after a similar program in Maine — aims to keep everyone covered while lowering premiums and freeing states to eliminate key Obamacare insurance protections.
…Under MacArthur’s proposal, which isn’t yet available in legislative text, states would be able to opt out of Obamacare’s requirement that people be charged the same for coverage regardless of their health status. But they’d also have to set up an invisible risk-sharing program to protect against sicker patients being priced out of the market.
The hope is that by protecting insurers from really expensive customers, it will bring down the costs for the rest of the risk pool. That will allow insurers to lower premiums, which in turn will entice more customers into the individual market.
…The main difference between Obamacare’s reinsurance program and the one now proposed by Republicans is who qualifies. Under reinsurance, once medical bills passed a certain threshold — initially $45,000 under Obamacare — the federal government, and not the insurer, would pick up the costs. But under the invisible risk pool concept, qualifying enrollees would be identified when they sign up. Under Maine’s approach, for example, individuals with eight qualifying diagnoses, including HIV and kidney failure, were by the high-risk pool.
One downside to this approach: It provides no protection against customers who unexpectedly rack up big medical bills. If someone is severely injured in a car accident, for instance, and requires multiple surgeries, the insurer would be on the hook for the full cost of that care.
But the biggest question about the GOP proposal is whether it will be adequately funded. The plan offered by Republicans before adjourning two weeks ago allocated $15 billion over nine years. There’s widespread agreement that much more money will be needed.
…The invisible risk-sharing program would also create new winners and losers within the health insurance industry. A company’s competitiveness in the market would depend again in part on how well it evaluates and prices its customers’ risks — a skill that insurers haven’t had to worry about since Obamacare required them to accept and treat all customers the same, regardless of health status….