March 10, 2017 Edition

House Republicans Release Repeal and Replace Bills

On Monday, March 6, the House Ways and Means and Energy and Commerce Committees released their bills to repeal and replace the Affordable Care Act. The bills essentially provide significant tax relief to insurers, while making coverage less affordable and less comprehensive for consumers. Mark ups on these proposals are expected tomorrow, Wednesday, March 8.

Provisions of particular interest to CHEAC are noted below:

Prevention and Public Health Fund. Beginning in FY 2019, the appropriations for the prevention and public health fund are repealed. Any unobligated FY 2018 funds at the end of the fiscal year are rescinded.

Medicaid Expansion. The Supreme Court ruling allowing states to opt into the Medicaid expansion is codified. However, the ability for states to opt into expansion expires December 31, 2019. After January 1, 2020, the enhanced match for newly eligible beneficiaries is repealed and the traditional matching rate (FMAP), which is currently 50% is reinstated.  For new eligibles enrolled prior to January 1, 2020, the enhanced match only continues so long as the enrollee does not have a break in coverage for more than one month, otherwise, the enhanced match is no longer available for that enrollee and instead the traditional matching rate is applied.

Per Capita Cap. A per capita cap model (per enrollee limits on federal payments) is implemented beginning in FY 2020. State spending in FY 2016 is used as the base year to set targeted spending in enrollee categories (elderly, blind and disabled, children, non-expansion adults, and expansion adults) in FY 2019. The amount is adjusted annually based on the consumer price index. In FY 2020, states that spend higher than their targets will received reductions to Medicaid funding in the following fiscal year.

Refundable Tax Credits. A refundable and advanceable tax credit for the purchase of health insurance is created. Credits are adjusted by age and cannot exceed $14,000. The credits are available to those making up to $75,000 and phases down by $100 for every $1,000 in income higher than that threshold.

Health Savings Accounts. The use of health savings accounts is encouraged through increasing the limit on aggregate health savings account contributions per year to cover the annual deductible and out-of-pocket expenses under a high deductible plan ($6,550 for an individual; $13,100 per family) beginning in 2018.

Essential Health Benefits. The requirement that plans provide the 10 essential health benefits is repealed and the decision regarding required benefits is deferred to states beginning December 31, 2019.

Changes to Current Eligibility Determinations. There are several changes to eligibility including:

  • Providing a temporary 5% FMAP increase for states that increase the frequency of their eligibility redeterminations to every 6 months.
  • Reverting the Medicaid income eligibility level for children back to 100% of the FPL from 133% of the FPL as the ACA allowed. States can continue to cover children at a higher FPL through the State Children’s Health Insurance Program (CHIP).
  • Eliminating the current retroactive eligibility coverage, which goes back three months and only limit retroactive coverage to the month the applicant applied.
  • Repealing expanded authority to make presumptive eligibility determinations beyond those for children, pregnant women and cervical cancer patients. This includes eliminating hospital presumptive eligibility, which California implemented.
  • No longer allowing individuals to enroll and receive Medicaid benefits prior to providing documentation verifying citizenship or eligible immigration status.

 DSH. The Disproportionate Share Hospital (DSH) cuts imposed by the ACA are eliminated for expansion states in 2020 and non-expansion states in 2018.

Safety Net Funding for non-expansion states. $10 billion over five years is provided to non-expansion states based on the number of individuals below 138% of the FPL, made available through increased matching rates through CY 2022.

Stability Funds. A Patient and State Stability Fund is created, which a state may access if their uninsured population for individuals below 100% FPL increased from FY 2013 to 2015 or if fewer than three plans offer coverage on the exchange individual market in 2017. $15 billion per year is appropriated in FY 2018 and FY 2019. From 2020-2026, $10 million is annually appropriated. A state match will be phased in.

Continuous coverage. The individual mandate is repealed after December 31, 2015, and instead a penalty is assessed for gaps in coverage. Beginning in open enrollment for FY 2019, a 30% late-enrollment surcharge is assessed on market entrants that had a lapse in coverage for greater than 63 days.

Links to Bills and Summaries

 Legislative recommendations from the Ways and Means Committee

Section-by-section of the Ways and Means legislation

Legislative recommendations from Energy and Commerce

Section-by-section of the Energy and Commerce legislation

GOP “American Health Care Act” clears First Hurdle

The House Ways and Means and Energy and Commerce Committees advanced their respective repeal and replacement bills without accepting any amendments. The bills will be heard in the House Budget Committee next week before heading to the House floor. The Congressional Budget Office has not yet scored the bills. Several organizations have voiced their opposition, including the AARP, the American Hospital Association and the American Medical Association.

Both NACCHO and NACO have issued press releases on the GOP’s bills.

The Kaiser Family Foundation has also updated their interactive plan comparison tool.

Legislative Update

The CHEAC Legislative Committee met for our second and final in-person meeting of the year to review the last batch of introduced bills. An updated bill chart with all newly added bills will available next week.  CHEAC’s current bill chart can be found here.

A few actions taken by the Legislative Committee are highlighted below:

Chronic Disease Prevention and Wellness Promotion

SB 300 (Monning) – as introduced 2/13/17 – Support

Requires safety warning labels, stating that “drinking beverages with added sugar contributes to obesity, diabetes and tooth decay” be placed on sugar-sweetened beverages (SSB) by 7/1/18.

Communicable Disease Control

AB 511 (Arambula) as introduced 2/13/17 – Support

Replaces universal tuberculosis (TB) testing with universal tuberculosis screening, with testing only if indicated, in a variety of code sections pertaining to temporary nursing assistants, volunteers in crisis nurseries, and park or recreational staff, among others.  AB 511 is a HOAC sponsored bill.

Health Coverage/Health Reform

AB 340 (Arambula) as introduced 2/7/17 – Support

Requires that EPSDT screenings include screening for trauma.

Tobacco Control

AB 725 (Levine) as introduced 2/15/17  & SB 386 (Glazer) as introduced 2/14/17 – Support

Bans smoking and disposal of cigar/cigarette waste at a state coastal beach, all parks, public campgrounds, monument sits, landmark sites and sites of historical interest deemed by the state. Smoking includes the use of e-cigarettes.

IHSS/CCI heard in Assembly Budget Subcommittee No. 1

This week, the Assembly Budget Subcommittee No. 1 on Health and Human Services heard In-Home Supportive Services (IHSS) issues, including the Governor’s action to discontinue the Coordinated Care Initiative (CCI) and the elimination of the county IHSS maintenance of effort (MOE).

The Assembly put forth a proposal that would:

  • Increase the county MOE by $626 million and reinstitute the 3.5% cap on growth.
  • Create a special fund to supplement 1991 Realignment funds until growth funds can fully cover the increased MOE. Once 1991 Realignment revenues are in excess of the MOE costs, Realignment growth would then replenish the state special funds.
  • Continue statewide collective bargaining.

The Subcommittee did not move the proposal, but instead postponed a vote on the proposal for two weeks, until March 22, allowing counties additional time for consideration. The proposal was outlined in the agenda, beginning with page 13.

CHEAC has sent letters in opposition to the Governor’s action, which can be found here.

Senate and Assembly Budget Subcommittees hear CDPH Items

The Senate Budget Subcommittee No. 3 and Assembly Subcommittee No. 1 on Health and Human Services convened their respective hearings this week on issues related to the California Department of Public Health (CDPH). Dr. Smith, CDPH director, provided members with a general overview of the department, while several deputies provided members with program specific updates related to chronic disease and family health. CDPH highlighted activities related to Tobacco Tax funding (Prop 99 and Prop 56), violent death reporting, and childhood lead poisoning prevention program, among others.

Chairs of both Subcommittees seemed particularly interested in CDPH identifying public health areas that the Legislature could invest additional resources. All items were held open.


Senate Budget Subcommittee No. 3

Assembly Budget Subcommittee No. 1