Washington DC Update:
HOUSE REPUBLICAN RELEASE PROPOSED LEGISALTION TO REPEAL AND REPLACE AFFORDABLE CARE ACT – PROPOSAL COULD HAVE MAJOR SWEEPING IMPACT TO MEDICAID ACROSS NATION
SACRAMENTO, CA [BY MARTY OMOTO, CDCAN LAST UPDATED 03/06/2017 05:35 PM] – The Republican controlled House Energy and Commerce Committee released today proposed legislation to repeal and replace the Affordable Care Act, also known as “Obamacare” that includes provisions that would have major sweeping impact to Medicaid – called “Medi-Cal” in California.
House Republicans call the proposed legislation a step that will “…responsibly unwind Obamacare’s Medicaid expansion…”
The proposed legislation is sure to encounter stiff opposition from House and US Senate Democrats and disability and senior advocates in California and across the nation.
The legislation will go through changes as it moves through the process in the US House of Representatives, and approval, at least of the bill in its current form by both the House and US Senate is far from certain.
The proposal is likely to draw opposition from some Republicans in both houses, including those who simply want to repeal the landmark federal health care law with no replacement.
The proposed legislation is titled the “American Health Care Act”, and House Republicans intend to move the measure through a federal budget process known as “reconciliation” that can speed up the time needed for the bill to make its way through Congress by limiting debate in both houses. The process has significance in the US Senate because debate there would be limited to 20 hours under US Senate rules, meaning the legislation would not be subject to a filibuster, and would only require a simple majority to pass.
The House Energy and Commerce Committee has scheduled a markup of this legislation (essentially its first hearing) on Wednesday, March 8, at 10:30 a.m., in room 2123 of Rayburn House Office Building.
IMPACT TO CALIFORNIA
The specific impact of the proposed legislation to California is still being analyzed by policymakers and advocates, but some details have emerged (CDCAN will issue a more detailed report later tonight or tomorrow morning). The impact of each proposal within the proposed legislation varies on different Medicaid populations, though the proposed cap on reimbursements would impact every Medicaid recipient in a state:
CAPS MEDICAID PAYMENTS: The legislation proposes a new way to reimburse the states for their Medicaid expenses (called “Medi-Cal” in California) by requiring states to transition to a “per-capita cap” financing system. This would cap federal Medicaid spending for each Medicaid recipient, in exchange for providing more flexibility to the States in what Medicaid benefits and services they can provide. Supporters of this proposal say it can be a way for the federal government to control costs while giving new flexibility to states in providing Medicaid services. Opponents fear that capping reimbursements to the States will have the impact of lessening ability of states to expand needed services and supports to people who need it; significantly restrict a state’s ability to respond to increased costs in health care, including prescription drug costs because reimbursements are capped. This proposal would have an unknown but potentially significant impact on funding for other Medicaid funded services in California, including those that fund regional center funded services for eligible persons with developmental disabilities.
MEDICAID EXPANSION: Legislation proposes to stop the Medicaid (called “Medi-Cal” in California) expansion under the Affordable Care Act by freezing new enrollments after 2 years – this refers to persons who are only eligible for Medicaid (Medi-Cal) under the expansion authorized by the federal Affordable Care Act. Persons currently enrolled under the Medi-Cal expansion (under the Affordable Care Act) would be allowed to keep their Medi-Cal benefits, but only if they do not have a break in eligibility for more than one month, effective in 2020. In California, this could have impact to the approximately 4 million Californians (of the total Medi-Cal population of nearly 14 million Californians) who became eligible for Medi-Cal under the expansion allowed under the Affordable Care Act
ELIMINATES 6% ADDITIONAL FEDERAL MATCHING FUND FOR COMMUNITY FIRST CHOICE OPTION: Legislation proposes to eliminate what the House Energy and Commerce Committee calls the “bonus” 6% in federal matching Medicaid funding for the Community First Choice Option under the Affordable Care Act, and would return to prior federal law without that additional 6% (no effective date is listed). Community First Choice Option provides Medicaid funding for much of California’s In-Home Supportive Services (IHSS) program. Medicaid usually provides 50% matching funds to a state, with the state providing the other 50%, though there are certain programs or expansion efforts – such as those authorized under the Affordable Care Act, that provide a much greater federal contribution. The federal Medicaid match for the Community First Choice Option is at 56% instead of the more “normal” 50% – and it is that 6% that the legislation proposes to eliminate. If Congress and the President approved this provision, it would not mean a loss in benefits or services under IHSS, but would mean that California would have to make up the difference of the loss of that 6% “bonus” with State general funds (or other funding). That loss in federal funding however could mean that California would then be forced to reduce State general fund spending on other services and programs.
ESSENTIAL HEALTH BENEFITS: Legislation proposes to repeal the requirement that State Medicaid plans must provide the same “essential health benefits” that are required by plans on the exchanges, effective December 31, 2019.
REPEAL AFFORDABLE CARE ACT COST SHARING AND TAX CREDIT SUBSIDIES: the legislation proposes to replace the existing income-based assistance under the Affordable Care Act with a new “Patient and State Stability Fund”, funded at an unspecified amount, that would provide states with flexibility to decide whether or how they will continue to provide financial assistance to their Medicaid recipients (enrolled under the Medicaid expansion allowed under the Affordable Care Act) moving forward.
LINKS TO COPY OF LEGISLATION AND RELATED DOCUMENTS
COPY OF ENTIRE PROPOSED LEGISLATION FROM HOUSE ENERGY AND COMMERCE COMMITTEE (INCLUDING RECOMMENDATIONS FROM THAT COMMITTEE AND THE HOUSE WAYS AND MEANS COMMITTEE) – PDF DOCUMENT COPY (66 PAGES) FROM HOUSE ENERGY AND COMMERCE WEBPAGE:
COPY OF SECTION BY SECTION SUMMARY BY HOUSE ENERGY AND COMMERCE COMMITTEE OF THE LEGISATION – PDF DOCUMENT COPY (8 PAGES) FROM THE HOUSE ENERGY AND COMMERCE WEBPAGE: