Health Insurance

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Healthcare reform

Under the leadership of Center Director Gerald Kominski, a “rapid response” team of six 
researchers began tracking in December 2016 major activity surrounding “repeal and replacement” of the ACA.

The team – all post-graduate students from the Department of Health Policy and Management at the UCLA Fielding School of Public Health – compiles a multi-page weekly report that has short descriptions of events such as legislators’ actions on repeal and ACA-related court cases at the federal level; health coverage plan changes or proposals in various states; health insurance and ACA-related reports published by organizations such as the Commonwealth Fund and polls by the Kaiser Family Foundation; relevant journal articles and news stories, such as marketplace enrollment tallies and the planned departure of Humana, Inc. the from state health exchanges in 2018.

Find weekly briefs compiled by the “rapid response” team below:

Senate health care bill goes from “Repeal and Replace” to “Repeal and Delay”1,2,3,4,5,6,7,8

Over the July 15-16th weekend, Majority Leader Mitch McConnell announced that the vote on the Senate’s health care bill, the Better Care Reconciliation Act (BCRA), would be delayed indefinitely due to Senator John McCain’s absence following surgery needed to remove a blood clot from his eye. Without Senator McCain, the bill did not have the necessary support to proceed. On Monday night, two more Republican senators, Sens. Mike Lee (UT) and Jerry Moran (KS), then came out against the bill. Sen. Moran said that he opposed the bill because it does not “repeal the ACA or address health care’s rising costs.” Sen. Lee expressed similar sentiments, adding that the bill did not “go far enough in lowering premiums for middle-class families.” These two solid votes against the bill added to the two senators, Sens. Susan Collins (ME) and Rand Paul (KY), who had already spoken out against BCRA and effectively killed the bill. 

Responding to the failure of BCRA in the Senate, President Trump turned to Twitter to show support for Republicans repealing the ACA without an immediate replacement. This method has been called “repeal and delay” because it would leave a 2-year period for congress to come up with a replacement for the ACA before the repeal goes into effect. McConnell said that he would go down the path of repeal and delay and plans to soon hold a vote on the House-passed bill. During the voting process, an amendment to replace the House-passed bill with a slightly revised version of the 2015 reconciliation bill that repeals most of the ACA would be put forward. In order to start the process, however, McConnell would still need 50 votes. With McCain out of DC, Republicans only have 51 votes. Collins voted against the 2015 measure and immediately came out against voting to repeal the ACA without a replacement, alongside Sens. Shelley Moore Capito (WV) and Lisa Murkowski (AK). These three votes are enough to stop repeal and delay from getting enough momentum, however McConnell has said that he would still move to hold the vote in order to put senators on the record, likely holding a vote early  next week, although it is not yet clear what bill they would be voting on. GOP Senators have continued to meet to discuss their options and ways forward with repealing the ACA.

President Trump has since said that he plans to let the ACA fail if there is no progress on repealing the legislation. The president claimed that he and Republicans will not own the ACA if it fails, however polling on the subject indicates that 59% of the public would consider an ACA failure to be the fault of Republicans and that President Trump should try to make the ACA work (75%) rather than make the law fail so that they can replace it (19%). It is up to the Trump administration to continue making payments to insurance companies for the law’s cost-sharing reductions, to enforce the individual mandate, and to adequately advertise open enrollment periods for the federally-facilitated health insurance marketplace. And contrary to the popular line of discourse from Republicans about the ACA’s insurance exchanges, there is growing evidence that the individual market has been stabilizing and that insurers are starting to make a profit, all while the government’s projected spending on health care is less under the ACA than it would have been without it. 

CBO releases two scores of GOP legislation 9,10,11,12,13

The CBO released two separate scores of draft bills for repealing the ACA. The first score came out on Wednesday and focused on the revived bill that would repeal the ACA without a replacement, known as the Obamacare Repeal Reconciliation Act (ORRA). The CBO originally scored a version of the ORRA in 2015, and much like their score at that point, this one estimated that 32 million more Americans would be uninsured under the repeal only legislation compared to current law. Although the updated version of the bill would continue funding the ACA’s cost-sharing subsidies for two years, the CBO still predicts that insurers would leave the health insurance marketplaces by 2020 and leave half of the country without access to individual coverage options. The bill is also estimated to decrease the federal deficit by $473 billion over 10 years, largely coming from cuts to federal funding for Medicaid. The second CBO score focused on the repeal and replace plan from GOP Senators, known as the Better Care Reconciliation Act. In terms of the number of uninsured, this score is the same as the previous version of the BCRA, estimating that 22 million more would be uninsured under the drafted legislation compared to current law. However, the new score estimated that the updated legislation would reduce the federal deficit by $420 billion over a decade, an increase over the prior estimate due to the preservation of a number of ACA taxes in the new bill. The score did not include an analysis of Sen. Ted Cruz’s amendment. Republicans have been very critical of the CBO recently and have worked to undermine the agency’s reports. In response, eight former CBO directors sent a letter to Congress objecting to the recent attacks on the agency. 

HHS releases report on Sen. Ted Cruz’s Consumer Freedom amendment14,15

The Trump administration released a preliminary report on Ted Cruz’s Consumer Freedom amendment. The report assumed that the amendment would be added to the ACA rather than as a part of the GOP’s BCRA a scenario that, thus far, has not been discussed in Congress. The report suggests that the amendment would lower the cost of health insurance. However, a number of economists have reviewed the analysis and found it to be unclear and possibly deliberately misleading. For example, as Loren Adler and Matt Fielder at the Brookings Institute pointed out, a chart comparing individual market monthly premiums in 2017 to those under the Cruz amendment shows the average premium for younger people under the Cruz amendment than under current law. The report also focuses solely on premiums and does not include costsharing or the benefits that would be covered under the different plans. 

Urban Institute analysis of BCRA’s effect on the number of uninsured nonelderly people16

The Urban Institute released a state-by-state analysis of the effects of the July 13th version of BCRA on the number of nonelderly uninsured residents. On average, the analysis found that the number of nonelderly uninsured Americans would increase 78% by 2020, from 30.78 million to 54.8 million. The law’s effects would vary by state, ranging from a 20% increase in Georgia to 299.4% increase in West Virginia. California would see an increase of 138.8% in the number of uninsured nonelderly residents.