27 Jun New developments in Senate health care bill
CBO score released on Senate Health Care Bill, new provision added to penalize lapse in coverage
by TN Council on Developmental Disabilities
Due to rapid developments this week, we are writing with updates related to the Senate health care bill, the “Better Care Reconciliation Act“.
Yesterday, Monday 6/26, the Congressional Budget Office estimated that an estimated 22 million more Americans to be uninsured in the coming decade (compared to approximately 24 million in the House version) and would reduce federal spending by $321 billion by 2026 (compared with $119 billion for the House’s version.) The Washington Post notes that the CBO’s estimate is limited to a 10 year timeframe, and major changes in the Senate version would take place in years 11, 12, 13, including a phase-out of Medicaid expansion (which Tennessee did not do) and lower-growth rate for federal payments to states under the “per capita cap” model. (Learn more about Per Capita Caps proposed in each bill, plus the unique impact in TN, from the Sycamore Institute in this short, helpful post, published on Friday 6/23).
Additionally, a new provision was added to the Senate health care bill, which would make those who had a lapse in coverage for 63 days or more wait six months before obtaining insurance. This provision was not included in the first draft of the Senate bill, which means it was not part of the score by the CBO. The provision is intended to address concerns that people would only sign up for health coverage when they’re sick, leading to higher costs. This is a concern because the bill removes the “individual mandate” that was part of the Affordable Care Act, which currently issues a financial penalty – adjusted for income – for those who choose not to purchase insurance.
As we reported on Friday, several Senators, including Tennessee’s, were waiting for the CBO score before deciding how to vote. The vote is expected on Thursday of this week (6/29). As of last night, there are reports that Senators are expressing concern over the CBO score.
It is our responsibility to educate Tennessee’s Senators before Thursday about the impact on people with disabilities.
Use this one-pager when making contact with Sen. Alexander and Sen. Corker. You can reach their offices by calling the Capitol Switchboard at 202-224-3121.
Health Affairs released a helpful blog post yesterday outlining key elements of the Senate draft. Highlights about the impact of the Senate version include:
- Ending Hospitals Presumptive Eligibility Option (§ 125), which allowed certain hospitals to provide care faster by temporarily enrolling children and pregnant women who met income requirements instead of waiting for a full eligibility screening. (Read more here).
- Eliminating Enhanced Federal Funding To Cover the Medicaid Expansion Population (§ 126)
- Eliminating The Essential Health Benefit Coverage Standard For The ACA Expansion Population (§ 126), which includes things like mental health, emergency, and maternity care. Read more here.
- Enhancing Federal DSH Allotments For Non-Expansion States (§127)DSH stands for “Disproportionate Share Hospital”, which disproportionately serve low income payments. This temporary payment increase in effect rewards states that have not adopted the Medicaid expansion (like Tennessee).
- Eliminating Retroactive Eligibility (§128), which helps insure that indigent people are not turned away from expensive care because they are not yet Medicaid enrollees. The House and Senate measures both would shorten the retroactive eligibility look-back period from 3 months to 1 month. Retroactive eligibility has been a feature of Medicaid since it was created in 1965.
- Giving Non-Medicaid Expansion States (More) Additional Federal Funding For Hospital Care (§129), which is another reward for non-expansion states like Tennessee.
- Encouraging States To Conduct More Frequent Eligibility Redeterminations (§130), which checks to see if the person still qualifies for Medicaid. Typically, this occurs annually under current law.
- Allowing States To Impose A Work Requirement As A Condition Of Eligibility (§131) on non-disabled, nonelderly, and nonpregnant adults. Both measures would use the TANF work rules as the basis of a new Medicaid work policy.
- Limiting States Use Of Provider Taxes As Source Of State Funding (§132) Broad-based and uniformly applied provider taxes have been an explicitly recognized feature of federal Medicaid policy since the early 1990s and are integral to the funding of state programs.
- Establishing Per Capita Caps (§133) Like the House, the Senate would exempt certain state expenditures and certain populations from the cap calculations, including CHIP enrollees, beneficiaries served by the Indian Health Service, people enrolled on the basis of a breast or cervical cancer diagnosis, and children – up to age 18 – entitled to Medicaid on the basis of disability or blindness. Several analyses have indicated that due to the magnitude of overall cuts, the “carve outs” for these populations will not guarantee coverage. There are a few differences from the House bill, including: the way the “base year” for establishing the cap amount would be calculated (the Senate version would permit states to select a base period consisting of 8 consecutive calendar quarters between FY 2014 and the third quarter of FY 2017, rather than using FY 2016).
- Creating a Block Grant Option: The Medicaid Flexibility Program (§ 134) The draft limits the block grant to people who belong in the enrollee category (created for purposes of the per capita cap formula) known as “other nonelderly, nondisabled, non-expansion adults.” (Senate Draft §133). The scope of the program thus focuses on women and the very poorest and most vulnerable parents and caretakers.