By Jill Zorn
While Congress is not actively working on overt health care repeal at the moment, major threats to health care programs continue.
Frequent (private jet) flyer HHS Secretary Tom Price may be gone, but the Trump administration continues to up the ante on Affordable Care Act (ACA) sabotage. Their bag of tricks includes a shorter open enrollment season, shutdown of the enrollment system during crucial weekend hours, huge cuts to advertising and enrollment assistance budgets, and frequent claims that “Obamacare” is imploding/exploding.
Connecticut’s marketplace, Access HealthCT, is protected from some of these efforts. For example, our exchange controls its marketing and outreach budget and is not dependent on the federal government for that funding. Still, with disinformation constantly emanating from the federal government, the challenge will be getting the word out that the ACA is a reliable source of coverage and people should enroll.
And Connecticut’s marketplace is certainly vulnerable to some of the forms of sabotage. Of particular concern is the continued uncertainty surrounding payment of cost sharing reductions that is driving higher insurance rates. As this blog post explains, the rates set in Connecticut are 16.7% higher on average, based on the assumption these payments will not be received from the federal government. This poses an extra hardship for people that are not eligible for subsidies based on their income and must pay the full cost of their insurance premiums.
Federal Budget and Tax Reform
Both the House and Senate are working on budget frameworks for 2018 that rely on huge cuts in expenses to partly offset their planned huge cuts to taxes. At the same time, they are working on tax “reform” which will translate into massive tax cuts for the ultra-rich and corporations, and lead to the need to cut expenses even further.
As with the effort to repeal the ACA, the budget is being drawn up by Republicans only, with no input from Democrats. And, just as in the repeal fight, the budget could be passed with only 50 Republican votes in the Senate via the budget reconciliation process.
The draft budget under consideration in the House includes:
- Implementation of the American Health Care Act (AHCA). This was the repeal bill that passed in the House but died in the Senate. Even though it didn’t become law, the massive cuts to Medicaid in that bill, made by imposing funding caps, are now part of the baseline in the proposed House budget.
- Proposed cuts to Medicaid and other health programs of $1.5 TRILLION over the next 10 years
- Cuts to Medicare of just under $500 billion and privatizing the program through vouchers
- Other major cuts to discretionary programs like SNAP (food stamps) and housing aid
The proposed Senate budget resolution includes similar draconian cuts to health and social service programs. Once both chambers pass a budget resolution, they will have to come together in a conference committee to reach a compromise on the budget framework and reconciliation instructions.
October 1 came and went, without Congress passing legislation to reauthorize the Children’s Health Insurance Program (CHIP). While Connecticut has sufficient funds to keep our program running through February, several states are already seeking emergency funding or requesting to curtail enrollment.
The good news is both chambers are currently working on CHIP legislation. But disagreements on the length of the reauthorization, how to pay for the program and what legislative vehicle should be used to get the measure to the president’s desk could lead to further delays. As this New York Magazine article points out, any delay poses a fundamental danger to the program:
The longer this all drags on, the more some states will begin curtailing CHIP services, and the more likely it will become that the reauthorization bill will be taken hostage by interest groups looking for must-pass legislation to pull their own pet legislation through Congress.