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Must-Pass Funding Bill May Reveal ACA Exchange Secrets

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The House has put new Affordable Care Act public exchange system reporting rules in a critical new government funding package.

One provision could show how many federal employees really work on ACA programs.

Another provision could give observers much more information about ACA public exchange enrollment while the open enrollment period is under way. 

(Related: DOL Fiduciary Rule Spared Death in Spending Bill)

The House Rules Committee has revealed the possible contents of the funding measure, which is really a proposed amendment to an unrelated bill, H.R. 244, in a collection of H.R. 244 documents posted on its website.

The committee prepares legislation to go to the House floor.

The committee plans to start packaging H.R. 244 for floor action at 3 p.m. Tuesday. The committee posts live video of most of its meetings on the web.

Congress passed one emergency government funding bill Friday. That new law was enough to keep the government running for just one more week.

House Republicans worked with House Democrats to hammer out the 1,665-page legislation now under consideration, the Consolidated Appropriations Act, 2017, in an effort to provide enough funding to keep the government open at least until September.

House leaders intend to bring the package to the floor by attaching it as an amendment to H.R. 244, the HIRE Vets Act bill.

The funding amendment would not make major changes to Affordable Care Act rules and programs, but it would make some small changes. Here’s a look at some of the proposed changes.

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1. Preventive Health Fund Spending Report

Section 219 of Title II would require the secretary of the Department of Health and Human Services to publish detailed web reports on how HHS uses the preventive health cash provided by Section 4002 of the Patient Protection and Affordable Care Act of 2010.

PPACA is one of the two laws in the ACA package.

Critics of the ACA have argued that former President Barack Obama’s HHS used the PPACA Section 4002 fund as a slush fund, to pay for whatever it wanted to pay for.

2. ACA Program Staffing

Section 220 of Title II would require the HHS secretary to give reports showing how many federal employees and federal contractors are working on “implementing, administering, enforcing or otherwise carrying out the provisions of the ACA, and the amendments made by that act.” That could, include, for example, figures on how many people work on, the HHS exchange enrollment and account administration system.

The ACA staffing reports would have to cover the 2018 fiscal year and each fiscal year since 2010.

Fiscal year 2018 starts Oct. 1.

The reports would have to show how much funding HHS offices or divisions received to support the employees’ and contractors’ efforts.

3. ACA Public Exchange Spending Reports

Section 221 of Title II would require the HHS secretary to publish a detailed description of how much money the Centers for Medicare & Medicaid Services, an arm of HHS, has spent on the ACA public exchange program each fiscal year since 2010, and how much it expects to spend on the program in fiscal year 2018.

4. ACA Public Exchange Enrollment Reports

Section 222 of Title II would require the HHS secretary to send the House and Senate detailed ACA public exchange enrollment data during the ACA individual major medical open enrollment period.

5. ACA Risk Corridors Program

The ACA risk corridors program originally was supposed to use cash from thriving ACA public exchange plan issuers and, possibly, the government to help struggling issuers in 2014, 2015 and 2016.

Republican critics of the ACA called the program an insurance company bailout and blocked funding to it. At this point, insurers have received about 15% of what they thought they’d get for 2014 and nothing else.

Insurers argue that they based business decisions and premium rates on government promises that the risk corridors program would exist, and that the government should make the payments it said it would to make.

Section 223 of Title II would forbid CMS from using any cash transferred to the CMS program management account by the Consolidated Appropriations Act, 2017, to make risk corridors program payments.

6. Women’s Preventive Health Benefits

Congress seems to be close to agreeing that the ACA preventive services benefits mandate for breast cancer screening is special.

Section 226 of Title II would treat the ACA breast cancer benefits coverage requirement as if it were in effect before the ACA came along at least until Jan. 1, 2019. The provision apparently would shield the provision from any later efforts to roll back ACA preventive services benefits requirements. 

— Read The Glory Days Are Over: 4 Tips for Investing in a Low-Return World on ThinkAdvisor.


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