5 Tips for ACA Change Binge Watchers

In theory, some sick people who had been members of employer-sponsored health plans were supposed to be able to get health coverage.

The Health Insurance Portability and Accountability Act of 1996, the law that created the health insurance access requirement, did not set any affordability standards for the coverage for sick people.

Some states set up risk pools, or subsidized government health plans, for people classified as uninsurable, but many of those risk pools were underfunded. Some, including the risk pool in California, had low benefits limits, and some, including the risk pool in Illinois, had long waiting lists.

That meant ordinary uninsured people who needed expensive care had to depend on charity care, impoverish themselves enough that they could qualify for Medicaid, or go without the care.

H.R. 1628 would let states with risk pools apply for waivers from some ACA rules. It would also provide $8 billion in subsidies over five years specifically to help consumers in states with ACA rule waivers, and another $100 billion market stabilization fund that could be used to help people with health problems.

If states used all of the H.R. 1628 subsidy money to help people with health problems, that might be only enough cash to provide risk pool coverage for about 600,000 of the 2.2 million current individual health coverage users who have health problems, according to analysts at Avalere Health.

The money specifically provided for helping individual coverage policyholders with health problems would only be enough to provide coverage for about 110,000 of the 2.2 million individual health coverage users with health problems, according to the Avalere analysts. 

(Photo: Thinkstock)

3. Efforts to eliminate the ACA essential health benefits package standards could touch all people with fully insured commercial health coverage. 

One amendment added to H.R. 1628 would let a state that applied for an ACA rule waiver establish its own EHB package, rather than using the benchmark set by the U.S. Department of Health and Human Services. 

(Related: View: 4 Reasons Insurers Should Always Cover Treatment for Autism)

A state could, for example, eliminate the need for a state-regulated insurance policy to offer maternity benefits, mental health benefits, coverage for name-brand drugs, or expensive types of therapy aimed at people with autism.

Changes in a state’s EHB package could affect benefits for people with fully insured group coverage as well as people with individual major medical coverage.

Elizabeth MacDonough (Photo: Congressional Pictorial Directory)

4. The Senate parliamentarian has a budget of $1,999,000.

Senate customs give the Senate parliamentarian, a Senate staffer who works for the Senate majority leader, the authority to decide which provisions in a budget measure are germane to the federal budget.

(Related: ACA Repealers Face Byrd Rule Constraints)

Senate parliamentarians tend to be obscure officials who rarely attract much notice, except during heated budget fights. They are said to be hard to replace, because they have rare knowledge built up over years of working for the Senate.

Elizabeth MacDonough, the current parliamentarian, has been serving in that position since 2012. She has a bachelor’s degree from George Washington University and a law degree from Vermont Law School.

The House revealed, when it was considering H.R. 244 — the vehicle for getting the Consolidated Appropriations Act, 2017, bill through the House — that MacDonough’s office is big enough to have a significant budget.

The House appropriations bill included $1,999,000 in funding for MacDonough’s office for the rest of the federal government’s current fiscal year, which ends Sept. 30. 

(Photo: Thinkstock)

5. Republican governors have their own dog in this fight.

One source of drama could be Republican governors.

In the past, many Republican governors have agreed to take Affordable Care Act Medicaid expansion money. They may be leery of efforts to reduce Medicaid funding. Some analysts suggest that H.R. 1628 could cut Medicaid funding by a total of about $880 billion over 10 years.

Even governors who would be willing to accept a new Medicaid funding formula might not be eager to be in charge of new fights over matters such as whether a state’s essential health benefits package ought to require a health plan to cover mental health care, or maternity care.

— Read GOP Bill’s Medicaid Cuts Draw Fire From Insurers, Governors on ThinkAdvisor.