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House, Senate Republican Leaders Near ACA Spending Fight

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Members of Congress could end up keeping Affordable Care Act spending levels, including the current curb on ACA risk corridors program spending, about the same.

The federal government’s fiscal year starts Oct. 1.

Members of the House are now debating H.R. 3354, the “Make America Secure and Prosperous Appropriations Act, 2018,” bill. That bill would set federal spending levels for many federal departments, including the U.S. Department of Health and Human Services, for 2018.

The version of H.R. 3354 now on the House floor appears to include a provision, Section 527, that would block any federal spending on implementing or enforcing the Affordable Care Act. 

(Related: Trump Makes Deal With Democrats on Debt Limit, Harvey Aid)

The full Senate Appropriations Committee marked up its own version of that bill, the “FY 2018 Labor, HHS & Education Appropriations Bill.” Committee members approved their version of the bill by a 29-2 vote.

The committee’s Labor-HHS Appropriations Subcommittee approved a version of the bill Wednesday.

The Senate version does not appear to have a bill number, and the Senate Appropriations Committee did not seem to have posted the full text of its version.

The Republican leaders of the Senate Appropriations Committee said in a statement that their version of the appropriations bill would keep the current federal rule that requires the ACA risk corridors program to rely solely on payments from thriving ACA exchange plan issuers to cover program costs.

The ACA risk corridors program was supposed to ease insurers’ fears about participating in the ACA public exchange program by using payments from thriving issuers to help issuers that did poorly in 2014, 2015 and 2016. HHS has had trouble collecting payments from thriving exchange plan issuers and has been able to make only about 15% of the payments promised for 2014. It has not made any of the payments promised for 2015 and 2016.

The Senate appropriations bill would also eliminate funding for the Medicare Independent Payment Advisory Board. The 15-member board was supposed to help come up with ideas for controlling Medicare costs. In theory, the recommendations could override federal law.

Other bill provisions would require the federal government to publish more information about Affordable Care Act-related spending, and about the number of federal employees and contractors working on implementing, administering or enforcing the ACA, according to the Republican summary of the bill.

Committee Democrats said the committee’s version of the bill “includes full funding for the ACA Navigator program and other outreach and enrollment support programs.”

The subcommittee’s version of the bill “does not include new language restricting HHS’ authority to administer or enforce the ACA,” committee Democrats said.

In the past, the House has often proposed sharp cuts in domestic spending programs, and the Senate has proposed measures that would keep spending roughly at prior-year levels. The Senate has often succeeded at restoring most or all of the funding cut by the House.

—Read The Megadeal Congress Should Strike This Month on ThinkAdvisor.

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