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Bill Could Strip ACA Premium Subsidies from New York and Pennsylvania Residents

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Members of the House are considering a bill, H.R. 6311, that could disconnect the Affordable Care Act premium tax credit subsidy from the ACA public exchange system — and keep residents of New York state, Pennsylvania, Oregon and Washington state from using the tax credit.

The House Ways and Means Committee reviewed H.R. 6311, the “Increasing Access to Lower Premium Plans Act of 2018″ bill, earlier this week, while considering, or “marking up,” a large collection of bills related to health insurance.

(Related: PPACA: A History)

Rep. Pete Roskam, R-Ill., is the lead sponsor.

One part of the bill would let anyone buy catastrophic, “copper level” major medical coverage, or coverage designed to pay about 50% of the actuarial value of the standardized ACA major medical “essential health benefits” package. People eligible for the ACA premium tax credit  could use the tax credit to pay the catastrophic coverage premiums.

Today, to try to reduce the odds that insured consumers will end up with huge out-of-pocket medical costs, the U.S. Department of Health and Human Services makes copper level plans available to people under 30 and to older people who are unable to pay for bronze coverage, or coverage designed to cover about 60% of the actuarial value of the EHB package. Consumers cannot use the premium tax credit to pay for catastrophic coverage.

Another part of H.R. 6311 would let consumers use the ACA premium tax credit to pay for individual major medical coverage purchased outside the ACA public exchange system.

In theory, well-known health insurers, or insurers with strong agent networks, could use that provision to avoid having to pay ACA public exchange user fees. In states, the user fee is 3.5% of the premiums.

The ACA system was modeled after the Medicare Advantage and Medicare Part D prescription drug plan markets. Consumers can already buy coverage through those markets without going through a centralized public exchange program.

H.R. 6311 would restrict use of the ACA premium tax credit subsidy to plans that comply with the ACA underwriting and benefits requirements, and to plans that exclude coverage for abortion.

Rep. Suzan DelBene, D-Wash., noted during the markup that the provision would conflict with state mandates in New York state, Pennsylvania, Oregon and Washington state that require health plans to cover abortion services.

DelBene talked about a scenario in which H.R. 6311 was passed as written, and implemented as written, and states like Washington state did not change their abortion benefits mandates.

In that scenario, “no one in my state would be eligible for premium tax credits,” DelBene said.

DelBene proposed an amendment to change the provision. The DelBene proposal lost on a 15-22, party-line vote.

The Markup

The committee has 24 members who are Republicans and 15 who are Democrats.

All of the bills considered were introduced by Republicans. The committee approved all of the bills reviewed, and it rejected all of the amendments proposed by the Democrats. Most of the votes were along party lines.

Bills designed to support wellness benefits programs and make the health savings account program more generous and easier to use attracted some support from Democrats.

Some of the other bills past would put off the implementation of the ACA “Cadillac plan” excise tax, or on high-cost health benefits packages, and suspend efforts to collect the ACA employer coverage mandate penalties.

The bill with the most bipartisan support appears to be H.R. 6312, the “Personal Health Investment Today Act” bill. The bill provides that qualified sports and fitness expenses, but not horseback riding expenses, will be treated as amounts paid for medical care, according to summaries by the staff of the Joint Committee on Taxation.

Rep. Ron Kind, D-Wis., appears to be the member who was most likely to cross over to vote with the opposing hearing.


Links to resources related to the markup, including video recordings of the markup sessions, are available here.

— Read PricewaterhouseCoopers: PPACA Exchanges May Add Sales, Headacheson ThinkAdvisor.

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