Latest Update on Congressional Health Reform Activity
This week, the Senate released two bills as part of its efforts to repeal the Affordable Care Act (ACA):
- A revision to the Better Care Reconciliation Act (BCRA) eliminating the “Ted Cruz Amendment” which provided funding to create coverage alternatives for high-risk individuals (see our revised chart) and;
- The Obamacare Repeal Reconciliation Act (ORRA), a bill that would repeal many of the major provisions of the ACA within a two-year period, but does not offer plans to replace those provisions.
We summarize the ORRA below. More activity, including a possible vote or further bill changes, is expected from the Senate next week. NASHP will continue to update and analyze developments as they emerge
Summary of the ORRA (as published 7/19/2017) |
Insurance Reform |
| Individual tax penalty/mandate: Zeroed (2016) |
| Employer tax penalty/mandate: Zeroed (2016) |
| Advance Premium Tax Credits (APTC): Repealed (2020); includes repeal of all requirements related to conducing eligibility for APTC. |
| Cost-sharing Reduction (CSR): Appropriated through 2019. Repealed in 2020 |
Restrictions related to abortion:
|
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs):
|
Medicaid |
Medicaid expansion: Repealed (2020); includes:
|
Presumptive eligibility:
|
Medicaid benefits
|
| FMAP: Changes to 50% for territories (2020)DSH cuts: Repealed (2018)Eligibility and Enrollment: Repeals state requirement to coordinate eligibility and enrollment systems. (2020) |
Taxes |
| Cadillac tax: Repealed from 2020-2025; Reinstates Tax in 2026 |
| Net investment tax: Repealed (2017) |
| Chronic care tax: Repealed (2017) |
| Tanning tax: Repealed (September 2017) |
| Tax on health insurance executives: Repealed (2017) |
| Medical device tax: Repealed (2018) |
| Prescription medication tax: Repealed (2018) |
| Annual fee on health insurance carriers: Repealed (2018) |
| Medicare surtax: Repealed (2018) |
| Employer retiree drug benefit tax deduction: Reinstated (2017) |
| Delivery system |
| Funding freeze on prohibited entities (Planned Parenthood): Imposes a one-year freeze on mandatory funding to prohibited entities which include non-profit, essential community providers primarily engaged in family planning and reproductive health services, that provide abortions in cases that do not meet the Hyde amendment exception for federal payment and received over $350 million in federal and state Medicaid dollars in fiscal year 2014. |
| Community Health Centers: Provides an additional $422 million for the Community Health Center Program in 2017. |
| Prevention and public health |
| Prevention and public health fund: Eliminated (2019) |
| State Substance Use/ Mental Health Fund: Appropriates $75 million in each of 2018 and 2019 for grants to states to address the substance abuse public health crisis or urgent mental health needs. |
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
