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October 26, 2017

It’s Complicated.

Another day, another proposal aimed at repealing the Affordable Care Act. Our Government Affairs duo, Joel Wood and Joel Kopperud, tackle the latest news out of Washington, D.C., which includes a very tight timeline for tax reform (for broker specific provisions we’re following, see the Steptoe memo below).

Could there be a vote before Thanksgiving?

Tax Reform Issues Update

President Trump and congressional Republicans are striving to make significant process on tax reform legislation in the next few weeks and months. The following memo, as referenced in the video above, focuses on two issues of potential interest to The Council—(1) the proposal to reduce the tax rate on passthrough income to a top rate of 25 percent and (2) the proposal to provide immediate expensing for “new investment.”

Read the memo produced by our legal team at Steptoe & Johnson. (login required)

Hatch-Brady Proposal Challenges Alexander-Murray

Senate Finance Committee Chairman Orrin Hatch (R-Utah) and House Ways and Means Committee Chairman Kevin Brady (R-Texas) announced yesterday a bicameral agreement to pair structural ACA reforms with a temporary two-year funding extension for the health law’s cost-sharing reduction (CSR) program. The proposal seems to challenge the short-term, bipartisan market stabilization package announced last week by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA).

The agreement proposes to address aspects of the ACA, including delaying the individual and employer mandates and expanding Health Savings Accounts (HSAs). The agreement, in principle, would fund CSRs if structural reforms to Obamacare are incorporated. It includes:

  • Funding for CSRs through 2019, with pro-life protections. For 2018, carriers must meet certain conditions to receive CSRs. These conditions would be determined in consultation with the secretaries of treasury and health and human services to prevent “double dipping.”
  • Relief from the individual mandate from 2017-2021. This time frame should produce enough savings to cover the cost of providing relief from the employer mandate and the HSA expansion policy.
  • Relief from the employer mandate from 2015-2017. Employers would be exempt from penalties if they did not provide coverage based on requirements of the mandate.
  • Expansion of HSAs to increase the maximum contribution limit.

The full legislative language will be released in coming days.

How to Fix the Value-Based Payment System

Harold Miller’s latest report, Why Value-Based Payment Isn’t Working, and How to Fix It, covers topics such as the strengths and weaknesses of the fee-for-service payment system and how other various payment methods stack up—including pay for performance, shared savings and risk programs, bundled payments, and narrow and tiered networks.

Miller, the president and CEO of The Center for Healthcare Quality and Payment Reform, also puts forth his vision for what a truly successful, patient-centered payment system looks like. Elements include provider teams working together to meet patient needs; the patient’s ability to select a provider team based on quality standards and outcomes; and a total amount that the patient and insurer will pay for all of the services received with respect to a given need.

Read the executive summary.

Joel Wood, SVP, Government Affairs
Pilot test will evaluate MACRA’s ability to reduce costs

Joel Kopperud, VP, Government Affairs
Cheaper Health Plans Promoted by Trump Have a History of Fraud
The New York Times

Cheryl Matochik, SVP, Strategic Resources & Initiatives
Report: Half of U.S. medical care delivered at emergency rooms
United Press International

Blaire Bartlett, Director, Government Affairs
Trump declares opioid epidemic a national public health emergency