I have attached a link to the Committee Print for the Budget Reconciliation Legislative Recommendations Relating to Repeal and Replace of the Patient Protection and Affordable Care Act.
http://www.foxnews.com/politics/interactive/2017/03/06/text-american-health-care-act/
Here are my thoughts.
I don't believe this is as great as the GOP will say it is or as scary as the Dems will say it is. There is a little bit here for everybody.
Admittedly the Democrats will be incensed by the abortion language in the bill as the Committee made it very clear they will fund abortion in only the most strict circumstances. The Republicans may be a bit miffed in that a lot of the safety net of the ACA is still in place.
I am now going to go through the bill and talk about notes I made while reviewing it.
Sec 103 Federal Payments to States Section B
In the Definitions section of this, it is made clear that places like Planned Parenthood will now be considered "Prohibited Entities" and will receive no federal funding for their abortion operations.
Sec 112 Repeal of Medicaid Expansion (A, 1)
There is a clause about "at the option of the state" and it is very confusing over whether the state may option to cover an expansion of their Medicaid rolls or of the state can apply for an exception. In either case, it is clear that the thing we wrote about last week about California may have California correct in their reading.
Sec 112 Section C
The Essential Health Benefits Requirement is gone. This can be both good and bad. While removing some of these "essential health requirements" may lower premiums, it may alter plan descriptions in a way that reduces the amount of care a member can get. We will talk about the counter to this in a bit because there is an answer to this.
Sec 114 Reducing State Medicaid Costs
Bottom line, if you win the Mega Millions lottery and you are on Medicaid....you aren't anymore. They count lottery winnings against income and that will push you over the threshold and you are done with Medicaid.
Sec 114 Subsection 1
It looks like there will no longer be any backdating of effective dates into Medicaid. It looks like the government is no longer in the business of buying claims.
Sec 114 Subsection 2
No Medicaid for illegal aliens. This section makes it crystal clear there will be no Medicaid payments for any unauthorized individuals and increased verification checks will be completed prior to authorization with no medical claims paid until authorization is released. There is language in the bill saying the states can adopt their own "grace period" but the question is, if they do provide coverage is the state on the hook for it or can they pass it off to the feds as a "qualified expense". The bill is not very clear on this.
Sec 115 Safety Net Funding (yes, that is the actual title)
Subsection 2 jumped out at me because it deals directly with providers and it appears that there will no longer be any balance billing on ACA or Medicaid plans. While at face value that doesn't mean much because of current patient financial responsibility on Medicaid but it does set a standard that says the providers will be taking the government offered reimbursement. Let's see who actually does and who actually walks.
Sec 116 Providing Incentives for Increased Frequency of Eligibility Determinations
Subsection K will give our Democrat friends fits because it drops the eligibility checks down to every 6 months. I believe we in NJ have been doing this already but it will be interesting to see how this plays out in states where this will be something new.
Sec 121 Per Capita Allotment for Medical Assistance
While this section had a lot of meat in it and I will be reading this through a few times but Medicare Cost Sharing is now considered an Excluded Expenditure. My question is what Medicare Cost Share? Is it like where PAAD pays for Medicare premiums and copays?
Sec 121 Subsection 2
This deals with members I would consider Dual Eligibles and how Medical Assistance Payments will be made.
Sec 121 Subsection D
This section deals with HSA contributions but what really stuck out to me was how taxpayers with seriously delinquent tax debt will not be able to receive or place HSA account deposits. All the new HSA rules will kick in for 2018.
Sec 6050X Returns by Health Insurance Providers Relating to Health Insurance Coverage Credit
Two things stuck out to me in that it looks like reporting is now at a federal level and no longer the state and there will be no more monkeying around wit the WR-30 as employers and such used to do back in the day (much to our chagrin).
Sec 6050X Subsection 2
Acknowledgement of the utilization issue. This validates my whole argument with the ACA. It's nice to see Congress sees it as well.
Sec 6050X Subchapter C (B)
In here they talk about repayment limit on million dollar claims. The question is they never stated whether it was single occurrence or aggregate.
This same subchapter also notes how states will be forced to take a bigger bite in paying Medicaid claims.
Sec 2711 Encouraging Continuous Health Insurance Coverage
There is now a Late Enrollment Penalty similar to Medicare Part D but the new LEP is equal to 30% of the monthly premium rate. It looks like the LEP only lasts a year unlike the Medicare Part D LEP which is a lifetime penalty.
Subtitle II
This section deals with several taxes and fees that have been eliminated
For 2018 the tax on Prescription medications has been repealed
For 2018 the tax on OTC drugs has been repealed
For 2018 the tax on health insurance has been repealed
For 2018 the tax on Net Investment Income has been repealed
For 2018 the tax on tanning salons has been repealed
There will also be a new rating system for coverage in 2018. This means your rate is going to move one way or the other. The bill does not say exactly what the new rates will be based on but seeing how it is all guaranteed issue, I don't see major changes here.
So, there it is. This is a basic outline. I will keep reading this and see if anything else jumps out at me but for now this is it.
Like I said, I don't think it is as great as the GOP says or as horrible as the Dems say it is.
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