BBB signed
President Trump signed into law last week the reconciliation bill. The bill makes large changes on a number of domestic policy areas. In terms of health care, I recommend looking at KFF’s tracker that compares the House and Senate version (the Senate version is the version that ultimately was enacted). A few last-minute changes:
- CSR funding for Exchange plans was excluded
- Medicare physician fee schedule conversion factor adjustment was set at 2.5%.
- A rural health care fund of $50 billion that would be paid out over the next 5 years.
Impacts:
- Individual Market – With last minute swerves, there currently aren’t available estimates on what the final bill’s impacts would be on the individual market. However Wakely’s analysis of the House version of the bill is among the most comprehensive analysis of the bill. Urban Institute also has state by state estimates.
- Medicaid – KFF has useful estimates on the potential distribution of federal Medicaid spending cuts by state. You can find it here
- Overall – CBO estimates that the bill would increase the number of uninsured by 11.8 million. Matt Fiedler provides useful context on the forthcoming unprecedented increase in the number of uninsured
Potential Medicare Cuts : As Modern Healthcare notes the passage of the bill (and resulting deficit increases) results in triggering PAYGO sequestration. PAYGO sequestration has never been applied before, but absent Congressional action would result in an estimated $540 billion cuts to Medicare over the next 10 year starting in 2026.
What’s Next
- Budget Bill – Congress will next turn its attention to passing a budget before the September 30th deadline. Several observers note that issues like waiving PAYGO sequestration, CSR funding, ePTC expiration, and other items could be discussed as part of the budget process.
- More Reconciliation –House/Senate Republicans have also already raised the potential of passing 1 to 2 more reconciliation bills this Congressional term. Potential legislation that ultimately was not included in the most recent legislation (for example further Medicaid cuts as well as further tax cuts have been raised as potential items for discussion.
