December 7, 2017
Another busy week in Washington for health policy. A few updates on tax reform and other health policy influencers.
Tax Reform: Last week the Senate passed a tax reform bill that had major health policy implications. What happens next? Since the Senate and House bills differ, a conference committee is created. A conference committee is staffed by members of both the House and Senate with a goal of creating a new bill. This new bill is then sent back to the House and Senate who both need to approve it. A number of topics will be considered:
- Sequestration- The tax reform bill significantly increases the federal deficit. Thus, automatic cuts (i.e., sequestration) would happen unless Congress suspends PAYGO (the law that requires the cuts). Suspending PAYGO is being discussed as something to be included in the final tax bill.
- Health Insurance Tax- There is also increased discussion of including a two year (2018 and 2019) suspension of the health insurance tax as part of the tax plan.
- CSRs/Reinsurance – There has also been discussion of potential CSR funding or funding for reinsurance (both proposals are being pushed by Senator Collins). Hopes for these provisions seem to be dimming as opposition by House Republicans are increasing.
The timing of the tax reform bill is very uncertain. Reports have circulated that a new bill/final passage may not happen until later in December or potentially early next year.
Budget Bill – Negotiations on passing the annual spending bill continue. If Congress cannot pass a spending bill before Saturday, the government will shut down. The spending bill is considered the main vehicle for approving spending for the CHIP program. While states have, to date, managed to avoid shutting down their CHIP programs, without funding in December it is likely that multiple states will have to institute enrollment freezes or close their program.
What’s Next- What topic will Congress focus on after tax reform? A number of Congressional Republicans have raised the issue of entitlement reform, specifically with a goal of cutting Medicare and Social Security. If there were to happen it would likely happen in the Spring of 2018.
Open Enrollment- HHS announced that plan selections reached 3.6 million for the Healthcare.gov states. Charles Gabba has estimated that when you include SBMs the national total is 5.8 million. For most states, with only one week to go for Open Enrollment, a significant ramp-up will be needed to reach last year’s total of 12.2 million.
Data Watch- CMS’ Office of the Actuary announced that healthcare spending grew at 4.3%, which was slower than the 5.8% increase the US experienced in 2015. Spending growth fell across Medicare, Medicaid, and private insurance.