Repub­li­cans jockey over post-King re­form plans

Modern Healthcare - - REGIONAL NEWS - By Paul Demko

WASH­ING­TON— Con­gres­sional Repub­li­cans are ner­vously wrestling with how to re­spond if the U.S. Supreme Court in June strikes down Oba­macare pre­mium sub­si­dies in up to 37 states.

There are at least five pro­pos­als from Se­nate and House Repub­li­cans, and they dif­fer con­sid­er­ably. Most seem in­tended to de­lay or re­duce the pain of mil­lions of Amer­i­cans los­ing cov­er­age un­til af­ter the 2016 elec­tions. But it’s highly un­cer­tain whether Repub­li­cans can unite be­hind a sin­gle plan.

Sen. Ron John­son (R-Wis.) in­tro­duced a bill, backed by Se­nate Ma­jor­ity Leader Mitch McConnell, to keep cur­rent sub­si­dies in place through Au­gust 2017. His plan would pro­hibit new cus­tomers in the ex­changes from re­ceiv­ing sub­si­dies, re­peal the in­di­vid­ual and em­ployer man­dates, and elim­i­nate the Af­ford­able Care Act’s es­sen­tial benefits re­quire­ments.

A pro­posal by Sen. Ben Sasse (R-Neb.) would phase out sub­si­dies over 18 months. Dur­ing the tran­si­tion pe­riod, in­sur­ers would be barred from rais­ing pre­mi­ums.

House Ways and Means Com­mit­tee Chair­man Paul Ryan (R-Wis.) pro­posed a flat tax credit to peo­ple re­ceiv­ing sub­si­dies through the fed­eral ex­change, and let states opt into a more con­ser­va­tive re­form model with­out in­sur­ance man­dates.

The most con­ser­va­tive House Repub­li­cans are craft­ing a plan that would re­place the ACA with an ex­pan­sion of health sav­ings ac­counts, med­i­cal mal­prac­tice caps and a pro­vi­sion al­low­ing in­sur­ers to sell plans across state lines.

Dean Clancy, a con­ser­va­tive health­care pol­icy an­a­lyst, said that in­stead of tweak­ing the ACA be­cause of panic over the po­ten­tial elim­i­na­tion of sub­si­dies, Repub­li­cans should of­fer a more com­pre­hen­sive re­place­ment bill, even if it’s cer­tain to be ve­toed.

But Yev­geniy Fey­man, a fel­low at the con­ser­va­tive Man­hat­tan In­sti­tute, said Repub­li­cans need to ex­tend cov­er­age sub­si­dies if the high court kills them. “They def­i­nitely don’t want to put red state gov­er­nors into a cor­ner where the only op­tion they re­ally have is to go to HHS and say, ‘We’re go­ing to set up an ex­change,’ ” he said.

Tim Jost, a law pro­fes­sor at Wash­ing­ton & Lee Uni­ver­sity who sup­ports the ACA, said the John­son and Sasse bills would re­sult in far fewer Amer­i­cans be­ing able to ob­tain af­ford­able cov­er­age, and would pro­duce se­vere in­sur­ance mar­ket dis­rup­tion.

The pres­i­dent, he pre­dicted, would tell Congress to pass a sim­ple leg­isla­tive fix clar­i­fy­ing that sub­si­dies are avail­able in all states.

“The ap­proach of the Obama ad­min­is­tra­tion has been, ‘You broke it, you bought it,’ ” Jost said.

Sen. Ron John­son (R-Wis.) in­tro­duced a bill, backed by Se­nate Ma­jor­ity Leader Mitch McConnell, to keep cur­rent sub­si­dies in place through Au­gust 2017.

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