The Hill’s Sam Baker notices that Republicans weren’t fudging when they promised to attach legislation repealing portions of the Affordable Care Act to critical legislation. Several Republicans on the Senate Finance Committee have filed amendments to the South Korea free trade agreement that would eliminate sections of the law or legislate other health care changes. Below is a summary of some of the most critical amendments:
— SEN. ORRIN HATCH (R-UT): repeals the tax on medical devices, the employer free rider, and the maintenance of effort provision that bars states from cutting Medicaid eligibility. He also offered amendments that would not implement the renewal of a trade assistance program “until the Secretary of Health and Human services certifies that health insurance premiums have been reduced, on average, by $2,500,” repeals a provision of the ACA that requires insurers to spend 80 to 85 percent of premium dollars on health care services (the so-called Medical-Loss Ratio), and restores “over-the-counter drug purchases as a qualified medical expense without a prescription for FSAs, HSAs, HRAs, and Archer MSAs.” A separate measure also bars any facility that provides abortions from receiving Medicaid funds — even in cases where the woman’s life is in danger.
— SEN. CHUCK GRASSLEY (R-IA): sunsets the Independent Payment Advisory Board (IPAB) as of December 31, 2020, but preserves the authority for any recommendations made under the IPAB during 2020 to be implemented during 2021 and beyond.
— SEN. MIKE CRAPO (R-ID): removes regulations which would restrict the development of the ACO model to certain providers and facilities, makes “adequate” payment updates to ambulatory surgery centers, prevents CMS from cutting physician payments when developing rates for Medicare Advantage.
— SEN. PAT ROBERTS (R-KS): repeals payment reductions to home health providers, exempts Critical Access Hospitals from consideration by IPAB for payment reduction through 2018, stipulates that regulations must be done through a notice of proposed rulemaking with a minimum of 60 days for comment to begin on date of publication of the rule in the Federal Register (this would severely slow down the implementation effort)
— SEN. MIKE ENZI (R-WY): eliminates Medicaid and insurance subsidy eligibility for early retirees (addresses the language that could allow 5 million early retirees to become eligible for Medicaid).
— SEN. JOHN THUNE (R-SD): repeals the CLASS Act, a provisions of the health care law that provides long-term care insurance.
Many of these amendments — repealing the tax on medical devices, eliminating the employer free rider provision (which requires large employers that don’t offer insurance to pay a fee if their employees are receiving government subsidies), and increasing payment rates to various providers — would increase the national deficit, something the senators don’t seem particularly concerned about. Almost all of the amendments filed list the budget offset for the spending increases as “to be determined.”