Will we see the end of Medicaid as we know it? Let’s get right to it in this week’s Federal Budget Watch, thanks to our friends at the Center on Budget and Policy Priorities.
Today, House Republicans circulated a 19-page blueprint to their conference that lays out the contours of the ACA “repeal and replace” legislation they intend to move in early to mid-March. This document, while short on some critical details, confirms their intention to eliminate in the near future the extra federal funding for the Medicaid expansion and convert Medicaid into a block grant or per capita cap — the end of Medicaid as we know it. It also contains no plan to protect people with pre-existing conditions and others who lacked access to affordable coverage before the ACA, while it doubles down on expanding Health Savings Accounts that do little for families struggling to pay for insurance — but provide large tax breaks for the wealthy.
We will have more information on this soon.
Republican leaders have indicated their goal of marking up the Energy and Commerce Committee’s share of a “repeal and replace” bill in the week after the Presidents’ Day recess. The Ways and Means Committee reportedly aims to mark up its share of the bill in March as well. Of course, these dates could slip.
Meanwhile the Trump Administration released an Executive Order on the ACA yesterday. Here is a quick analysis:
Trump Administration’s New Health Rule Would Reduce Tax Credits, Raise Costs, For Millions of Moderate-Income Families – http://www.cbpp.org/research/health/trump-administrations-new-health-rule-would-reduce-tax-credits-raise-costs-for
“The Trump Administration’s new proposed rule on health care would raise premiums, out-of-pocket costs, or both for millions of moderate-income families. If finalized as proposed, the rule would reduce the amount of health care that marketplace plans have to cover. That would allow individual-market insurers to offer plans with higher deductibles and other out-of-pocket costs than they can now sell through the marketplaces. It would also have the hidden impact of reducing the Affordable Care Act’s (ACA) premium tax credits, which help moderate-income marketplace consumers afford health care. As a result, the rule would force millions of families to choose between higher premiums and worse coverage.”
Other Legislative Updates
This week, the House is working on bills related to veterans and labor department rules, including a one resolution (House Joint Resolution 42) that would nullify a rule that limits states’ ability to drug-test applicants for unemployment compensation.
The Senate has been focused on nominations. Last week, they confirmed Betsy DeVos as Education secretary, Jeff Sessions for Attorney General, Tom Price as Secretary of Health and Human Services and Steven Mnuchin for Secretary of the Treasury. The next nominees to be considered are:
- Mick Mulvaney to be OMB director
- Scott Pruitt to be EPA administrator
- Wilbur Ross to be Commerce secretary
- Ryan Zinke to be Interior secretary
- Ben Carson to be HUD secretary
- Rick Perry to be Energy secretary
The Senate will likely be consumed by confirmation battles over President Trump’s Cabinet nominations for the rest of this month.
Congress now has less than 11 weeks to complete action on the FY 17 appropriations bills (under a current continuing resolution) to keep the government running before funding from the stopgap measure expires April 28, with three of those weeks scheduled to be recess periods: Feb. 20-24 and April 10-21. We understand that the serious discussions and negotiations on this between the Administration and Congressional leaders will begin in earnest after the President’s Day recess.
Uncertainty over military spending threatens to make consideration of a final funding package for the rest of the fiscal year even more complicated, as the Trump administration is expected to request a supplemental appropriation for the Pentagon and to pay for the wall along the border. The Pentagon money will be framed as an emergency. It’s unclear whether the cost of the wall will be declared an emergency and not paid for, or whether we’ll see efforts to cut FY17 nondefense discretionary spending to pay for it. The conservative House Freedom Caucus, is demanding that military increases be paid for by cuts in non-defense appropriations.
After indications that the Trump administration would skip submitting an early budget outline, it appears that it will send a “skinny budget” (preliminary budget) to Congress in March. White House spokesman Sean Spicer recently said a budget request to Congress could be “released in a few weeks.”
President Trump has also promised to unveil a big tax-cutting plan in coming weeks. House Republicans continue to work to put together a tax reform bill including tax cuts for the wealthy.
We should hear more about these proposals when President Trump addresses a joint session of Congress on Feb. 28. Newly inaugurated presidents often deliver this type of speech instead of a formal State of the Union address, giving them a full year instead of a few weeks to fully assess the state of the country.
Below is a tentative timeline of what we could see through the summer and fall.
TENTATIVE Timeline of Threats to Federal Health and Safety Net Programs
Politico obtained a copy of a leaked legislative timeline of the next year from House Republicans, listing specifics on what they need to do — and by when — in this new Congress. The detailed cheat sheet — distributed by House GOP leadership in a closed-door session — about the 14 key deadlines in 2017. The document provides a skeleton for what needs to happen over the next year.
AARP Letter to Energy and Commerce on Medicaid
AARP sent this letter to the Committee on Energy and Commerce for a hearing their oversight subcommittee held on Medicaid. The letter contains useful language on who benefits from Medicaid and warns against proposals calling for a block grant or per capita cap. You can read the full letter here.
Contact info for Colorado congressional delegation: