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District Policy Group

Repeal and Replace: President Continues Attempts to Dismantle ACA

President Trump recently announced plans to end cost sharing subsidies under the ACA that reduced premium costs and helped lower-income Americans pay for their healthcare. The move is a continuation of the Administration’s attempts to replace and repeal the ACA after previous failed attempts by Congress to push through a repeal bill earlier in the year. In Congress, a few lawmakers on both sides of the aisles are urging the administration to continue payments in order to stabilize ACA markets in the short term.

Last week, Senators Lamar Alexander (R-TN) and Patty Murray (D-WA), the top two ranking members on the Senate health committee, struck a bipartisan deal that would allow subsidy payments to continue while also making it easier for states to obtain waivers for specific Obamacare provisions. While President Trump has publicly spoken negatively about the bill, reports are he is still encouraging Senator Alexander to continue efforts on a compromise. It is still unclear whether the bill will receive enough support in Congress to pass in time for the ACA’s 2018 open enrollment period beginning November 1. More likely, the bill will be included in end of year legislation that includes funding for FY 2018 federal programs.

If the cost-sharing subsidies are ended, it will lead to significantly higher costs for some individuals enrolled in ACA plans with the costs of these plans estimated to rise about 20% in 2018 according to a CBO report. These subsidy cuts would make affordable healthcare less accessible for many Americans currently enrolled in plans under the ACA, including those with mental health issues. Currently, over half of enrollees (6 million) qualify for cost-sharing subsidies under Obamacare.

CHIP Reauthorization

With just over two months remaining in the Congressional session, there are many priorities lawmakers must address including a bill to reauthorize federal funding for the Children’s Health Insurance Program. Funding for the program expired on Sep. 30th, though most states have enough funding to continue programs through the end of the year. The Senate Finance Committee recently voted on and passed the KIDS Act, a five-year reauthorization bill. Committee Chairman Orrin Hatch (R-UT) and ranking Sen. Ron Wyden (D-OR), said that advancing the KIDS Act “is a step to protecting low-income families.” Next the bill will move to full consideration by the Senate though no vote has been scheduled. Meanwhile, the House Energy and Commerce Committee passed the HEALTHY KIDS Act, which contains CHIP funding provisions that are nearly identical to the Senate bill.

Both pieces of legislation now face the difficult hurdle of finding new offsets to pay for the funding provisions.

White House, Agencies and Congress Prioritizing Efforts to Address Opioid Epidemic

Since the spring when President Trump announced establishment of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, agencies and Congress have been prioritizing policy efforts related to addressing the opioid epidemic. The President’s Commission released a draft interim report on July 31 urging the President to declare a state of emergency for the opioid crisis that would make available flexibilities and additional resources. Though President Trump verbally declared the opioid crisis as a national emergency, no official declaration has been made. Recent reports suggest the White House will issue an emergency declaration this week or in the coming days. CPNP submitted comments in response to the draft interim report. While the Commission’s final report was originally due October 31, the deadline has been extended to November 1 and work could continue beyond that as the Commission continues to schedule meetings to hear from additional stakeholders.

Over the summer and continuing this fall, Congress has scheduled a number of hearings to explore proposals from stakeholders and agency directors on policies to address the opioid epidemic. Last week, Chairman Greg Walden (R-OR) of the House Energy and Commerce Committee, called on lawmakers to “redouble our efforts to match the growing crisis.” These comments come ahead of a committee hearing scheduled this week for October 25, where members will receive updates on implementation of the Comprehensive Addiction and Recovery Act of 2016. The oversight and investigations sub-committee will also be looking into the issue of pill dumping.

CPNP recently submitted a “statement for the record” in cooperation with a number of Pharmacy Stakeholder Group partners encouraging passage of legislation that allows pharmacists to obtain a DATA waiver. H.R. 3991, the Expanded Access to Opioid Abuse Treatment Act of 2017, a recently introduced bill, would enable pharmacists to obtain a DATA waiver in the same manner as PAs and NPs.

State Medicaid Expansion Efforts Target Mental Health and Substance Abuse Treatments

The Kaiser Family Foundation and the National Association of Medicaid Directors came out with a report on October 19th that stated 26 states this year expanded or enhanced Medicaid benefits and at least 17 states plan to do so next year. According to the report, the increased benefits were largely for mental health and substance abuse treatment. The number of states adding or expanding benefits is the highest in the past decade.

Key findings in the report show that despite uncertainty about federal legislative changes, many states were continuing efforts to expand benefits, move ahead with payment and delivery system reforms, increase provider payment rates, and increase community-based long-term services and supports. Key areas to watch include federal legislative efforts to restructure and limit federal Medicaid financing as well as Section 1115 waiver activity (state waiver proposals and CMS approvals). These issues will have implications for states, providers, and beneficiaries that could shape the future of the Medicaid program in FY 2018 and beyond.

Managed Care Organizations (MCOs) continue to be the predominant Medicaid delivery system used by states. Twenty-six of the 39 MCO states reported that they plan to use authority to receive expanded federal matching funds for adults receiving inpatient psychiatric or substance use disorder (SUD) treatment in an institution for mental disease (IMD) for no more than 15 days a month included in the 2016 managed care regulations. Additionally, close to half of MCO states reported that the day limit is insufficient to meet acute inpatient or residential treatment needs for those with a serious mental illness.

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