Daily on Healthcare: Healthcare getting crowded out in September…Congress mulls options to stabilize Obamacare

Healthcare getting crowded out in September: Having failed to pass legislation repealing and replacing Obamacare before leaving for recess, Congress now returns to Washington with a full plate that is likely to crowd out even a modest effort to address the healthcare law. September is crunch time for Congress, which has punted on a slew of critical legislation now set to expire by the end of the month. Lawmakers are expected to get right to work on a massive government spending bill, now complicated by the sudden need for a significant infusion of federal funds to help Houston recover from epic flooding caused last month by Hurricane Harvey. Republican aides told the Washington Examiner the path forward on fiscal 2018 spending has not been determined, but that the appropriations panels are prepared with a short-term bailout measure, known as a continuing resolution, that would buy Congress more time to work out a long-term plan. But there isn’t much time to get it done. The fiscal year ends on Sept. 30 and if Congress does not refresh funding by then, a partial government shutdown would result. Sept. 30 is also the date that funding expires for the Children’s Health Insurance Program. Meanwhile, Congress is going to have to find a way to pass a bill to extend the debt ceiling. Additionally, earlier on Tuesday morning, Attorney General Jeff Sessions dropped another bombshell when he announced that the Trump administration was rescinding DACA, forcing Congress to come up with a legislative fix to immigration.

Senate committee considers its options for stabilizing the Obamacare exchanges. Customers who buy coverage on the exchanges are facing higher gross premiums and fewer choices heading into 2018. The Senate Health, Education, Labor and Pensions Committee have pledged to work to arrive at a bipartisan solution, but have limited timing to arrive at a deal, as final plans have to be agreed upon by insurance companies and states by the Sept. 29 deadline. Furthermore, any bipartisan deal would have to be able to pass not only the fractured Senate, but the more conservative House. In general, conservatives have rejected the idea of pumping money into Obamacare absent a broader effort to repeal and replace the law. Here are the policy proposals likely to be discussed:

* Cost-sharing reduction subsidies: Tennessee Republican Sen. Lamar Alexander, HELP committee chairman, said he believes the funds should be appropriated, but some Republicans describe them as a “bailout” for insurance companies. Congress could appropriate the money, expected to reach $10 billion in 2018. Democrats, however, aren’t necessarily going to be willing to vote in favor of appropriating the funds, and have alluded to how doing so may come across as a tacit acknowledgement the Obama administration illegally distributed the funds.

*Suspending taxes: Health insurers and small businesses have said suspending the health insurance tax would reduce premiums for customers by between 3 and 5 percent, and the medical device industry has planned to increase pressure on members of Congress, arguing the tax will stifle innovation and job creation.

*State flexibility: Republicans have said they want states to have more flexibility when it comes to carrying out Obamacare or the choices state lawmakers make about insurance provisions. One way to do that is through the 1332 waivers under the law, known as “innovation waivers.”

* Reinsurance: The program injects federal funding into the system, so medical costs for sicker enrollees are covered without significantly raising the cost of premiums for those who use less medical care. Reinsurance programs were implemented nationwide under Obamacare, with $10 billion paid out in 2014, $6 billion in 2015, and $4 billion in 2016. The program was intended to provide stability as the exchanges were starting and was never meant to be permanent. Now, some lawmakers, including governors, would like to.

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Is socialized healthcare a litmus test for Democrats in 2018? A surge of Democratic support for socialized healthcare is sparking new questions over whether the issue is becoming a litmus test for Democrats ahead of the 2018 midterm elections. Single-payer healthcare, in which the government offers free or subsidized health coverage to everybody, has largely been on the sidelines of the Democratic Party’s policy platform, but that is quickly changing as Sen. Bernie Sanders, I-Vt., gains clout in the party and Republicans struggle to repeal Obamacare. Sanders is expected to release a new version of his Medicare-for-all single-payer healthcare plan soon. He has pushed for the system for years while in both the House and Senate and touted a similar plan when he challenged Hillary Clinton last year for the Democratic presidential nomination. While universal healthcare has been a plank in the Democratic Party’s platform, party leadership has long shied away from embracing the idea because it would be incredibly expensive and hugely disruptive, especially to the private healthcare industry and the half of the country who gain their insurance through their employers.

Obamacare navigators in “financial limbo hell.” Obamacare’s 98 navigators, which are nonprofits or advocacy organizations tasked with Obamacare outreach efforts, weren’t just surprised by news of their funding getting cut by nearly 40 percent. They also haven’t gotten any word of what their grant award for 2018 will be. The current grants expired on Friday. “It’s full stop for us,” said Shelli Quenga, director of programs for the Palmetto Project, a statewide nonprofit in South Carolina that receives navigator grants. “There isn’t other funding available in our organization right now to just switch everybody to say ‘hey we can pay you off of this money instead. We’re in financial limbo hell.” Navigators also need to know how much funding they will get under the new performance formula that the Centers for Medicare & Medicaid Services will use to determine funding. HHS announced a new funding formula that gives out funding on the basis of how well a navigator meets its enrollment goal. For example, if a navigator met 100 percent of its enrollment goal for the 2017 coverage year, then it gets the same amount for 2018, but if it only got 70 percent then will get 70 percent of its 2017 funding.

Insurers face Obamacare rate deadline Insurers must submit prices for 2018 plans today but insurers still face uncertainty over the fate of Obamacare subsidies next year.

Insurers were given a few extra weeks to determine their rates for 2018, which still need to be approved by state regulators. Insurers also have until the end of the month to sign their contracts with the federal government for offering Obamacare plans on the individual market.

The deadline comes a day before the Senate Health, Education, Labor and Pensions Committee is expected to hold hearings on stabilizing the individual market. HELP Chairman Sen. Lamar Alexander, R-Tenn., has said he hopes to get a stabilization deal through the Senate by the end of the month, but it remains unclear what would be in that deal.  

Time is running out for Obamacare repeal that bypasses filibuster. Republicans have until Sept. 30 to repeal Obamacare with only 51 votes in the Senate under the current budget resolution, further complicating the GOP’s attempts to try again after a failed attempt in late July. The Senate Parliamentarian ruled on Friday that the procedural tool called reconciliation, which Republicans hoped to use to bypass a filibuster in the Senate, expires on Sept. 30.

Anthem scales back Obamacare offerings in Missouri. Major health insurer Anthem will scale back its presence in Missouri next year and will be in just 68 of the 85 counties where it currently offers plans. Anthem’s decision comes amid ongoing worries about the number of Obamacare insurers that will offer coverage in 2018. About a week ago, the last “bare” county to not have any Obamacare insurer was filled with an insurer, but concerns still remain about whether there will be enough competition. Anthem said it has been difficult to price plans due to the “shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance.”

California would be first to give residents a third gender option. California is moving to make it easier for transgender people to identify as the gender of their choice with legislation that would give residents a way to chose on all state documents, including birth certificates and driver’s licenses. Democratic state Sens. Toni Atkins of San Diego and Scott Wiener of San Francisco introduced legislation this spring that would add a third option to the conventional male and female choices people have when asked to declare their sex. “The inability for people to accurately identify themselves on government documents has been a real, tangible issue for the community for years, and this policy to fix it is long overdue,” Wiener told the Washington Examiner. “Forcing people to lie on their government documents is terrible policy and a violation of people’s basic civil rights.”

Obamacare advocacy group: ‘Impossible’ to plug hole from outreach funding cuts Protect our Care, a major Obamacare advocacy group, is doubtful that outside spending can make up for a steep cut in ad funding for Obamacare outreach. The group said during a press call Tuesday that it is meeting with other outside groups on what it can do to make up for a 90% cut to ad funding announced by the Trump administration last week. The administration plans to spend $10 million on ad funding for 2018 open enrollment, a 90% decline from the $100 million spent for the 2017 open enrollment period. This was double the roughly $50 million budget from 2016.  “It is impossible to make up for what the administration is failing to do,” said Leslie Dach, campaign director for Protect Our Care and a former official at Health and Human Services under the Obama administration. “It is impossible to replace the funding and it is impossible to replace the system because the administration knows who is coming to visit the website and might need a nudge.”

Editorial: Good riddance to a wasteful Obamacare promotion budget: The Washington Examiner editorial board writes: “Today, as [Obamacare] continues to ruin the private insurance market, Democrats are trying to establish an excuse-in-advance for its complete failure. They are crying “sabotage” because the Trump administration is rightly moving to slash the advertising and promotional budget for Obamacare’s health insurance exchanges. The complaint has no basis in reality.”

RUNDOWN

Axios ACA allies plot their own enrollment push

Washington Post Obamacare, the sequel, starts now

The Hill Obamacare advocates: Hole too deep to make up outreach cuts

Reuters Bad blood over Obamacare fight lingers as Congress returns

CNN New class of drugs targets aging to help keep you healthy

Politico Senate’s Obamacare spending would build on heavy lifting by states

New York Times Opioids aren’t the only pain drugs to fear

Vox Congress prepares to do the bare minimum to stabilize the marketplace

STAT News Trump administration rewriting a rule that made transgender healthcare accessible. Patients are scared

Calendar

TUESDAY | Sept. 5
Senate and House back in session.

Deadline for insurers to file rates for Obamacare plans. Details.

4 p.m. President Trump to meet with congressional leaders to discuss fall agenda.

WEDNESDAY | Sept. 6

10 a.m. 216 Hart. The Senate Health, Education, Labor and Pensions Committee will hold a hearing on stabilizing the Obamacare exchanges. State insurance commissioners will testify. Details.

10 a.m. SD-342 Dirksen. Senate Committee on Homeland Security and Governmental Affairs hearing on “The History and Current Reality of the U.S. Health Care System.” Details.

10 a.m. 215 Dirksen. Senate Finance Committee hearing to consider HHS nominees. Details.

11 a.m. 124 Dirksen. Senate Appropriations Subcommittee markup of HHS spending bill. Details.

Noon. Cato Institute. 1000 Massachusetts Ave. NW. Discussion on “The Long-Term Effect of Health Insurance on Near-Elderly Health and Mortality.  Details.

THURSDAY | Sept. 7

Sept. 7-8. Ronald Reagan Building. 1300 Pennsylvania Avenue NW. Medicare Payment Advisory Commission public meeting. Details.

9 a.m. National Press Club. 529 14th St. NW. National Survey on Drug Use. Details.

9 a.m. 216 Hart. The Senate Health, Education, Labor and Pensions Committee will hold a second hearing on stabilizing the Obamacare exchanges, with several governors testifying. Details.

10 a.m. 215 Dirksen. Senate Finance Committee hearing on CHIP reauthorization. Details.

10:30 a.m. 106 Dirksen. Senate Appropriations Committee markup of HHS spending bill. Details.

11 a.m. Newseum. 555 Pennsylvania Ave. NW. Research!American discussion with federal agency officials on “Is a Disease-Free World Within Reach?” Details.

FRIDAY | Sept. 8

9:15 a.m. AEI. 1789 Massachusetts Avenue NW. Govs. John Hickenlooper and John Kasich discuss bipartisan proposal to stabilize health insurance market. Details.

Noon. G50 Dirksen. Alliance for Health Policy discussion on “Stabilizing the Individual Market in Uncertain Times.” Details.

TUESDAY | Sept. 12

10 a.m. 420 Dirksen. The Senate Health, Education, Labor and Pensions Committee will hold a third  hearing on stabilizing the Obamacare exchanges, with discussions on state flexibility. Details.

2:30 p.m. Brookings. 1775 Massachusetts Ave. NW. Event on “Inclusive School Environments: Improving Outcomes for Students With and Without Disabilities.” Details.