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Bills Bills Bills: A synopsis of current policies affecting health care


Senate Tax Bill (passed in early December)

  • Senate tax bill passed on 12/2 would abolish enforcement of ACA requirement that most Americans have health insurance coverage or face a tax penalty (confusingly, it doesn’t abolish the requirement itself, only the enforcement of the punishment)
  • Budget analysts say that this could cause an extra 13M people to be uninsured and drive up insurance premiums

House Tax Bill (passed in November)

  • Differs on tax rates and has different tax brackets than the Senate bill. Also eliminates estate tax.
  • Does not end enforcement of ACA insurance mandate tax penalty

Both Bills

  • Both have been passed by their respective chambers, which means that Congress must now negotiate their differences
    • They are trying to create a final plan for Trump to sign before Christmas
  • Both are expected to lead to significant cuts in Medicare funding  – ~$25 billion
  • Could also eliminate $1 billion for Prevention and Public Health Fund, part of the CDC’s prevention budget
    • This is expected to lead to fewer low-income people getting breast cancer screening

Executive Order/2018 Marketplace

  • Through 2018, individuals can get comprehensive coverage through the ACA regardless of whether or not the have a preexisting condition
  • Cost-sharing subsidies that were threatened will still be available in 2018 for individuals under 250% of poverty level
    • However, the federal govt isn’t reimbursing insurers for these subsidies, so they may make up the difference by raising premiums.
  • On that note, most are expecting premiums for health insurance to be higher but not necessarily for all types of plans, so it’s recommended that people shop around
  • There is still a tax if you don’t have health insurance coverage through 2018 (2.5% of taxpayer’s income)
  • Some insurers may be selling “short-term plans” that are less expensive but may not cover essential health benefits and may exclude those with preexisting conditions

Essential Health Benefits

  • May not necessarily be covered under “short-term” health plans that people can enroll for in 2018
  • Through the Centers for Medicare and Medicaid Services, the Trump administration proposed a rule late Friday (10/27) that could allow states flexibility in requiring insurance companies to cover what are known as “essential” health benefits
  • The rule will officially be published Nov. 2, with a comment period lasting until Nov. 27
  • With current plans, states must select a “benchmark” plan to set the standard for how generously insurers must cover essential benefits, which include categories such as maternity care and mental-health services. If CMS goes ahead with its proposed changes, states won’t have to choose from a limited, fixed menu of benchmark plans. Instead, they can select a la carte.

Birth Control Coverage

  • Trump administration issued 2 new rules:
    • 1. Exempts any employer from providing birth control coverage because of religious objections (including higher education, NFPs, publicly traded for-profit)
    • 2. Exemption for employers other than publicly traded for-profit employers if they object based on undefined “moral” reasons
  • Right now, impossible to predict how many employers will take advantage of new exemptions
  • Many women will face out-of-pocket costs for birth control that make it difficult/impossible to use the birth control method that best fits their needs
  • Systems like Title X and Medicaid were not designed to absorb costs from patients that would normally be getting private birth control coverage
  • Other federal and state protections for birth control coverage still remain, but this can be difficult to navigate and understand
  • Hundreds of thousands of women are expected to lose coverage
  • Notre Dame is the first higher education institution to announce that they will drop birth control coverage for students, faculty and staff >>> UPDATE: Notre Dame announced that they have reversed their decision and it will still be accessible through university-sponsored plans:


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