Last night, House Republican leadership released its ACA Repeal and Replace bill. Below is a chart listing major relevant provisions.
Key Takeaways:
- More frequent redetermination of eligibility will result in a meaningful decline in Medicaid enrollment. More money from the federal government for enforcement of eligibility provisions will also negatively impact enrollment which, as we have noted, is probably higher than it is supposed to be,
- Repeal of presumptive eligibility for certain categories of enrollees and limiting retroactive eligibility will reduce health care utilization
- Notwithstanding restoration of DSH payments, the ACA repeal as proposed is very bad news for inpatient hospitals.
- Subsidies in the individual market will be reduced significantly but impact should be mitigated somewhat by $100 million to states to stabilize their markets. How that money will be distributed will have a greater impact on utilization than repeal of the individual mandate which was never very effective. Not a great outcome for insurers
- Look for everyone to take a stand on ensuring mental health and SUD programs survive
- Repeals metal levels and actuarial values which will provide more flexibility to insurers to design affordable insurance products
- All taxes will be repealed but look for some pressure to build to exclude from repeal taxes imposed on high wage earners
- Relaxation of age bands and essential health benefits requirements will probably not survive in the Senate.
- Reduction in 6 percent bonus in federal match rate for community based attendant services will mitigate shift from NFs to home and community based services
- Markup tomorrow morning and Senate reaction will provide clarity on the future. Right now we are betting on passage in some form.
Call with questions. More to come.
Emily Evans
Managing Director
Health Policy
HedgeyeEEvans
