Members of Congress say their efforts to bolster the ACA are running up against the administration’s efforts to repeal and replace it.

March 26—A day after the Trump administration in court backed full repeal of the Affordable Care Act (ACA), members of Congress warned about potential impacts on public and private insurance coverage.

In a March 25 filing by the Department of Justice (DOJ) with the 5th U.S. Circuit Court of Appeals, the administration backed the ruling of a federal judge in Texas that the entire ACA was unconstitutional due to Congress’s elimination of the individual-mandate tax penalty.

When the case was before the District Court, the DOJ argued for tossing only two provisions of the ACA: a requirement that health plans cover individuals with pre-existing conditions and a requirement barring plans from charging a higher premium due to pre-existing conditions. At the time, DOJ leaders said the rest of the law, including Medicaid expansion, could remain in place.

The new filing was an “abhorrent decision,” Rep. John Yarmuth (D-Ky.), chairman of the House Budget Committee, said at a March 26 hearing to discuss the administration’s proposed FY20 budget for the U.S. Department of Health and Human Services (HHS).

The filing “makes it “crystal clear to the American public that this president has zero interest in protecting their health care in any form,” Yarmuth said to Eric Hargan, deputy secretary of HHS.

Hargan said the decision to pursue full judicial repeal of the law was not under his purview.

Similarly, Rep. Scott Peters (D-Calif.) said Democrats want to find ways to stabilize the ACA, but it was difficult to talk to Hargan about that while the DOJ is working to have the law overturned.

“It puts us in a very defensive position,” Peters said. “If the administration is trying to cut up the whole thing, it is very, very difficult for us to feel like we’re in a cooperative mood or feel like we can trust it.”

This week, House Democrats rolled out a legislative plan to strengthen ACA coverage by expanding federal insurance subsidies to more marketplace enrollees and reversing the administration’s regulatory changes that allow for lower-cost, less-expansive plans. Other Democrats are pushing Medicare buy-in or Medicare-for-all single-payer plans.

Budget Concerns

Democrats on the panel similarly criticized the administration’s proposed FY20 budget, which also called for repealing and replacing the ACA through the 2017 Graham-Cassidy-Heller-Johnson legislation that was narrowly defeated in the Senate.

Specifically, they were concerned about the $1.4 trillion reduction in projected spending increases over the coming 10 years for Medicaid.

Rep. Steven Horsford (D-Nev.) warned that capping Medicaid spending for each state particularly would affect the ability of growing states to keep up with increases in the future needs of their residents.

Hargan countered that the budget offsets the cut with the addition of $1.2 trillion and gives states greater flexibility in allocating such funding.

“So, it might appear to say it cuts Medicaid by certain [amounts], but actually the money is mostly shifted into a more flexible budget,” Hargan said.

Such flexibility could increase access to care because states could use the funding to eliminate the Medicaid enrollment waiting lists of disabled residents. The lists total 650,000 applicants nationwide, according to one report cited by members of Congress.

Rep. Bobby Scott (D-Va.) warned that the budget’s proposal to link future Medicaid spending increases to general inflation, rather than medical inflation, will decrease the purchasing power of the block grants.

Marketplace Enrollment Issues

Other members of Congress were concerned that the administration proposed cutting outreach and advertising for enrollment in health plans sold in the ACA marketplaces. Advertising would be cut by 90 percent and in-person assistance by more than 80 percent—a total of nearly $150 million.

 “Don’t you think it would be useful to help get the word out that insurance is indeed available, in terms of one mechanism at least to get young people, who are healthy, into the pool and to keep insurance premiums down?” Peters said.

Hargan noted that federally funded “navigators” have gotten decreasing shares of marketplace participants enrolled in recent years. He cited the example of one navigator that received $200,000 and enrolled a single applicant.   

“That’s an area where there seemed like there was some waste going on,” Hargan said.

This week, the administration reported that 11.4 million consumers selected or were automatically re-enrolled in marketplace health plans during 2019 open enrollment. The total was 400,000 fewer than had coverage in 2018.

Hargan said outreach and advertising by health plans and private brokers is a better option for reaching consumers.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Tuesday, March 26, 2019