Capitol Comments

Remember that after the Affordable Care Act passed, numerous commentators predicted that increased insurance coverage, achieved through purchase of individual plans through the ACA marketplace or expanded Medicaid coverage, would precipitate a primary care shortage? Experts feared that those with new coverage would not actually have access to care and those previously insured might experience decreased access to primary care. Studies have shown that primary care availability hasn’t suffered as expected.

The National Association of Attorneys General called on insurance companies to prioritize non-opioid pan management options. CVS Health announced it would place a 7 day restriction on opioid prescriptions for new pain patients. CVS Foundation announced $2 million for medication-assisted treatment and recovery services.

The bill proposed this week by Senators Graham and Cassidy would repeal many provisions of the  Affordable Care Act and redesign the Medicaid program. Through 2026 the federal government would  provide each state a block grant in lieu of funding for Medicaid expansion and subsidies for health insurance purchased through the ACA marketplaces. Federal funding for Medicaid, absent the expansion, would be converted to a per capita cap basis, reducing federal expenditures over time. After 2026, the block grant would disappear. The bill would also eliminate consumer insurance protections of the ACA including prohibitions against annual and lifetime limits and underwriting practices related to pre-existing conditions.  

On Aug. 30, Ohio Gov. John Kasich and a bipartisan group of 7 other governors released a letter to congressional leaders that outlines reforms Congress should consider to strengthen states’ health insurance markets. 

The latest version of the Senate’s Better Care Reconciliation Act, or BCRA, was released July 20, 2017. According to the CBO analysis, the new version of the BCRA would reduce federal deficits by $420 billion over the 2017-2026 period, the net result of a direct spending decrease of $903 billion partially offset by a $483 billion decrease in revenues. Of special interest to states, the reduction in Medicaid spending is $772 billion, or 85 percent of the reduced spending, directly impacting states’ budgets. The effects of the bill on the number of uninsured is little changed from the earlier version. In 2018, 15 million more people would be uninsured than under current law and would reach 22 million in 2026.

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