The Republican Party will soon be the party of health care. You watch.
-President Donald J. Trump, March 23, 2019
Opening with the above quote from President Trump, the Republican Study Committee (RSC) released the first part of its healthcare plan entitled: A Framework for Personalized, Affordable Care. An accompanying press release from the RSC Chairman Mike Johnson (R-LA) states that the “RSC Health Care Plan would protect vulnerable Americans – including those with pre-existing conditions, chronic illness, and serious health issues – while reducing premiums, deductibles, and overall health care costs.” The proposal is similar to the Graham-Cassidy legislation released in the fall of 2017 that was criticized for likely resulting in significant coverage losses if implemented as drafted.
The RSC plan proposes to keep the ACA’s requirement that individual market plans cover pre-existing conditions while at the same time eliminating certain ACA market reforms intended to protect individuals with pre-existing conditions from discrimination and requiring comprehensive coverage. Instead, the RSC plan would provide federal funding for states to supplement the medical costs of eligible high-risk individuals by states designing and operating their own high-risk pools, referred to as “Guaranteed Coverage Pools.” States could choose whether or not to administer a Guaranteed Coverage Pool resembling a traditional high-risk pool, or implement other innovative reinsurance programs to help reduce premiums.
The RSC plan would implement the Trump administration policies regarding short-term limited duration plans and calls for the expansion of health savings accounts by eliminating the requirement that health savings accounts be linked to a high-deductible health plan and expand the scope of eligible healthcare expenditures. Individuals and families would be permitted to contribute larger amounts to health savings accounts than under current law, increasing the limits from $3,500 for individuals and $7,000 for families to $9,000 for individuals and $18,000 for families. The goal of these proposals is to “empower Americans to use their money – tax-free – to cover more health-related expenses including insurance premiums, direct primary care service fees, and health sharing ministry dues.”
Medicaid expansion under the ACA would be eliminated, as the RSC plan would phase out the Medicaid expansion’s enhanced Federal Medicaid Assistance Percentage (FMAP) rates to “eventually match normal FMAP rates.” The proposal would repackage funding from the ACA’s Medicaid expansion and subsidies provided to eligible individuals enrolling in Exchange coverage into block grants that could be given directly to states so that they can address the needs of their Medicaid beneficiaries. An analysis of a similar policy proposal in Graham-Cassidy found that it will reduce federal funding to states by $215 billion dollars in the first ten years and more than $4 trillion dollars over a twenty year period.
Another proposal in the RSC plan includes enhancing portability protections for individuals who are moving from employer-sponsored coverage to the individual insurance market. This proposal is intended to “bridge the portability gap” left under the Health Insurance Portability and Accountability Act (HIPAA). Notably, it would include a continuous coverage requirement of twelve months or a person could be subject to an exclusion period of up to twelve months for a pre-existing condition. The RSC did not include proposed legislative text. Roger Marshall (R-KS), who is the chairman of the RSC healthcare task force, stated in an interview ahead of the RSC plan’s release that he thinks “2020 is all about health care, and then Americans have very much a binary choice – the choice between government-controlled health care, or in the individual controlling their health, the individual and the patient.” The White House also continues to work on several healthcare proposals in close coordination with the Department of Health and Human Services Secretary Alex Azar and the Centers for Medicare & Medicaid Services Administrator Seema Verma.
*Special thanks to Hayley White, Law Clerk and District of Columbia Bar license pending, for her assistance in preparing this post.