Federal Health Update

Written by: Erin Miller
Date Posted: July 28, 2017

A modified repeal of the Affordable Care Act failed to pass out of the U.S. Senate just before midnight mountain time last night. Republican Sens. Susan Collins, John McCain and Lisa Murkowski joined all of the Democratic senators in opposing the bill. Our Colorado senators were split on the bill, with Sen. Michael Bennet voting against the bill and Sen. Cory Gardner voting in favor of the bill, which would have resulted in 16 million Americans losing their health insurance coverage and impacted tens of thousands of kids in Colorado. (We provided some background on how we got to this point in our post yesterday.) The failure of this bill is a testament to everyone who attended rallies and called their senators and made their voices heard speaking up for Colorado kids. Click here to read more about what the “skinny” repeal bill would have done, what it would have meant for Colorado kids, and what’s next for health reform and children’s health care at the federal level.

What would the bill have done?

The final version of the bill would have:

  • eliminated the tax penalty on individuals who do not have health insurance (also known as the individual mandate),
  • paused the tax penalty on employers who do not offer affordable coverage (also known as the employer mandate),
  • paused the tax on medical devices,
  • eliminated the Prevention and Public Health Fund, which provides expanded investments in prevention and public health to improve health outcomes and to enhance health care quality,
  • increased the maximum contributions to Health Savings Accounts for two years,
  • provided funding for states to seek waivers under the Affordable Care Act and changed the approval process for those waivers,
  • increased the amount of funding for Community Health Centers, and,
  • prohibited federal funds from being sent to certain entities that provide abortions for one year (even though, under current rules, federal funding cannot be used for abortions except in limited cases).

How would this bill have affected Colorado kids?

Nationwide, the non-partisan Congressional Budget Office projected that about 16 million people would have lost their health insurance coverage over the next 10 years, with most of that loss (15 million) occurring next year. It’s likely that tens of thousands of Colorado kids would have been included in that total. That coverage loss would have been caused by:

  • Increased premiums in the individual market and health insurance exchange due to the removal of the individual mandate. It was projected that premiums would have increased by roughly 20 percent. This would have made it harder for some Colorado families, especially those in high-cost rural areas, to afford health insurance coverage.
  • Repealing the requirement to carry health insurance coverage would also have created a reverse welcome-mat effect, or “unwelcome-mat” effect. This effect means that because people would not have been required to have health insurance, families would not have sought out the coverage options that have led them to learn that their children were already eligible for coverage programs such as Medicaid and CHIP.
  • Repealing the employer mandate would have meant that some employers would have stopped offering health coverage to their employees and employees’ families.

So, what’s next?

It’s possible that Republican leaders in Washington, D.C. will continue to fight for some of these harmful changes to the Affordable Care Act in budget negotiations or through tax reform in the coming months. Alternatively, lawmakers could work together in a bipartisan way to improve the Affordable Care Act. If lawmakers decide to work together, they could make a number of fixes to the law. They could establish a new reinsurance program at the federal level that would help insurance companies pay for care for the sickest enrollees and help keep everyone’s premiums down. They could also fix the “family glitch” in which some middle-income families face high health insurance costs but are not eligible for tax credits to make the insurance more affordable.

Under current law, the Trump administration also has the ability to either shore up the markets, or as they have indicated they are likely to do, make small changes that will continue to destabilize the individual insurance market. The changes that the Trump administration has made so far include creating additional public uncertainty about whether they will provide cost-sharing reduction payments to insurance companies, which allow those companies to keep premiums low, especially for individuals facing the most barriers to good health. They have also indicated that they will reduce marketing efforts to encourage Americans to sign up for insurance through the federal Marketplace and shorten the open enrollment period for signing up for coverage through the federal Marketplace. Since Colorado has our own, state-based Marketplace, we are able to continue our own efforts to market coverage available through our exchange and able to maintain a longer open enrollment period.

Erin Miller

About Erin Miller

Erin serves as the Vice President of Health Initiatives for the Colorado Children’s Campaign, leading efforts to improve health insurance coverage and quality for Colorado’s kids, improve access to health services, and ensure that every child has healthy places to live, learn, and play. Prior to joining the Children’s Campaign in September 2015, Erin worked on the Accountable Care Collaborative team at the Colorado Department of Health Policy and Financing. She has extensive experience evaluating federal, state, and local policies related to Medicaid, CHIP, the Affordable Care Act, and public health programs as well as working with legislators, policymakers, constituents, and other stakeholders to improve the health and well-being of vulnerable populations. Her professional experiences range from serving as a WIC Educator and Local Area Retail Coordinator for Denver Health to serving as a Special Assistant in the HHS Office of Planning and Evaluation in Washington DC and as a Health Policy Adviser and Budget Analyst for the U.S. House Budget Committee.