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General News    H2'ed 7/23/17

UPDATE: Senate health repeal FAILS the Byrd Rule; Freedom Caucus throws in the towel!

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" Grandfathering Certain Medicaid Waivers; Prioritization of HCBS Waivers: This section says that the Secretary will encourage states to adopt Medicaid Home and Community Based Services (HCBS) waivers but does not set forth any actual details for this plan. (Sec. 136)

" Reporting of CMS-64 Data (T-MSIS): This provision requires the Secretary of HHS to submit a report on Congress recommending whether expenditure data from the Transformed Medicaid Statistical Information System (T-MSIS) is preferable to data from state CMS-64 reports for making certain Medicaid decisions. (Sec. 133 -- 1903(h(5))

Provisions Not Subject to a 60-vote Byrd Rule Point of Order

" Medicaid Work Requirements: This provision allows states the option to impose work requirements on Medicaid enrollees who are nondisabled, nonelderly, and nonpregnant. Pregnant women are exempt from any work requirements for 60 days after giving birth. (Sec.131)

" Providing Safety Net Funding for Non-Expansion States -- This section provides $10 billion for non-expansion states. (Sec. 129)

" State Stability and Innovation Fund: This section includes abortion restrictions on funding for the State Stability and Innovation Fund by tacking the Fund onto the CHIP program.(Sec. 106)" Equity Adjustment: This provision provides for adjusting the per capita cap targets of low and high-spending states to promote equity. (Sec. 133 -- 1903(c)(5))

" Repeal of Cost-Sharing Subsidy Program: This section permanently repeals cost-sharing subsidies beginning in 2020. (Sec. 209)

" Reporting of CMS-64 Data: This provision requires states to include information on per capita cap enrollment and expenditures, psychiatric hospital expenditures, and children with complex medical conditions in their Medicaid expenditure reports. (Sec. 133 -- 1903(h)(1))

Still Under Review

" Waivers for State Innovation (Essential Health Benefits): This section amends Sec. 1332 of the ACA to allow states to waive age rating, essential health benefits, and pre-existing condition requirements so long as their proposal does not increase the federal deficit. (Sec.207)

" Small Business Health Plans: This section would allow small businesses to establish"association health plans" that could be sold across state lines. For regulatory purposes, these plans would be treated as part of the large group market and thus would be exempt from many ACA requirements such as covering essential health benefits. (Sec. 139)

" Change in Permissible Age Variation in Health Insurance Premium Rates ("Age Tax"):This section allows insurers to charge older Americans at least five times more than what they charge younger individuals. (Sec. 204)

" Flexible Block Grant Option for States: This section allows states the option to receive a lump sum Medicaid "block grant" instead of the per capita cap payments. (Sec. 134)

The Senate could theoretically overrule the Parliamentarian, but that would be a declaration-of-war kind of thing, and give the GOP yet-another black eye in the ethics and honesty department. So I doubt Mitch would go there on a bill that's probably doomed anyway.

Also (h/t FirstAmendment in the comments): Sen. Bernie Sanders' staff was instrumental in arguing the case before the Parliamentarian. Good job, Senator and staff!

Mark Meadows, chairman of the far-far-far-right Freedom Caucus (in the House) now says passage of Trumpcare is "almost impossible," according to this tweet from Matt Fuller:


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