Legislative Update. Steven Larrabee, Senior Government Affairs Specialist

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1 Legislative Update Steven Larrabee, Senior Government Affairs Specialist June 1, 2017

2 Agenda Federal Health Care Reform ACA Reset GOP Reconciliation Plan Regulation Maine 2

3 What s worked - Access 3

4 What s worked Access (particularly low income) 4

5 American Health Care Act Reconciliation Legislation Maintains many ACA components: Preexisting conditions Guarantee availability and renewability of coverage Coverage of adult children up to age 26 Cap out-of-pocket expenditures No health underwriting* No lifetime and annual limits No discrimination on basis of race, nationality, disability, age or sex Essential Health Benefits* 5

6 American Health Care Act (cont.) Medicaid Repeals state option to expand Medicaid by 12/31/19 Funding for expansion would phased out starting in 2020 Provides $10B in safety net funding for non-expansion states Federal Subsidies Advanced Premium Tax Credits and Cost Sharing Reduction Payments remain until 12/31/19 Replaced with advanceable, refundable tax credits adjusted by age (indexed to CPI+1): Under age 30: $2,000 Between 30-39: $2,500 Between 40-49: $3,000 Between 50-59: $3,500 Over age 60: $4,000 Additive for families and capped at $14,000. Available in full up to $75,000 ($150,000 joint) & phased out for higher incomes 6

7 American Health Care Act (cont.) Patient and State Stability Fund $100B from ; beginning in 2020 states must provide matching funds that increase over time State option on use of funds, but defaults to federal reinsurance program (75% of claims between $50K-$350,000) Continuous Coverage Repeals Individual and Employer Mandate Penalty (but reporting requirements appear to remain) 30% surcharge for those without continuous coverage Applies to Individual and Small Group Taxes Repeals many taxes (HIT, Medical Device, OTC Rx, Medicare Tax, etc). Increases thresholds for FSAs and HSAs ($6,550/$13,100). Delays Cadillac Tax until January 2025 Other Repeals AV and Metallic Tiers (12/31/19) Allows 5 to 1 age rating at state s discretion (1/1/2018) 7

8 Amendments to AHCA Manager s Amendments (March 20, 2017) Changes to ACHA Medicaid provisions Allow states to opt for block grants rather than per-capita cap for certain populations Moves most tax repeals dates up from 2018 to 2017 Adds $15 billion to the Patient & State Stability Fund for 2020 to cover maternity, mental health, and substance use disorder care Federal Invisible Risk Sharing Program (April 6, 2017) Creates federal invisible risk sharing program within the Patient and State Stability Fund Appropriates $15 billion beginning 2018 and lasting until 2026 Not enough funding to create a credible program Voluntary issuer participation 8

9 American Health Care Act (cont.) MacArthur Amendment (April 26, 2017) Limited Waiver Authority Essential Health Benefits Community rating rules, except for the following categories, which are not waivable: Gender; Age (except for reductions of the 5:1 age ratio previously established); Health Status (unless the state has established a high risk pool or is participating in a federal high risk pool) Waiver must attest that the purpose of their requested waiver is to reduce premium costs, increase the number of persons with healthcare coverage, or advance another benefit to the public interest in the state. Upton Amendment (May 3, 2017) Modifies the underlying legislation s Patient and State Stability Fund to make available an additional $8 billion from 2018 to 2023 to States who have applied and been granted a waiver from community rating 9

10 CBO Coverage Impact 10

11 CBO Examples of Subsidy Impact 11

12 What s the Senate s Plan? "I don't know how we get to 50 (votes) at the moment. But that's the goal. - U.S. Senate Majority Leader Mitch McConnell Reuters 5/24/17 For Majority Leader Mitch McConnell, writing a Republican-only health care bill that can pass the Senate boils down to this question: How do you solve a problem like Dean, Lisa, Patrick, Ted, Rand and Susan? - Alan Fram (AP) 5/30/17 12

13 Maine Maine Guaranteed Access Reinsurance Association (MGARA) LD 659 Right-to-Shop LD 445 Surprise Billing LD 1557 Small Employer Self-Insurance/Stop Loss LD 608 Mandates Naturopaths LD 1030 Telehealth LD 949 Lyme Disease LD 1417 ACA-related Legislation Contraceptive Coverage LD 1237 Preventative Health Services LD