Last week, prior to departing Washington, D.C. for a two week congressional recess, House Republicans and the Trump Administration worked to come to an agreement on the American Health Care Act (AHCA), legislation to repeal and replace the Affordable Care Act (ACA).  Vice President Pence was heavily engaged in the negotiations.  Proposals to gain the support of conservatives threatened to derail the support of moderate Republicans, and by the end of the week, no deal was reached.

Early in the week, House Speaker Paul Ryan (R-WI) indicated that “productive talks” to move forward on health care reform were taking place and were at the “conceptual stage.”  Among the proposals raised was giving States the ability to request a waiver from the essential health benefit requirement  as well as from the community rating requirement.  The community rating proposal, which would allow insurers to charge higher premiums for sicker people, generated significant opposition, including from House Chief Deputy Whip Patrick McHenry (R-NC), who called this weakening of protection for people with pre-existing conditions, “a bridge too far.”

On April 6, 2017, the House Rules Committee approved an amendment to add a $15 billion Federal Invisible Risk Sharing Program to the pending AHCA bill, to help marketplace insurers pay for high-cost enrollees.  An April 7, 2017 analysis of the Federal Invisible High Risk Program by Milliman Inc. found that the actual costs of the program, whether hospitals and physicians are paid at Medicare or commercial rates, would be more than $15 billion.  Adoption of the risk-sharing amendment did not move the vote tally significantly, although House leadership has cautioned that members of Congress could be called back to Washington for a vote during the recess, if a deal can be struck.

As health care reform legislative talks continue, policymakers and stakeholders are also focused on the outlook for current ACA cost-sharing subsidies.  The Trump Administration and congressional leadership are negotiating a solution, with some advocating the subsidies be preserved and some urging that they be stopped.  Even staunch ACA critics are concerned that halting the subsidies would be an unfair disruption to the insurance market, before a longer-term resolution can be reached.  Speaker Ryan has promised that the House of Representatives will not drop its lawsuit against these subsidies, maintaining that it is an important separation of powers issue and that the Obama Administration spent billions of dollars in subsidies without the necessary congressional appropriation.  The case, now House v. Price (formerly House v. Burwell), is on hold at the U.S. Court of Appeals for the District of Columbia Circuit, with a status report from both sides due May 22, 2017.  Nearer term, insurers including the Alliance of Community Health Plans (ACHP), are encouraging House and Senate leaders to appropriate funding for these subsidies as part of an omnibus Fiscal Year 2017 appropriations bill before April 28, 2017, when current federal funding expires.