Administration, Lawmakers Jockey Over Health Bill; Trump May Act on Drug Pricing

Bipartisan legislation from Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) aimed at stabilizing the individual health insurance market was unveiled days ago with enough cosponsors from both parties to ensure Senate approval if Majority Leader Mitch McConnell (R-KY) were to bring it up for a vote.  McConnell has not laid out any plans to bring up the measure, however, amid mixed signals from President Trump about how he views the bill and opposition from House Speaker Paul Ryan (R-WI).

The compromise bill (view bill text and summary) would extend reimbursement for the Affordable Care Act’s (ACA) cost-sharing reduction subsidies for the rest of this year, 2018 and 2019.  The proposal also would give more flexibility to states seeking Section 1332 waivers, which allow states to bypass some ACA rules under certain conditions. In addition, individuals over age 30 would be eligible to purchase catastrophic plans offering basic coverage.  

McConnell says he is waiting on a clear signal from the president that he would sign the bill before scheduling action, but that appears unlikely without more concessions to House conservatives. Those could include repealing the individual mandate and delaying enforcement of the employer mandate, expanding use of health savings accounts (HSAs).  On Sunday, Office of Management and Budget Director Mick Mulvaney suggested adding provisions to expand association health plans and encouraging the sale of insurance across state lines, reforms which are already included in the recent White House executive order directing federal regulators to make the changes through regulation.

Some form of the legislation could advance in a year-end package, but its fate largely depends on support from the White House.  

In addition, President Trump is reportedly considering creation of a White House task force to address the cost of prescription drugs, which could be made public this week as part of an expected announcement on the opioid abuse crisis. He has long criticized the rising costs of drugs and referred to the industry as “getting away with murder.”

Geoff Manville
by Geoff Manville

Principal, Mercer’s Law & Policy Group

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