Health reform implementation

Budget’s effect on health law unclear

A new Congressional Research Service report says it is unclear how much the House GOP budget would affect the new healthcare law. 

In his “Path to Prosperity” blueprint, House Budget Committee Chairman Paul Ryan (R-Wis.) wrote that his budget “starts by repealing the costly new government-run healthcare law.” 

{mosads}In practice, though, the budget proposal’s effects on the law are turning out to be remarkably murky, even for the experts.

The CRS report obtained by The Hill says that neither the budget resolution nor the “Roadmap to Prosperity” that preceded it “provided sufficient detail regarding specific provisions that would be repealed or retained to determine the disposition of [numerous] provisions.”

The House approved Ryan’s budget last week in a party-line vote.Some effects from the Ryan budget are clear: The Republican budget retains a half-trillion dollars in cuts to Medicare payments, for example.

Conversely, it would clearly eliminate only a small number of provisions in the new healthcare law. 

The future of many other provisions is unclear, however, including some whose repeal would have an immediate impact. For example, drug makers this year started offering a 50 percent discount for medicines in the Medicare “doughnut hole,” but according to CRS “it is unclear whether this discount would be retained or repealed under the budget proposal.”

Other provisions whose fate is unknown include those “related to the quality and efficiency of healthcare, such as those creating value-based purchasing programs, quality reporting systems and demonstrations and pilot programs that would test various patient care models including accountable care organizations,” the CRS report said. “Additionally, no details were provided that would indicate how provisions related to the healthcare workforce and program integrity would be affected.”

Also in doubt: insurance reforms, such as the prohibition on health plans denying coverage for people with pre-existing conditions. Either way, the Republican budget makes it clear that it eliminates the requirement that everyone buy insurance, without which those reforms may be unsustainable.

“Such requirements,” the CRS report says, “simultaneously may constrain the ability of issuers to minimize the risk they bear, and create greater incentives that could lead to an insured population that is disproportionately sicker” and in need or more or more intensive healthcare. This could lead “to higher health insurance prices and greater spending overall,” the CRS report states.

According to an earlier analysis by the Congressional Budget Office, provisions eliminated by the budget include:

• The individual mandate;

• Employer requirements and penalties; 

• Health insurance exchanges and the premium credits and cost-sharing subsidies for exchange coverage;

• The temporary high-risk pool program;

• The early retiree reinsurance program;

• Small-business tax credits;

• The tax on “high-cost” health plans that starts in 2018; and

• The long-term care CLASS Act program.

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