Senate GOP unveils draft of healthcare overhaul bill -AND- Final budget agreement provides over $1 billion to improve Medi-Cal provider payments

CAL/AAEM News Service at
Wed Jul 12 10:41:17 PDT 2017



June 22, 2017


Senate GOP unveils draft of healthcare overhaul bill



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By Leslie Small


On Thursday morning, Senate Republicans finally unveiled a draft version of
their bill that would repeal and replace the Affordable Care Act.


The draft (PDF), which is titled the "Better Care Reconciliation Act of
2017," has many similarities to the version passed by the House in May. For
example, it repeals the ACA's individual mandate and several of the law's
taxes on the healthcare industry-including the health insurance tax. But it
also includes several key differences.


Crucially for insurers, the legislation will fund cost-sharing reduction
payments through 2019. Both Congress and the Trump administration had
previously refused to say what would happen to those subsidies after a court
case challenging their legality is resolved, which made it difficult for
insurers to decided where to offer ACA exchange plans next year and how to
price them.


Here's a look at the other key parts of the bill:


For Medicaid:


*  The Senate's bill phases out Medicaid expansion from 2020 to 2024.

*  Like the House bill, the Senate's measure would change Medicaid's
open-ended funding structure to a per-capita cap arrangement. However, the
Senate's measure makes even deeper cuts Medicaid funding starting in 2025.

*  It allows states to require nondisabled, nonelderly, nonpregnant
individuals to satisfy a work requirement before being eligible for Medicaid


For the individual market:


*  Unlike the House bill, which replaced the ACA's income-based premium
subsidies for individual market customers with age-based tax credits,
subsidies are income-based in the Senate's version. But they are
considerably less generous than the ACA's-capping income eligibility at 350%
of the federal poverty level rather than 400%.

*  The measure would set aside $15 billion per year in 2018 and 2019, and
$10 billion per year in 2020 and 2021 for arrangements with health insurers
"to address coverage and access disruption and respond to urgent healthcare
needs within states."

*  It also sets up a "long-term state stability and innovation program,"
which would get $62 billion in funding over eight years.

*  Like in the House bill, the Senate's draft measure gives states
flexibility to opt out of many of the ACA's provisions regulating the
individual markets. But the Senate's version uses a different mechanism,
instead tweaking existing 1332 waivers.




June 26, 2017


Final budget agreement provides over $1 billion to improve Medi-Cal provider



 <> California
Medical Association



Last November, the California Medical Association (CMA) took on Big Tobacco
to improve access throughout the Medi-Cal program. California voters
overwhelmingly approved Proposition 56, which added a $2 tax on tobacco
products and stipulated that funds should increase access by improving
provider payments.


In January, the Governor's budget redirected all tobacco tax revenues to
support the state's General Fund obligations. In May, he doubled down on his
proposal, offering no additional funding to improve provider payments.


Restoring Prop. 56 funds was CMA's #1 budget priority, and we engaged the
legislature through earned media, digital advertising, grassroots outreach
and direct advocacy.


The legislature heeded CMA's leadership and efforts - both houses rejected
the Governor's proposal and laid out a different framework for appropriating
tobacco tax revenues into the final budget.


The Senate and Assembly have now approved the state budget, which includes a
Prop. 56 appropriation bill that provides over $1 billion ($546 million in
state funds plus a federal match) for the 2017-2018 fiscal year to improve
provider payments.




Jeff Wells
Deputy Editor, CAL/AAEM News Service


Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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