The deal struck this week to reopen the government and avert default left the Affordable Care Act mostly untouched, with the single Obamacare provision that made it into the agreement unlikely to do much harm to the law.
The Health and Human Services secretary will now have to personally vouch to Congress that proper safeguards are in place to insure subsidies for buying health insurance go to only those who qualify. She’ll have to provide a report by Jan. 1 detailing how that will happen, and within seven months the HHS inspector general’s office will be required to produce its own report on how the verification systems are working.
Other than adding a few more reports, the provision barely changes the Affordable Care Act, and is a far cry from the delay, defund, or repeal cries Republicans sounded just weeks ago.
Under Obamacare, people earning one to four times the federal poverty level can get a subsidy to help pay for the health insurance plans, which they’re now required to hold. The insurance marketplaces, or exchanges, opened for business — some successfully, some not — on Oct. 1, and income-verification measures are already in place.
The exchanges compare applicants’ reported income with IRS and Social Security data, as well as wage information available through Equifax, a credit-reporting agency. If that doesn’t substantiate what an applicant says, the exchange will ask for additional information or documentation.
In July, the administration announced that in 16 states and Washington, which are running their own exchanges, they would make an exception for one year only. When an applicants’ projected income is more than 10 percent below what the IRS or Social Security data indicate, and there’s no Equifax data to support it, and the individual can’t provide a reasonable explanation for the change, states can choose not to audit them.
Instead ““ in 2014 only ““ the state exchanges have the option of auditing a statistically significant sample of this group rather than each member. Everyone applying for insurance would still be subject to perjury charges for lying.
It wasn’t immediately clear what the impact of Wednesday’s agreement would be on HHS’s decision to grant states that reprieve in 2014. Statistical verification is used by the IRS to verify claims, and the law did grant HHS flexibility in its implementation timeline, so it’s not clear the July decision would need to be changed.
HHS did not comment on the new provision.
Republicans have long raised concerns that Obamacare will encourage fraud, and the administration’s July announcement renewed those criticisms. “Remember ‘liar loans,’ the low- or no-documentation mortgages that took borrowers at their word without checking pay stubs or W-2s?” The Wall Street Journal editorial board wrote at the time. “Obamacare is now on the same honor system, with taxpayers in tow.”
The House GOP passed a bill last month that would tighten verification procedures by requiring the HHS inspector general to certify that a program to consistently and accurately verify income is in place before HHS can provide any subsidies. That had the potential to be seriously disruptive, as Judy Solomon, vice president for health at the left-leaning Center on Budget and Policy Priorities, pointed out: It wasn’t clear how the inspector general would audit something that did not yet exist, so the subsidies could have been delayed.
“While the bill may sound innocuous, it would effectively blow up the operations of the new exchanges by preventing subsidies from starting on January 1,” she wrote.
What ended up in the final agreement that lawmakers passed on Wednesday was significantly weaker and unlikely to change the Affordable Care Act’s implementation. The reports may provide Republicans an additional chance to scrutinize or criticize, but it won’t stop the ACA train from pulling out of the station.
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"Even if House Republicans manage to get enough members of their party on board with the latest version of their health care bill, they will face another battle in the Senate: whether the bill complies with the chamber’s arcane ... Byrd rule, which stipulates all provisions in a reconciliation bill must affect federal spending and revenues in a way that is not merely incidental." Democrats should have the advantage in that fight, "unless the Senate pulls another 'nuclear option.'”
The House has passed a one-week spending bill that will avert a government shutdown which was set to begin at midnight. Lawmakers now have an extra week to come to a longer agreement which is expected to fund the government through the end of the fiscal year in September. The legislation now goes to the Senate, where it is expected to pass before President Trump signs it.
President Trump’s portrayal of an effort to funnel more Medicaid dollars to Puerto Rico as a "bailout" is complicating negotiations over a continuing resolution on the budget. "House Democrats are now requiring such assistance as a condition for supporting the continuing resolution," a position that the GOP leadership is amenable to. "But Mr. Trump’s apparent skepticism aligns him with conservative House Republicans inclined to view its request as a bailout, leaving the deal a narrow path to passage in Congress."
Democrats in the House are threatening to shut down the government if Republicans expedite a vote on a bill to repeal and replace Obamacare, said Democratic House Whip Steny Hoyer Thursday. Lawmakers have introduced a one-week spending bill to give themselves an extra week to reach a long-term funding deal, which seemed poised to pass easily. However, the White House is pressuring House Republicans to take a vote on their Obamacare replacement Friday to give Trump a legislative victory, though it is still not clear that they have the necessary votes to pass the health care bill. This could go down to the wire.