By Ben Pistora
The September defeat of the Graham-Cassidy Bill has not brought an end to the health care debate in Washington DC. Rather, in the weeks since the most recent attempt to overturn the Affordable Care Act, numerous executive actions and legislative efforts to crater the effectiveness of the ACA have kept Americans’ worried about access to health care in the future.
On October 12, the Trump administration announced that an executive order ending the policy of Cost Sharing Reductions (CSRs) would take effect, an action in keeping with prior threats to sabotage the ACA. CSRs are government reimbursements to insurance companies to help to stabilize insurance markets and lower overall costs and were a key element of the viability of the ACA. The administration cited legal reasoning in their decision to end the CSR policy, however it is likely administrators also knew the effects could be potentially disastrous. In August, anticipating a potential move regarding CSRs, the Congressional Budget Office released a report outlining the impact of a CSR rollback; higher premium costs, the loss of coverage for up to 1 million Americans, and a federal deficit increase of up to $194 billion. Since the announcement, several states have already announced likely premium hikes.
In mid October, the Administration struck another blow to a core tenant of the ACA in creating exceptions to the Affordable Care Act’s promise of no-cost contraceptive coverage. The new rules broaden the entities that may claim religious objections to providing contraceptive coverage to include both nonprofit organizations and for-profit companies. Also included are higher educational institutions that arrange for insurance for their students, as well as individuals whose employers are willing to provide health plans consistent with their beliefs.
Of these developments, Rev. Jimmie Hawkins, Director of the Presbyterian Church Office of Public Witness said “access to contraception is the cornerstone for gender equity and economic prosperity. Revoking universal access is an affront to women everywhere and a distortion of the principle of religious liberty.”
The 205th Presbyterian Church (U.S.A.) General Assembly (1993) provided clarity on the issue as well, passing an overture which included directions to advocate “for prompt funding of a comprehensive family planning program that will be offered without cost to any man or woman who states a need; and calls upon Congress and the president to include comprehensive family planning in any proposal for national health care.”
This turmoil is igniting some political will in Congress to slow the free-fall of the ACA and stabilize insurance markets. Recently, a potential deal was struck in Congress between Sens. Lamar Alexander (R-TN.) and Patty Murray (D-WA.) regarding the sustenance of CSRs. At the moment, the plan seeks to extend officially appropriated CSR funding through 2019 and restore the $109 million outreach dollars aimed to encourage individual exchange signups.
The plan has proven controversial among congressional Republicans. Some prominent GOP leaders have opposed the effort as a “bailout” of the ACA, but others, including Freedom Caucus Chair Rep. Mark Meadows (R-NC.) have signaled the deal as a, “good start”. Sen. John McCain (R-AZ.) has already indicated his support. Nevertheless, the administration remains a roadblock to the success of the Murray-Alexander initiative. While he did initially indicate support for the CSR appropriation, President Trump has since walked back that statement, making the push on legislators even more crucial.
Although battles over the ACA and looming budget votes have dominated the narrative of the past weeks, the issue of CHIP, the Children’s Health Insurance Program, remains critical and is not receiving the attention it requires. Per the Children’s’ Defense Fund, there are roughly nine million children and 370,000 pregnant women who depend on the benefits of the CHIP Program annually. First introduced in 1997, CHIP was the result of a bipartisan effort between senators and the Clinton White House and operates as a companion program to Medicaid, helping provide health insurance coverage to Americans under the age of 18 within 138% of the federal poverty level. CHIP has seen reauthorization on numerous occasions through the Bush and Obama Administrations, but the Senate missed its most recent deadline on Sept. 30. Since then, despite bipartisan support, CHIP has not seen reauthorization and reauthorization does not appear likely until after the budget negotiations. States that did not fund CHIP through Medicaid expansion and subsequently rely on federal funds now face impending expirations. These expirations mean that children may be thrown of programs in the upcoming months in states such as Alabama, Minnesota, Colorado, and Utah. It is critical that Congress understands the consequences and acts quickly on reauthorizing these funds before coverage is slashed for millions of children in the coming months.