Thanks to Hall Render for outreach to Health staffers on the Hill for National Rural Health Day! Twenty-six legislators acknowledged the work of State Offices of Rural Health, rural providers and communities. NOSORH partnerships, framing messages and ensuring is focusing its efforts on we take advantage of every opportunity to share messages about rural needs as we move forward with our important policy work.

The following update was provided by Hall Render, NOSORH Legislative Liaison:

Republicans Sweep Elections, ACA Future in Doubt
On November 8, Donald Trump was elected President and the Republican Party retained control over the House and lost two seats in the Senate to give them a 52-48 majority. The unexpected Republican sweep puts the future of the Affordable Care Act (ACA) in doubt.

While President-elect Trump campaigned on immediately “repealing and replacing” the ACA and even called for a special session to repeal the law, even repealing portions of ACA will take time. Trump’s transition website says it will seek to replace the ACA with Health Savings Accounts and high-risk pools for people with expensive medical conditions. The website also discusses the need to “modernize Medicare” and maximize state flexibility on Medicaid.

The legislators who will likely be primarily responsible for the future direction of the health care law will be Speaker of the House Paul Ryan (R-WI), who recently unveiled his “Better Way plan,” House Ways and Means Chairman Kevin Brady (R-TX), Senate Finance Chairman Orinn Hatch (R-UT), Senate Majority Leader Mitch McConnell (R-KY) and Senator John Thune (R-SD).

Another key figure will be Rep. Tom Price (R-GA) who was nominated on November 29 to be HHS Secretary.  Price is the House Budget Chairman and one of the more active members on health related issues.  Price is a former orthopedic surgeon from Atlanta and represented a district just north of Atlanta so his record on rural health issues is limited. Price has been a staunch critic of the ACA, but has worked across the aisle on Medicare/Medicaid issues.

Price’s plan to replace the ACA, named the “Empowering Patients First Act,” would repeal the entire ACA, but the replacement sections deal with the individual market. While the Price plan doesn’t address Medicaid, it is very close to Speaker Ryan’s plan in most areas. Both plans would end the current exchanges and system of mandatory entitlement subsidies with a system of tax credits. Ryan’s plan is not specific about the credits. Under Price’s proposal, the amount of the tax credits varies based on age but not health status. Price’s plan calls for credits of between $900 and $3,000 annually.

Since Republicans will not have the 60 votes in the Senate, they will likely use the same budget mechanism Democrats used to pass the ACA in 2010- budget reconciliation. Budget reconciliation is a two-step process that requires the House and Senate to first pass a budget resolution and then pass the reconciliation itself.

A Republican replacement plan would likely be implemented as a transition period for those losing coverage.  Revision of regulations requires publishing revisions for notice and comment. In 2015, the House and Senate voted to repeal much of the law but left Medicare cuts in place through the reconciliation process.  This process was a blueprint for House and Senate Republicans and could expedite the ACA repeal process.  Nevertheless, Republican leadership has indicated that ACA replacement will take considerable time.

Trump to Nominate Verma to Head CMS
On November 30, President-elect Trump nominated Indiana health consultant Seema Verma as the next CMS Administrator. Verma, an Indiana resident, was the architect behind Vice-President-elect Mike Pence’s Medicaid expansion model known as Health Indiana Plan 2.0. If confirmed, Verma will oversee the Trump administration’s efforts to unwind the ACA and replace it with conservative health policies. Verma will also be charged with implementing Medicare’s new physician payment system, MACRA.

Congress Returns to Washington
The House and Senate returned in mid-November to begin the “lame duck” portion of the congressional calendar.  The session is expected to run through December 9, at which point Congress will adjourn the 114th Congress. The only must-do item on the Congressional agenda is funding the federal government which expires December 9.  House Republicans have begun work on a continuing resolution to fund the government through March or May of 2017, a strategy requested by President-elect Trump’s transition team.

The spending bill will be added to the growing list of health reforms Congress has pledged to tackle in 2017. The repeal and replacement of the ACA and an overhaul of Medicare are at the top of the list.

House Republicans indicated this week that an overhaul of the Medicare system is a priority within the first six to eight months of 2017.  Medicare reform was not an issue President-elect Trump campaigned on, so it’s unclear whether the White House would support a substantive overhaul.

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