Summary
On Friday, House Republican leadership released the Lower Health Care Premiums for All Americans Act, as their proposed solution to the expiring enhanced premium tax credits (EPTCs)(press release). Impact Health is currently working on a full summary of the bill, which features the following provisions:
- Expands the rules regarding who can form Association Health Plans;
- Clarifies that stop-loss insurance is not health insurance coverage;
- Codifies regulation allowing employers to offer employees tax-advantaged funds to pay for individual insurance as custom health option and individual care expense (CHOICE) arrangements.
- Funds cost sharing reduction (CSR) payments beginning 2027
- Increases pharmacy benefit manager (PBM) transparency in the commercial market.
While the package features proposals with broad Republican support, the bill is unlikely to pass without the support of moderate Republicans who seek to extend the EPTCs in some form. Discussions to add such an amendment to the Republican package fell apart over the weekend, and instead Reps. Fitzpatrick (R-PA), Kiggans (R-VA), Lawler (R-NY), and Valadao (R-CA) will offer their amendment, which would extend a modified version of the EPTCs for two years, before the Rules Committee tomorrow.
The amendment is unlikely to be advanced to the House floor, which leaves discharge petitions as the only remaining option for an EPTC extension. The Democrats’ discharge petition, which is a three-year extension of the EPTCs has 214 signatures with no Republican support, while Rep. Fitzpatrick and Rep. Gottheimer (D-NJ) discharge petitions for modified extensions have some level of bipartisan support. Even if a discharge petition were to garner enough support to be passed by the House, the Senate is unlikely to take up the measure before the end of year.
MAHA Update
The Department of Agriculture (USDA) approved six new state waivers to restrict food purchases using Supplemental Nutrition Assistance Program (SNAP) benefits. These states join 12 others that already placed limits on the use of SNAP benefits to purchase “junk” food and/or soda earlier this year.
APTC Information Collection
Last week, CMS noticed a proposed collection of information to require state Exchanges to submit a sample of household tax information to review for improper APTC payments. CMS has been reporting on improper APTC payments administered through the federal platform since the fiscal year 2022 report. Comments on the proposed information collection are due February 9th.
Regulatory Update
The Office of Management and Budget (OMB) is currently reviewing the following rules:
- ACA Marketplace: The HHS Notice of Benefit and Payment Parameters for 2027 proposed rule
- Medicare:
- Procurement of Domestic PPE. An advance notice of proposed rulemaking that would detail program incentives and requirements for Medicare providers and suppliers to invest and phase-in the procurement of American made personal protective equipment (PPE) and essential medicine to secure our nation’s health and safety.
- MA and Part D: Advance Notice of Methodological Changes for Calendar Year (CY) 2027 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies
- Medicaid:
- Gender-Affirming Care.
- A proposed rule titled, “Medicaid Program; Prohibition on Federal Medicaid Funding for Sex Trait Modification Procedures Furnished to Children and Youth.”
- A proposed rule titled, “Medicare and Medicaid Programs; Hospital Condition of Participation: Limiting Participation Based on the Performance of Sex Trait Modification Procedures on Children.”
- State Directed Payments. A proposed rule titled, “Medicaid Managed Care-State Directed Payments.” The proposed rule appears intended to advance a presidential memorandum released on June 6, which directs HHS to “eliminate waste, fraud, and abuse in Medicaid, including by ensuring Medicaid payments rates are not higher than Medicare, to the extent permitted by applicable law.”
- Medicaid Tax Waivers. A proposed rule titled, “Preserving Medicaid Funding for Vulnerable Populations – Closing a Health Care-Related Tax Loophole.”
- Gender-Affirming Care.
- Prescription Drugs:
- A proposed rule titled, “Improving Transparency into Pharmacy Benefit Manager Fee Disclosure” and a proposed rule addressing Transparency in Coverage requirements.
- CMMI Drug Pricing Models. A proposed rule for a Global Benchmark for Efficient Drug Pricing (GLOBE) Model and a proposed rule for Guarding U.S. Medicare Against Rising Drug Costs (GUARD) Model
- Nutrition:
- Head Start. A notice from the Administration for Children and Families titled, “Publish Request for Information: Nutrition Services in Head Start Programs
- Immigration:
- Unaccompanied Children. An interim final rule titled, “Unaccompanied Children Program Foundational Rule; Update to Include Proof of Identity and Income Verification Standards.”