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January 2018 Federal Update
January 29, 2018
Tax Bill’s Repeal of Health Mandate Threatens Patient Access
On Dec. 20, Congress approved a final tax bill that repeals the individual mandate – the provision in the current health law requiring Americans to buy health coverage.
According to the Congressional Budget Office (CBO), eliminating the insurance requirement from current law would lead to 13 million more Americans being uninsured by 2027 and would increase premiums by 10 percent annually.
The bill also threatens charitable giving by doubling the standard deduction, thus reducing the number of donors who would be able to itemize their charitable contributions on their tax returns and denying them the tax benefit of their charitable giving. This could result in harm to communities across the country which rely on social and medical services provided by charitable organizations.
The bill does, however, preserve a portion of the orphan drug tax credit, which is used to encourage development of new treatments for relatively rare conditions, including many cancers. It also preserves the medical expense deduction for those who incur high medical costs.
ACS CAN Submits Comments to the Centers for Medicare and Medicaid Services
Medicaid 1115 Demonstration Waivers
Over the past year, several states have sought approval from the Centers for Medicare and Medicaid Services (CMS) to take alternative approaches to providing health care coverage to low-income individuals and families covered by the state Medicaid program. The requests, known as 1115 demonstration waivers, must be approved by CMS before they can be implemented.
On Dec. 1, ACS CAN submitted comments to a proposed 1115 waiver at the federal level for New Hampshire’s Health Protection Program. New Hampshire seeks approval from CMS to implement a workforce training initiative that would require certain enrollees to participate in work requirements or job training programs to remain eligible for health care coverage through the Medicaid program. ACS CAN’s comments conveyed our concern that these policies can be problematic for cancer patients who are often unable to work during treatment. The policies could also limit enrollment and create significant barriers to care for low-income New Hampshire residents managing complex chronic conditions, such as cancer. As reported in an update this past fall, ACS CAN also submitted comments to CMS on a proposed 1115 waiver submitted by Massachusetts. CMS has yet to make a final decision on that waiver proposal.
CMS Draft Letter for Plan Year 2019
On Dec.7, ACS CAN submitted comments on the CMS’ draft letter to issuers for plan year 2019. The agency’s letter establishes many of the rules followed by individual plans in state marketplaces. ACS CAN expressed concern for many of the proposed changes to the letter, including the relaxing of network adequacy standards, which will make it harder for consumers to shop for and understand the plans. Our letter also cautioned against relaxing federal oversight of exchange plans.
House and Senate Pass Short-Term Funding Bill
Congress left town before the end of the year without finishing work on a variety of important issues. The U.S. House and Senate were only able to come to agreement on a short-term funding bill that keeps federal funding at current year levels until Jan. 19, which provided temporary extensions for a variety of programs including both the Children’s Health Insurance Program (CHIP) and Federally Qualified Health Centers (FQHCs). Funding for CHIP and FQHCs is extended only through the first and second quarters of 2018.
On January 22nd, the U.S House and Senate passed another short-term funding bill that will fund the federal government through February 8th, and ended a 3 day government shut down. The bill includes funding to reauthorize the Children’s Health Insurance Program (CHIP) for six years as part of a short-term extension in the FY18 spending bill. However, lawmakers delayed consideration of renewed funding for Federally Qualified Health Centers (FQHCs) until later budget negotiations are completed, threatening access to critical primary care and cancer prevention services for low-income Americans. In 2016, 26 million people relied on more than 1,000 FQHCs for their health care nationwide.
Unfortunately, funding for FQHCs comes from the Prevention and Public Health Fund which provides critical public health dollars to CDC at a cost of $750 million. ACS CAN will continue to call on Congress to come to an agreement on a budget deal, increase funding for the National Institutes of Health (NIH) by $2 billion and extend federal funding for both CHIP and FQHCs.
Broken Promises Report Release
On Dec. 13, ACS CAN joined tobacco control partners to release the annual Broken Promises to Our Children report. The report tracks state spending on tobacco prevention and cessation programs. According to the 2017 Broken Promises to Our Children report, most states are failing when it comes to protecting kids from tobacco. This year, states will collect $27.5 billion, up from nearly $26.7 billion last year, from the tobacco settlement agreement and tobacco taxes combined, but will spend only 2.6 percent of those dollars ($721.6 million) to prevent kids from becoming addicted to tobacco and to help adults quit. Only two states – California and Alaska – provide more than 90 percent of the Center for Disease Control and Prevention’s (CDC) recommended funding level. Twenty-nine states and the District of Columbia are spending less than 20 percent of what the CDC recommends. Connecticut and West Virginia have allocated no state funds for tobacco prevention programs. ACS CAN media advocacy staff participated in joint promotion of the report across the country with mentions in Maine’s Sun Journal, New Hampshire Public Radio, Providence Business News and Worcester.com among others. We will continue to reference the report during 2018 tobacco control campaigns.