UPDATE: House PASSES bill package to improve ACA while also lowering drug prices. 183 Republicans vote no.

I didn't write about this yesterday because I was both swamped and a little confused about how the various bills were being packaged and voted on, but I think I have it straightened out now.

Back on March 26th, the House Democrats formally rolled out H.R. 1884. The official title of this bill is the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019", or PPECMHCMAA, which is terrible, so I've simply shorthanded it as "ACA 2.0".

HR 1884 is actually more of a catch-all collection of a dozen or so smaller, standalone ACA improvement bills, each of which either repairs an ACA provision which has been damaged or sabotaged in the past; protects an existing ACA provision from future sabotage; or strengthens & enhances the ACA going forward.

I thought that the original gameplan by the House Democrats was to break the larger bill back up into the individual "mini-ACA 2.0" bills, including both individual committee hearings and separate floor votes for each. And as of a couple of weeks ago, that seemed to still be the plan: The House Energy & Commerce Committee held hearings on six of the "mini-bills", along with another six bills related to prescription drug regulation. All twelve bills then passed out of committee to the House floor, and last week, one of the twelve (H.R.986, the "Protecting Americans with Preexisting Conditions Act", which would nullify Trump's sabotage of 1332 Waivers), was indeed passed by the full House of Representatives.

This week, however, it looks like either I misunderstood the House Dems' timetable on the rest of the ACA 2.0 bills, or they simply changed their mind about how to proceed, because they've decided to go back to packaging several of the bills together again, along with several of the prescription drug bills (per Ariel Cohen & Rachel Cohrs of Inside Health Policy):

The House will vote next week on legislation that combines key drug-pricing and Affordable Care Act bills, House Majority Leader Steny Hoyer (D-MD) said Wednesday (May 8). H.R. 987 contains seven bills, packaging popular, bipartisan drug-pricing policies with partisan measures designed to shore up the Affordable Care Act’s markets.

“I hope Republicans join with us to strengthen health care and lower prescription drug costs instead of continuing their efforts to sabotage our health care system,” Hoyer said in a statement. While the three drug pricing bills have garnered some GOP support, none of the four ACA measures have any Republican backing.

The seven bills in question include these three Prescription Drug bills...

  • H.R. 938, the "Bringing Low-cost Options and Competition while Keeping Incentives for New Generics (BLOCKING) Act of 2019," introduced by Reps. Kurt Schrader (D-OR) and Buddy Carter (R-GA), would discourage parking of 180-day exclusivity by a first generic applicant that is blocking the approval of other generics.
  • H.R. 1499, the "Protecting Consumer Access to Generic Drugs Act of 2019,"introduced by Rep. Bobby Rush (D-IL), would make it illegal for brand-name and generic drug manufacturers to enter into agreements in which the brand-name drug manufacturer pays the generic manufacturer to keep a generic equivalent off the market.
  • H.R. 965, the "Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2019," introduced by Reps. David Cicilline (D-RI), Jim Sensenbrenner (R-WI), Jerrold Nadler (D-NY), Doug Collins (R-GA), Peter Welch (D-VT), and David McKinley (R-WV), would establish a process by which generic manufacturers could obtain sufficient quantities of brand drug samples for testing thereby deterring gaming of safety protocols that brand manufacturers use to delay or impede generic entry.

...along with these four ACA 2.0 bills:

  • H.R.1385, the “State Allowance for a Variety of Exchanges (SAVE) Act,” introduced by Reps. Andy Kim (D-NJ) and Brian Fitzpatrick (R-PA), would provide states with $200 million in federal funds to establish state-based Marketplaces. Under current law, federal funds are no longer available for states to set up state-based Marketplaces.
  • H.R. 1010, a bill to provide that the rule entitled “Short-Term, Limited Duration Insurance” shall have no force or effect, introduced by Rep. Kathy Castor (D-FL), would reverse the Trump Administration’s expansion of junk insurance plans, also known as short-term, limited-duration insurance plans.

  • H.R.1386, the “Expand Navigators’ Resources for Outreach, Learning, and Longevity (ENROLL) Act,” introduced by Rep. Kathy Castor (D-FL), would provide $100 million annually for the Federally-Facilitated Marketplace (FFM) navigator program. The bill would reinstate the requirement that there be at least two navigator entities in each state and would require HHS to ensure that navigator grants are awarded to entities with demonstrated capacity to carry out the duties specified in the Affordable Care Act. The bill would also prohibit HHS from considering whether a navigator entity has demonstrated how it will provide information to individuals relating to association health plans or short-term, limited-duration insurance plans.

  • H.R. 987, the “Marketing and Outreach Restoration to Empower (MORE) Health Education Act of 2019,” introduced by Rep. Lisa Blunt Rochester (D-DE), would restore outreach and enrollment funding to assist consumers in signing up for health care, which has been slashed by the Trump Administration.

Put more simply, the four ACA 2.0 bills would:

  • Provide $200 million in federal funds to help states establish their own ACA exchanges (interestingly, this one has bipartisan support from Rep. Fitzpatrick of Pennsyvania)
  • Nullify Donald Trump's attempt to flood the market with #ShortAssPlans by resetting them back to Obama-era regulations: They'd go back to being limited to 3 months per year, without renewals within the same year.
  • Restore HealthCare.Gov's Navigator/Outreach budget to $100 million/year after Trump slashed the budget down by 84% (along with requiring the funds to be used properly); and
  • Restore HealthCare.Gov's Marketing/Outreach budget to $100 million/year after Trump slashed the budget down by 90% (along with requiring the funds to be used properly)

You can watch the live hearings on C-SPAN here.

As for the other two ACA bills which already passed out of committee, one of them (H.R.986) is the one which passed the full house last week; the sixth one (H.R. 1425, which calls for $10 billion/year for reinsurance programs) has been delayed. Instead, it looks like one of the other ACA 2.0 bills which hasn't actually had committee hearings yet will be next up to bat...and it's the single most important one of the bunch.

It's imortant to note that while all four of the ACA 2.0 bills above are important, three of the four don't actually move the ACA forward...they simply repair some of the damage done to it by the Trump Administration over the past two years. The only one which actually moves the ball forward is H.R. 1385, which helps states set up their own ACA exchanges.

Again: All four are important and I support each of them, but H.R. 1868 is the main course; that's the one which would remove the 400% FPL income eligibility cap for ACA subsidies while also beefing up the underlying subsidy formula:

Rep. Lauren Underwood’s (D-IL) bill, H.R, 1868, would expand eligibility for premium tax credits beyond 400 percent of the federal poverty level and increase the size of the tax credit in all income brackets. The legislation was introduced in the Ways & Means Committee in March but has yet to be formally considered by the committee or scored by the Congressional Budget Office.

Left-leaning stakeholders have long said that a reinsurance bill must be paired with legislation to expand subsidies because reinsurance tends to help middle-and-upper-income individuals and does not benefit those below the poverty line.

...But Ways & Means, which has jurisdiction over Underwood’s bill, has spent more time this Congress focusing on drug pricing than ACA premiums, and the committee likely would need to take up Underwood’s bill before it moves to the floor.

UPDATE Thursday evening: As expected, H.R.987 passed the full House this evening:

House Democrats on Thursday forced Republicans to vote against their own drug pricing bills by packaging them with measures intended to shore up ObamaCare.

The House passed the package in a 234-183 vote, with Democrats drawing only five Republicans to vote with the majority.

Four of the 5 Republicans who voted for the bill package are rated as being in "competitive" districts by Cook Political report (Fitzpatrick, Herrera Beutler, Katko and Upton), so they aren't surprising. Fitzpatrick in particular isn't a surprise since he co-sponsored H.R. 1385. Chris Smith of New Jersey is a bit of a surprise, though, since he's in a pretty safe district.

The only downside here, of course, is that there's no chance in hell that Mitch McConnell will ever bring the bill(s) up for a vote in the Senate, and even if he did...

President Trump, who has made lowering drug prices a key priority, said he supports the drug pricing provisions but would veto the ObamaCare legislation if it ever passed the Senate.

Well, yeah...seeing how three of the four ACA-related bills directly negate Trump's own sabotage policies in the first place.

Ah, well.