Like Causes?

Install the App
TRY NOW

house Bill H.R. 1425

Expanding Obamacare Tax Credits, and Encouraging States to Expand Medicaid While Punishing Those That Don’t

Argument in favor

This bill would expand the availability & value of Obamacare’s premium tax credits and increase marketing for the exchanges to encourage people to enroll. It would also encourage more states to expand Medicaid and give Medicare the power to negotiate drug prices.

jimK's Opinion
···
06/28/2020
Support the people. Put at least as much funding to help our populace with their medical needs as we do to subsidize corporate farms, financial institutions and our multi-national corporations. Trickle down economics does not and never has worked; Our country’s increasing wealth gap proves this. Trickle down economics only results in the people at the bottom being trickled upon by elites who need them to maintain their personal cash flows. … … … Oh yeah, be very wary regarding promises made by the trump. The trump had made a comment that he has a solution to assure pre-existing coverage to be part of most health insurance policies - he would allow them to charge newly insured members totally different rates if they needed pre-existing condition coverage - thus defeating the whole concept of pre-existing coverage by essentially making insurance unaffordable to those who have critical pre-exiting conditions when they enroll. Just another friggin game to juggle the intent of ‘pre-existing’ condition coverage into a ‘pay lots more’ to get your pre-existing condition coverage.
Like (90)
Follow
Share
Dicr's Opinion
···
06/28/2020
We’re in the grips of a pandemic, let’s get this done.
Like (75)
Follow
Share
Lara's Opinion
···
06/28/2020
I support this. I want my representatives to vote to strengthen, expand, and improve the ACA, not dismantle it.
Like (61)
Follow
Share

Argument opposed

This partisan bill expands Obamacare’s tax credits in a fiscally irresponsible way and would try to use the threat of federal funding cuts to coerce states into expanding Medicaid. Even worse, it is a backdoor attempt end the longstanding ban on the use of federal funding for abortions.

burrkitty's Opinion
···
06/28/2020
Threatening the states with punishment cuts is blackmail and doing it is illegal. That’s true whether it’s forcing expanding Medicaid or “defunding” Sanctuary Cities. Even if I agree with the gist of the bill, I cannot agree to blackmailing the States to force compliance without a vote. It’s the principle of the thing.
Like (45)
Follow
Share
Sneaky-Pete's Opinion
···
06/28/2020
By no means do I support increased funding for the Affordable Care Act (ACA or Obamacare)..... Period. SneakyPete. 👍👍👍👍 6.28.20
Like (25)
Follow
Share
Caren's Opinion
···
06/28/2020
NO AND HECK NO TO EXPANDING OBAMACARE!! It caused healthcare costs to go up, insurance premiums and deductibles to go and for benefits to become subpar causing individuals to refrain from getting some care unless it is emergent. If that wasn’t bad enough those who are on Obamacare and mandated to have insurance saw their premiums go up also. Does the financial oppression hurt yet? Do you still believe you’re going to get something that somebody else pays for?? You, are then believing the greatest of lies!!
Like (12)
Follow
Share

What is House Bill H.R. 1425?

This bill — the Patient Protection and Affordable Care Enhancement Act — would expand eligibility for premium tax credits & increase the size of the tax credits; incentivize states to expand Medicaid & penalize those that don’t; increase funding for Affordable Care Act (ACA or Obamacare) outreach; and seek to lower prescription drug rates. A breakdown of its provisions can be found below.

HEALTHCARE COSTS & PREEXISTING CONDITIONS

This section would expand eligibility for premium tax credits used to purchase insurance on the Obamacare exchanges beyond 400% of the federal poverty line (FPL), and would increase the size of the tax credits for individuals and families. It would also reverse the Trump administration’s changes for determining annual updates to premium tax credit eligibility & maximum out-of-pocket limits.

The so-called “family glitch”, whereby an individual is locked out of receiving subsidized coverage for their family because their cost of self-only coverage on an exchange doesn’t exceed 9.5% of annual income, would be fixed to consider the cost of obtaining family coverage.

States would be provided with $200 million in federal funds to establish state-based health insurance exchanges if they choose to do so. A Health Insurance Affordability Fund would be established with $10 billion in annual funding to give states the option of establishing a reinsurance program or using the funds to provide financial assistance to reduce out-of-pocket costs for individuals enrolled in qualified health plans. It would require the Centers for Medicare & Medicaid Services (CMS) to establish and implement a reinsurance program in states that don’t apply for federal funding.

This bill would also repeal an October 2018 guidance issued by the Dept. of Health and Human Services (HHS) related to “State Relief and Empowerment Waivers” under the ACA. The guidance loosened restrictions of Section 1332 state innovation waivers, which became available to states in January 2017 under the ACA, by expanding the definition of coverage to include short-term plans and allowing existing state legislation about enforcing Obamacare satisfied the waiver requirement.

HHS would be required to conduct consumer outreach and enrollment educational activities for the ACA exchanges and would receive $100 million for this purpose each year. The outreach would be culturally & linguistically appropriate to the needs of the populations being served as well as be provided to populations residing in high health disparity areas. It would also receive $100 million per year for the Navigator program, which seeks to raise awareness of marketplace plans & help people apply for coverage & subsidies.

HHS & the state regulatory authority would be required to ensure that any excessive, unjustified, or unfairly discriminatory rates on the exchanges are corrected before, or as soon as possible after, implementation through mechanisms such as denying rates, modifying rates, or requiring rebates to consumers. HHS would be able to apply civil monetary penalties to health insurers that fail to comply with a corrective action taken by HHS and may make the plan involved eligible for classification as a qualified health plan.

Additionally, the Government Accountability Office (GAO) would be required to examine whether HHS has been conducting maintenance of healthcare.gov during annual open enrollment in order to minimize any disruptions to the use of the website.

MEDICAID EXPANSION

This section would incentivize Medicaid expansion by providing for 100% federal medical assistance percentage (FMAP) for Medicaid expansion beneficiaries for the first three after a state expands Medicaid. It would then decline to 95% FMAP in year four, 94% FMAP in year five, and 93% FMAP for year six, while in year seven & beyond it would decline to 90%. This FMAP schedule is what was available to states that expanded Medicaid, and would give parity to states that chose to expand Medicaid after 2014.

States that choose not to expand Medicaid would be punished with a 0.5% reduction in FMAP for each quarter of non-expansion, with a maximum reduction of 10%. States that choose not to expand Medicaid would also be required to submit an annual report to HHS and Congress providing a detailed description of its Medicaid program and uninsured rates, including the number of uninsured individuals in the state at or below 138% of the federal poverty line, information on current state eligibility levels for different categories of beneficiaries, a description of uncompensated hospital care costs & the sources of those costs, and a detailed description of any efforts underway to provide care to those without health insurance.

The ACA’s increased payments for primary care physicians who treat Medicaid beneficiaries would be reauthorized for five years, and they would be required to be compensated at no less than the Medicare rate.

Individuals determined to be eligible for Medicaid or the Children’s Health Insurance Program (CHIP) beneficiaries would be eligible for 12 consecutive months, and wouldn’t lose eligibility due to minor fluctuations in their income throughout the year. Women would remain eligible for Medicaid or CHIP for one year postpartum so that women with medical complications related to pregnancy can be prevented, detected, and treated.

Funding for CHIP would be permanently authorized, which would prevent the expiration of funding for CHIP at the end of fiscal year 2027. Policies that facilitate enrollment in CHIP and monitor quality would be permanently extended. States would have the option to increase Medicaid and CHIP eligibility levels for children to up to 300% of FPL without receiving a waiver.

LOWERING PRESCRIPTION DRUG PRICES

This section would end the ban on Medicare negotiating directly with drug companies and create new tools to force drug companies to come to the table to negotiate on drug prices (including for newly-launched drugs) with the Health and Human Services (HHS) Secretary. Subsequently, it would also give all Americans access to the federally negotiated lower drug prices known as the maximum fair price (MFP). A given drug’s negotiated price would remain in place until it has two or more generic competitors.

To stop drug companies from charging American customers a different, higher price for the same drug as compared to foreign customers, this bill would limit the maximum price for any negotiated drug to be in line with the average price in a country comparable to the U.S. For comparison purposes, this bill would look to six countries: Canada, the United Kingdom, Germany, France, Australia, and Japan.

Drug companies that aren’t in compliance with this requirement would face an escalating penalty which starts at 65% and increases by 10% for every quarter of non-compliance to a maximum of 95%.

A $3 billion Fair Price Negotiation Implementation Fund would be established to carry out this section.



Impact

People buying insurance on ACA exchanges; prescription drug buyers; insurance providers; states that haven’t expanded Medicaid; and relevant federal agencies including HHS & CMS.

Cost of House Bill H.R. 1425

$170.80 Billion
The CBO estimates that enacting this bill would increase the deficit by $170.8 billion over the 2020-2025 period.

More Information

In-DepthHouse Energy & Commerce Committee Chairman Frank Pallone (D-NJ) offered the following statement on the introduction of this package:

“The American people are anxious about their health and their economic future, and this legislation provides critical relief by making health care and prescription drugs more affordable. It’s commonsense legislation that takes the savings from lower prescription drug costs and invests it into lowering health care premiums and expanding access to affordable care. All around, that’s a win for the American people. We must take action to lower these soaring costs, expand access to health care, rein in the Trump Administration’s efforts to sabotage the ACA and protect people with pre-existing conditions.”

House Ways & Means Committee Chairman Richard Neal (D-MA) added:

“While Republicans continue their efforts to dismantle America’s health care system in the midst of a pandemic, Democrats are putting forward a plan to expand access to care and lower costs. We slash prescription drug prices, create larger premium tax credits available to more people, and devote funding to reduce out-of-pocket costs for everyone. With this legislation, we also take important steps to ensure patients are protected. The bill encourages remaining states to expand Medicaid and support vulnerable Americans, puts an end to the expansion of ‘junk’ insurance plans, and prevents states from using federal waivers to allow discrimination against patients with pre-existing conditions. And importantly, we also address the inequities in care that COVID-19 has brought to the fore through targeted assistance for Hispanic, Black, and Native Americans. For the health and financial security of workers and families across the country, Congress needs to pass this legislation.”

Energy & Commerce Committee Ranking Member Greg Walden (R-OR) & Rep. Michael Burgess (R-TX) explained Republicans’ opposition to this bill in its committee report:

“This bill provides $100 billion over 10 years for States to establish reinsurance programs strictly for individuals enrolled in the Patient Protection and Affordable Care Act’s (PPACA) qualified health plans (QHPs). The bill is not paid for, nor does it contain a State match or State allocation formula, delegating the latter to the Secretary of the Department of Health and Human Services (HHS) like the transitional reinsurance program did. Finally, the bill does not include language affirming the long-standing consensus that Federal dollars should not pay for abortion services.

Walden & Burgess added that during the 115th Congress when Republicans controlled the House, they offered what they believe to be a better plan for state reinsurance under the American Health Care Act:

“Congress has taken recent steps to provide States with reinsurance opportunities. In the 115th Congress, the House-passed H.R. 1628 American Health Care Act, included the Patient and State Stability Fund. This provision would have provided States with flexibility and resources to cut out-of-pocket costs like premiums and deductibles, promote access to health care services, and repair insurance markets. For States that chose not to access the available funding, the Federal government would have established and implemented a reinsurance program. In addition to reinsurance, the Patient and State Stability Fund’s uses of funds included: helping high-risk individuals enroll in health insurance coverage; promoting participation in the individual market and small group market; and providing assistance to reduce out-of-pocket costs, such as copayments, coinsurance, premiums, and deductibles. The fund included a modestly phased-in State match, as well as a State allocation formula based on each State’s previously incurred claims. The Patient and State Stability Fund was fully paid for and included language affirming the long-standing consensus that Federal dollars should not pay for abortions services.”

The White House issued a veto threat against this legislation in the event that it were to reach President Donald Trump's desk, which read in part:

"The Administration strongly opposes House passage of H.R. 1425. This bill attempts to exploit the coronavirus pandemic to resuscitate tired, partisan proposals that would send hundreds of billions of dollars to insurance companies in order to paper over serious flaws in Obamacare. Furthermore, H.R. 1425 would pay for this bailout by imposing price controls that undermine the American innovation the entire globe is depending on to deliver the vaccines and therapeutics needed to respond to the coronavirus... While any time is an inopportune time to dramatically undermine the development of innovative medicines, H.R. 1425 is even more imprudent given the current focus on developing vaccines and therapeutics rapidly to help America and the world combat the coronavirus. To take such an action simply to double down on the same expensive, inefficient, and bureaucratic approach to health coverage that the American people endured for the past decade makes it even more misguided and counter to the most urgent needs of the country."

This legislation passed the House Energy & Commerce Committee on a party-line vote of 30-22


Media:

Summary by Eric Revell

(Photo Credit: iStock.com / LIgorko)

AKA

Patient Protection and Affordable Care Enhancement Act

Official Title

To amend the Patient Protection and Affordable Care Act to provide for a Improve Health Insurance Affordability Fund to provide for certain reinsurance payments to lower premiums in the individual health insurance market.

bill Progress


  • Not enacted
    The President has not signed this bill
  • The senate has not voted
  • The house Passed June 29th, 2020
    Roll Call Vote 234 Yea / 179 Nay
    IntroducedFebruary 28th, 2019

Log in or create an account to see how your Reps voted!
    Support the people. Put at least as much funding to help our populace with their medical needs as we do to subsidize corporate farms, financial institutions and our multi-national corporations. Trickle down economics does not and never has worked; Our country’s increasing wealth gap proves this. Trickle down economics only results in the people at the bottom being trickled upon by elites who need them to maintain their personal cash flows. … … … Oh yeah, be very wary regarding promises made by the trump. The trump had made a comment that he has a solution to assure pre-existing coverage to be part of most health insurance policies - he would allow them to charge newly insured members totally different rates if they needed pre-existing condition coverage - thus defeating the whole concept of pre-existing coverage by essentially making insurance unaffordable to those who have critical pre-exiting conditions when they enroll. Just another friggin game to juggle the intent of ‘pre-existing’ condition coverage into a ‘pay lots more’ to get your pre-existing condition coverage.
    Like (90)
    Follow
    Share
    Threatening the states with punishment cuts is blackmail and doing it is illegal. That’s true whether it’s forcing expanding Medicaid or “defunding” Sanctuary Cities. Even if I agree with the gist of the bill, I cannot agree to blackmailing the States to force compliance without a vote. It’s the principle of the thing.
    Like (45)
    Follow
    Share
    We’re in the grips of a pandemic, let’s get this done.
    Like (75)
    Follow
    Share
    I support this. I want my representatives to vote to strengthen, expand, and improve the ACA, not dismantle it.
    Like (61)
    Follow
    Share
    Why in the world would you vote Nay to help Americans get healthcare and provide more tax credits? You would have to be a monster.
    Like (43)
    Follow
    Share
    Ignore the republicans. They are idiots. They have had 10 years to come up with a better plan & they have zilch. They have done NOTHING BUT BE OBSTRUCTIONISTS. THEY DO NOT KNOW HOW TO ACTUALLY BE LEGISLATORS. And worse. When they do legislate there is nothing but rhetoric in the bills - they TALK THE TALK BUT NEVER WALK THE WALK.
    Like (35)
    Follow
    Share
    All industries work better at scale, but there is almost no downside to scaling up health care. The more people in the insurance pool, the less expensive it is for everyone. There is zero downside to this bill. Unless you have moral objections to poor people receiving life saving care at an affordable price.
    Like (29)
    Follow
    Share
    By no means do I support increased funding for the Affordable Care Act (ACA or Obamacare)..... Period. SneakyPete. 👍👍👍👍 6.28.20
    Like (25)
    Follow
    Share
    Update: Yes, I support this bill, but believe we need to Implement Medicare For All! Save lives, because all citizens are covered. Bring down costs, as the government has the ability to negotiate pharmaceutical & healthcare prices. Have better outcomes, as they do in other countries. Right now Gilead, a company that had US backing, our tax dollars, to come up with Remdesivir, a life-saving COVID-19 treatment, is going to change” $390 per vial to governments “of developed countries” around the world, and the price for U.S. private insurance companies will stand at $520 per vial.... anticipated pricing ...is $3,120 for a typical U.S. patient with commercial insurance.” Our system is evil. Implement Medicare For All and put these greedy ass pharmaceutical companies in their place!
    Like (20)
    Follow
    Share
    DO IT! DO THE RIGHT THING FOR ONCE!
    Like (18)
    Follow
    Share
    Strengthen the healthcare act. Expand so everyone can have affordable healthcare.
    Like (18)
    Follow
    Share
    Being able to expand our health system is the correct thing to do. It is insane the Trump administration would be doing something so horrifying as trying to undermine the systems health care during a global pandemic. As the country turns 244 years old and celebrates its new Independence Day we should think about what direction the country should head in. We should not let it go in the wrong direction and keeping Americans alive and healthy and it’s citizens and residents is the right thing to do and expanding benefits seems correct. The next best thing would be Medicare for all in the future to improve the system.
    Like (17)
    Follow
    Share
    Yes I think we should help those who are less fortunate among us to include the millions of Americans without health insurance during a pandemic. If we don’t spend our money helping each other then what’s the point?
    Like (15)
    Follow
    Share
    Healthcare is a human right. I question those of you opposing - you must be healthy, or working and have health insurance through our company, or you must have enough money saved to pay out of pocket $800.00 per month for ONE person. (that is what I was paying 6 years ago when contracting) Once again your selfish individualism shows. Please realize your continuing good health depends on the heath of your neighbors. Open your mind, you are living an illusion, the ass clown lies - he will not save the nation. All of use CARING for EACH OTHER will!
    Like (13)
    Follow
    Share
    To not provide healthcare in the middle of a pandemic - that is what is both irresponsible and immoral. Pass this bill.
    Like (12)
    Follow
    Share
    NO AND HECK NO TO EXPANDING OBAMACARE!! It caused healthcare costs to go up, insurance premiums and deductibles to go and for benefits to become subpar causing individuals to refrain from getting some care unless it is emergent. If that wasn’t bad enough those who are on Obamacare and mandated to have insurance saw their premiums go up also. Does the financial oppression hurt yet? Do you still believe you’re going to get something that somebody else pays for?? You, are then believing the greatest of lies!!
    Like (12)
    Follow
    Share
    Yes vote for
    Like (11)
    Follow
    Share
    Just do it!
    Like (11)
    Follow
    Share
    We don't have to keep Obamacare, the ACA forever. I really, honestly would support a bill from the Republicans and even if this "president" if they had one that provided affordable, equitable, comprehensive healthcare for all Americans. I don't care who it's from: all Americans deserve healthcare, because being able to care for yourself is a human right. Too many people are living in sickness and poverty because of the excessive costs of healthcare in America. Until someone comes up with a better plan/bill, let's improve what we already have and keep it strong so people can stay healthy, especially in this time of COVID-19 and extremely high unemployment. Until all Americans can get the care they need without going poor, we will never be a great country.
    Like (11)
    Follow
    Share
    Right now, more than ever, the ACA is needed. With people loosing their jobs due to Corona and people getting sick, Obamacare needs to be readily accessible to people who may have never thought they'd need it.
    Like (10)
    Follow
    Share
    MORE