On the Hill
The House of Representatives passed the Republican-supported American Health Care Act (AHCA), legislation intended to repeal and replace the Affordable Care Act. The vote, 217 – 213, saw 20 Republicans vote against their party’s bill and no Democrats voting in support. The bill, which was originally introduced in March, underwent amendments to appeal to the conservative Freedom Caucus, which was seen as responsible for its early failure. The accepted amendments loosen regulations on insurance companies on the plans they sell, allowing states to define essential health benefits and to apply for waivers to opt out. The AHCA includes cuts to Medicaid and changes coverage of pre-existing conditions by removing the “community rating” requirement that bars insurers from charging people with pre-existing conditions more for their insurance. The legislation was voted on in the House prior to the Congressional Budget Office (CBO) scoring the bill, but the CBO is expected to release the AHCA scoring the week of May 22. The Senate is currently revising the AHCA, making significant changes to the bill. A vote is not expected until June, at the earliest, due to the Senate’s need for a CBO score and rulings from the Senate Parliamentarian, which will determine what sections of the bill may be passed through reconciliation (requiring 51 Senate votes instead of 60 votes).
At the agencies
George Sigounas has been named as the new administrator of the Health Resources and Services Administration (HRSA). Sigounas, a cancer researcher, was most recently a professor at East Carolina University. HRSA is responsible for improving care for rural, uninsured patients and overseeing blood, organ and tissue donations.
Gopal Khanna, the former chief information officer for Minnesota and most recently the director of Illinois’ Data Analytics Healthcare and Human Services Innovation Incubator, has been appointed as the director of the Agency for Healthcare Research and Quality (AHRQ). Khanna also served as the CIO of the Peace Corps under President George W. Bush. AHRQ not only has been on the receiving end of criticism from Republican lawmakers, but also is threatened to be eliminated in President Trump’s skinny budget proposal. Randy Pate has been selected as director of the Center for Consumer Information and Insurance Oversight (CCIIO), the agency that oversees the Affordable Care Act (ACA) exchanges. Pate previously served as vice president of public policy for Health Care Services Corporation and as a health policy fellow at the Heritage Foundation.
Scott Gottlieb was confirmed by a 57-42 vote to head the Food and Drug Administration on May 11. Gottlieb was able to garner the support of five Democrats, but the vote was primarily along party lines. During his confirmation hearing, Gottlieb outlined his top priority as dealing with the opioid crisis. He also faced controversy over conflicts of interest.
In the marketplace
Aetna announced it will not sell coverage in the individual marketplaces in Nebraska or Delaware, completely withdrawing from the ACA exchanges. Both states will now be left with only one insurer for 2018. The company cited losses totaling $700 million in the individual marketplace in the last three years, and it expects to lose an additional $200 million despite shedding 75 percent of its individual members in the last year. About 255,000 individual members now remain. Humana was the first large national insurer to leave the marketplaces in February.