POLICY BRIEFINGS


Ryan Announces Plans for ACA Replacement


House Ways and Means Chairman Paul D. Ryan (R-Wisc.) has declared plans to release a Republican alternative to the ACA by the end of March as one of his top priorities. Along with House Energy and Commerce Chairman Fred Upton (R-Mich.) and House Education and Workforce Chairman John Kline (R-Minn.), Rep. Paul was appointed to a working group in January by Majority Leader Kevin McCarthy (R-Calif.) to create a comprehensive replacement for the ACA. The focus on preparing an ACA replacement is due in part to the Supreme Court decision in the King v. Burwell case expected this spring, which could invalidate health care subsidies for three-quarters of states. Rep. Ryan has reiterated that
the replacement plan will not simply tweak language in current law in order to keep federal subsidies in place.


Legislation Introduced to Repeal the Health Insurer Tax


Bipartisan legislation has been introduced in the House to repeal the ACA’s tax on health insurance companies. The bill was introduced by Rep. Charles Boustany (R-La.), a cardiovascular surgeon, and Rep. Kyrsten Sinema (D-Ariz.). Rep. Boustany had previously introduced the bill in the 113th Congress with more than 200 co-sponsors. According to the Congressional Budget Office (CBO), the tax would yield $14.3 billion in revenue by 2018, though the tax could largely be passed to consumers through higher premiums and out-of-pocket costs.


Avalere Releases New Analysis on Specialty Tiers


According to a new analysis, exchange benefit designs increasingly place all medications for some conditions on a specialty drug tier. Avalere Health found that in some exchange plans, drugs used to treat complex diseases such as cancer, HIV, and multiple sclerosis are only included on the highest cost-sharing drug formulary tier. As can be seen in the graph below, Avalere finds that in five of the 20 drug classes reviewed, some plans placed all drugs in a class on the specialty tier. Medications placed on specialty tiers require significant out-of-pocket costs for patients. Specialty tier designs are used by insurance plans in order to increase enrollment through low and stable premiums, which is the main characteristic consumers use for the purpose of plan selection.


Senators Contact CMS Regarding MA Star Ratings


A group of 40 senators led by Sen. Rob Portman (R-Ohio) and Sen. Bill Nelson (D-Fla.) have submitted a letter to the Centers for Medicare and Medicaid Services (CMS) outlining their concerns regarding the star rating system used to provide beneficiaries with a means to assess the quality of Medicare Advantage (MA) plans. A plan’s star rating is also tied to quality bonus payments. The senators worry that the star rating system does not accurately assess a plan’s performance, which could lead to reduced resources for that plan. This would be especially detrimental for plans serving vulnerable populations. The senators urged the agency to further take into consideration population risk factors and socioeconomic status in determining a plan’s star rating.



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