Chairman Black introduced the reconciliation bill reported out of the Budget Committee on March 20 as H.R. 1628. Chairman Walden and Brady filed two Manager’s Amendments to H.R. 1628 with the Rules Committee which is scheduled to meet on Wednesday morning at 10:00 a.m. to craft a rule for the consideration of the bill in the House of Representatives.The first Manager’s Amendment has been tagged as making technical changes. Most of the amendment fixes typographical errors, clarifies effective dates, and makes other technical changes with a few exceptions. First, the amendment strikes the requirement that insurance companies impose a 30 percent penalty for individuals who do not maintain continuous coverage in the small group market. The penalty remains in the individual market.Second, the amendment rewrites the section of the bill providing a refundable tax credit for the purchase of health insurance. The summary of the amendment indicates that the section was rewritten based upon guidance from the Senate to ensure the provision will maintain its reconciliation protections on the Senate floor.The second Manager’s Amendment has been tagged as making policy changes including the following changes to the bill.

• Redrafts the language in the bill phasing out the Medicaid expansion to clarify that if a state expands Medicaid moving forward the state would not receive the enhanced federal matching.
• Permits states to impose a work requirement in Medicaid for non-disabled, non-elderly and non-pregnant adults. Work requirements are defined by the same activities used in the Temporary Assistance for Needy Families (TANF) program.
• Increases the inflation factor by an additional 100 basis points in the Medicaid per capita cap program for elderly and disabled populations.
• Allows states to opt in to a Medicaid block grant program. If states elect to enter the program, they must do so for a period of ten years.
• Establishes a $1 million American Health Care Implementation Fund at the Department of Health and Human Services for the implementation of the law.
• Repeals most of the tax provisions beginning in calendar year 2017 with a few exceptions. The limitation on the deduction of health insurer executive pay and the Medicare tax on unearned income are not moved forward. Also, there is one additional year of relief from the so-called “Cadillac Tax” on the most generous employer provided health insurance plans.
• The threshold for deducting medical expenses is further lowered from 7.5 to 5.8 percent. The Affordable Care Act raised the threshold from 7.5 to 10 percent.

The media is reporting the creating of a fund to purchase health insurance. The amendment does not create a fund but Republicans expect the Senate to raise the threshold back to 7.5 percent and use the funds generated from doing so to provide additional assistance to vulnerable older populations to purchase insurance.

Rich Meade

Rich Meade, a Vice Chairman at Prime Policy Group and Chair of the firm’s Healthcare Practice has over 25 years of experience in legislative, regulatory, political and public relations strategy. He previously served as Chief of Staff to the House Budget Committee. Rich has helped his clients navigate many complex regulatory and legislative landscapes to achieve many public policy successes including transitioning to a new Medicare payment and quality system, and developing, with the Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC), a health information exchange (HIE) on the Nationwide Health Information Network (NwHIN).