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Hill Staff Talks Health Law Repeal as HHS Signs Up Consumers

By Andrew Siddons and Rebecca Adams, CQ Roll Call

November 16, 2016 -- Republican committee staff members say their party is weighing a range of options for repealing and replacing the Affordable Care Act, with an eye toward making sure that people don't lose their insurance coverage.

Speaking at a briefing by the Alliance for Health Reform, staff members who work on health policy said that Democrats can be a productive part of the conversation on replacement. And Democratic aides urged congressional Republicans to listen to President-elect Donald Trump's campaign promises when pursuing a health care overhaul of their own.

"I hope the Republicans will reach out to us. I have a great number of great President-elect Trump quotes that shows clearly we could work with the President-elect," said Wendell Primus, a top adviser on health policy to House Democratic leader Nancy Pelosi, D-Calif. "I think my boss would be willing to work with the President-elect to improve our health care system, improve coverage and improve quality."

During the campaign, Trump embraced certain aspects of the health care law, including its guarantee of coverage for people with preexisting conditions and allowing young adults to remain on their parents health insurance plans until they turn 26. At times, he has even embraced the individual mandate requiring most Americans to buy insurance and said he wants every American to be covered. Democrats hope that Trump follows through on some of his campaign statements.

"We should be embracing President-elect Trump's commitment, stated commitment, to covering every American and not disrupting policies so much," said Chris Jennings, who advised both the Obama and Clinton administrations on health care policy.

Republican aides echoed lawmakers who in recent days said they want to proceed with a replacement in a bipartisan manner.

"There has been bipartisan support for making certain changes to the Affordable Care Act before the election, so I think there are obviously areas where there can be bipartisan agreement," said Emily Murray, a health adviser for House Ways and Means Committee Republicans.

Other observers think that Republicans have a political imperative to quickly craft a repeal that provides time to come up with an adequate replacement that will help people remain insured.

"It will be extremely difficult for Republicans in the Congress to wait until they have a consensus document about legislative language defining what the replacement looks like to have a repeal," said Gail Wilensky, a Republican health consultant who formerly chaired the Medicare Payment Advisory Commission. Doing anything that strips people of their insurance coverage would be risky, she added. "Having a large block of people without any kind of coverage going into the 2018 election would not be regarded as a place that most politicians want to be."

Ongoing Open Enrollment

The discussion came as the Centers for Medicare and Medicaid Services announced that about 1 million people—nearly 250,000 new customers and more than 760,000 returning customers—signed up for coverage during the first 12 days of the enrollment period that runs from Nov. 1 through Jan. 31. That represents about 53,000 more people than over the same timeframe last year.

However, about one-third of customers at the start of last year's sign-up season were new customers during the first two weeks, compared to just under one-fourth in the first 12 days this year.

About 4.5 million people have visited the website, which allows people in 39 states to buy insurance. Other states have their own marketplace websites.

More than 8,000 people contacted the call centers that answer questions about coverage after the Nov. 8 election to explain how much their coverage means to them, CMS Acting Administrator Andy Slavitt told reporters. Consumers are expressing concern by asking about the election's impact and whether they should still buy coverage.

"It puts people very much at ease when they understand this is the law of the land," said Slavitt.

CMS held off on routine outreach efforts until after the election, Slavitt said. Since the election, "each day has seen more enrollments than the previous day."

The administration is ramping up its publicity efforts, including a video from Obama that federal officials emailed to people who have registered with About 2.5 million people who are buying individual coverage outside of the exchanges could get a subsidy if they instead buy through the marketplace, Slavitt noted.

Slavitt promised a "great transition" to the next administration—as soon as Trump administration officials contact the agency.

However, consumers' concerns underscore the fragility of the marketplace as Republicans plan to repeal the law.

Congressional Republicans have discussed a transition period, but the Trump administration could act quickly in 2017 to stop enforcing the law's mandates or drop a defense of litigation against the administration's funding of subsidies.

Health plans have signed contracts for 2017, which Slavitt said he expected insurers to honor. Plans have been in the midst of preparing bids to participate in 2018.

But it's not clear whether the Trump administration would penalize insurers if some were to decide to scale back coverage. The main recourse that federal officials have if a plan withdraws is to ban the insurer from participating in exchange coverage for five years if the plan completely drops all of its individual coverage options both within and outside of the exchanges.

Even as Slavitt sounded reassuring notes and said federal officials had held dozens of conversations with insurance executives since the election, he acknowledged that insurers may drop coverage in 2018.

"Plans are going to continue to adjust their strategy based on what they're hearing and learning," Slavitt said.

A report from the liberal Center for American Progress (CAP) released Tuesday said that a gradual transition is unlikely if Republicans move to repeal the law, regardless of whether the legislation delays the effective date of repeal for two years as the GOP has previously supported. Republicans would be unable to use the reconciliation process to kill a number of insurance protections in the law, such as allowing young adults to stay on parents' plans, preventing insurers from rescinding coverage after their customers get sick, banning annual or lifetime limits on insurance, and banning insurers from denying people coverage because they had been sick.

"If these consumer protections remain without the premium tax credits or individual mandate penalties, it would cause chaos and spiraling costs in what is left of the individual market for health insurance," CAP said.

The center found that "even with a delayed effective date, the reconciliation bill approach would cause massive disruption and chaos in the individual market for health insurance. The complete unraveling of the market would occur by the end of 2017."

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