According to Politico, Congress appears no closer to reaching a consensus on health care after lawmakers hashed out plans Wednesday to avoid stark cost increases for millions of Americans when enhanced Obamacare subsidies expire at year’s end. “Right now, it’s like trench warfare,” Sen. Bill Cassidy (R-La.) said during a Wednesday Senate Finance Committee hearing, speaking to the state of bipartisan negotiations on a health care deal.

Lawmakers are floating a variety of proposals in the Senate. Here are some of them:

Cassidy’s HSA plan: Cassidy hoped his Finance Committee colleagues would get on board with his pitch to replace the subsidies with deposits in Obamacare enrollees’ health savings accounts. But Republicans spent much of the hearing decrying deficiencies they see in Obamacare, and Democrats insisted that the extension of the subsidies was the best way to help insurance customers. Ranking member Ron Wyden of Oregon also warned that the HSA plan would incentivize patients’ enrollment in junk health care plans that don’t provide adequate coverage. 

Extending the ACA subsidies: Some Republicans have said they’d support a partial extension of the subsidies, while others, like Cassidy, are proposing alternatives. At one point in Wednesday’s Senate Finance hearing, Sen. Michael Bennet (D-Colo.) repeatedly banged his fist on the table to loudly defend Obamacare and demand universal coverage.“Let’s fix the system before we double, triple and quadruple the prices,” he said.

A GOP health care megabill: Earlier this week, President Donald Trump’s top political aide raised the possibility of pursuing a go-it-alone bill — a sequel to the sweeping tax-focused megabill the GOP passed this summer. House Republicans are privately plotting a health care overhaul.But pursuing a GOP-only health care bill would require building almost complete unity among congressional Republicans — a tall order given deep divisions in the party over a health care approach. Sen. Lisa Murkowski (R-Alaska) said she would not want to take that route, arguing that it would undermine efforts to work with Democrats on other issues like funding the government.

A House proposal: Ways and Means Committee Republicans are floating a bill similar to Cassidy’s that would give ACA enrollees the ability to elect to receive a portion of financial assistance from insurers directly in their tax-advantaged health savings accounts. At a Wednesday health subcommittee hearing on chronic disease, Democrats launched sharp criticisms of the concept, arguing that HSAs couldn’t replace the enhanced subsidies. Some Republicans pushed back, endorsing HSAs, but most were more focused on criticizing the ACA tax credits. “This city, this government, has been feeding an insurance industry with its insatiable appetite for more and more and more,” said Rep. Greg Murphy (R-N.C.). “Do you believe that patients should have a choice in their health care or should we as a federal government tell them what to do with their health care? That’s what HSAs are about. They give patients choices.

1) Heads Up!  Today at 11:00 State Budget Director Blake Washington will discuss whether an expiring NYS corporate tax rate will be extended, the state’s current year finances, and the instructions state agency leaders have been given by DoB as they prepare their agency budgets and adjust to recent changes at the federal level.  Here’s a link to the show at 11:00:  https://capitolpressroom.org/

2) Democrats in the state Legislature are preparing for a fierce debate next session over calls to reform a controversial 2017 criminal justice law that prevents youth offenders from being tried as adults, State of Politics reports.

3) MCO TAX NEWS (Source:  Politico)New York was given a three-month grace period to wind down a health plan that was projected to bring in $3.7 billion over two years, the so-called MCO Tax that was enacted into law as part of last year’s state budget.  The Centers for Medicare and Medicaid Services announced guidance Friday for states to roll back taxes on managed care organizations, which relied on a loophole that was closed in the One Big Beautiful Bill Act signed into law in July.  The new timeline adds three more months than expected in the tax’s life, in a sight reprieve for hospitals, nursing homes and other health care facilities slated to receive some of the proceeds through Medicaid rate hikes.  

Health policy experts initially anticipated the tax would be canceled at the start of 2026, in accordance with the One Big Beautiful Bill Act. The slightly extended timeline will likely net the state an additional $400 million, according to Michael Kinnucan, health policy director for the Fiscal Policy Institute, a nonpartisan think tank. “This reprieve, where we get another three months of funding, allows us to take a little bit of the pressure off, but in the next several years we’re still going to need to find money to keep hospital rates adequate,” Kinnucan said. It’s unclear what the overall financial impact of the CMS changes will be for New York. The state’s Division of Budget and Department of Health each said they are reviewing the guidance but declined to comment on it.Under the new timeline, Kinnucan anticipates the state will ultimately net $2.1 billion from the MCO tax. That could saddle the Hochul administration with a shortfall as large as $1.6 billion.

If you have an objection to the NYS Council signing on to this letter, please let me know at your earliest convenience.  I’m at 518 461-8200 or lauri@nyscouncil.org

WEBINAR ANNOUNCEMENT FROM LAC:

Please join the Legal Action Center’s No Health = No Justice Initiative and our partners for our upcoming webinar. We will explore the current threats facing harm reduction funding and services, and examine how opioid settlement funds can help sustain and strengthen this work. The session will also highlight strategies and community examples of advocating for the responsible and effective use of these funds.  

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