STATE AND FEDERAL PHARMACY INTELLIGENCE RESOURCE

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Feb
10

Affordable Care Act Repeal and Replacement in 2017?

by Lauren Fuller

President Donald J. Trump and the Republican Congress repeatedly promised to expeditiously repeal the Patient Protection and Affordable Care Act (“Affordable Care Act” or “ObamaCare”). The Republicans in Congress tried multiple times during the last six years to repeal the legislation but were thwarted by Presidential veto power. Due to the complexities of repealing and replacing the Affordable Care Act that has been developing in stages since its 2010 enactment, questions remain about whether those promises can be fulfilled in 2017, or whether efforts will continue into 2018. SAFPhIR will keep subscribers informed of those changes.

Some of the provisions that affect managed care and pharmaceutical manufacturers are the following: prohibition on lifetime annual insurance limits; extension of dependent coverage; changes to the appeals process; prohibition on pre-existing condition insurance exclusions; guaranteed insurance coverage and renewability; essential health benefit requirements; refundable tax credits; state Medicaid expansions; prescription drug rebates; hospital value-based purchase programs; quality ratings; Medicare Advantage payment changes; a Medicare coverage gap program; formulary requirements for prescription drug plans and Medicare Advantage prescription drug plans; Medicare annual wellness visits; comparative effectiveness research requirements; creation of a new biosimilars pathway of approval; and significant taxes (“annual fees”) on pharmaceutical manufacturers, medical device manufacturers and health insurance providers.

Questions remain about whether ObamaCare will be completely repealed and replaced or simply modified and reshaped. In June 2016, House Republican leadership released a plan for repealing and replacing the ObamaCare at http://abetterway.speaker.gov. This plan was supported by the five Chairmen of House committees of health jurisdiction and the House Speaker Paul Ryan. Highlights of that plan are the following:

* Portable insurance with tax credits to help buy health insurance in the individual market.

* Patient-centered health care expanded by use of health savings accounts.

* Employer-based insurance preserved.

* State risk pools so that no one falls in the cracks.

* Small business and individuals allowed to band together.

* Wellness programs rewarded by employers.

* Medical liability reform to establish reasonable limits and allow recovery of full medical costs.

* Pre-existing condition protections.

* Dependents ensured to age 26.

* Continuous coverage protections.

* Medicaid empowerment grant to states to design programs that best meet their needs.

* Electronic health record improvement.

* Medicare Advantage strengthened.

* Medicare enhancements.

It is clear that Republicans intend to reduce the cost of premiums and provide more control and choice for individuals.

As many as 100 bills have been introduced to address ObamaCare and the congressional committees are working their way through some of those bills. Speaker Ryan has repeatedly been quoted as maintaining that “repeal and replace” is the priority. While President Trump vowed to make quick changes to the law, he recently acknowledged that it may take until 2018 to pass the “repeal and replace” package. In any event, the Republicans still claim they will repeal and replace ObamaCare, as opposed modify it. Yet, they face significant procedural and political hurdles.

Due to its unpopularity and increasing costs, there is virtually no question that there will be a flurry of activity on the Affordable Care Act in congressional and state legislative sessions ahead. SAFPhIR is the essential tool to keeping track of the myriad of laws that will result. Also, the President-elect promised to halt the increasing number of regulations. SAFPhIR will provide immeasurable information to keep subscribers abreast of regulatory changes.

States, in reacting to the changes in the federal law, will undoubtedly be faced with addressing changes in their legislatures which will affect business operations of the managed care and pharmaceutical industries. Even the state Boards of Pharmacy will likely be faced with changes and SAFPhIR is the one-stop shop for these releases, too. SAFPhIR will continue to provide summaries and expert analysis with links to the final laws that affect managed care and pharmaceutical industries.

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