What May Happen in the Year Ahead?

Some of our favorite health policy journalists and experts are speculating about next steps in health policy (including VoxAxiosThe Hill, and Politico). Here are some key issues we will track closely:
  • Additional threats to the ACA? Congressional Republicans have an unclear strategy about the ACA. As noted in Politico, “GOP leaders don’t have a solution, but they don’t have an exit ramp, either; not after Republicans made repeal a central campaign pledge again and again for years.” The Administration will likely continue their efforts to sabotage the law with rule changes and budget cuts. Outcomes will likely include additional uncertainty in the insurance market and confusion for consumers.
  • Extension of the CHIP? The uncertainty facing CHIP is surprising given its historic bipartisan support. We hope and expect Congress will come together and fund a 5-year clean extension. The remaining original co-sponsor of the legislation creating CHIP, Senator Orrin Hatch (R-UT), announced his retirement at the end of his current term. We hope he will push CHIP across the finish line to continue his legacy for children.
  • Threats to entitlements? House Speaker Paul Ryan has openly discussed tackling spending on health care entitlements – Medicare and Medicaid – to reduce the deficit in 2018. (The deficit that the Republicans just blew up by over $1.4 trillion with their tax bill.) However, the slim Republican majority in the Senate makes this a non-starter for the Senate, according to Senate Majority Leader Mitch McConnell.
  • New types of Medicaid waivers? States are applying for waivers to require work requirements, small premiums and drug testing. Fortunately, Washington State is not expected to pursue these onerous and discriminatory restrictions on low-income enrollees.
  • State-level action to stabilize insurance markets? In response to federal action, some states may create individual mandates or implement their own reinsurance programs via 1332 waiver requests. It’s also possible that the Murray-Alexander bill will pass Congress, restoring federal funding for cost-sharing subsidies and reviving the federal reinsurance program (thank you Senator Murray for continuing to push this!). The Seattle Times editorialized last week in favor of health care fixes at the state and federal levels.
  • Progress on health care coverage expansions within Washington State? The recent election resulted in two positive changes in health policy in our state. First, the State Senate flipped back to Democratic control with the election of Manka Dhingra in the 45th Legislative District. This should allow more progressive ideas to move in Olympia. And the Seattle City Council welcomed health policy expert Teresa Mosqueda, one of two citywide representatives and the new Chair of the Housing, Health, Energy, and Workers’ Rights (HHEWR) Committee. We expect that these changes will help move policy proposals championed by NoHLA to expand affordable health care to all.
The scheduled end of the Deferred Action for Childhood Arrivals (DACA) program could create a public health crisis. President Trump claims he will only preserve the program in conjunction with border security measures (read: a wall between the U.S. and Mexico). Democrats are fighting hard to preserve this critical program.

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