Theexpanded version would expand several existing ACA commercialhealth insurance subsidy programs, fill holes, and add newprograms. (Photo: Diego M. Radzinschi/ALM)

Members of the U.S. House are preparing to vote on an AffordableCare Act (ACA) update package that could increase health insurers'individual major medical revenue by more than $257 billion over 10years, adding funding for ACA subsidy programs.

House Majority Leader Steny Hoyer, D-Md., announced Wednesdaythat House leaders' plan to bring the bill — an expanded version ofH.R. 1425, the "Patient Protection and Affordable Care ActEnhancement Act" bill — up for a vote Monday.

Resources

• Links to a collection of H.R. 1425 resources,including the final House Rules Committee print of thebill, are available here.
• The Congress.gov tracking page for H.$. 1425 isavailable here.
• A Congressional Budget Office analysis of the RulesCommittee print version of the bill is availablehere.

"Our bill encourages every state to expand Medicaid and aims tolower monthly premiums and out-of-pocket costs byproviding more generous cost-saving subsidies and taxcredits to help people better afford coverage under marketplaceplan," Hoyer said in a comment in the bill.

Here are seven other things to know about the bill.

1. The bill has been around for more than a year.

Rep. Angie Craig, D-Minn., introduced a shorter version of H.R.1425 in February 2019. Craig's version would have provided $10billion in funding per year for state individual health insurancereinsurance programs.

2. The bill has grown.

The House Rules Committee released the current version of thebill, the House Rules Committee Print 116-56 version, Monday.

That version fills 154 PDF pages.

3. The expanded version would expand several existing ACAcommercial health insurance subsidy programs, fill holes, and addnew programs.

If passed and implemented as written, the bill would:

• Increase the existing ACA premium tax credit subsidyprogram for commercial health insurance. The CBO analysts saythis provision would increase spending by $x billion over 10 years.Most of that money would go to health insurers. Health insurerswould then spend at least 80% of the extra revenue on health careand health care quality improvement efforts.
• Add subsidies to help low-income premium tax credit userspay deductibles, co-payments, coinsurance amounts and otherout-of-pocket amounts. This provision would provide $6.2billion over 10 years to replace the ACA cost-sharing subsidyreduction program, which Republicans in Congress have declined tofund.
• Based determinations about whether coverage for a worker is"affordable" by looking at the worker's entire family, not just theworker. "Fixing the family glitch" would cost $45 billion over10 years, according to the CBO analysts.
• Provide $16 billion over 10 years that states could use topay for a variety of health insurance affordability programs, suchas reinsurance programs.
• Provide $200 million in grants, over 10 years, that statescould use to set up state-based public exchange programs.

The bill would also kill the current short-term health insuranceregulations, which let states give insurers the option of keepingshort-term health insurance arrangements in place for up to threeyears.

4. The bill also would increase Medicaid funding.

The CBO analysts say one of the Medicaid section provisions,which would provide 12 months of continuous eligibility forparticipants in Medicaid and Children's Health Insurance Program(CHIP) plans, rather than requiring participants with fluctuatingincome to bounce back and forth between commercial coverage andMedicaid or CHIP coverage, would cost about $205 billion over 10years.

The second most expensive provision, a pay increase for primarycare physicians who treat patients with CHIP or Medicaid coverage,could cost $65 billion over 10 years.

5. Democrats would pay for the coverage expansion provisions bycalling for Medicare to negotiate for lower drug prices.

The CBO analysts say this provision could save about $582billion over 10 years, with peak annual savings of $141 billion, in2029.

6. The CBO thinks the bill could reduce the federal budgetdeficit a bit.

The CBO analysis shows that the Medicare drug price negotiationsprovision could save enough money to make the whole package lead toabout $15 billion in reductions in the federal budget deficit over10 years.

The savings would be small relative to the size of the federalbudget deficit: The U.S. federal government now has about $20trillion in national debt, and it has run up a deficit of $1.9trillion for the first eight months of federal fiscal year 2020,which started Oct. 1, 2019.

7. The fate of the bill is probably easy to predict, but mightnot be that easy to predict.

Democrats have 223 of the 435 seats in theHouse and are almost certain to pass H.R. 1425 there Monday.

Republicans hold 53 of the 100 seats in theSenate and typically pass over House bills like H.R. 1425without even holding committee hearings on he bills.

But Republican senators have worked with Democratic senators onsome health bills, and Republicans have shown some willingness toconsider Affordable Care Act change bills that would continue toallocate large sums for health insurance subsidies.

In 2017, Sen. Bill Cassidy, R-La., introduced an Affordable CareAct change bill, the Graham-Cassidy-Heller-Johnson bill draft, thatcould have replaced the current ACA subsidies with more $136billion in health insurance block grant funding for 2020. The blockgrant totals in that proposal would have grown every year, andincreased to $200 billion by 2026.

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