President Trump and Congressional Republicans have offered templates for a broad health reform bill. The proposals do not reinstate the expired enhancements to Affordable Care Act (ACA) premium tax credits (PTCs).

President Trump last month released a “health policy outline”that lays out his priorities for the upcoming health reform debate, His priorities are largely compatible with those of Congressional Republicans but there is not an exact overlap. Both initiatives, however, focus more on employers and insurers rather than on individuals. Neither would revisit the now expired enhanced PTC issue.

The Trump priorities include:

• Shifting payment of Obamacare cost reduction subsidies (CSRs) from insurance companies to individuals—likely through use of health savings accounts (HSAs)—and funding the CSRs.
• Imposing cost transparency rules on health insurance companies, hospitals and physicians
• Codifying into law the President’s drug price reduction agreements with pharmaceutical companies
• Expanding the number of medicines that can be purchased safely without a prescription
• Reforming pharmacy benefits managers (PBMs) rules
• Requiring health insurance companies to publish rate and coverage comparisons on their websites in plain English
• Requiring health insurance companies to publish on their websites the percentage of their revenues that are paid out in claims versus overhead costs and profits
• Requiring health insurers to publish on their websites the percentage of insurance claims they reject and average wait times for routine care
• Requiring any healthcare provider or insurer who accepts either Medicare or Medicaid to publicly and prominently post their pricing and fees to avoid surprise medical bills
• Codification of association health plans (AHPs)—AHPs allow employers (including self employed individuals) to band together to buy group health insurance plans that are not subject to the ACA’s minimum essential benefits (and other) rules
• Broadening of the rules governing availability of short-term limited duration health insurance
• Providing that self-funded health plans’ stop loss coverage will not be considered health insurance for purposes of ACA minimum essential benefits (and other) rules
• Creating CHOICE accounts (including enhanced tax benefits for new accounts)—the CHOICE plan design is built on the structure of current law individual choice health reimbursement arrangements)

Most Congressional Republicans would agree with most if not all of these recommendations (although the devil is in the detail and insurance/health care industry lobbying will impact the scope and depth of support these proposals receive). But they would add some employer-focused priorities, too. These include:

Prospects: Many of these GOP priorities generate intense opposition from Democrats, who have their own health reform priorities (including, for example, extending enhanced PTCs to individuals). Expect a fierce lobbying battle, too. And in this election year, with the huge increases in health insurance costs that kicked in last month, odds are there will be a lot of debate but only minimal chances for enactment of any substantive changes this year.

NAIFA Staff Contacts: Jayne Fitzgerald – Director –Government Relations, at jfitzgerald@naifa.org or Mike Hedge – Senior Director – Government Relations, at mhedge@naifa.org.