The House
Rules Committee is meeting on a resolution concerning the case this evening.
House Democrats are warning Republicans
that letting the federal courts kill all of the Affordable Care Act (ACA)
could kill programs many Republicans like — such as the ACA provision that’s
closing the Medicare Part D prescription drug plan benefits “donut hole” — as
well as the programs they commonly think of as “Obamacare.”
House Democrats have put the warning in
House Resolution 271, a measure that calls for the administration of President
Donald Trump to end efforts to overturn the ACA.
Rep. Colin Allred, D-Texas, is the lead
sponsor.
Members of the House Rules Committee are preparing to meet at 5 p.m.
Eastern Daylight Time today to package the resolution for action on the House
floor.
The committee plans to stream live video of the hearing here.
A recording of the video will be available after the meeting ends.
The resolution could come up for a vote on the
House floor any time this week, according to a bill consideration list posted
by House leaders.
The ACA is made up of two statutes that were
signed into law in 2010: the Patient Protection and Affordable Care Act and the
Health Care and Education Reconciliation Act.
Allred says in the text of H.Res. 271 that
killing all of the ACA would hurt people using ACA Medicaid expansion coverage,
and people with health problems, who might have no ability to buy individual
major medical coverage in some states if the death of the ACA eliminated the
federal ban on medical underwriting in the individual major medical market.
Allred also notes that killing all of the ACA
would eliminate the ACA provisions that have been closing the Medicare Part D
program benefits donut hole.
Before 2010, “Medicare enrollees faced massive
out-of-pocket prescription drug costs once they reached a certain threshold
known as the Medicare ‘’donut hole,’ and since the donut hole began closing in
2010, millions of Medicare beneficiaries have saved billions of dollars on
prescription drugs,” Allred says in the resolution text.
“At a time when 3 in 10 adults report not
taking prescribed medicines because of the cost, if the Trump administration
succeeds in its argument before the court, seniors enrolled in Medicare would
face billions of dollars in new prescription drug costs,” Allred says.
Medicare Part D Donut
Hole Primer
The Medicare Part D program sets a ceiling on
coverage for ordinary drugs. Once participants reach the minimum level for
catastrophic drug spending, then Medicare Part D plan catastrophic
coverage kicks in.
For 2019, the cap on ordinary coverage is
$3,820. The catastrophic spending level is $5,100 in out-of-pocket drug
spending.
While enrollees are in the donut hole, they
get a 75% discount on brand-name drugs and a 63% discount on generic drugs.
One goal of the donut hole system is to reduce
government spending on drugs for patients who reach the donut hole.
Another goal is to give patients a financial
incentive to avoid unnecessary use of the kinds of expensive drugs that could
get them into the donut hole.
Texas v. United States
Basics
Texas officials and other officials who oppose
the ACA filed the Texas v. United States in a federal district court in Texas,
in an effort to use a relatively small change in one ACA provision to get the
entire act nullified.
The ACA opponents have objected to an ACA
provision that requires many people to have what the government classifies as
solid major medical coverage, or minimum essential coverage.
Originally, the provision required some people
who failed to have minimum essential coverage for enough of the year to pay a
penalty.
The U.S. Supreme Court ruled that ACA
opponents could not sue to have the ACA’s “individual shared responsibility”
penalty, or individual mandate penalty, declared unconstitutional, because the
penalty was a tax, and a federal law prohibits taxpayers from suing to have the
courts use injunctions to block new taxes.
Congress later passed a legislative package
that included a provision setting the individual mandate penalty at zero.
ACA opponents have argued that, because the
penalty is now set at zero, the provision is simply a bare requirement for some
people to have minimum essential coverage, not a tax. Those opponents have
argued that the courts should declare that a bare requirement for people to
have health insurance is unconstitutional.
Because the ACA has no provision keeping the
rest of the act in force if one part is nullified, declaring the individual
mandate provision unconstitutional should overturn all of the ACA, ACA
opponents contend.
Trump administration lawyers originally sought
to separate the ACA provisions directly related to “Obamacare” — the major
medical insurance underwriting and pricing provisions — from the other
provisions. Trump’s lawyers asked the district court judge to overturn the
Obamacare provisions but leave the others intact.
Judge Reed O’Connor, the district court judge,
sided with the ACA opponents who brought the suit. He ruled that all of the ACA
is unconstitutional.
The case is now being appealed to the 5th U.S.
Circuit of Appeals.
California, New York state and other states
that support the ACA are seeking permission to intervene in the case. Those
states are fighting to keep the ACA in place.
The Trump administration is now saying that it
would like the court to accept the district court’s decision and overturn all
of the ACA.
Resources
The official congressional information page
for H.Res. 271 is available here.
Information about the House Rules Committee
meeting on the resolution is available here.
https://www.thinkadvisor.com/2019/04/01/texas-aca-case-could-re-open-medicare-part-d-donut-hole/
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