LegislativeR E V I E W

The “Three Buckets Strategy” is explained in this issue,

however, whether this “bucket” strategy will prove to

be a winning one remains to be seen.

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Hope you are enjoying the summer and crossing off

some items from your bucket list!

Action for the “Third Bucket” Bills

The House Republican “repeal and replace” ACA strategy relies on three (3) buckets. They are:

1. The reconciliation process2. Regulations3. Regular order legislation.

This issue of Legislative Review discusses the third bucket strategy and some legislation that is part ofthis strategy.

The Three Buckets Strategy Explained

Bucket 1: Reconciliation

Reconciliation is a Senate parliamentary procedure that allows bills to pass in the Senate with a simple majority. This mechanism of reconciliation was deemed necessary since a repeal of the ACA was unlikely to gain anyDemocratic votes. In the Senate, Republicans have aslim majority of 52 with 51 votes needed to pass areconciliation bill.

The rules restrict measures using reconciliation tobudgetary items. As a result, a full repeal of the ACAis not possible using reconciliation. Lawmakers had to focus their efforts on measures having a budget impact. As a result, wholesale changes of the insurance market reform provisions, for example, could not be included in the AHCA.

VOL. XXII, ISSUE 7 JULY 2017

The information contained in this publication is intended for the general information of our clients. It should not be construed as legaladvice or legal opinion regarding any specific or factual situation.

Sincerely yours,

Karen Knippen, RHU, REBCSenior Vice President

EUCLID MANAGERS® has been serving the independent agentsince 1976 with a portfolio of group health, professional liabilityand individual health, life, annuity and long-term care products.We proudly represent UnitedHealthcare, Delta Dental of Illinois,MetLife and UnitedHealthOne Individual. We encourage yourfeedback and suggestions. Please call your EUCLID MANAGERS®

Marketing Representative or Marcy Graefen at (630) 238-2915for more information. Website: www.euclidmanagers.com

Letter from Karen Knippen

continued on page 2

LegislativeR E V I E W

Bucket 2: Regulation

According to at least one analysis, the ACA has more than 1,000 references to the phrase “Secretary shall.” These statements allowed the Secretary of HHS to establish rules on a wide variety of provisions in the law.

Some examples are:

• “The Secretary shall, by regulation, provide for the development of standards for the definitions of terms used in health insurance coverage.”

• “The Secretary shall promulgate regulations for enforcing the provisions of this section and may provide for appropriate penalties.”

• “The Secretary shall establish… procedures to protect against waste, fraud, and abuse.”

• “The Secretary shall ensure that access to needed services is made available with a minimal impact on premiums.”

Given that so much of the implementation of theACA relied on regulations, the new Secretary of HHShas a powerful tool to alter the ACA by writing new regulations.

New regulations have already been finalized thatshorten the open enrollment period and strengthenthe documentation necessary to qualify for enrollment due to a special enrollment event.

In the past month a “request for information” was issued asking for ideas to reduce the regulatory burden of the ACA. Specific requests for feedback include:

• Empowering patients and promoting consumer choice

• Stabilizing the individual, small group, and non- traditional health insurance markets

• Enhancing affordability

• Affirming the traditional regulatory authority of the States in regulating the business of health insurance.

Bucket 3: Regular Order

Regular order refers to bills that will go through the regular process for any bills considered by Congress. These bills are introduced, heard in committee, amended and, finally, brought to the floor for a vote. In the House a bill in regular order needs a simple majority; 218 votes. Republicans hold 241 seats. As a result, Republicans have breathing room when attempting to pass legislation whether any Democrats join them or not.

The Senate is a different story. Republicans number 52 in the Senate. And, there must be 60 votes to overcome a filibuster in the Senate. As a result, eight (8) Democrats, at a minimum, must vote for any bill for it to pass.

Regular order is the sole means to impact many of the provisions in the ACA especially as they relate to the insurance reforms which are not strictly budget related.

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LegislativeR E V I E W

Third Bucket Bills to Date

HR 2372 ensures that veterans who are not already enrolled in and receiving health insurance through the Veterans Affairs Department can obtain tax credits for individual coverage under the American Health Care Act (AHCA). This measure passed on a voice vote.

HR 2579 allows tax credits to be available for COBRA coverage under the AHCA. This bill passed 267-144.

HR 2581 would require that anyone accessing tax credits through the AHCA verify their immigration or citizenship status. The bill passed 238-184 with seven (7) Democrats voting for the bill.

HR 1101 allows small businesses to join together in association health plans. This bill passed 236-175.

HR 2550 would allow for an incremental expansion of telehealth coverage under Medicare. This bill is pending.

HR 2599 addresses Medicare payment for orthotics and prosthetics. This bill is pending.

Wish List Items

The number of bills slated for the “third bucket” is unknown. Presumably, any bill that is introduced by Republicans that addresses health insurance or health care could be put in the bucket. And, some long standing “talking points” may appear including the sale ofinsurance across state lines and tort reform.

The Trump administration likely has a few items that they’ll add to the bucket as well.

“Repeal and Replace” Timeline

The Senate is hopeful that they can pass a reconciliation bill by early July. This would allow time for a conference committee to reconcile differences between the House and Senate bills. Passage of the reconciled bill istargeted for late summer.

Timing is important because the reconciliation bill vehicle is holding up action on the current budget. And, Congress has a full plate of legislative priorities including tax reform that Republicans would like to tackle while they have control of the House and Senate.

Some pundits have criticized the three (3) bucket approach. They say that Republicans will not be able to find eight (8) Democrats to vote for the “third bucket” bills. Time will tell.

The more immediate concern is whether the Senate can deliver a “repeal and replace” measure of its own. And, getting final approval through the House is likely to be a challenge.

In the meantime, open enrollment for 2018 is just around the corner.

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Legislative REVIEW

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INSIDE:Action for the “Third Bucket” Bills

Legislative Review is published by Euclid Managers, 234 Spring Lake Drive, Itasca, IL 60143. For more information, contact your MarketingRepresentative or Marcy Graefen at (630) 238-2915 or marcy@euclidmanagers.com. © Permission to quote with credit to source.

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