Nominations

Yesterday, the Senate Finance Committee approved the nomination of Seema Verma to become administrator of the Centers for Medicare & Medicaid Services (CMS), setting up a confirmation vote in the full Senate.

Appropriations

Rumors are that President Trump will cut non-defense discretionary (NDD) spending to pay for a $54 billion increase in defense spending in his FY18 budget.  NDD spending would be cut by a corresponding amount to pay for the increase.  It is unclear whether this plan has the support of House or Senate Republicans who seemed skeptical about the plan.  At least eight Democrats would be needed to overcome a filibuster in the Senate to pass any spending bill and Democrats in both the House and the Senate greeted the plan with major opposition.  This plan would likely mean significant across the board cuts to domestic programs, including the CDC.

Officials are now saying that the “skinny budget” will be sent to Congress on March 16th.  OMB Director Mulvaney said that the “skinny budget” would propose rebuilding the military, restoring nuclear capabilities, increasing school “choice,” and securing the United States border.  The full budget is not expected until May.

ACA Legislation

Although there is still no specific ACA repeal and replace proposal, a draft of a House Republican repeal bill was leaked on February 24th. The leaked draft raises significant concerns about protecting access to care through the ACA’s Marketplaces and state Medicaid programs.  It would reverse the ACA’s individual mandate, significantly altering the operation of the ACA’s Marketplaces, and eliminate taxes that currently fund subsidies.  Instead, individuals would get tax credits to subsidize purchase of health insurance, with the amount of the subsidy based on age rather than income, as is the current ACA structure.

The proposal would also eliminate Medicaid expansion by 2020.  States could opt to continue to provide Medicaid to the expanded eligibility groups after that date but they would bear much more of the financial burden of that expansion, as they would no longer receive enhanced federal reimbursement for the population.  The proposal also does away with the entitlement structure and replacing it with per capita caps.

Medicaid Changes

Last weekend, governors from around the country gathered at the annual National Governors’ Association meeting in DC.  Health care was a topic throughout the weekend and Republican governors unveiled a proposal to overhaul Medicaid by dramatically changing its funding structure.  The proposal would shift Medicaid from an open-ended federal entitlement program where the federal government matches state spending to a program designed by each state with a pre-set financial limit (per capita cap).  Under the proposal, states would be given the authority to control enrollment and eligibility to address costs and could use new benefit designs such as work requirements and premiums.