Three House Committees Feb. 6 held separate hearings related to the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152). Both Democrats and Republicans highlighted their support of guaranteeing coverage of pre-existing conditions but continued to disagree on the fundamentals of the ACA. The hearings offered a preview of where members may try to legislate in the 116th Congress.
Energy and Commerce Health Subcommittee Hearing
The House Energy and Commerce Health Subcommittee held a Feb. 6 hearing on the Texas v. United States court case and its impact on Americans with pre-existing conditions. The AAMC previously submitted an amicus brief expressing concern about a number of provisions of the ACA that would be considered null and void if the plaintiffs were successful, including protections for patients with pre-existing conditions.
The hearing follows a Dec. 14 ruling from the U.S. District Court for the Northern District of Texas that found that the individual mandate provision of the ACA is unconstitutional, since the penalty for failing to maintain minimum coverage was reduced to zero on Jan. 1. The court further ruled that the individual mandate could not be severed from the remaining provisions of the ACA, thereby invalidating the entire law.
In her opening remarks, Health Subcommittee Chair Anna Eshoo (D-Calif.) noted, “For those enrolled in the Affordable Care Act, if the Republican lawsuit is successful, the 13 million Americans who gained health insurance through the Medicaid expansion will lose their health insurance; the 9 million Americans who rely on tax credits to help them afford their insurance plan will no longer be able to afford their insurance; and health insurance costs will skyrocket across the country when healthy people leave the marketplace for junk insurance plans that won’t cover them when they get sick, leaving the sick and most expensive patients in the individual market, driving up premiums.”
She also announced that the committee will hold a legislative hearing next week on three bills related to the ACA, including bills to overturn the administration’s rule that expanded short-term limited duration plans, to restore funding for ACA enrollment outreach, and to reverse Section 1332 waivers that would allow states to change their insurance markets.
In his comments, full Committee Ranking Member Greg Walden (R-Ore.) weighed in on the issue, stating, “Let me speak on behalf of all Republicans: We fully support protecting Americans with pre-existing conditions.” He also highlighted his support of the American Health Care Act, which he noted would prohibit insurance companies from denying or not renewing coverage or raising premiums on individuals due to a pre-existing condition.
Both Rep. Walden and Subcommittee Ranking Member Michael Burgess, MD (R-Texas), referenced a Feb. 5 letter they sent to Committee Chair Frank Pallone (D-N.J.) and Subcommittee Chair Eshoo requesting a hearing on the Medicare for All proposal. The letter notes, “Given the Committee’s broad health care jurisdiction, we have a responsibility to review any legislative proposal that is supported by so many members of the House majority, especially one that threatens to impact directly the lives of millions of Americans by upending how they receive their coverage, including those with employer and union-sponsored plans.”
Chairman Pallone expressed his displeasure with the letter during his opening comments. He stated, “You’re saying to us that you want to repeal the ACA and then you want to have a hearing on Medicare for All … When does a member of Congress, let alone the Chairman or Ranking Member, ask for a hearing on something that they oppose?”
During the hearing, witnesses agreed that Judge O’Connor’s decision would likely be overturned. In his testimony, constitutional lawyer and writer Simon Lazarus referred to the lawsuit as “a transparently political enterprise” that “likely will be given short shrift before the appeals process has run its course.”
Education and Labor Hearing
The House Education and Labor Committee Feb. 6 held a hearing to discuss threats to workers with pre-existing conditions, as well as the potential impacts of the ACA lawsuit, Texas v. United States.
Chairman Bobby Scott (D-Va.) opened the hearing by stating, “Until efforts to repeal and sabotage this historic legislation cease, workers with pre-existing conditions will be at risk of losing access to the care they need to live healthy and fulfilling lives.”
During the hearing Rep. Phil Roe, MD (R-Tenn.), announced that he plans to introduce a bill next week that would extend insurance protections under the Employee Retirement Income Security Act (ERISA P.L. 93-406) to small group and individual markets. Roe stated, “It treats them, me as an individual — and I’ve been on the individual market — exactly like a large corporation and that solves the problem … We have covered everybody and treated each individual exactly the same as a big company. It should be simple to do.” A spokesman for Rep. Roe indicated that the legislation would be formally introduced next week.
Appropriations Labor-HHS Subcommittee Hearing
The House Appropriations Labor-Health and Human Services-Education Subcommittee Feb. 6 held an oversight hearing on the impact of the Trump administration’s policies on the ACA.
Subcommittee Chair Rosa DeLauro (D-Conn.) used her opening statement to list a number of actions the Trump administration has taken to affect the ACA, including “new rules to intentionally increase premiums and out-of-pocket costs for families covered by ACA health plans.” DeLauro specifically mentioned the administration’s terminating cost-sharing reduction payments to insurers, dramatically reducing funding for enrollment outreach and assistance, supporting lawsuits to strike down the ACA, and unveiling a draft rule that would cut subsidies for individuals enrolled in the individual market.
DeLauro stated, “This committee has the responsibility to stop the administration undermining health care for millions of Americans; to stop it from allowing insurance companies to discriminate again with junk plans; and to stop it going after the very mechanisms we have in place to hold down costs for Americans”
Republican members of the committee focused their comments on their criticisms of the ACA, such as rising insurance premiums, and the lack of insurer options in many places.