The second week of the Trump administration has proven to be relatively quiet for health reform as we await the confirmation of a new Health and Human Services Secretary. Rep. Tom Price (R-GA) moved one step closer to the Secretary’s office when Senate Finance Committee Republicans suspended committee rules and voted unanimously to favorably advance his nomination to the full Senate, despite the lack of a quorum resulting from the absence of Democrats who boycotted due to dissatisfaction over Price’s answers regarding certain investment and business dealings. And House and Senate committees continue to hold hearings on the ACA and alternatives, but no clear plan for replacement seems to be emerging.

The Fourth Open Enrollment Period Ends

The fourth open enrollment period ended very quietly on January 31, without the fanfare and enrollment push that accompanied the end of open enrollments in the Obama administration. Charles Gaba reports that HealthCare.gov again this year allowed an “in line by midnight” extension to the open enrollment period for people who were unable to finish enrollment by midnight but who called the HealthCare.gov call-in center and left their contact information. A number of state marketplaces also allowed in-line enrollment extensions. It is unclear if and when total enrollment numbers for 2017 will become available.

Darrel Issa’s ACA Replacement Plan

On January 30, 2017, Congressman Darrell Issa (R-CA) threw another health reform plan into the mix, his “Access to Insurance for All Americans Act.” His plan would allow anyone to enroll in Federal Employee Health Benefit Program (FEHB) health plans. FEHB plans are available everywhere, offer generous benefits and broad networks, and are sold without health, age, or gender underwriting. Issa’s plan would allow employers to subsidize coverage of their employees and states to offer Medicaid coverage through the FEHB. It is unclear how the premiums for the uninsured would be covered, other than that individuals would be able to deduct the cost of insurance premiums from their taxes, a measure that would offer little or no help to most low-income uninsured.

The ACA, of course, offers access to multi-state plans that are administered by the Office of Personnel Management, which runs the FEHB program. The hope of the drafters was that these plans would be equivalent to FEHB plans in availability and generosity. The ACA clearly stated, however, that the multi-state program would be offered separately from the FEHB with a separate risk pool, that FEHB plans would not be required to participate in the program, and that the administration of the program would not be allowed to divert resources from or otherwise undermine the FEHB program. Obviously federal employees, a powerful constituency, were concerned that their contractual benefits not be undermined by efforts to cover the uninsured.

The multi-state plan has not been a success. At this point it is not yet nationwide and includes only Blue plans which offer products pretty much indistinguishable from the products they otherwise offer in the marketplace. None of the FEHB insurers other than the Blue plans signed on.  Conscripting FEHB plans to enroll the uninsured continues to be a theoretical option for health care reform, but an attempt to do so would have to overcome the political and practical obstacles that undermined the ACA multi-state plan program.

The Individual Mandate

Finally, apparently some people believe that the January 20 Executive Order has ended enforcement of the individual responsibility requirement. The Executive Order expressly did not, and legally could not, in itself end enforcement of legal and regulatory requirements of the ACA. This includes the requirements that individuals indicate on their 1040 whether or not they have had continuous insurance coverage throughout 2016; file a form 8965 if they qualify for an exemption from the penalty; and pay the penalty for months that they did not have minimum essential coverage or qualify for an exemption. For 2016, the annual penalty is $695 per adult and half that for minors (up to a total amount per family of $2,085) or, if greater, 2.5 percent of household income above the filing limit.