An Affordable Care Act replacement that emphasizes state flexibility will be a top Republican priority once Congress reconvenes in January, according to congressional staffers.
Addressing rising prescription drug prices may also be on the agenda.
Republican and Democratic legislative aides shared their parties' agendas in background briefings with reporters Thursday.
GOP staffers say under their party's proposed repeal and replacement of the ACA, states must take the lead in deciding how to maintain insurance coverage for the 20 million people who gained coverage under the law.
One bill that's drawing interest among Republicans is the Patient Freedom Act, first introduced by Sen. Bill Cassidy (R-La.) in 2015. The bill proposed that states would distribute funds for their residents to pay premiums through health savings accounts. The bill would abolish the ACA's requirements that nearly all individuals buy coverage and that medium-size and larger employers offer health benefits.
Under the bill, people would receive the subsidies based on age rather than income, so low-income people would get the same amount as wealthy people.
A Republican Senate staffer said states would be able to decide on the scope of benefits offered by health plans.
Katherine Hempstead, a senior adviser at the Robert Wood Johnson Foundation, which largely supports the ACA, said the Patient Freedom Act is "directionally interesting" because it emphasizes transparency in provider prices.
David Hogberg, a senior fellow at the National Center for Public Policy Research, a conservative think tank, wrote that insurers would be able to offer and consumers would be able to buy health plans that are "free of Obamacare's costly mandates." That would mean people could buy plans without coverage for maternity care, behavioral services, prescription drugs, or preventive care.
Those currently are deemed minimum essential benefits under the ACA. Eliminating the mandate for those benefits would mean that people who want such coverage would have to pay higher premiums, experts say.
Stuart Altman, a professor of health policy at Brandeis University, cautioned that making federal premium subsidies available to everyone rather than targeting them to lower-income people and those without employer health benefits would not leave enough financial assistance for Americans who most need it.
Congressional staffers noted that repealing and replacing the ACA will not be the only healthcare priority during the upcoming session. Congress will have to reauthorize the Prescription Drug User Fee Act (PDUFA), which allows the Food and Drug Administration to collect fees from drug companies for staffing and to expedite approval of new therapies. Fees can range from $500,000 to $1 million.
PDUFA must be reauthorized every five years, and is now on track to end in September 2017. Since it's a must-pass bill, some see it as a possible vehicle for legislation to curb rising prescription drug prices.
But many worry that measures to limit price increases could hinder innovative new products. So there will be a struggle between the goals of controlling costs and encouraging the development of new treatments.
On top of that, the pharmaceutical industry is planning a large lobbying and public relations campaign to block legislation limiting drug pricing.
