Insurance market stabilization out: a look at Congress' spending omnibus

Of the $88 billion HHS appropriation announced Wednesday night, not a penny is going toward Obamacare. Congress is however extending oversight requirements on HHS regarding its administration of the health exchanges.

Congressional leaders released the long-awaited $1.3 trillion, two-year spending omnibus after days of wrangling behind closed doors over contentious policies that included an embattled stabilization package for the individual market that would fund cost-sharing reduction payments and a $30 billion reinsurance pool.

Despite initial optimism from insurers, House leaders announced on Monday they were dropping the stabilization plan, hours after the release of legislative text from Sens. Lamar Alexander (R-Tenn.) and Susan Collins (R-Maine) and U.S. Reps. Greg Walden (R-Ore.) and Ryan Costello (R-Pa.).

Insurers who had been optimistic following the weekend's negotiations for CSRs and reinsurance were left disappointed by this late-breaking collapse of the deal long advertised as bipartisan. Prospects for passage took a turn for the worse over the past few weeks as the White House became involved with policy demands the Trump administration wanted, including auto-renewal of short-term plans and anti-abortion language.

Lawmakers on both sides cited irreconcilable disagreements over applying anti-abortion language known as Hyde Amendment protections to the CSRs, but the legislation ultimately proposed including policies advocated by the Trump administration and opposed by Democrats.

By Wednesday, the stabilization conversation broke down into a politicized quarrel that lawmakers noted will likely continue into the midterm elections.

The only omnibus provisions that addressed the Affordable Care Act were extensions of oversight mandates.

The CMS must give congressional committees of jurisdiction advance notice before releasing ACA-related data or grant opportunities to the public. The Trump administration will also be required to "publish ACA-related spending by category since its inception" and make public the number of employees, contractors and "activities" that implement, administer or enforce any of the law's provisions.

Congress also once again bars the administration from making any risk-corridor payments to insurers.

The renewed ban on risk corridors comes as two high-profile cases filed by carriers over outstanding payments currently await judgment in a federal appeals court.

The finalized deal was a blow to insurers, who immediately expressed their disappointment in how the stabilization effort ended.

"In every other market, state and federal leaders have supported healthy markets that deliver better affordability and care," America's Health Insurance Plans said in a statement. "Through employer-provided coverage, Medicare Advantage, and Medicaid managed care, nearly 300 million Americans see the value that insurance providers bring to improve health, access and financial security. Americans who rely on the individual market deserve the same access to stable and affordable comprehensive coverage."

And Justine Handelman, senior vice president at the Blue Cross and Blue Shield Association expressed the group's disappointment that "critical market stabilization measures" weren't included in the bill.

"Unless Congress acts now, premiums will again increase significantly and consumers could have even fewer health plan choices," Handelman said. "Already, half the counties in the U.S. have only one insurer. Congress must find a path forward to provide consumers with the peace of mind they deserve. Millions of Americans are depending on lawmakers to act."

Neither AHIP or the Blues association publicly endorsed the Alexander-Collins-Walden-Costello bill, although they were leaders in an industry coalition letter on Monday urging Congress to fund CSRs and reinsurance.

Insurers did win in a battle with Big Pharma over the Medicare Part D "donut hole" provision from last month's budget bill. Although pharmaceutical groups were lobbying hard to change the new policy that phases down the carriers' financial liability for the cost of prescription drugs not covered by Medicare while raising it for drugmakers, the tweak didn't make it into the omnibus.

The big-money health items in the deal include a $3 billion boost in funding for the National Institutes of Health, which brings the total to more than $37 billion. This includes $500 million for a new research initiative on opioid addiction, development of alternative pain medication and treatments for addiction.

Rural communities will also see a hefty $135 million increase in health program funding, including $100 million for a new program on addiction treatment and prevention, with an extra $30 million available through the National Health Service Corps.

Rural areas got outreach grants to support collaborative healthcare delivery models, hospital flexibility grants and a boost to telehealth efforts, bringing total HHS spending for those rural programs to $290.8 million.

Programs targeting the opioid epidemic also got a substantial cash infusion, as promised, with $3.6 billion of the total $4.65 billion allocated for the epidemic funneling through HHS.

Community health centers get a $135 million increase over last year to expand addiction prevention and treatment services as well as access to overdose reversal drugs.

Correction: An earlier version of this story stated incorrectly that the oversight provisions were new, but they were included in the 2016 and 2017 bills as well.